Alkoholbruk, partilfredshet og samlivsstatus. Før, inn i, og etter svangerskapet – korrelater eller konsekvenser?

Abstract

Women in Norway usually reduce or stop using alcohol when they realize that they are pregnant. However, information about their postpartum drinking pattern is scarce, and we also know little about how expecting fathers drink. Moreover, information of any effects of alcohol consumption before and during pregnancy on relationship quality and stability after the child is born is also scarce. This thesis explored the extent to which expecting parents changed their alcohol consumption levels when the woman becomes pregnant. Furthermore, we assessed the development of mother’s alcohol consumption postpartum, and associations between drinking and relationship satisfaction and dissolution. Method: The data collection was conducted as part of the Norwegian Mother and Child Cohort Study (MoBa), which is a prospective population based cohort study conducted by the Norwegian Institute of Public Health. Participants were recruited between1999-2008, and the cohort presently includes 114 500 children, 95 200 mothers and 75 200 fathers. The sample size and demographical characteristics varied depending on the particular research question in focus. Paper I examined mothers’ and fathers’ alcohol consumption levels before and into the pregnancy, at respectively 17th and 19th week of gestation, respectively. It also examined to what degree changes in alcohol consumption affected both partners’ relationship satisfaction. The analysis was conducted within an APIM framework. The reference recall period before pregnancy was 3 months for mothers and 6 months for fathers. The paper included a total number of 82 363 couples. Paper II examined how mothers resume their pre-pregnancy drinking level after the child is born and how the consumption develops towards the child’s first three years. The mothers’ alcohol consumption levels before pregnancy was used as a predictor and her civil status and number of children were used as moderators. The mothers were divided into three different groups; married (n=34 516), cohabitants (n=40 824) and single (n=1 797). Postpartum alcohol consumption was measured at four different times (0-3 months; 4-6 months; 18 months: and 36 months after birth). Paper III examined the extent to which pre-pregnancy alcohol consumption affects postpartum relationship satisfaction and risk for divorce three years after the birth. Relationship satisfaction was used as a mediator in order to explain any relationship between pre-pregnancy alcohol use and relationship dissolution. The sample included married and cohabiting mothers divided into three alcohol consumption groups: low-risk (n=67 155/89.2%); medium- risk (n=6 609/8.8%); and high-risk (n=1 467/1.9%). The study used data collected at 17th week of gestation, and 4-6; 18; and 36 months postpartum. Results: The results of paper I revealed that both expecting mothers and fathers reduced their alcohol consumption when the women got pregnant. First-time parents had the highest initial level of alcohol use and they also reduced their consumption more than experienced parents The fathers’ reduction was not related to the mothers’ reduction. The results from paper II indicated that 44.6% of the mothers had started to drink alcohol already when the child was three months old. The resumption pattern showed a steady increase towards 18 months, where 90% of the mothers were drinking. Their postpartum alcohol use was most strongly predicted by their pre-pregnancy alcohol use. Married and cohabitating parents had higher frequency of drinking compared to single mothers. However, single mothers reported more alcohol units when drinking. The results from paper III indicated that the high-risk consumption group had 55% higher odds of being divorced three years after the birth, although alcohol consumption itself was not causing relationship deterioration. Rather high consumers tend to have several characteristics associated with higher risks for marital dissolution; being younger, having unplanned pregnancies, not being married, and having shorter relationship duration. The relationship between pre-pregnancy alcohol use and divorce was mediated by relationship satisfaction. Conclusions: In Norway both men and women seem to reduce their alcohol consumption when they expect a child. The rather strong reduction of the fathers’ alcohol use was a surprise and may indicate an early identification with the role as a father, and could reflect the high level of gender equity in Norway. Alcohol consumption in pregnancy and postpartum also seem to be a function of marital status and number of children. Information about the importance of marital status and number of children on mothers’ alcohol consumption levels could be useful when tailoring preventing interventions towards parents with small children. Moreover, high levels of alcohol consumption were associated with lower levels of relationship satisfaction during the first years of the child, and a higher risk for relationship dissolution. However, family structures seem to predict mothers’ alcohol consumption more strongly than fathers’ and mothers’ alcohol consumption predict relationship satisfaction and dissolution when parenting young children.