Introduction

Globally, use of substances such as alcohol, tobacco and other illicit substances, in a way that could harm the users’ health, have escalated through time in all segments of the population and has become one of the growing public health and socioeconomic concerns. Alcohol shares the highest-burden that accounts for 3.8% of all global deaths and 4.6% of the global burden of diseases and neuropsychiatric disorders [1–3]. Risky use of alcohol causes significant morbidity and mortality (particularly from injuries) and societal harm such as social disruption from crime, unemployment and marital disharmony [2, 3].

The negative health consequences of alcohol consumption are more profound for pregnant women and their fetuses. Alcohol consumption during pregnancy has also shown to be one of the leading causes of preventable birth defects and developmental problems comprising language and motor delays and deprived academic achievement [4–6].

New studies indicate that even low levels of prenatal alcohol exposure could adversely affect the developing fetus. Cognitive and socio-emotional deficits, among children exposed to even small amounts of alcohol, are found [7]. Consumption of 2 or more standard drink of alcohol/day in early pregnancy is associated with significant problems on the fetus. It can cause miscarriage, preterm birth and low birth weight compared to children born from non-drinkers. In addition, other studies reported that women who consumed more than three drinks per week during the first trimester had a significant harmful health effect on their pregnancy. The consequence would be five folds more if they took five or more units of alcohol per week [8–12]. Furthermore, binge‐drinking (commonly defined as consuming 4 or more units of alcohol at one occasion for women) during pregnancy is more harmful because of its serious toxic effects on fetal neurodevelopment crossing the placenta [13, 14].

The adverse effects of prenatal alcohol exposure can range from subtle developmental problems, or fetal alcohol effects, to full-blown fetal alcohol spectrum syndrome (FASS). However, it is not limited to infancy and childhood; prenatal exposure to alcohol, particularly in early pregnancy, has also been found to increase the likelihood of developing an alcohol disorder in adulthood [15, 16]. Given these consequences and the belief that there is no safe time or amount to consume alcohol in pregnancy, the CDC recommends complete abstinence [17, 18].

Studies have reported alcohol consumption among pregnant women ranging from 19.5% in South Africa to 59% in Nigeria [19–26].

Similarly, studies conducted on the prevalence of binge drinking among pregnant women showed between 3% in Canada and 25% in Congo [3, 27–31]. A study in New Zealand also revealed 10% of pregnant women drank seven and more units of alcohol per week which is the other clinically significant patterns of alcohol use [30].

According to studies from different countries showed that socio-demographic factors (age, marital status, educational status, and occupation), obstetric history (gestational age, unplanned pregnancy, gravidity, and history of abortion), social support and behavioral issues like use of Khat and cigarette smoking were determinants of alcohol consumption during pregnancy [32–37]. Additionally, studies reported that awareness about the harmful effect of alcohol on fetus, attitude and culture of the population were determinants of alcohol consumption [36, 38–40].

Alcohol consumption and its associated problems among pregnant women increased globally [41]. In low-income countries including Ethiopia, the rapid increase of the consumption of alcohol has also been indicated for decades, especially reproductive-age women are affected [1, 42]. Both traditional and commercially produced alcohol beverages are widely spread more than ever which are also an important contributing factors for increased alcohol consumption in Ethiopia [1, 38].

People in Ethiopia that include pregnant women highly consume alcohol beverages, especially the traditionally prepared alcohol beverages like Areki, Teje, Tella that have higher percentages of alcohol amount [43–45]. Thus, locally made alcohols are being used excessively without control in different holidays, religious festivals, parties, and almost in daily family meals and day to day life [43–45].

Despite the adverse health effects of alcohol consumption is profound, its assessment with determinants among pregnant women is limited. In particular, there is a scarcity of information on binge drinking of alcohol by measuring or calculating the amount consumed. Addis Ababa, the capital city of Ethiopia where the current study was conducted, is heavily affected with consumption of alcohol [1]. Therefore, this study was intended to assess the magnitude of alcohol consumption and binge drinking among pregnant women, and its determinants in Kolfe sub city, Addis Ababa, Ethiopia. The finding of this study will have significant contributions for health program managers, policymakers, clinicians and researchers.

Materials and methods

Results and discussion

Results

Description of socio-demographic characteristics

A total of 367 pregnant women were interviewed that made 92.44% response rate. This study revealed almost three fourth (74.7%) of participants were married. Seven out of ten (70.8%) participants were non-educated, whereas women who completed secondary education and above were 26 (7.1%). The age of participants ranged between 15 and 49 with mean age 27.43 (SD ± 4.77) years. Regarding ethnicity, Amhara and Oromo comprise the majority, 114 (31.1%) and 107(29.2%) respectively. Nearly half of the participants (48.2%) were followers of orthodox religion followed by Muslims (35.7%). The majority (42.5%) of pregnant women were housewives. Similarly, one-third of participants’ monthly average income was between1001-2000 ETB (Table 1).

