Motivation for alcohol consumption or abstinence during pregnancy: A clinical-qualitative study in Brazil

English version

Autoři: Júlia Lustosa Martinelli ^aff001; Carla Maria Ramos Germano ^aff001; Lucimar Retto da Silva de Avó ^aff001; Bruno José Barcellos Fontanella ^aff001; Débora Gusmão Melo ^aff001
Působiště autorů: Department of Medicine, Federal University of São Carlos, São Paulo, Brazil ^aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223351

Souhrn

Background

In Brazil, alcohol consumption is estimated to range from 7 to 40% in pregnant women. This research investigated the motivation for alcohol consumption or abstinence during pregnancy in a purposive sample of Brazilian women.

Methods

Clinical-qualitative research was conducted, in which 14 women participated, identified as risk-drinkers during pregnancy by the T-ACE screening tool. Data were collected through semi-structured individual interviews. Reports were recorded, transcribed and investigated by a thematic content analysis approach. The results were discussed based on a comprehensive and interpretive framework.

Results

Sixteen themes were extracted and these were then classified into three thematic categories: (a) general motives for alcohol use, (b) specific motives for drinking during pregnancy, and (c) reasons for partly or fully abstaining from drinking during pregnancy. Social motives were the most relevant, particularly due to deeply rooted cultural values. Enhancement motives were widely mentioned and associated with a hedonic posture. Consumption also aimed to deal with negative emotions, characterizing two types of coping specifically to pregnancy: first, perceiving pregnancy as a period of less opportunity for social interaction and, therefore, drinking alcohol at home to compensate; secondly, perceiving pregnancy as a period of greater irritability, and hence experiencing difficulties to abstain. On the other hand, concern about fetal health, disapproval of consumption by relatives and health professionals, as well as the social construction of mothering were reported as reasons to abstain.

Conclusions

Some specificities influence the decision to continue or discontinue alcohol consumption during pregnancy. To reduce consumption, we suggest educational actions based on a collective health perspective, articulated with individualized measures that allow identification and proper intervention for women at risk.

Klíčová slova:

Pregnancy – Alcohol consumption – Qualitative studies – Emotions – Habits – Brazil – Religion – Beer

Zdroje

1. Joya X, Garcia-Algar O, Salat-Batlle J, Pujades C, Vall O. Advances in the development of novel antioxidant therapies as an approach for fetal alcohol syndrome prevention. . Birth Defects Research Part A: Clinical Molecular Teratologya. 2015;103(3):163–77. doi: 10.1002/bdra.23290

2. DeVido J, Bogunovic O, Weiss RD. Alcohol use disorders in pregnancy. Harvard Review of Psychiatry. 2015;23(2):112–21. doi: 10.1097/HRP.0000000000000070 25747924

3. Walker MJ, Al-Sahab B, Islam F, Tamim H. The epidemiology of alcohol utilization during pregnancy: an analysis of the Canadian Maternity Experiences Survey (MES). BMC Pregnancy Childbirth. 2011;11(1):52. doi: 10.1186/1471-2393-11-52 21745414

4. Chang G. Screening for alcohol and drug use during pregnancy. Obstetrics Gynecology Clinics. 2014;41(2):205–12. doi: 10.1016/j.ogc.2014.02.002 24845485

5. Nykjaer C, Alwan NA, Greenwood DC, Simpson NA, Hay AW, White KL, et al. Maternal alcohol intake prior to and during pregnancy and risk of adverse birth outcomes: evidence from a British cohort. Epidemiol Community Health. 2014;68(6):542–49. doi: 10.1136/jech-2013-202934 24616351

6. Kaup ZOL, Merighi MAB, Tsunechiro MA. Evaluation of alcohol consumption during pregnancy. Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(9):575–80. doi: 10.1590/S0100-72032001000900005

7. Freire TM, Machado JC, Melo EV, Melo DG. Effects of alcohol consumption during pregnancy. Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(7):376–81. doi: 10.1590/S0100-72032005000700002

8. Mesquita MA, Segre CAM. Frequency of alcohol effects in fetus and pattern of alcohol consumption by pregnant women at a public maternity hospital in São Paulo city, Brazil. Journal of Human Growth Development. 2009;19(1):63–77. doi: 10.7322/jhgd.19903

9. Kassada DS, Marcon SS, Pagliarini MA, Rossi RM. Prevalence of drug abuse among pregnant women. Acta Paulista de Enfermagem. 2013;26(5):467–71. doi: 10.1590/S0103-21002013000500010

