Transcript for CDC Telebriefing: New Vital Signs Report – Why are millions of US women at risk of alcohol-exposed pregnancies?

OPERATOR: Welcome and thank you for standing by.  At this time all participants are in listen only mode until the question and answer section of today’s call.  At that time, if you would like to ask a question, please press star one.  Today’s conference is being recorded.  If you have any objections, please disconnect at this time.  I would now like to turn the meeting to your host, Ms. Belsie González.  You may begin, thank you. 

BELSIE GONZÁLEZ: Thank you Liza and thank you all for joining us today for the release of a new CDC Vital Signs, this one on alcohol use and pregnancy.  We are joined today by Dr. Anne Schuchat, principal deputy director of the CDC.  I would like to turn the call over now to Dr. Schuchat. 

DR. ANNE SCHUCHAT: Thank you, this is Dr. Anne, Schuchat, principal deputy director for CDC.  Thank you so much for joining today’s call.  CDC works 24/7 to protect the health, safety and security of all Americans.  One of the ways we do this is by identifying health risks and working to address them.  This vital signs report contains important information on fetal alcohol spectrum disorders which are completely preventable birth defects and developmental disabilities caused by exposure to alcohol during pregnancy.  About 3.3 million women are at risk of exposing their developing baby to alcohol.  This is because they are drinking alcohol and not using any birth control measures to prevent pregnancy.  Today’s report also found that 3 in 4 women who want to get pregnant as soon as possible are drinking alcohol. 

We know that alcohol use during pregnancy can cause fetal alcohol spectrum disorder, which are physical, behavioral and intellectual disabilities that last a lifetime.  We think between 2 and 5% of children might have a fetal alcohol spectrum disorder.  These disorders are completely preventable by making sure a developing baby is not exposed to alcohol at any time during the pregnancy.  About half of all pregnancies in the United States are unplanned.  Even if planned, most women do not know they are pregnant until they are 4-6 weeks into the pregnancy.  This means the woman might be drinking and exposing the developing baby to alcohol without knowing it.  Alcohol can cause problems for a developing baby at any stage of pregnancy, even as early as the first few weeks.

 In today’s report, the facts come from CDC’s 2011 to 2013 national survey of family growth.  This survey gathers information on family life, marriage, divorce, pregnancy, infertility, use of contraception and men’s and women’s health.  National estimates of alcohol exposed pregnancy were calculated among non-pregnant, nonsterile women age 15 to 44 years.  Making healthy choices throughout pregnancy benefits both the woman and her developing baby.  A woman’s partner, family and friends can support her choice not to drink while pregnant.  It is important to recognize that women do not drink during pregnancy to intentionally hurt their baby.  They are either not aware of the risks, not aware they are pregnant or they need help to stop drinking.

 My message for women is to talk with your health care provider about your plans for pregnancy, alcohol use and ways to prevent pregnancy if you are not planning to get pregnant.  Stop drinking alcohol if you are trying to get pregnant or could get pregnant.  Ask your partner, family and friends to support your choice not to drink during pregnancy or while trying to get pregnant.  Ask your health care provider or another trusted individual about resources for health if you can’t stop drinking on your own. Doctors, nurses and other clinicians have a role here too.  We recommend health care providers conduct alcohol screening and counseling to identify women who drinking and at risk of exposing their developing baby to alcohol.  It takes about six to 15 minutes.  This is an important clinical practice to use with all adult patients and especially important for adult women who may become pregnant.  Fetal alcohol spectrum disorders do not occur if the developing baby is not exposed to alcohol during pregnancy.

 Alcohol screening and brief counseling has been proven to work.  It is recommended for all adults, including pregnant women.  The affordable care act requires new health insurance plans to cover alcohol screening services without cost to the patient.  Most health insurance plans are required to cover FDA approved birth control for all women as well as patient education and counselling without cost to the patient.  I encourage state and local governments to work with their Medicaid programs to make sure alcohol screening and counseling services are reimbursable.  Thank you for joining us today and helping to get the word out that alcohol can harm a developing baby, even before a woman knows she is pregnant.  The bottom line is pretty straightforward.  Drinking alcohol during pregnancy can have serious lifelong consequences for your baby.  The risk is real.  Why take the chance? 

BELSIE GONZÁLEZ: Thank you, Dr. Schuchat. LizaI Believe we are ready for questions, pleasae 

OPERATOR: Thank you.  At this time, as a reminder, if you would like to ask a question, please press star 1, record your first and last name when prompted and give us a few moments, please. 

BELSIE GONZÁLEZ: Do we have any questions? 

OPERATOR: Yes, Ma’am, our first question comes from Leigh Ann Winick of CBS News.  Your line is open. 

LEIGH ANN WINICK I am just wondering if you could characterize what the trend is.  Is the 3.3 million a high or low or improvement over previous years? 

