Literature review

Alcohol is a teratogen that can readily cross the placenta, resulting in damage to the brain and

other organs of the developing embryo and fetus (Popova et al., 2017). National Institute of

alcohol and alcoholism define problem/risky use of alcohol as drinking in a way that can

negatively impact our health and life, but the body is not physically dependent on the substance.

Alcohol use in any amount is harmful to both the fetus and the mother such as maternal alcohol

intoxication and alcohol use disorder, abortion, stillbirth, low birth weight, and prematurity

(Wubetu et al., 2019). Popova et al., (2017) estimated the global prevalence of alcohol use in

pregnancy to be 9·8% and Fetal Alcohol Syndrome (FAS) to be around 14·6 cases per 10000

population and that each year about 119,000 children are born with FAS. In the studies done so

far the common factors associated with drinking alcohol during pregnancy were age, race

(Shmulewitz & Hasin, 2019), educational status (Shmulewitz & Hasin, 2019), socioeconomic

factors (Macleod et al., 2021), depression (Baptista et al., 2017), social support and partner

alcohol use (Shmulewitz & Hasin, 2019) and availability of locally brewed alcohol (Udon,

2011).

The crossectional descriptive study conducted by Udon (2011) to assess alcohol consumption

among pregnant women attending antenatal clinic at Jigme Dorji Wangchuk National Referral

Hospital (JDWNRH) in Thimphu, Bhutan. Structured questionnaires and alcohol use disorder

identification test (AUDIT) questions were used for face to face interview with 312 pregnant

women. The study found that lifetime alcohol consumption was 203 (65.1%), regular drinking

during the last 12 months, 165 (52.9%), last three months, 79 (25.3%), last one month 74,

(23.7%) and last week 34 (10.9%). The factors associated were tradition, culture and customs

and drinking to promote sleep and comfort.

In a cross sectional study done by (Paudel et al., 2018) to assess independent associations

between behavioral risk factors during pregnancy and maternal socio-economic characteristics. It

included 52 clusters of Dhanusha District of Nepal in a total of 426 pregnant women in their

second trimester where 13.3% of the participants reported harmful alcohol drinking. It showed

that socio-economic factors significantly associated with more than one behavioral risk factors in

expectant mothers were age, caste/ethnicity, birth origin, women education, women occupation,

wealth index and parity. However Macleod et al., (2021) argued that employment status,

education status, relationship status, parity and gestation were not associated with risky drinking.

In a cross sectional study conducted by (Tesfaye et al., 2020) to assess prevalence and associated

factors of alcohol use among pregnant women attending prenatal care at public hospitals

included 585 pregnant women with the response rate of 98.6% at public hospitals in Addis

Ababa in Ethiopia. The prevalence of alcohol use among pregnant women were 37.1%. Factors

like no formal education, pre-pregnancy alcohol use, partner alcohol use, and poor social support

were statistically associated with alcohol use during pregnancy.

Likewise in another cross sectional study carried out by (Mpelo et al., 2018) where 365

randomly selected pregnant women attending antenatal care services in Dodoma region were

included. It showed a prevalence of 15.1%. Pre-pregnancy alcohol use and having relatives who

use alcohol were associated with alcohol use. Moreover, other associated factors included low

education status, making local brews as a source of income, and not having had complications in

previous pregnancies.

A systematic review by (Dargie et al., 2019), reviewed prevalence of Alcohol use during

pregnancy and its association with partner alcohol use in East Africa. The review included

eighteen studies with the total sample size of 41,022 and it revealed that the overall pooled
prevalence of alcohol use during pregnancy from the random effects method was found to be

18.85%. They found out pregnant women partners’ alcohol use did not have a significant

association with study subjects alcohol use during pregnancy; i.e. OR=0.32 (95% CI: -0.39, 1.03)

A systematic review and meta-analysis carried out by (Addila et al., 2020) aimed to estimate the

pooled prevalence and the effect size of associated factors of alcohol consumption during

pregnancy in Sub-Saharan Africa countries resulted in 963 original studies where 37 studies in

qualitative synthesis and 30 articles in the systematic review and meta-analysis were included.

The overall summary estimated prevalence of alcohol consumption during pregnancy was found

to be 20.83% (95% CI: 18.21, 23.46). The pooled estimate of meta-analysis showed that

depression, partners’ alcohol use, knowledge on harmful effect of alcohol consumption and,

unplanned pregnancy were statistically significant factors with alcohol consumption during

pregnancy

In conclusion prevalence of alcohol use is inadmissibly high and the common factors associated

with it is level of education and socioeconomic status. This literature review shows that alcohol

use during pregnancy is prevalent around the world hence for immediate action studies needs to

be carried out in our country to avoid consequence of the use of alcohol during pregnancy.
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