Evaluation of a retrospective diary for peri-conceptual and mid-pregnancy drinking in Scotland: a cross-sectional study

INTRODUCTION: Heavy episodic ('binge') drinking among women in Scotland is commonplace; pre-pregnancy drinking is associated with continued antenatal drinking. Evidence for effectiveness of standardised antenatal alcohol assessment is lacking. Alcohol-exposed pregnancies may be missed. We assessed peri-conceptual and mid-pregnancy consumption using a week-long retrospective diary and standard alcohol questionnaires, and evaluated the agreement between these instruments.

MATERIAL AND METHODS: Cross-sectional study in two Scottish health board areas involving 510 women attending mid-pregnancy ultrasound scan clinics. Face-to-face administration of alcohol Retrospective Diary and AUDIT or AUDIT-C assessed weekly and daily alcohol consumption levels and patterns. Depression-Anxiety-Stress Scale (DASS-21) assessed maternal wellbeing. A sub-sample (n=30) provided hair for alcohol metabolite analysis. Pearson's correlation coefficient investigated associations between questionnaires and alcohol metabolite data.

RESULTS: The response rate was 73.8%. The Retrospective Diary correlated moderately with AUDIT-C and AUDIT but elicited reports of significantly higher peri-conceptual consumption, (median unit consumption on 'drinking days' 6.8; range 0.4-63.8). Additional 'special occasions' consumption ranged from one to 125 units per week. Correlations between DASS-21 and Retrospective Diary were weak. Biomarker analysis identified three instances of hazardous peri-conceptual drinking.

CONCLUSIONS: Women reported higher consumption levels when completing the Retrospective Diary, especially regarding peri-conceptual 'binge' drinking. Routine clinical practice methods may not capture potentially harmful or irregular drinking patterns. Given the association between pre-pregnancy and antenatal drinking, and alcohol's known teratogenic effects, particularly in the first trimester, the Retrospective Diary may be a useful low-tech tool to gather information on alcohol intake patterns and levels.