The prevalence of antenatal alcohol use and associations with co-occurring substance use and mental health: analysis of 50,225 women during pregnancy in the UK

Background: Alcohol consumption during pregnancy is a significant public health concern, with global and UK prevalence rates estimated at 9.8% and 41.3%, respectively. The antenatal period offers a critical window for interventions to reduce alcohol use and mitigate risks to both mother and child. This study aimed to investigate the prevalence and predictors of antenatal alcohol consumption using data from a large sample of UK women engaged with a pregnancy support app.Methods: Cross-sectional data were collected from 50,225 pregnant women who used Tommy’s pregnancy support app between September 2020 and January 2024. Alcohol use was assessed via a binary question, and other health behaviours, mental health conditions, and physical health indicators. Logistic regression analyses were conducted to identify predictors of antenatal alcohol consumption.Results: The prevalence of antenatal alcohol consumption was 16.91%. Women who reported smoking (OR = 2.50, 95% CI: 2.32-2.69) and illicit drug use (OR = 6.79, 95% CI: 6.09-7.57) antenatally had significantly higher odds of alcohol consumption. Mental health conditions (OR = 1.09, 95% CI: 1.04-1.15) and depressive symptoms (OR = 1.08, 95% CI: 1.03-1.14) were also associated with increased odds of drinking during pregnancy. Physical health conditions were associated with reduced odds of alcohol use (OR = 0.87, 95% CI: 0.82-0.93).Conclusion: This study highlights the need to improve adherence to guidelines recommending complete abstinence from alcohol during pregnancy. Findings suggest that women who smoke or use drugs, are particularly at risk of antenatal alcohol consumption. Digital health tools could play a crucial role in providing tailored support and interventions to reduce alcohol consumption and improve maternal and fetal health outcomes.