Table 1

Socio-demographic characteristics of pregnant women in Kolfe Keranio sub city (n = 367), Addis Ababa, Ethiopia.

Variables	Frequency	Percent
Age
15–19	8	2.2
20–24	100	27.2
25–29	117	31.9
30–34	106	28.9
≥35	36	9.8
Mean (SD)	27.43±4.775
Marital status
Married	247	67.3
Single	81	22.1
Divorced	31	8.4
Widowed	8	2.2
Ethnicity
Amhara	114	31.1
Oromo	107	29.2
Gurage	91	24.8
Tigrie	32	8.7
Others	23	6.3
Religion
Orthodox	177	48.2
Muslim	131	35.7
Protestant	40	10.9
Catholic	10	2.7
Others	9	2.5
Educational status
Not educated	127	34.6
Primary education	123	33.5
Secondary education	91	24.8
Above secondary education	26	7.1
Occupation
Employed	105	28.6
Housewife	156	42.5
Own business	106	28.9
Average monthly house hold income
≤ 1000 Birr	44	12
1001–2000	109	29.7
2001–3000	76	20.7
3001–4000	61	16.6
>4000	77	21

Assessment of obstetric history of respondents

As shown in Table 2 below, the majority of pregnant women (40.3%) were in the second trimester. Almost three quarters (73%) of pregnant women had a planned pregnancy. Three or more out of ten (31.6%) of pregnant women had a history of abortion.

Table 2

Obstetric history of the pregnant women in kolfe Keranio sub city (n = 367) Addis Ababa, Ethiopia.

Variables	Frequency	Percent
Trimester of pregnancy
First trimester	38	10.4
Second trimester	148	40.3
Third trimester	131	35.7
Number of pregnancy(gravidity)
One	88	24
Two	148	40.3
≥ Three	131	35.7
Number of alive children
No child	112	30.5
One	134	36.5
Two	65	17.7
> Two	56	15.3
Planned pregnancy
Yes	268	73
No	99	27
History of abortion
Yes	116	31.6
No	251	68.4

Though most of the participants were in the second and third trimester, the proportion of alcohol consumption value was high among first trimester 21 (55.26%) (Fig 1).

Fig 1

Alcohol consumption among pregnant women respected to trimesters of pregnancy in Kolfe Keranio sub city (n = 367), Addis Ababa, Ethiopia.

Alcohol consumption, binge drinking and other substances during pregnancy

As illustrated in (Table 3) below, 146(39.8%) of pregnant women drank alcohol. The majority (44.4%) of participants predominately drank Tella. Fifty-four (14.71%) of participants consumed alcohol 2–4 times per month, while 15 (4.09%) of pregnant women drank four and above times per week. On the other hand, 13 (3.54%) of women had the experience of binge drinking during their pregnancy.

Table 3

Alcohol consumption and binge drinking among pregnant women in kolfe sub city (n = 367), Addis Ababa, Ethiopia.

Variables	Frequency	Percent)
Alcohol consumption before pregnancy
Yes	179	48.8
No	188	51.2
Alcohol consumption during pregnancy
Yes	146	39.8
No	221	60.2
Binge drinking during pregnancy
Yes	13	3.54
No	354	96.46
Frequency of alcohol consumption during pregnancy
≤ once a month	36	9.81
2–4 times per month	54	14.71
2-3times per week	41	11.17
≥ 4 times per week	15	4.09
Type of alcohol use
Tella	65	44.4
Teje	9	6.3
Areki	14	9.7
Beer	41	28.5
Wine	9	6.3
Others	7	4.9
Cigarette smoking during pregnancy
Yes	10	2.7
No	357	97.3
Khat use during pregnancy
Yes	39	10.6
No	328	89.4

Awareness about the harmful effect of alcohol use

As demonstrated in Fig 2, Two hundred forty-four (66.5%) pregnant women have awareness, answered all six questions correctly regarding the harmful effect of alcohol consumption. Among those who have awareness, only 69 (28.28%) consumed alcohol. Whereas, of those who answered the awareness questions incorrectly, 76 (62.6%) drank alcohol.

Fig 2

Magnitude of alcohol consumption among pregnant women respected to awareness about the harmful effect of alcohol on fetus in Kolfe Keranio sub city (n = 367), Addis Ababa, Ethiopia.