DR. ANNE SCHUCHAT:  Thank you for that question.  The answer is a little bit complex.  The last time we looked at this, the number was about 2 million.  But the questions that were asked were somewhat different.  So we can’t do a direct comparison.  We do know, though, that rates of drinking alcohol among young women have been increasingand so has binge drinking among young women.  So we don’t have an exact comparison.  I think the key point is that it is quite common for women who could become pregnant to be drinking alcohol. 

LEIGH ANN WINICK: As a follow-up, is there anything to say about the age at pregnancy?  Has that been going up? We know teen pregnancy is down. Have we seen an older maternal age for first baby? 

DR. ANNE SCHUCHAT: Thanks for that question. Fortunately, teen pregnancy rates are coming down. We are really pleased about that progress. What we found in this analysis was that the higher risk of alcohol among women who could get pregnant was in women during their 20s.  The teens were much less likely to be drinking alcohol as were the oldest age group. It was women in their 20s. That’s pretty similar to what we see in general. 

BELSIE GONZÁLEZ We are ready for the next question?

OPERATOR:  Our next question comes from Meera Senthilingham from CNN International.  Your line is open. 

MEERA SENTHILINGHAM: I wondered where this fits into the broader concern of drinking alcohol during pregnancy and the rates of FASDs in the U.S. 

DR. ANNE SCHUCHAT: We are concerned about the problem of drinking during pregnancy as well as drinking among women who may become pregnant.  Our latest statistic is that about 10% of women who know they are pregnant are drinking alcohol.  Of course, that is much lower than the three and four women who might be pregnant.  We would like to bring that rate down.  There are a number of resources available to help clinicians screen women who are pregnant for alcohol and to counsel them about how to cut down or stop.  And there are a number of resources for women.  Our website has much of that.  The rate of fetal alcohol spectrum disorder is somewhat difficult to estimate.  We believe that up to 1 in 20 U.S. schoolchildren may have a fetal alcohol spectrum disorder.  The numbers can be different depending on how actively the information is sought and how specifically the exams are done to evaluate children.  It may be as common as 1 in 20 or 5%. 

DR. ANNE SCHUCHAT:  Your next question? 

DR. ANNE SCHUCHAT:  Or maybe there is a follow-up question. 

MEERA SENTHILINGHAM: A brief follow-up.  How big of a role do you think this 3 and 4 that are unaware that they are pregnant, how big a role that plays in the numbers of that 5% that have FASD?  Is it likely to be a driver of it? 

DR. ANNE SCHUCHAT: I think in the United States, we are 1 out of 2 pregnancies occurring to someone who isn’t planning to get pregnant.  It is difficult to know whether you are pregnant during the first month or so.  Those two features conspire to say almost a majority of the pregnancies are occurring in people who don’t realize they are pregnant, yet, weren’t expecting it or didn’t recognize it.  We do think raising awareness about those risks, especially in that first month before you even realize you are pregnant are very important.  The specifics about parental awareness of pregnancy among babies that do develop the fetal alcohol spectrum disorder isn’t information that I have. So I can’t tell you for sure whether most of those mothers were unaware of their pregnancy. I think it is quite likely. We do know that women do so much to try to make sure that they can have a healthy baby.  People stop smoking. They eat carefully and ask about what medications they should or shouldn’t take. They get the flu vaccine and Tdap. Of course, women are working really hard to increase the chance that their baby will be alcohol.  Not drinking alcohol is one of the best things you can do to improve the chances that your baby will be healthy. 

DR. ANNE SCHUCHAT:  Next question, operator. 

OPERATOR: The next will be Marcia Frellic of Medscape.  Your line is open. 

MARCIA FRELLIC: Thank you. Could you tell me more about the screening?  What would you tell primary care physicians about who to test and when? 

DR. ANNE SCHUCHAT:  We recommend that everybody, all adults, be screened for alcohol and counseled about reducing their alcohol consumption if they have problems with it.  This is recommended to be done on an annual basis for the general population and, of course, with pregnant women, we want to make sure they are being asked about alcohol and connected with resources. So we do provide more information about how to do this.  It is a pretty simple screening and intervention.  It can be done by a doctor or a nurse and there are also automated questions that the computer can do to help screen a person before the clinician talks with them.  This can take just a few minutes.  In a busy practice, a few minutes is precious. This is one of those interventions that is effective and cost effective and easy to apply. So we really want it to be used more commonly. We think that it is actually pretty uncommon right now for adults to have recalled being asked about alcohol use during a regular checkup. We think it is very important for that to be part of a normal evaluation. 

MARCIA FRELLIC:  I think this would be a new conversation that we’re introducing here. 

