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，并评估怀孕是如何解决的（生孩子还是终止妊娠）对这些轨迹的影响。在这项研究中，“不想要的”指的是女性试图终止的怀孕。这些酒精轨迹会在短期和长期内影响胎儿和妇女的健康。在短期内，对于意外怀孕的妇女来说，在怀孕期间不停止饮酒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，并且怀孕后饮酒会损害安全母乳喂养的能力。从长远来看，怀孕后继续或重新酗酒对妇女的健康和今后怀孕的健康都有影响。虽然有些研究从总体上考察了妇女的这些饮酒轨迹，但这些研究主要侧重于人口统计和酒精模式对变化的影响，而不关注意外怀孕的妇女（寻求终止妊娠的妇女是其中的一小部分）。考虑到一半的怀孕是意外怀孕，以及意外怀孕的女性在怀孕期间可能比其他女性喝得更多或更不可能戒酒，这种缺乏研究的情况令人惊讶。这项发展性研究将使用来自创新的拒绝研究数据集的数据。“拒绝”研究是一项前瞻性的纵向研究，研究对象是在美国30个地点寻求但不一定接受选择性终止妊娠的意外怀孕妇女。初步分析表明，样本中的妇女酗酒率明显高于其他妇女。这项二级分析研究将使用结构方程模型（Structural Equation Modeling），通过两年的随访访谈，从基线开始分析饮酒量的变化，包括轨迹是否因女性是终止妊娠还是足月妊娠而有所不同。此外，这项研究将通过确定可改变的风险因素（如情感）来扩展先前关于怀孕和育儿过渡期间酒精摄入量变化的研究

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.