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Salud mental

Print version ISSN 0185-3325

Salud Ment vol.30 n.1 México Jan./Feb. 2007

 

Artículos originales

Riesgos asociados al consumo de alcohol durante el embarazo en mujeres alcohólicas de la Ciudad de México

Shoshana Berenzon Gorn1 

Martha Romero Mendoza1 

Marcela Tiburcio Sainz1 

Ma. Elena Medina-Mora Icaza2 

Estela Rojas Guiot1 

1Investigadora de la Dirección de Investigaciones Epidemiológicas y Psicosociales del Instituto Nacional de Psiquiatría Ramón de la Fuente.

2Directora de la Dirección de Investigaciones Epidemiológicas y Psicosociales del Instituto Nacional de Psiquiatría Ramón de la Fuente. Correspondencia: Dra. Martha Romero. Dirección de Investigaciones Epidemiológicas y Psicosociales, INP. Calzada México-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, 14370, México, DF, E-mail: romerom@imp.edu.mx

Resumen:

El alcoholismo constituye uno de los primeros problemas de salud pública en la mayoría de los países y afecta de manera diferencial a hombres y mujeres.

El impacto que tiene el consumo de sustancias en la vida y salud de las mujeres se relaciona con los roles, funciones y expectativas que les son asignados, entre ellas el cuidado y continuidad de la familia. Es por eso que la ingesta de alcohol durante el embarazo representa una problemática particular debido a que afecta la salud de la madre y la del producto.

Durante el embarazo la mujer alcohólica tiene un riesgo elevado de presentar importantes complicaciones obstétricas. Además, aumenta el riesgo de que los niños nazcan con bajo peso, diversas anomalías congénitas y afecta el desarrollo conductual y del aprendizaje. En un estudio de casos y controles realizado en el Estado de México, se encontró que el 11% de las entrevistadas había ingerido bebidas alcohólicas durante el embarazo; el 5% de las madres del grupo control y 2% de los casos bebió durante la lactancia; no obstante, en el modelo de regresión logística ninguna de las variables consideradas predijo la mortalidad postnatal. Por otra parte, un análisis de regresión logística realizado con datos de la Encuesta Nacional de Adicciones de 1988 documenta que el consumo de alcohol durante el embarazo es un factor de riesgo para tener bebés con malformaciones congénitas (OR=3.4).

Como se observa, los datos sobre lo que ocurre en México provienen de investigaciones realizadas en población general, por lo tanto, los objetivos de este trabajo son: 1) analizar las características de la ingesta de alcohol en un grupo de mujeres que acudieron a tratamiento por problemas de alcoholismo, 2) identificar los antecedentes familiares de consumo de alcohol en este grupo de mujeres y 3) conocer las consecuencias del consumo en los hijos.

Se realizó un estudio de casos en donde se entrevistaron a 200 mujeres que solicitaron ayuda para tratar problemas relacionados con su manera de beber, en dos clínicas de tratamiento de la Ciudad de México. Se utilizó la versión en español del CIDI-SAM y otras secciones para evaluar la ingesta de alcohol durante el embarazo y la lactancia y antecedentes familiares de consumo. Las entrevistas se realizaron por personal de las dos clínicas, se solicitó la colaboración voluntaria de las entrevistadas y se dio una breve explicación sobre los objetivos de la investigación, haciendo énfasis en el carácter confidencial de los datos. Los diagnósticos de dependencia al alcohol se obtuvieron a través de los criterios propuestos en el Manual Diagnóstico y Estadístico de los Trastornos Mentales.

Ciento treinta y cuatro mujeres reportaron haber estado embarazadas alguna vez, 57.5% de ellas consumió algún tipo de bebida durante el período de gestación. En este grupo se encontró un porcentaje elevado de antecedentes familiares de consumo (93.5%), sobre todo en padres y hermanos; el 70.3% de las mujeres que bebieron durante su embarazo cubrió por lo menos 3 de los 7 indicadores de dependencia del DSM-IV. El 12% de las mismas presentó aborto espontáneo, 13.7% parto prematuro; 5.5% muerte fetal; 6.8% anomalías congénitas y 13.7% tuvieron bebes con bajo peso.

Los análisis de regresión logística mostraron que el consumo de alcohol durante el embarazo aumenta 7.9 veces el riesgo de tener hijos prematuros y 2.1% de que los hijos consuman alcohol posteriormente. La severidad de la dependencia aumenta el riesgo de tener hijos de bajo peso (OR=3.7), y que éstos desarrollen problemas de consumo ulteriormente (OR=2.7). Del mismo modo, el consumir todos o casi todos los días incrementa el riesgo de que los hijos tengan problemas con su manera de beber (OR=2.9). Se identificó que el tener hermanos alcohólicos (OR=2.11) y el cubrir los criterios de dependencia severa (OR=2.21) son factores que predicen el consumo de alcohol durante el embarazo.

Los resultados coinciden con otras investigaciones que reportan historia familiar positiva de abuso de alcohol en mujeres con problemas de alcoholismo. Por otro lado, la proporción de mujeres que suprimieron el consumo durante la gestación (42.5%) es superior a la referida por otros autores. Las prevalencias de aborto espontáneo, muerte fetal y anomalías congénitas encontradas son superiores a lo reportado en población general.

Los hallazgos sugieren que existen mayores dificultades de suprimir el consumo entre las mujeres que tienen dependencia más severa. El impacto de la exposición al alcohol durante el período de gestación responde a un modelo complejo en el que interactúan diversos factores, por lo tanto se requieren más estudios longitudinales para determinar el peso de cada una de las variables involucradas y la naturaleza de la relación entre ellas.

Palabras clave: Mujeres alcohólicas; consumo de alcohol; aborto espontáneo; anomalías congénitas; parto prematuro; México

Summary:

Alcoholism is among the main worldwide public health problems and it affects men and women differentially. Several studies show that, when compared to men, women develop more severe dependence, more family and social consequences and experience more difficulties to stop drinking.

Differences on the impact that substance abuse has on women’s life and health are related to the roles, functions and social expectancies placed on them concerning the continuity and care for the rest of the family. For this reason, alcohol intake constitutes a special problem since it affects the health of both the mother and her offspring.

Alcoholic women have a higher risk of suffering obstetric complications during pregnancy, such as placenta insufficiency, intrauterine development retardation, early placenta detachment, spontaneous abortion, stillbirth and pre-term delivery. Alcohol abuse during pregnancy is also associated with low weight offspring, congenital abnormalities and further behavioral and learning difficulties. In some countries, drinking during pregnancy is considered an offense which requires legal action. In some cases, women may be put in jail until delivery and lactation. In other regions, children welfare authorities view drinking during pregnancy as a form of aggression or neglect. Such measures prevent women from searching prenatal attention which in its case might lead to severe health consequences for the mother, the embryo and the society.

Estimates of alcohol consumption during pregnancy around the world vary considerably and figures range from 4.1% to 83%. However, the variation might be related to the amount of alcohol units and the period of time considered in each measurement.

A case-control study in Naucalpan, Mexico, found that 11% of the women interviewees admitted having drank during pregnancy, 5% of the mothers in the control group and 2% of the case group stopped drinking during lactation. Still, any of the considered variables was found to predict postnatal mortality through logistic regression analyses. Another study performed with data from the 1988 National Survey on Addictions documents that alcohol intake during pregnancy is a risk factor for congenital abnormalities (OR=3.4).

The available data about the risks associated with drinking during pregnancy in Mexico comes from research in general population, while little is known about clinical population. For this reason, the objectives of this article are: 1. to analyze the characteristics of alcohol consumption in a group of women who sought help to stop drinking, 2. to identify family history of alcohol abuse in this group and 3. to explore the consequences of drinking on their offspring.

In this case study, interviews were held with 200 women who attended two treatment agencies in Mexico City due to alcohol consumption problems. The questionnaire used includes the Spanish version of the CIDI-SAM and other sections to explore drinking during pregnancy and lactation, as well as family history of alcoholism. Selection criteria were: 1. aged 18 or older, 2. seeking help for the first time, 3. physical and mental conditions that would allow to answer the questionnaire, 4. having drank during the previous year.

Women agreed to participate voluntarily once the objectives of the study were explained and confidentiality assured. Personnel of both treatment agencies administered the questionnaire and interviews lasted 60 minutes average. The diagnostics of alcohol dependence were obtained according to DSM-IV criteria. Data were analyzed with the statistical program SPSS v. 10, for Windows.

A total of 134 women reported having been pregnant at least once, and 57.5% of them admitted having drank alcoholic beverages during pregnancy. Age ranged from 18 to 61 years (mean=40), 50% were married or living with a partner, 18% were divorced or separated and 13% had never married. The number of children ranged from 1 to 12 with a mean of 3.

High percentages of family history of alcohol abuse were found among this group (93.5%): mostly the father (72.7%), siblings (63.6%) and the partner (48.1%). Significant differences in family history of alcohol use were found between women who drank during pregnancy and those who did not drink.

Around 66% reduced alcohol intake after the confirmation of pregnancy; however, 26% continued drinking as usual and 6.5% started drinking at this period. The mean number of drinks consumed per drinking occasion during pregnancy was 3.5, being the traditional beverage pulque (48.8%) and beer (34.9%) the preferred beverages. In addition, 9.2% also took medical drugs.