DR. ANNE SCHUCHAT:  Well, it is not unheard of, certainly, asking about smoking and drinking and other substances is an important part of the medical exam.  We know that it is often done the first time you see a clinician. It is not done regularly.  We do think it is important to do this on a more regular basis.  Many people have difficulty with alcohol at different stages in their life.  The key point here today is that drinking too much for women means any alcohol use, if you are pregnant. So it is not a number or question of how many. It is any drinks.  If you are pregnant at any time during the pregnancy.  We do know that alcohol can be harmful to a developing baby at any stage during the pregnancy. 

MARCIA FRELLIC:  Thank you. 

DR. ANNE SCHUCHAT:  Next question. 

OPERATOR: Next comes from Tracy Clark-Flory of Vocativ.  Your line is open. 

TRACY CLARK-FLORY: I’m wondering how serious the risk is for a woman who is drinking very mildly or moderately during that month when she hasn’t yet found out that she is pregnant. 

DR. ANNE SCHUCHAT: You know, we can’t put a number on that for any individual woman. What we can say is that fetal alcohol spectrum disorders are 100% preventable if there is no alcohol exposure at all.  There may be factors other than how much a person drinks, such as genetic factors that predispose them and their babies to be at higher risk.  We don’t know which woman this is going to occur in or in which pregnancy it is going to occur in. That’s why we say that, why take the risk?  Drinking any alcohol during any time in the pregnancy, even before you realize you are pregnant, could be harmful.  We urge women and their partners and their friends to be supportive of that idea about, I’m not going to drink for a while, because I’m thinking about getting pregnant. 

DR. ANNE SCHUCHAT: Next question? 

OPERATOR: The next question comes from Karen Weintraub of freelancer. Your line is open. 

KAREN WEINTRAUB: Thanks for taking my question.  I was curious if you could provide a little more demographics information.  Are there particular communities that are harder hit, this universal 3% of the entire population or some communities are harder hit than others? 

DR. ANNE SCHUCHAT:  Thank you. We found that the factors that were more likely to be present among women who were at risk for an alcohol-exposed pregnancy were age, in the 20s, particularly, the highest risk was the 20s. The 25-29 year old group, we didn’t find any differences that were significant in race or ethnicity. We found that married women or women who were cohabitating were more likely to be drinking and having potential for an alcohol-exposed pregnancy compared with single or divorced women. We also found that women with more education, rather than those with less than high school education were at risk, but that was primarily becaus those with less than a high school education were teens and we had very few teens that were at risk for an alcohol-exposed pregnancy. We also found that smokers and women who had one previous live birth as opposed to none or more than one were at higher risk. So there were a number of age and other demographic factors associated but I think the bottom line is that 3 in 4 women who were at risk for an alcohol-exposed pregnancy had been drinking. So we think this is common enough that rather than focus on just one of these demographics, we want to get the word out to everybody.  Many women just don’t realize they could get pregnant or in the early stages of pregnancy but they are really keen to make sure they have a healthy baby when they do eventually become pregnant.  The time to think about stopping drinking is before you try starting to get pregnant. 

DR. ANNE SCHUCHAT:   Next question. 

OPERATOR: The next question comes from Cat Ferguson of buzz feed news. 

CAT FERGUSON: Thanks for taking my question. Just to be clear, are you recommending that fertile women don’t drink alcohol.  I am wondering where the recommendation falls here. 

DR. ANNE SCHUCHAT:  what we are recommending is that women who are not trying to get pregnant make sure they have a conversation about birth control and how to avoid becoming pregnant.  If they are not using contraception and are fertile and are drinking, they could be at risk for an alcohol-exposed pregnancy. 1 in 2 deliveries in this country occurs to someone who wasn’t trying to get pregnant when they got pregnant. We do think that fertile women that are not using contraception ought to be aware that they may become pregnant and that drinking during even that first couple weeks of pregnancy can be risky. We know that women work so hard to make sure they have healthy babies.  We realize that early time in pregnancy is often when women aren’t even thinking about those health risks.  We want them to recognize that.  So the key message is, if you are not trying to get pregnant, it is just fine to drink, as long as you are really not going to get pregnant. Many women who are not trying to get pregnant are drinking and able to get pregnant, because they are not using contraception.  Next question? 

OPERATOR: As a reminder, if you would like to ask a question, please press star 1 on your line and record your first and last name when prompted.  Give us a few moments, please. 

BELSIE GONZÁLEZ: Liza, it seems like we don’t have any other questions. 

OPERATOR:  Not at this time. 

BELSIE GONZÁLEZ: Thank you, Dr. Schuchat, for joining us today as well as the reporters.  For follow-up questions, call the press office at 404-639-3286 or send an e-mail to media@CDC.gov. Thank you for joining us. This concludes our call. 

OPERATOR: Once again, thank you for joining today’s conference. This now concludes your conference and all lines will be disconnected at this time.  

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES