Background
Methods
Ethics approval
Design and setting
Participants and recruitment
Public antenatal services
Pregnant women
Recruitment procedure
Data collection procedures
Measures
Pregnant women’s alcohol consumption since pregnancy recognition
Receipt of antenatal care for maternal alcohol consumption
Characteristics associated with receipt of care
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Pregnant women’s characteristics. Women reported: whether they were of Aboriginal or Torres Strait Islander origin; their age; their highest level of education completed; whether this was their first pregnancy; and whether they had consumed alcohol since pregnancy recognition [56]. Women’s allocated model of antenatal care (hospital and community-based midwifery clinic, specialist medical clinic, midwifery group practice continuity of care, multidisciplinary care for women with complex medical needs, AMIHS, multidisciplinary care for women with identified vulnerabilities) and residential postal code were obtained from the electronic medical record and appointment systems.
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Antenatal service characteristics. The antenatal service’s postal code was obtained from the electronic medical records and women reported the type of antenatal care provider seen in their visit with the service (possible responses: midwife, hospital doctor (e.g. specialist obstetrician, registrar), Aboriginal Health Worker, other, don’t know).
Acceptability of antenatal care for maternal alcohol consumption
Statistical analyses
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‘assessment (AUDIT-C)’: reported receipt of a question consistent with the first AUDIT-C question (for women who reported in the survey that they had not consumed alcohol since pregnancy recognition (i.e. AUDIT-C score = 0)) and reported receipt of all three questions consistent with the AUDIT-C (for women who reported in the survey that they had consumed alcohol since pregnancy recognition (i.e. AUDIT-C score ≥ 1)).
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‘complete advice’: reported receipt of advice that it is safest not to consume alcohol during pregnancy and of the potential risks associated with alcohol consumption during pregnancy (for all women regardless of their alcohol consumption since pregnancy recognition).
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‘referral offered or followed up’: reported receipt of referral offer or follow up for women who reported in the survey that they had consumed alcohol at medium or high risk levels since pregnancy recognition (i.e. AUDIT-C score: ≥ 3).
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‘complete care’: reported receipt of complete advice (all women) and referral offered or followed up (for women who reported in the survey an AUDIT-C score ≥ 3).
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‘all guideline recommended elements’: reported assessment via AUDIT-C (all women) and complete advice (all women) and referral offered or followed up (for women who reported in the survey an AUDIT-C score ≥ 3).
Results
Participants
Characteristic | N (%) |
---|---|
Age | |
Mean (SD) | 29 years (5 years) |
Aboriginal, or Torres Strait Islander, or both | 80 (6%) |
Highest education level completed | |
Completed high school or less | 398 (29%) |
Completed technical certificate or diploma | 496 (36%) |