Factors associated with alcohol consumption among pregnant women

As shown in Table 4, educational status, occupation, plan of pregnancy, history of abortion, awareness about the harmful effect of alcohol, and family social support of pregnant women were significant predictors of alcohol consumption among pregnant women. The higher odds alcohol consumption was observed among non-educated and attained primary education pregnant women with (AOR 95% CI = 8.47 (2.42, 29.62) and AOR 95% CI = 4.26 (1.23, 14.74), respectively compared to those completed secondary education and above.

Table 4

Determinants of alcohol consumption among pregnant women in Kolfe Keranio sub city Addis Ababa, Ethiopia (n = 367).

Variables	Alcohol consumption during pregnancy
	Yes	No	COR (95% CI)	A OR (95% CI)
Religion
Orthodox	76	101	1.00	1.00
Islam	43	88	0.65 (0.41, 1.04)	1.25 (042, 2.13)
Protestant	24	16	1.99 (0.99, 4.01)	3.01 (0.96, 5.02)
Catholic	2	8	0.33 (0.69, 1.61)	0.23 (0.11, 1.71)
Others	1	8	0.166 (0.02, 1.36)	7.09 (0.68, 18.4)
Educational status
Not educated	65	62	4.40 (1.56, 12.40)	8.47 (2.42, 29.62)*
Primary education	61	62	4.13 (1.47, 11.66)	4.26 (1.23, 14.74)*
Secondary education	15	76	0.83 (0.27, 2.54)	1.41 (0.38, 5.23)
Above secondary education	5	21	1.00	1.00
Occupation
Employed	34	71	1.00	1.00
housewife	87	69	2.63 (1.57, 4.41)	4.18 (2.13, 8.22)*
own business	25	81	0.65 (0.35, 1.18)	0.76 (0.35, 1.66)
Plan of pregnancy
Yes	85	183	1.00	1.00
No	61	38	3.46 (2.14, 5.58)	2.47 (1.33, 4.60)*
Trimesters of pregnancy
First	21	17	1.41 (0.69, 2.85)	1.01 (0.49, 5.11)
Second	46	114	0.46 (0.29, 0.73)	0.81(0.12, 3.00)
Third	79	90	1.00	1.00
Number of pregnancies
One	32	56	1.00	1.00
Two	56	92	1.06 (0.61, 1.84)	1.77 (0.51, 7.42)
≥ Three	58	73	1.39 (0.79, 2.42)	3.53 (0.85, 14.43)
History of abortion
Yes	66	50	2.82 (1.79, 4.44)	3.33 (1.33, 6.05)*
No	80	171	1.00	1.00
Awareness about effect of alcohol
Yes	69	175	1.00	1.00
No	77	46	4.25 (2.68, 6.72)	4.66 (2.53, 8.61)*
Family social support
Have no family social Support	65	58	2.25 (1.45, 3.51)	2 (1.14, 3.53)*
Have family social support	81	163	1.00	1.00

Note.

* refers significant association.

Pregnant women who were housewives had a fourfold risk of alcohol consumption (AOR 95% CI = 4.18 (2.13, 8.22) compared to employed women. Women whose last pregnancy was unplanned had a two folds risk of alcohol consumption than their counters (AOR 95% CI = 2.47(1.33, 4.60). Likewise, pregnant women who had a history of abortion were prone to three-fold risk for alcohol consumption compared to pregnant women who hadn’t [AOR 95% CI = 3.33 (1.33, 6.05)]. Women who had awareness about the effect of alcohol on fetus and them found to be a protective factor for alcohol consumption compared to those who had no awareness [AOR 95% CI 4.66 (2.53, 8.61)]. Moreover, in assessment family social support, more than half (66.5%) of them scored greater than or equal to 14 from the total score of MSPSSf. This study also found pregnant women who hadn’t family social support had a two-fold risk for alcohol consumption [AOR 95% CI = 2 (1.14, 3.53) compared to those who had family social support.

Discussion

The overall prevalence of alcohol consumption among pregnant women was 39.78% (34.74, 44.99). The finding from this study is lower than Ethiopia Demographic and Health Survey (45%) [52]. However, the prevalence of alcohol consumption reported in this study was higher than research conducted in Jimma hospital and Bahir Dar dwellers which are 31.3% and 34%, respectively [48, 53]. The possible reason could be the time of the study; population difference, and study design. A study conducted in Bahir Dar was community-based, unlike the current study which was institution-based.

This study’s alcohol consumption prevalence was also higher than the findings from some of the African countries such as 16% in Uganda [54], 19.6% in South Africa [21], 25% in Uganda [22], 32.5% in Congo [23], 20.4% in Ghana [55] and 22.6% in South Nigeria [38].