At least three out of the seven criteria proposed in DSM-IV for alcohol dependency were met by 70.3% of the women who drank during pregnancy. More severe dependence was found among the women who drank during pregnancy than among the group of women who abstained.

As to the consequences of drinking, 12% of the women reported spontaneous abortion, 13.7% pre-term deliveries, 5.5% stillbirth, 6.8% congenital abnormalities and 13.7% low birth weight. When comparing women who drank and those who did not during pregnancy, significant differences were found in the percentage of pre-term deliveries (X2=5.63; p=0.01) and congenital abnormalities (X2=4.22; p=0.05).

A number of logistic regression models was assessed using three independent variables: drinking during pregnancy, frequency of alcohol consumption and severity of dependence. Dependent variables, on the other hand, were spontaneous abortion, pre-term delivery, stillbirth, congenital abnormalities, low birth weight, alcohol use by the offspring and drinking problems in the offspring.

The analysis shows that alcohol consumption during pregnancy is related to pre-term deliveries (OR=7.9), and alcohol use by the offspring (OR=2.1). Severity of dependence is related as well to low birth weight (OR=3.7) and further drinking problems in the offspring (OR=2.7). Likewise, drinking every day or almost every day is also related to later drinking problems in their children (OR=2.9). Finally, having siblings who drink (OR=2.11) and meeting alcohol dependency (OR=2.21) criteria are factors that predict alcohol consumption during pregnancy.

These results are consistent with other studies that report positive family history of alcohol abuse among alcoholic women. The proportion of women who stopped drinking during pregnancy (42.5%) is higher than the one reported by other authors. Prevalence of spontaneous abortion, stillbirth and congenital abnormalities are higher than the prevalence reported among general population.

These findings suggest that women with severe dependence face more difficulties to stop drinking during pregnancy in spite of the social stigma imposed to future mothers who drink. The results provide some elements that support an association of alcohol abuse during pregnancy with adverse pregnancy outcomes. Nevertheless, the impact of fetal alcohol exposure responds to a complex model where a number of interacting factors, longitudinal reaserch is needed to determine the weight of each participating variable and the underlying relationship between them.

Key words: Alcoholic women; alcohol consumption; pregnancy; spontaneous abortion; congenital abnormalities; pre-term delivery; Mexico

Texto completo disponible sólo en PDF.

Referencias

1. ABEL EL, SOKOL RJ: Incidence of fetal alcohol syndrome and economic impact of FAS-related anomalies. Drug Alcohol Dependence, 19:51-70, 1987. [ Links ]

2. ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION: Estudio de viviendas 2002. Programa de Educación de Necesidad de Servicios para el Abuso de Substancias, Puerto Rico, 2002 [ Links ]

3. AMERICAN PSYCHIATRIC ASSOCIATION: Diagnostic and Statistical Manual of Mental Disorders. Washington, 1994. [ Links ]

4. BACH LA: Alcoholismo, mujeres y familia. Rev Española de Drogodependencia; 122(4):257-61, 1997. [ Links ]

5. BAER JS, SAMPSON PD, BARR HM y cols.: A 21-year longitudinal analysis of the effects of prenatal alcohol exposure on young adult drinking. Archives General Psychiatry 60:386-391, 2003. [ Links ]

6. BOLUMAR F, REBAGLIATO M, HERNANDEZ-AGUADO Y, FLOREY CD: Smoking and drinking habits before and during pregnancy in Spanish women. J Epidemiology Community Health, 48(1):36-40, 1994. [ Links ]

7. BORGES G, GARRIDO F, CARDENAS V, IBARRA J, BOBADILLA JL: Parental alcohol consumption and postneaonatal mortality. J Community Applied Social Psychology, 3:17-27, 1993. [ Links ]

8. BORGES G, TAPIA R, LÓPEZ M, MEDINA-MORA ME, PELCASTRE B, FRANCO F: Alcohol consumption and pregnancy in the Mexican national addiction survey. Cad Saúde Publ, 13(2):205-211, 1997. [ Links ]

9. BRADLEY K, BOYD-WICKIZER J, POWELL S, BURMAN M: Alcohol Screening Questionnaires in Women. A Critical Review. JAMA, 280:166-171. 1998. [ Links ]

10. CAETANO R, MEDINA-MORA ME, SCHAFER J, MARIÑO MC: The structure of DSM-IV alcohol dependence in a treatment simple of Mexican and Mexican American men. Addiction, 94(4):533-541, 1999. [ Links ]

11. EIMAN ML, FAJARDO M, HOYOS A, IVAÑEZ P y cols.: Boletín Epidemiológico Semanal, 5(32), 301-312. Instituto de Salud Calos III; Ministerio de Sanidad de Consumo, 1997. [ Links ]

