5 Things to Know About Alcohol Use During, After Pregnancy

1. Alcohol use during pregnancy remains a serious public health concern.

According to data from 2018–2020, nearly 14% (or 1 in 7) pregnant people report current drinking and about 5% (or 1 in 20) report binge drinking during the past 30 days. Alcohol use during pregnancy is associated with an increased risk for miscarriage, stillbirth, SIDS, and preterm birth and can cause a range of lifelong behavioral, intellectual, and physical disabilities known as fetal alcohol spectrum disorders (FASDs). The postpartum period presents an additional opportunity to identify excessive alcohol use, have patient-centered discussions about underlying reasons for excessive alcohol use, and to intervene to reduce associated health risks as well as the potential for alcohol consumption during a future pregnancy.

2. Alcohol screening and brief intervention (SBI) is effective.

Alcohol SBI is a proven clinical preventive service with decades of research showing that it is effective for reducing excessive alcohol use, which includes any use during pregnancy. Alcohol SBI involves an evidence-based set of screening questions to identify patients' alcohol use patterns and facilitate a short conversation with patients who drink excessively, and to provide resources and a referral to treatment when appropriate. Alcohol SBI is recommended by the US Preventive Services Task Force (USPSTF) for all adults in primary care, including people who are pregnant, and is endorsed by major medical professional organizations as well as the Centers for Disease Control and Prevention (CDC). Alcohol SBI can identify patients whose alcohol use patterns increase their risk for many harmful health conditions, including adverse pregnancy outcomes. Having this information then enables the clinician to address potentially underlying issues and to provide timely advice about reducing the patient's alcohol use.

3. Alcohol SBI is not being conducted routinely.

Recent data show that most pregnant patients who reported past 30-day alcohol use are not being advised by a clinician to stop or to reduce their use. Fewer than half of clinicians report feeling very confident in screening for alcohol use, and only about one third report feeling very confident in conducting brief interventions for alcohol use with their pregnant patients. Only about 1 in 4 people with a recent live birth and who reported alcohol use in the postpartum period were advised about excessive alcohol levels.

4. Opportunities exist to increase alcohol SBI during pregnancy and in the postpartum period.

Only two thirds of clinicians report using evidence-based, USPSTF-recommended screening tools such as the AUDIT-C or the Single Alcohol Screening Question (SASQ). The USPSTF recommends that a brief intervention provides tailored feedback about the potential consequences of a patient's current drinking habits. The entire process takes a few minutes which can be spread out before and during the appointment and supported by multiple staff members. Alcohol SBI also may be reimbursable. Multiple brief intervention sessions reduce patients' alcohol consumption more effectively, increase adherence to drinking guidelines, and increase the likelihood of abstaining completely from alcohol use during pregnancy.

5. Resources to support implementation of alcohol SBI are available and may improve confidence and proficiency.

CDC and its partners have resources that can support implementation of alcohol SBI in practice. This includes clinical decision support tools that can be used with electronic health records. Communication materials for clinicians are also available to facilitate discussing alcohol use during pregnancy with patients and implementing and conducting alcohol SBI. These materials are based on extensive message testing with clinicians and patients. CDC is working with multiple clinician organizations and national partners to encourage uptake of these resources.