Similarly, the magnitude from this study was higher compared to some studies in western countries like the United Kingdom (28.5%), Russia (26.5%) and Switzerland (20.9%) [19]. However, it is in line with a study conducted in Geneva that showed around 36.3% of the women drank at least one glass of alcohol during pregnancy [20]. In contrast to the above, alcohol consumption in this study was far lower compared to the results in Nigeria (59.3%) [26], Ghana (48%) [24], and Australia (56%) [25]. The observed discrepancy might be due to the type of alcohol consumed, study period, awareness and perception about the effect of alcohol on the fetus, and socio-cultural difference among the participants.

The magnitude of binge drinking, which is known for its hazardous effect on the fetus, was 3.54% (1.89, 5.98). It was similar to the findings to the studies in America (3.1%) [28], Canada (3%) [27], and South Africa (4.6%) [29]. However, it was much lower than the findings from studies in New Zealand (9%) [30], Uganda (10%), Congo (20.16%) [31], and Congo (25.42%) [23].

Another pattern of alcohol consumption, hazardous drinking which is found as a risk factor for abortion and miscarriage, was also determined in this study. It has still an immense negative health effect on the fetus. Of those pregnant women who consumed alcohol, 4.9% (2.03, 6.65) of them drank four or more unit of alcohol per week. Similarly, 11.7% of pregnant women in this study reported as they drank 2 to 3 unit of alcohol per week. Around 14% of participants were drinking 2 to 3 units of alcohol per month. A similar study conducted in New Zealand revealed 10% of pregnant women drank 7 units or more of alcohol within a week which was higher than the current study [30]. The discrepancy of the magnitude of binge drinking and amount of alcohol taken per week observed might be due to socio-demographic difference, study design, year of study, and awareness and perception about the effect of alcohol on the fetus.

This study also showed a significant association between not having formal education and alcohol consumption. It is in line with findings from previous studies [38, 53, 56]. It could be due to non-educated women might not have awareness on the harmful effect of alcohol consumption. However, another study showed that highly educated pregnant women were more likely to consume alcohol [32].

The occupation was also significantly associated with alcohol consumption. Being a housewife was shown as risky for alcohol consumption compared to being employed and working their businesses. This finding is supported by other studies [48, 57]. It could be explained by housewives dependent behavior on their spouse that could create distress and their usual engagement in a routine home activity that includes preparing traditional alcohol beverages. Whereas, studies in European countries revealed that employed pregnant women are more likely prone to alcohol consumption [32]. Again, pregnant women lacking awareness about the harmful effect of alcohol on the fetus were more likely to consume higher levels of alcohol than pregnant women who have the awareness. This finding is supported by other similar studies [36, 38, 55]. The other important factor significantly associated with alcohol consumption is family social support. According to the current study, pregnant women who had not family social support had higher odds of alcohol consumption which is consistent with other studies [33, 34]. But, a study conducted in Boston, Massachusetts revealed that social support is not a factor for alcohol consumption [58].

Moreover, a woman whose pregnancy was unplanned and had abortion history had a higher chance of consuming alcohol. This finding is also in line with the result of other studies [35–37, 48]. The possible reason could be that grief due to the previous abortion, psychological and physiological effect of abortion that might eventually cause distress and alcohol consumption.

Unlike some previous studies [35, 38, 59, 60], the current study didn’t show a significant association between women age, gestational age, gravidity, ethnicity, number of alive children, religion, average monthly income, previous alcohol use, chat use, and cigarette smoking with alcohol consumption of pregnant women. Even though alcohol consumption is culturally accepted, the amount and frequency of alcohol drinking may be under-reported by pregnant women because of the possible perceived stigma and recall bias during the interview. Likewise, estimating the amount of alcohol drank by participants and changing the different type of alcohol into the standard unit was challenging and may not be accurate. It is also a real challenge and considered as a limitation for alcohol and other substances study across the world that includes the current research.

Conclusions

This study revealed a higher magnitude of alcohol consumption among pregnant women. The prevalence of binge drinking and the amount and frequency of drinking per week among pregnant women was also higher. Factors such as not being educated, being housewife, having unplanned current pregnancy, having a history of abortion, not having awareness about the effect of alcohol on the fetus and not having family social support were significantly associated with alcohol consumption. Interventions focused on creating awareness about the harmful effects of alcohol on pregnancy; strengthening social support, and family planning services have to be developed and implemented. Moreover, we recommend to future researchers to conduct longitudinal study considering devices that help to measure the amount of alcohol in the blood.