Completed university or college degree or higher | 469 (34%) |
Area index of disadvantage | |
Most disadvantaged | 574 (42%) |
Mid disadvantaged | 454 (33%) |
Least disadvantaged | 335 (25%) |
First Pregnancy | 571 (42%) |
Pregnancy risk level | |
Low risk | 851 (62%) |
High risk | 512 (38%) |
Consumed alcohol since pregnancy recognition (yes) | 133 (10%) |
Antenatal service geographic remoteness | |
Major city | 1146 (84%) |
Regional or rural | 217 (16%) |
Provider/s seen in antenatal visit | |
Midwife only | 821 (60%) |
Doctor only | 198 (15%) |
Midwife and doctor | 298 (22%) |
Other provider involved | 46 (3%) |
Receipt of assessment and care for maternal alcohol consumption in antenatal visits
Asked about alcohol consumption and assessment consistent with AUDIT-C
Element of care reportedly received | Initial antenatal visit (N = 473) | Subsequent antenatal visits (N = 890) | Comparison between care at initial and subsequent antenatal visits | |||||
---|---|---|---|---|---|---|---|---|
n | % | 95% CI | n | % | 95% CI | Adjusted Odds Ratio (95% CI)a | p-value | |
Asked about alcohol consumption | 420 | 88.8 | 85.63–91.33 | 127 | 14.3 | 12.13–16.72 | 47.61 (33.82–67.02) | p < 0.001 |
Assessment (AUDIT-C) | 304 | 64.3 | 59.95–68.59 | 69 | 7.8 | 6.17–9.70 | 21.40 (15.71–29.16) | p < 0.001 |
Advised safest not to consume | 299 | 63.2 | 58.86–67.56 | 141 | 15.8 | 13.59–18.39 | 9.13 (7.04–11.83) | p < 0.001 |
Advised of potential risks | 182 | 38.5 | 34.09–42.87 | 187 | 21.0 | 18.46–23.81 | 2.35 (1.84–3.01) | p < 0.001 |
Complete advice (safest not to consume and potential risks) | 166 | 35.1 | 30.79–39.40 | 78 | 8.8 | 7.08–10.80 | 5.63 (4.17–7.59) | p < 0.001 |
Referral offered or followed upb | 1 | 50.0 | 0.00–100.00 | 0 | 0.0 | 0.00–0.00 | – | – |
Complete care (complete advice and referral offered or followed up) | 165 | 34.9 | 30.58–39.18 | 77 | 8.7 | 6.98–10.68 | 5.66 (4.19–7.64) | p < 0.001 |
All guideline elements (assessment, complete advice and referral offered or followed up) | 132 | 27.9 | 23.86–31.95 | 34 | 3.8 | 2.75–5.29 | 9.75 (6.55–14.50) | p < 0.001 |
Advice
Referral offered or followed up
Complete care (advice and referral)
All guideline elements (assessment, advice and referral)
Association between receipt of assessment and care for maternal alcohol consumption and characteristics of pregnant women and antenatal services
Characteristic | Assessment (AUDIT-C) | Complete Care (complete advice and referral offered or followed up) | All guideline elements (assessment, complete advice and referral offered or followed up) | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n (%) | Bivariate Unadjusted OR (95% CI) | p-value | Multivariable Adjusted OR (95% CI) | p-value | n (%) | Bivariate Unadjusted OR (95% CI) | p-value | Multivariable Adjusted OR (95% CI) | p-value | n (%) | Bivariate Unadjusted OR (95% CI) | p-value | Multivariable Adjusted OR (95% CI) | p-value | |
Age | 29 years (SD: 5 years) | 0.97 (0.94–1.01) | 0.13 | 0.98 (0.94–1.02) | 0.41 | 28 years (SD: 6 years) | 0.92 (0.89–0.96) | < 0.001 | 0.96 (0.92–1.00) | 0.04 | 28 years (SD: 6 years) | 0.94 (0.90–0.98) | < 0.01 | 0.97 (0.93–1.02) | 0.23 |
Aboriginal or Torres Strait Islander origin or both | 0.27 | 0.53 | < 0.01 | 0.04 | 0.05 | 0.20 | |||||||||
Yes | 18 (75.0%) | 1.71 (0.67–4.39) | 1.37 (0.52–3.61) | 15 (62.5%) | 3.32 (1.42–7.77) | 2.59 (1.06–6.31) | 11 (45.8%) | 2.29 (1.00–5.26) | 1.78 (0.74–4.28) | ||||||
