New Estimate of U.S. Alcohol-exposed Pregnancies and Births Published in Women's Health Issues

WASHINGTON, DC (Jan. 14, 2019) — In 2016, the U.S. Centers for Disease Control and Prevention (CDC) released an estimate that 3.3 million women in the U.S. are at risk for alcohol-exposed pregnancies each month. A new estimate published in the journal Women's Health Issues suggests the expected actual number is substantially lower: an estimated 731,000 per month.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, based in the Department of Health Policy and Management at the George Washington University Milken Institute School of Public Health (Milken Institute SPH).

Sarah C.M. Roberts, DrPH, at Advancing New Standards in Reproductive Health (ANSIRH) at University of California, San Francisco (UCSF) and Kirsten M. Thompson, MPH, at UCSF used the same data source that CDC did – information about women aged 15-44 from the National Survey of Family Growth – but modified the approach regarding the chances of becoming pregnant, alcohol exposure once a pregnancy is established, the level of alcohol consumption considered harmful, and the fact that pregnancy outcomes could include miscarriage and abortion as well as births. They estimated the prevalence of alcohol-exposed pregnancies (AEPs) to be 1.2 percent of pregnancies and alcohol-exposed births (AEBs) to be 0.8 percent, or 481,000 births per month. 

This estimate of expected actual numbers of alcohol-exposed pregnancies and births “does not question the importance of alcohol use during pregnancy as a public health problem or deny that public health efforts should be expended” to address it, Roberts and Thompson wrote. Their concern is that overestimating the scope of the problem could lead to moral panic and more stigmatizing and punitive approaches to alcohol use during pregnancy, which can in turn lead to less prenatal care use and more adverse birth outcomes. 

“These estimates provide an important alternative to the CDC estimates and the approach we used should inform future efforts to estimate AEPs and AEBs, which may be more relevant public health metrics,” the authors concluded. 

“Public health efforts to address alcohol use during pregnancy must be carefully crafted to avoid discouraging women from seeking care,” said Women’s Health Issues Editor-in-Chief Amita Vyas, PhD, MHS, an associate professor of prevention and community health at Milken Institute SPH. “This study makes an important contribution to those efforts by providing an estimate based on the best available scientific evidence.”

The article “Estimating the Prevalence of United States Women with Alcohol-exposed Pregnancies and Births” was published online Jan. 14 as an article in press and will appear in the March/April issue of Women’s Health Issues