10. Baptista FH, Rocha KBB, Martinelli JL, Avó LRS, Ferreira RA, Germano CMR, et al. Prevalence and factors associated with alcohol consumption during pregnancy. Revista Brasileira de Saúde Materno Infantil. 2017;17(2):271–9. doi: 10.1590/1806-93042017000200004

11. Moreno MA. Prenatal Alcohol Exposure: No Safe Amount. JAMA Pediatrics. 2017;171(8):820. doi: 10.1001/jamapediatrics.2017.1093 28586867

12. World Health Organization (WHO). Guidelines for the identification and management of substance use and substance use disorders in pregnancy. Switzerland: WHO Press; 2014 [cited 12 Dec 2018]. Available from: https://www.who.int/substance_abuse/publications/pregnancy_guidelines/en/.

13. Fabbri CE, Furtado EF, Laprega MR. Alcohol consumption in pregnancy: performance of the Brazilian version of the questionnaire T-ACE. Revista de Saude Publica. 2007;41(6):979–84. doi: 10.1590/s0034-89102006005000044 17923888

14. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Atenção ao pré-natal de baixo risco. Brasília, DF: Ministério da Saúde; 2013 [cited 12 Dec 2018]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/atencao_pre_natal_baixo_risco.pdf.

15. Sociedade Brasileira de Pediatria (SBP). Campanha Gravidez sem álcool; 2017 [cited 12 Dec 2018] [Internet]. Available from: http://www.sbp.com.br/campanhas/campanha/cid/gravidez-sem-alcool/.

16. Oliveira TR, Simões SMF. The alcoholic beverage consumption by the pregnant women: an exploratory study. Escola Anna Nery. 2007;11(4):632–8. doi: 10.1590/S1414-81452007000400012

17. Harrell ZA, Karim NM. Is gender relevant only for problem alcohol behaviors? An examination of correlates of alcohol use among college students. Addictive behaviors. 2008;33(2):359–65. doi: 10.1016/j.addbeh.2007.09.014 17993250

18. Agrawal A, Dick DM, Bucholz KK, Madden PA, Cooper ML, Sher KJ, et al. Drinking expectancies and motives: A genetic study of young adult women. Addiction. 2008;103(2):194–204. doi: 10.1111/j.1360-0443.2007.02074.x 18199298

19. Cox WM, Klinger E. A motivational model of alcohol use. Journal of Abnormal Psychology. 1988;97(2):168–80. doi: 10.1037//0021-843x.97.2.168 3290306

20. Hauck Filho N, Teixeira MAP. Drinking motives assessment: a review of the literature. Psico. 2011;42(1):7–15. doi: 10.15603/2176-1019/mud.v20n1-2p1-6

21. Cooper ML. Motivations for alcohol use among adolescents: Development and validation of a four-factor model. Psychological assessment. 1994;6(2):117–28. doi: 10.1037/1040-3590.6.2.117

22. Miller WR. Motivational interviewing: research, practice, and puzzles. Addictive behaviors. 1996;21(6):835–42. doi: 10.1016/0306-4603(96)00044-5 8904947

23. Cooper ML, Russell M, Skinner JB, Windle M. Development and validation of a three-dimensional measure of drinking motives. Psychological assessment. 1992;4(2):123–32. doi: 10.1037/1040-3590.4.2.123

24. Goldstein AL, Flett GL. Personality, alcohol use, and drinking motives: A comparison of independent and combined internal drinking motives groups. Behavior Modification. 2009;33(2):182–98. doi: 10.1177/0145445508322920 18836143

25. Kuntsche E, Knibbe R, Gmel G, Engels R. Who drinks and why? A review of socio-demographic, personality, and contextual issues behind the drinking motives in young people. Addictive behaviors. 2006;31(10):1844–57. doi: 10.1016/j.addbeh.2005.12.028 16460883

26. Theakston JA, Stewart SH, Dawson MY, Knowlden-Loewen SA, Lehman DR. Big-Five personality domains predict drinking motives. Personality Individual Differences. 2004;37(5):971–84. doi: 10.1016/j.paid.2003.11.007

27. Epler AJ, Sher KJ, Piasecki TM. Reasons for abstaining or limiting drinking: A developmental perspective. Psychology of Addictive Behaviors. 2009;23(3):428–42. doi: 10.1037/a0015879 19769427

28. Anderson KG, Grunwald I, Bekman N, Brown SA, Grant A. To drink or not to drink: Motives and expectancies for use and nonuse in adolescence. Addictive Behaviors. 2011;36(10):972–9. doi: 10.1016/j.addbeh.2011.05.009 21665373

