1Research Title

2Prevalence of alcohol consumption during pregnancy and its associated factors among the
3pregnant women availing antenatal services at Gyaltsuen Jetsun Pema Mother and Child Hospital
4in 2021.

5Background

6 Maternal consumption of alcohol can result in multiple problems for both mother and fetus that
7includes spontaneous abortion, still birth, low birth weight and prematurity. While alcohol is a
8potent teratogenic agent its use during pregnancy is reported to be prevalent across the globe
9including in Bhutan, therefore, the use of alcohol during pregnancy is a public health concern in
10Bhutan and beyond

11Popova et al., (2017) estimated the global prevalence of alcohol use in pregnancy to be 9·8% and
12Fetal Alcohol Syndrome (FAS) to be around 14·6 cases per 10000 population and they also
13estimated that each year about 119,000 children are born with FAS. Studies conducted amongst
14women accessing antenatal care in a range of countries indicate different levels of reported
15alcohol use during pregnancy: in Thailand 5.6% (Assanangkornchai et al., 2017), Korea it was
1616.4%.(Lee et al., 2017), in Nepal (Paudel et al., 2018) found out that substantial women drank
17alcohol during pregnancy while in India (Nulman et al., 2018) estimated 5.8% pregnant women
18in general population consumes alcohol.

19 The use of alcohol is widely accepted and practiced in Bhutan, as a result, the prevalence
20of alcohol use in Bhutan is generally high. The NCD STEPS survey (2019) found about 43% of
21Bhutanese population aged 15-69 years were current alcohol drinkers.
22National nutriotion survey (2015) reported that about 16% of pregnant women drank alcohol a
23week before the interview. A study conducted a decade ago by Udon (2011) reported high
24prevalence of alcohol use in pregnant women in Jigme Dorji Wangchuck National Referral
25Hospital. Nonetheless, it is important to periodically assess the prevalence and have the latest
26data to guide programmatic and policy interventions to reduce the use of alcohol during
27pregnancy.
28 With regards to the factors associated with alcohol consumption during pregnancy, the
29literature have shown factors such as low educational status (Shmulewitz & Hasin, 2019),
30socioeconomic factors (Macleod et al., 2021), depression (Baptista et al., 2017), poor social
31support and partner alcohol use (Shmulewitz & Hasin, 2019) and availability of locally brewed
32alcohol (Udon, 2011) among others to be associated with alcohol consumption during pregnancy.
33However, it would be useful to assess if these factors are associated with the target population of
34this study as well as to find if there are any unique associated factors among this target
35population.

36 This study is aimed at finding out the proportion of pregnant women drinking alcohol
37during pregnancy and assess the putative factors associated with drinking alcohol during
38pregnancy among the pregnant women availing antenatal services at GJPMCH from July to
39September 2021.The result of the study is expected to provide latest information of the
40prevalence of drinking alcohol during pregnancy among the targeted population to bridge the
41dearth knowledge gap.

42Research Question

43What proportion of pregnant women availing antenatal services at Gyaltsuen Jetsun Pema
44Mother and Child Hospital (GJPMCH) from July to September 2021 drink alcohol and what are
45the factors associated with drinking alcohol during pregnancy among them?

46Aim

47The aim of this study is to find out the proportion of pregnant women drinking alcohol during
48pregnancy and to find out the putative factors associated with drinking alcohol during pregnancy
49among the pregnant women availing antenatal services at GJPMCH from July to September
502021.

51

52

53

54

55
56Objectives
57Among the pregnant women availing antenatal services at GJPMCH from July to September
582021;
591. To find out the proportion of alcohol consumption during pregnancy,
602. To assess the factors associated with alcohol consumption during pregnancy
61Hypotheses
62Ha: x% of pregnant women drink alcohol during pregnancy at GJPMCH

63Ho: 0% of pregnant women drink alcohol during pregnancy at GJPMCH

64
65 Reference

66Assanangkornchai, S., Saingam, D., Apakupakul, N., & Edwards, J. G. (2017). Alcohol
67 consumption, smoking, and drug use in pregnancy: Prevalence and risk factors in Southern
68 Thailand. Asia-Pacific Psychiatry, 9(1). https://doi.org/10.1111/appy.12247

69Baptista, F. H., Rocha, K. B. B., Martinelli, J. L., De Avó, L. R. da S., Ferreira, R. A., Germano,
70 C. M. R., & Melo, D. G. (2017). Prevalence and factors associated with alcohol
71 consumption during pregnancy. Revista Brasileira de Saude Materno Infantil, 17(2), 271–
72 279. https://doi.org/10.1590/1806-93042017000200004

73Lee, S. H., Shin, S. J., Won, S. Du, Kim, E. J., & Oh, D. Y. (2017). Alcohol use during
74 pregnancy and related risk factors in Korea. Psychiatry Investigation, 7(2), 86–92.
75 https://doi.org/10.4306/pi.2010.7.2.86

76Macleod, C. I., Young, C., & Molokoe, K. (2021). Alcohol use during pregnancy : prevalence
77 and patterns in selected Buffalo City areas , South Africa. 25(February), 114–121.
78 https://doi.org/10.29063/ajrh2021/v25i1.13

79Ministry of Health. (2015). National Nutrition Survey Nutrition Programme Department of

80 Public Health Ministry of Health Bhutan.

81Nulman, I., Shulman, T., & Liu, F. (2018). Fetal alcohol spectrum disorder. Handbook of
82 Developmental Neurotoxicology, 5, 427–437. https://doi.org/10.1016/B978-0-12-809405-
83 1.00038-9

84Paudel, R., Lee, K., Singh, J. K., Yoo, S. J., Acharya, D., Kadel, R., Adhikari, S., Paudel, M., &
85 Mahotra, N. (2018). Prevalence of behavioral risk factors of cardiovascular diseases and
86 associated socio-economic factors among pregnant women in a rural area in Southern
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88 2122-5

89Popova, S., Lange, S., Probst, C., Gmel, G., & Rehm, J. (2017). Estimation of national, regional,
90 and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a
91 systematic review and meta-analysis. The Lancet Global Health, 5(3), e290–e299.
92 https://doi.org/10.1016/S2214-109X(17)30021-9
 93Shmulewitz, D., & Hasin, D. S. (2019). Risk factors for alcohol use among pregnant women,
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95 https://doi.org/10.1016/j.ypmed.2019.04.027

96Survey, S., Searo, W. H. O., Objectives, S., Survey, N. C. D. S., Survey, N. C. D. S., & Health,
97 P. (2019). STEPS Survey 2019 ; Data Analysis and Report Generation Terms of Reference (
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99Udon, P. (2011). Assessment of Alcohol consumption among pregnant women in antenatal clinic
100 in JDWNRH, Thimphu, Bhutan. 26(2), 112.

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