No (referent) | 286 (63.7%) | 150 (33.4%) | 121 (27.0%) | ||||||||||||
Education level | 0.08 | 0.17 | < 0.01 | 0.04 | < 0.01 | 0.04 | |||||||||
Completed high school certificate or less | 98 (68.1%) | 1.61 (1.00–2.59) | 1.50 (0.89–2.52) | 62 (43.1%) | 2.42 (1.47–3.98) | 1.82 (1.05–3.16) | 49 (34.0%) | 2.27 (1.33–3.87) | 1.88 (1.04–3.40) | ||||||
Completed technical certificate or diploma | 120 (67.4%) | 1.56 (1.00–2.45) | 1.50 (0.94–2.40) | 67 (37.6%) | 1.93 (1.19–3.12) | 1.82 (1.09–3.03) | 55 (30.9%) | 1.96 (1.17–3.30) | 1.93 (1.12–3.34) | ||||||
Completed university or college degree or higher (referent) | 86 (57.0%) | 36 (23.8%) | 28 (18.5%) | ||||||||||||
Area index of disadvantage | 0.14 | 0.14 | 0.20 | 0.30 | 0.05 | 0.03 | |||||||||
Most disadvantaged | 132 (66.3%) | 1.49 (0.94–2.37) | 1.02 (0.61–1.71) | 76 (38.2%) | 1.55 (0.96–2.52) | 1.15 (0.65–2.03) | 60 (30.2%) | 1.78 (1.04–3.05) | 1.28 (0.69–2.39) | ||||||
Mid disadvantaged | 102 (67.6%) | 1.58 (0.96–2.58) | 1.55 (0.93–2.58) | 54 (35.8%) | 1.40 (0.84–2.34) | 1.51 (0.87–2.60) | 48 (31.8%) | 1.92 (1.10–3.37) | 2.11 (1.17–3.79) | ||||||
Least disadvantaged (referent) | 70 (56.9%) | 35 (28.5%) | 24 (19.5%) | ||||||||||||
First pregnancy | 0.89 | 0.67 | < 0.01 | < 0.01 | < 0.01 | < 0.01 | |||||||||
Yes | 124 (63.9%) | 0.97 (0.66–1.43) | 0.91 (0.60–1.38) | 84 (43.3%) | 1.87 (1.27–2.74) | 1.78 (1.16–2.72) | 69 (35.6%) | 1.89 (1.26–2.84) | 1.91 (1.22–2.99) | ||||||
No (referent) | 180 (64.5%) | 81 (29.0%) | 63 (22.6%) | ||||||||||||
Pregnancy risk level | 0.20 | 0.49 | 0.02 | 0.04 | 0.06 | 0.12 | |||||||||
Low risk pregnancy | 282 (65.1%) | 1.53 (0.79–2.94) | 1.28 (0.63–2.61) | 158 (36.5%) | 2.71 (1.17–6.27) | 2.60 (1.05–6.44) | 126 (29.1%) | 2.33 (0.95–5.68) | 2.13 (0.82–5.53) | ||||||
High risk pregnancy (referent) | 22 (55.0%) | 7 (17.5%) | 6 (15.0%) | ||||||||||||
Antenatal service location | < 0.01 | < 0.01 | 0.01 | 0.02 | < 0.01 | < 0.01 | |||||||||
Regional or rural | 57 (78.1%) | 2.21 (1.22–3.98) | 2.74 (1.40–5.33) | 35 (48.0%) | 1.91 (1.15–3.17) | 2.04 (1.10–3.77) | 30 (41.1%) | 2.04 (1.22–3.42) | 2.38 (1.26–4.48) | ||||||
Major city (referent) | 247 (61.8%) | 130 (32.5%) | 102 (25.5%) | ||||||||||||
Provider/s seen in antenatal visit | 0.23 | 0.14 | 0.22 | 0.50 | 0.49 | 0.71 | |||||||||
Midwife only | 236 (66.5%) | 1.62 (0.65–4.02) | 1.99 (0.76–5.17) | 128 (36.1%) | 0.56 (0.23–1.39) | 0.53 (0.20–1.42) | 103 (29.0%) | 0.76 (0.29–1.96) | 0.74 (0.27–2.02) | ||||||
Midwife and doctor | 47 (56.0%) | 1.04 (0.39–2.77) | 1.21 (0.44–3.38) | 23 (27.4%) | 0.38 (0.14–1.02) | 0.44 (0.15–1.29) | 18 (21.4%) | 0.51 (0.18–1.46) | 0.56 (0.18–1.71) | ||||||
Other provider involved | 10 (71.4%) | 2.05 (0.48–8.77) | 3.11 (0.68–14.22) | 4 (28.6%) | 0.40 (0.09–1.71) | 0.41 (0.08–1.98) | 4 (28.6%) | 0.74 (0.17–3.26) | 0.87 (0.18–4.29) | ||||||
Doctor only (referent) | 11 (55.0%) | 10 (50.0%) | 7 (35.0%) |
Characteristic | Assessment (AUDIT-C) | Complete Care (complete advice and referral offered or followed up) | All guideline elements (assessment, complete advice and referral offered or followed up) | ||||||||||||
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n (%) | Bivariate Unadjusted OR (95% CI) | p-value | Multivariable Adjusted OR (95% CI) | p-value | n (%) | Bivariate Unadjusted OR (95% CI) | p-value | Multivariable Adjusted OR (95% CI) | p-value | n (%) | Bivariate Unadjusted OR (95% CI) | p-value | Multivariable Adjusted OR (95% CI) | p-value | |