29. Stritzke WG, Butt JC. Motives for not drinking alcohol among Australian adolescents: Development and initial validation of a five-factor scale. Addictive Behaviors. 2001;26(5):633–49. doi: 10.1016/s0306-4603(00)00147-7 11676375

30. Meurk CS, Broom A, Adams J, Hall W, Lucke J. Factors influencing women’s decisions to drink alcohol during pregnancy: findings of a qualitative study with implications for health communication. BMC Pregnancy Childbirth. 2014;14:246. doi: 10.1186/1471-2393-14-246 25060554

31. Anderson AE, Hure AJ, Kay-Lambkin FJ, Loxton DJ. Women’s perceptions of information about alcohol use during pregnancy: a qualitative study. BMC Public Health. 2014;14:1048. doi: 10.1186/1471-2458-14-1048 25297463

32. Jones SC, Telenta J. What influences Australian women to not drink alcohol during pregnancy? Australian Journal of Primary Health. 2012;18(1):68–73. doi: 10.1071/PY10077 22394665

33. Crawford-Williams F, Steen M, Esterman A, Fielder A, Mikocka-Walus A. “My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy. BMC Pregnancy Childbirth. 2015;15:79. doi: 10.1186/s12884-015-0506-3 25881173

34. Fundação Sistema Estadual de Análise de Dados (SEADE). Informação dos Municípios Paulistas; 2018 [cited 12 Dec 2018] [Internet]. Available from: http://www.imp.seade.gov.br/

35. Turato ER. Tratado da metodologia da pesquisa clínico-qualitativa: construção teórico-epistemológica, discussão comparada e aplicação nas áreas da saúde e humanas. Petrópolis, RJ: Vozes; 2003.

36. Sokol RJ, Martier SS, Ager JW. The T-ACE questions: practical prenatal detection of risk-drinking. American Journal of Obstetrics Gynecology. 1989;160(4):863–8. doi: 10.1016/0002-9378(89)90302-5 2712118

37. Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm Policy Ment Health. 2015;42(5):533–44. doi: 10.1007/s10488-013-0528-y 24193818

38. Jager J, Putnick DL, Bornstein MH. More Than Just Convenient: The Scientific Merits of Homogeneous Convenience Samples. Monogr Soc Res Child Dev. 2017; 82(2):13–30. doi: 10.1111/mono.12296 28475254

39. Fontanella BJB, Campos CJG, Turato ER. Data collection in clinical-qualitative research: use of non-directed interviews with open-ended questions by health professionals. Revista Latino-Americana de Enfermagem. 2006;14(5):812–20. doi: 10.1590/s0104-11692006000500025 17117269

40. Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2011.

41. Maguire M, Delahunt B. Doing a Thematic Analysis: A Practical, Step-by-Step Guide for Learning and Teaching Scholars. The All Ireland Journal of Teaching & Learning in Higher Education. 2017;9(3):3351–14. Available from: http://ojs.aishe.org/index.php/aishe-j/article/view/335.

42. Fontanella BJB, Ricas J, Turato ER. Saturation sampling in qualitative health research: theoretical contributions. Cad Saúde Pública. 2008; 24(1):17–27. doi: 10.1590/s0102-311x2008000100003 18209831

43. Fontanella BJB, Luchesi BM, Saidel MGB, Ricas J, Turato ER, Melo DG. Sampling in qualitative research: a proposal for procedures to detect theoretical saturation. Cad Saúde Pública. 2011; 27(2):388–94. doi: 10.1590/s0102-311x2011000200020 21359475

44. Rocha T. The influence of motives, expectations and personality in alcohol consumption. Master Thesis, University of Coimbra. 2012. Available from: https://estudogeral.sib.uc.pt/handle/10316/23240?mode=full.

45. Skagerström J, Häggström-Nordin E, Alehagen S. The voice of non-pregnant women on alcohol consumption during pregnancy: a focus group study among women in Sweden. BMC Public Health. 2015; 15:1193 doi: 10.1186/s12889-015-2519-2 26621365

46. Horton D. Alcohol use in primitive societies. In: Pittman DJ, White HR, editors. Society, culture and drinking patterns reexamined. New Brunswick, NJ: Rutgers Centre of Alcohol Studies; 1991. pp. 7–31.

