Alcohol consumption before, during, and after unwanted pregnancy

描述(由申请人提供)：本项目的主要目的是描述意外怀孕妇女在怀孕前、怀孕期间和怀孕后的饮酒轨迹，并评估怀孕解决(生孩子和终止妊娠)对这些轨迹的影响。在这项研究中，不想要的是指女性试图终止的怀孕。这些酒精轨迹在短期和长期都会影响胎儿和妇女的健康。在短期内，对于怀孕到足月的妇女来说，在怀孕期间不停止饮酒可能会导致一系列胎儿酒精影响，包括但不限于胎儿酒精综合症，怀孕后饮酒可能会损害安全母乳喂养的能力。从长远来看，怀孕后继续或恢复酗酒或大量饮酒会对妇女的健康和未来怀孕的健康产生影响。虽然一些研究检查了一般女性中的这些酒精轨迹，但研究主要集中在人口统计和酒精模式对变化的影响，而不是关注意外怀孕的女性(女性寻求终止的怀孕是其中的一部分)。考虑到一半的怀孕是意外的，而且意外怀孕的妇女在怀孕期间可能比其他妇女喝得更多或更少，这种研究的缺乏令人惊讶。这项发展性研究将使用创新的转向研究数据集的数据。Turn Away研究是一项前瞻性的纵向研究，对象是在全美30个地点寻求但不一定接受选择性终止妊娠的女性。初步分析表明，样本中的女性酗酒比例明显高于其他女性。这项二次分析研究将使用结构方程模型来分析酒精摄入量从基线到两年跟踪采访的变化，包括轨迹是否因女性是终止妊娠还是怀孕到足月而不同。此外，这项研究将通过确定可改变的风险因素(例如感觉)来扩展先前关于怀孕和育儿转变过程中饮酒变化的研究 关于怀孕、伴侣暴力、压力、抑郁/焦虑)与未能停止或减少饮酒有关。这些发现将有助于我们科学地理解意外怀孕和终止妊娠生下的孩子是如何影响酒精消费的。此外，这项发展研究的结果将被用于提供干预措施，以预防和限制意外怀孕妇女中接触酒精的怀孕和酒精损害的育儿。具体地说，研究结果将通过以下方式为酒精干预的适应提供信息：1)确定怀孕后未能停止/减少饮酒的可改变的危险因素，以及2)探索在怀孕前、产后或受孕期的一系列保健环境中接触到这一高危人群以提供干预的可能性。

DESCRIPTION (provided by applicant): The primary purpose of this project is to describe trajectories of alcohol consumption before, during, and after pregnancy among women with unwanted pregnancies, and assess how the pregnancy is resolved (having the child versus termination) influences these trajectories. In this study, unwanted refers to pregnancies women sought to terminate. These alcohol trajectories can affect fetal and women's health in both the short and long term. In the short term, for women who carry unwanted pregnancies to term, failure to stop alcohol consumption during pregnancy can cause a range of fetal alcohol effects including, but not limited to, Fetal Alcohol Syndrome, and alcohol consumption after pregnancy can impair the ability to breastfeed safely. In the long term, continuation or resumption of binge or heavy drinking after pregnancy has implications for women's health and health of future pregnancies. While some research examines these alcohol trajectories among women in general, the research focuses mainly on demographic and alcohol pattern influences on changes and does not focus on women with unintended pregnancies (of which pregnancies women sought to terminate are a subset). This lack of research is surprising given that half of pregnancies are unintended and the possibility that women with unintended pregnancies may drink more or be less likely to stop drinking during pregnancy than other women. This developmental study will use data from the innovative Turn away Study dataset. The Turn away Study is a prospective, longitudinal study of women with unwanted pregnancies who sought, but did not necessarily receive elective pregnancy terminations at 30 sites across the U.S. Preliminary analyses suggest women in the sample binge drink at rates notably higher than other women. This secondary analysis study will use Structural Equation Modeling to analyze changes in alcohol consumption from baseline through two-year follow-up interviews, including whether trajectories differ by whether the woman terminates or carries the pregnancy to term. In addition, this study will extend previous research on changes in alcohol consumption over the course of pregnancy and parenting transitions by identifying modifiable risk factors (e.g. feelings about pregnancy, partner violence, stress, depression/anxiety) associated with failure to stop or reduce alcohol consumption. Findings will contribute to our scientific understanding of how having a child from an unwanted pregnancy and pregnancy termination affects alcohol consumption. Further, findings from this developmental study will be used to inform interventions to prevent and limit alcohol-exposed pregnancies and alcohol-impaired parenting among women with unwanted pregnancies. Specifically, findings will inform adaptation of alcohol interventions by 1) identifying modifiable risk factors for failure to stop/reduce alcohol consumption after pregnancy recognition and failure to maintain pregnancy-related reductions in consumption and 2) exploring the possibility of reaching this high risk population to deliver the intervention in a range of health care settings either before pregnancy or in the postpartum or interconception periods.