Page 16 - Zero for nine: Reducing alcohol use during pregnancy via health counselling and Internet-based computer-tailored feedback

Chapter 1
prevalence rates which varied between 28.6% and 41.8% (Bakker, et al., 2010; Jentink, et al., 2011; Lanting, et al., 2009; Pfinder, et al., 2013). Although none of these studies are based on representative samples of Dutch pregnant women, these various studies jointly suggest that approximately 30% of the Dutch pregnant women use alcohol. This is much lower than the 71% prevalence in Denmark (Kesmodel, et al., 2003) and the 54% prevalence in Ireland (Donnelly, et al., 2008), but much higher than the 14.2% prevalence in Germany (Pfinder, et al., 2013), the 8% prevalence in the United States (Centers for Disease Control and Prevention, 2012), and the 6% prevalence in Sweden (Nilsen, et al., 2008). The approximate estimation of 30% of the Dutch pregnant women using alcohol stresses the need of developing an effective intervention to reduce prenatal alcohol use.
Determinants of prenatal alcohol use
When developing an intervention to reduce prenatal alcohol use, information is required on the target group: what are determinants of women who are drinking alcohol during pregnancy? In describing the current knowledge on these determinants, gaps in this knowledge are exposed, of which some are targeted in this dissertation.
Research has shown that pregnant women using alcohol differ in various aspects from pregnant women abstaining from alcohol (Skagerstrom, Chang, & Nilsen, 2011). Most of the studies on determinants of prenatal alcohol use have focused on predisposing and awareness determinants, showing that women who continue to drink alcohol in pregnancy are older (e.g. Haynes, Dunnagan, & Christopher, 2003; Nilsen, et al., 2008), have a higher education (e.g. Perham-Hester & Gessner, 1997), drink more alcohol before pregnancy (e.g. Chang, et al., 2007), more often smoke cigarettes in pregnancy (e.g. Comasco, et al., 2012) and perceive lower risk of prenatal alcohol use for the unborn baby (Testa & Reifman, 1996). A study conducted in Amsterdam further showed that pregnant women using alcohol are taller, have a more healthy BMI, less often have pregnancy hypertension, have lower mental distress and more often have a Dutch nationality (Pfinder, et al., 2013).
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