Increased mortality among women who drank alcohol during pregnancy

Women giving birth to children with fetal alcohol syndrome have a higher risk of early mortality. However, the risk of increased mortality associated with drinking at lower levels during pregnancy has not been evaluated previously. Accordingly, mortality at 20 years post recruitment was examined in a sample (N=570) of women recruited between 1980 and 1986, who drank more than 1 ounce of absolute alcohol per week (oz AA/wk) during pregnancy and compared to that in abstainers from the same low socioeconomic, African-American population. Using data from archival information and state mortality records, Cox proportional hazards survival models were constructed to determine whether alcohol use, cigarette use, infant birth weight, infant dysmorphia, and alcohol use and abuse by the woman's own mother (family history positive) were associated with increased risk for mortality. At follow-up (in 2003), 9.5% of the sample had died, with the rate for controls being 3.6%, for those alcohol users who stopped during pregnancy, 12.7%, and for the alcohol users who continued drinking throughout pregnancy, 12.5%. Thus, women using alcohol in pregnancy, whether they stopped or continued to use, were significantly (chi2 (2)=12.1, P<.01) more likely than abstainers to have died before follow-up. Nondrinkers' mortality rate was lower than that of other women from this low-income, high-risk population, whereas the drinkers' rate was 2.7 times higher. In a multivariate analysis, factors contributing to mortality risk included alcohol use and cigarette smoking, but not infant birth weight. Drinking at any level during pregnancy should be regarded as a risk factor for the mother as well as for offspring. Health care professionals working with such women should provide counseling and support for abstinence.