Alcohol Exposure Among Pregnant Women in Sub-Saharan Africa: A Systematic Review
J Popul Ther Clin Pharmacol Vol 20(3):e321-e333; October 18, 2013
Review
Celia L Culley, Tasha D Ramsey, Godfrey Mugyenyi, Gertrude N Kiwanuka, Joseph Ngonzi, Stuart MacLeod, Gideon Koren, Brian E Grunau, Matthew O Wiens

Background
The prevalence of general alcohol use in many countries of sub-Saharan Africa (SSA) is high. However, research examining alcohol use in among pregnant women within this population is limited. A review of the current status of research examining the prevalence of alcohol exposed pregnancies (AEP) is required to inform future research aiming to decrease this occurrence and its subsequent socio-economic complications.

Objective
The primary objective was to identify all published papers estimating prevalence and risk-factors of alcohol use among pregnant women in SSA. A secondary objective was to determine changes in alcohol use following pregnancy recognition.

Methods
PubMed/Medline, Embase, IPA, CINAHL were systematically searched using MeSH terms and keywords from inception date to March 2013. Studies from SSA reporting prevalence of alcohol use among pregnant women were included.

Results
Twelve studies were identified. Studies varied significantly according to design and study population. Prevalence of alcohol use during pregnancy ranged from 2.2%-87%. The most important risk-factors for alcohol use included tobacco use, partner violence, urban living, and having a male partner who drank alcohol. Only three studies examined changes in alcohol use prior to and following pregnancy recognition with absolute reductions of between 9% and 15%.

Conclusions
Although the burden of alcohol use during pregnancy is likely a significant problem, limited data currently exist for the majority of SSA countries. Furthermore, significant variation likely exists within various populations. Further research is required to explore alcohol use in pregnancy. Strategies to decrease AEP must be developed and implemented in standard pre-natal care.

Key Words: Sub-Saharan Africa, alcohol, pregnancy, women, systematic review, fetal alcohol spectrum disorder

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