12. ENCUESTA NACIONAL DE ADICCIONES: Instituto Mexicano de Psiquiatría, Dirección General de Epidemiología, Secretaría de Salud. Vol. Alcohol. 1988. [ Links ]

13. FISCHER S, LÖSER H: Alcohol in pregnancy: Maternal conflicts and preventive. Problems. 1999. [ Links ]

14. GARCIA DEL CASTILLO RODRIGUEZ JA: Drogas y género, Zaguán No.22, 2003. [ Links ]

15. GASKIN DE URDANETA A, ROSALES DE MARTINEZ N: Alcohol y gravidez: análisis de una muestra en la Maternidad Armando Castillo Plaza. Investigación Clínica, 38:66-67, 1997. [ Links ]

16. HOWELL EM, HEISER N, HARRINGTON M: A review of recent findings on substance abuse treatment for pregnant women. J Subst Abuse Treat, 16(3):195-219, 1999. [ Links ]

17. INSTITUTO DE LA MUJER: Mujer y drogas. Instituto Nacional de la mujer, Plan Nacional sobre Drogas, pág 7, Madrid, 1996. [ Links ]

18. MARIÑO MC, BERENZON S, MEDINA-MORA ME: Síndrome de dependencia al alcohol en pacientes alcohólicos: Comparación entre hombres y mujeres. Salud Mental, 28(4):33-39, 2005. [ Links ]

19. MARIÑO MC, MEDINA-MORA ME, DE LA FUENTE JR: Comparación de dos muestras de pacientes alcohólicos. Salud Mental 22(5):28-33, 1999. [ Links ]

20. MARIÑO MC, MEDINA-MORA ME, ESCOTTO J, DE LA FUENTE JR: Utilización de servicios en una muestra de alcohólicos mexicanos. Suplemento Salud Mental, 20(2):24-31, 1997. [ Links ]

21. MINISTRY OF PUBLIC WORKS AND GOVERNMENT SERVICES OF CANADA: Best Practices. Treatment and Rehabilitation for Women with Substance Use Problems. Health Canada, 84 p. Ottawa, 2001. [ Links ]

22. MONTESINOS JE, ALTUZAR M, BENITEZ F: Alcoholismo durante el embarazo: Un problema de salud subestimado. Ginecol Obstet Mex, 72:508-14, 2004. [ Links ]

23. NATIONAL INSTITUTE ON DRUG ABUSE: Advances in Research of Women Health and Gender Differences. Washington, 2002 [ Links ]

24. NATIONAL INSTITUTE ON DRUG ABUSE: National Pregnancy and Health Survey. Department of Health and Human Services. Public Health Service, National Institute of Health, Washington, 1996 [ Links ]

25. OFICINA DE LAS NACIONES UNIDAS CONTRA LA DROGA Y EL DELITO: Tratamiento del Abuso de Sustancias y Atención para la Mujer. Estudios monográficos y experiencia adquirida. Viena. 2005 [ Links ]

26. PAQUETE ESTADISTICO PARA LAS CIENCIAS SOCIALES (SPSS) para Windows versión 10.0.7 en español [Software de computadora]. Chicago, E. U.: SPSS, Inc., 2000. [ Links ]

27. SECRETARIA DE SALUD, DIRECCION GENERAL DE EPIDEMIOLOGIA, INSTITUTO MEXICANO DE PSIQUIATRIA Encuesta Nacional de Adicciones. México, 1988. [ Links ]

28. STEWART DE, STREINER D: Alcohol drinking in pregnancy. Gen Hosp Psychiatry, 16(6):406-12, 1994. [ Links ]

29. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION: National Survey on Drug Use and Health (NSDUH), SAMHSA, Office of Applied Studies, 2003. [ Links ]

30. URBANO A, AROSTEGI E: La Mujer Drogodependiente. Especificidad de Género y Factores Asociados. Ed. Universidad de Deusto, Bilbao, 216 p. 2004. [ Links ]

31. VILLALPANDO S, FLORES-HUERTA S, FAJARDO A, HERNANDEZ-BELTRAN MJ: Ethanol consumption during pregnancy and lactation. Changes in the nutritional status of predominantly breastfeeding mothers. Arch Med Res, 24(4):333-338, 1993. [ Links ]

32. WINDHAM GC, VON BEHREN J, FENSTER L, SCHAEFER C, SWAN SH: Moderate maternal alcohol consumption and risk of spontaneous abortion. Epidemiology, 8(5):509-14, 1997. [ Links ]

33. WORLD HEALTH ORGANIZATION: CIDI: Composite International Diagnostic Interview Version 1.1. World Health Organization, Ginebra, 1993 [ Links ]

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