47. Esper L. Psychosocial aspects associated with alcohol consumption: a comparison of pregnant women with abstinence, hazardous use, harmful use and alcohol dependence. Doctoral Thesis, University of São Paulo. 2015. Available from: http://www.teses.usp.br/teses/disponiveis/17/17148/tde-31082016-113457/pt-br.php. doi: 10.11606/T.17.2017.tde-31082016-113457

48. Marais S, Jordaan E, Viljoen D, Olivier L, de Waal J, Poole C. The effect of brief interventions on the drinking behaviour of pregnant women in a high‐risk rural South African community: A cluster randomised trial. Early Child Development Care. 2011;181(4):463–74. doi: 10.1080/03004430903450392

49. Högberg H, Skagerström J, Spak F, Nilsen P, Larsson M. Alcohol consumption among partners of pregnant women in Sweden: a cross sectional study. BMC Public Health. 2016;16:694. doi: 10.1186/s12889-016-3338-9 27484750

50. Geller PA. Pregnancy as a stressful life event. CNS Spectrums. 2004;9(3):188–97. doi: 10.1017/s1092852900008981 14999159

51. Watt MH, Eaton LA, Choi KW, Velloza J, Kalichman SC, Skinner D, et al. “It's better for me to drink, at least the stress is going away”: Perspectives on alcohol use during pregnancy among South African women attending drinking establishments. Journal of Social Science Medicine. 2014;116:119–25. doi: 10.1016/j.socscimed.2014.06.048 24997441

52. Bertol CE, Souza Md. Transgressions and adolescence: individualism, autonomy and identity representations. Psicologia: Ciência e Profissão. 2010;30(4):824–39. doi: 10.1590/S1414-98932010000400012

53. Garcia AM. E o verbo (re)fez o homem: estudo do processo de conversão do alcoólico ativo em alcoólico passivo. Niterói: Intertexto; 2004.

54. Elek E, Harris SL, Squire CM, Margolis M, Weber MK, Dang EP, et al. Women's Knowledge, Views, and Experiences Regarding Alcohol Use and Pregnancy: Opportunities to Improve Health Messages. Am J Health Educ. 2013;44(4):177–190. doi: 10.1080/19325037.2013.768906 28261370

55. Raymond N, Beer C, Glazebrook C, Sayal K. Pregnant women's attitudes towards alcohol consumption. BMC Public Health. 2009;9:175. doi: 10.1186/1471-2458-9-175 19500375

56. Associação de Ginecologia e Obstetrícia do Estado de São Paulo (SOGESP). Dia de conscientização da Campanha #gravidezsemalcool; 2016 [cited 12 Dec 2018] [Internet]. Available from: http://www.gravidezsemalcool.org.br/.

57. de Souza LH, dos Santos MC, de Oliveira LC. Alcohol use pattern in pregnant women cared for in a public university hospital and associated risk factors. Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(7):296–303. doi: 10.1590/S0100-72032012000700002 22948501

58. Jones TB, Bailey BA, Sokol RJ. Alcohol use in pregnancy: insights in screening and intervention for the clinician. Clinical Obstetrics Gynecology. 2013;56(1):114–23. doi: 10.1097/GRF.0b013e31827957c0 23314712

59. Wright TE, Terplan M, Ondersma SJ, Boyce C, Yonkers K, Chang G, et al. The role of screening, brief intervention, and referral to treatment in the perinatal period. American Journal of Obstetrics Gynecology. 2016;215(5):539–47. doi: 10.1016/j.ajog.2016.06.038 27373599

60. Chang G, McNamara TK, Orav EJ, Koby D, Lavigne A, Ludman B, et al. Brief intervention for prenatal alcohol use: a randomized trial. Obstetrics Gynecology. 2005;105(5 Pt 1):991–8. doi: 10.1097/01.AOG.0000157109.05453.84 15863535

61. Badinter E. Um amor conquistado: o mito do amor materno. Rio de Janeiro: Nova Fronteira; 1985.

62. Martins APV. “Let's raise your child”: puericulture doctors and maternal pedagogy in the twentieth century. História, Ciências, Saúde. 2008;15(1):135–54. doi: 10.1590/S0104-59702008000100008

63. Winnicott DW. A preocupação materna primária. In: Winnicott, DW, editor. Da pediatria à psicanálise: Obras escolhidas. Rio de Janeiro: Editora Imago; 2000. pp. 399–405.

64. Rubin R. Maternal identity and the maternal experience. New York: Springer; 1984.

65. Hays S. The cultural contradictions of motherhood: Yale University Press; 1998.

66. Alzuguir F. Álcool e gênero: uma combinação moral. Centro Lat-Am Sexualid Direitos Hum; 2012 [cited 12 Dec 2018] [Internet]. Available from: http://www.clam.org.br/entrevistas/conteudo.asp?cod=9131.