Age | 28 years (SD: 6 years) | 0.95 (0.91–1.00) | < 0.05 | 0.98 (0.93–1.04) | 0.57 | 27 years (SD: 6 years) | 0.88 (0.84–0.92) | < 0.001 | 0.91 (0.86–0.96) | < 0.01 | 26 years (SD: 5 years) | 0.88 (0.82–0.94) | < 0.001 | 0.91 (0.84–0.99) | 0.03 |
Aboriginal or Torres Strait Islander origin or both | < 0.01 | 0.01 | < 0.001 | 0.02 | < 0.001 | 0.02 | |||||||||
Yes | 11 (19.6%) | 3.27 (1.61–6.66) | 2.70 (1.23–5.92) | 14 (25.0%) | 4.08 (2.11–7.87) | 2.40 (1.15–5.04) | 8 (14.3%) | 5.18 (2.23–12.05) | 3.17 (1.22–8.24) | ||||||
No (referent) | 58 (7.0%) | 63 (7.6%) | 26 (3.1%) | ||||||||||||
Education level | < 0.01 | 0.04 | < 0.001 | 0.07 | 0.02 | 0.23 | |||||||||
Completed high school certificate or less | 31 (12.2%) | 2.32 (1.26–4.25) | 1.96 (1.01–3.80) | 36 (14.2%) | 3.12 (1.69–5.76) | 2.01 (1.00–4.01) | 17 (6.7%) | 3.19 (1.30–7.81) | 1.84 (0.67–5.05) | ||||||
Completed technical certificate or diploma | 20 (6.3%) | 1.12 (0.58–2.16) | 0.97 (0.49–1.94) | 25 (7.9%) | 1.61 (0.84–3.08) | 1.17 (0.58–2.34) | 10 (3.1%) | 1.44 (0.54–3.84) | 0.94 (0.33–2.68) | ||||||
Completed university or college degree or higher (referent) | 18 (5.7%) | 16 (5.0%) | 7 (2.2%) | ||||||||||||
Area index of disadvantage | 0.39 | 0.43 | 0.69 | 0.97 | 0.43 | 0.69 | |||||||||
Most disadvantaged | 33 (8.8%) | 1.61 (0.81–3.19) | 1.61 (0.76–3.40) | 36 (9.6%) | 1.22 (0.67–2.23) | 1.07 (0.53–2.15) | 18 (4.8%) | 1.48 (0.61–3.59) | 1.41 (0.51–3.84) | ||||||
Mid disadvantaged | 24 (7.9%) | 1.43 (0.70–2.93) | 1.50 (0.72–3.14) | 24 (7.9%) | 0.99 (0.52–1.89) | 1.00 (0.50–1.97) | 9 (3.0%) | 0.90 (0.33–2.45) | 0.98 (0.34–2.78) | ||||||
Least disadvantaged (referent) | 12 (5.7%) | 17 (8.0%) | 7 (3.3%) | ||||||||||||
First pregnancy | 0.57 | 0.59 | 0.13 | 0.55 | 0.83 | 0.63 | |||||||||
Yes | 27 (7.2%) | 0.87 (0.52–1.43) | 0.86 (0.50–1.48) | 39 (10.3%) | 1.44 (0.90–2.30) | 1.17 (0.69–1.98) | 15 (4.0%) | 1.08 (0.54–2.15) | 0.83 (0.38–1.78) | ||||||
No (referent) | 42 (8.2%) | 38 (7.4%) | 19 (3.7%) | ||||||||||||
Pregnancy risk level | 0.52 | 0.95 | 0.84 | 0.33 | 0.29 | 0.84 | |||||||||
Low risk pregnancy | 35 (8.4%) | 1.18 (0.72–1.92) | 1.02 (0.54–1.94) | 37 (8.9%) | 1.05 (0.66–1.67) | 0.74 (0.41–1.35) | 19 (4.6%) | 1.45 (0.73–2.89) | 0.92 (0.39–2.17) | ||||||
High risk pregnancy (referent) | 34 (7.2%) | 40 (8.5%) | 15 (3.2%) | ||||||||||||
Consumed alcohol since pregnancy recognition | 0.33 | 0.63 | 0.91 | 0.26 | 0.85 | 0.30 | |||||||||
Yes | 5 (5.2%) | 0.63 (0.25–1.60) | 0.79 (0.30–2.06) | 8 (8.3%) | 0.96 (0.44–2.05) | 1.60 (0.71–3.60) | 4 (4.2%) | 1.11 (0.38–3.21) | 1.83 (0.59–5.70) | ||||||
No (referent) | 64 (8.1%) | 69 (8.7%) | 30 (3.8%) | ||||||||||||
Antenatal service location | 0.78 | 0.85 | 0.41 | 0.68 | 0.48 | 0.82 | |||||||||
Regional or rural | 12 (8.3%) | 1.10 (0.57–2.10) | 0.93 (0.44–1.97) | 15 (10.4%) | 1.28 (0.71–2.32) | 1.17 (0.56–2.41) | 7 (4.9%) | 1.36 (0.58–3.19) | 1.12 (0.41–3.08) | ||||||
Major city (referent) | 57 (7.6%) | 62 (8.3%) | 27 (3.6%) | ||||||||||||
Provider/s seen in antenatal visit | 0.27 | 0.73 | < 0.01 | 0.03 | 0.11 | 0.48 | |||||||||
Midwife only | 39 (8.4%) | 1.26 (0.65–2.47) | 1.20 (0.52–2.77) | 44 (9.4%) | 2.55 (1.13–5.77) | 2.72 (1.07–6.90) | 22 (4.7%) | 2.89 (0.85–9.78) | 2.70 (0.67–10.84) | ||||||
Midwife and doctor | 13 (6.1%) | 0.89 (0.40–2.01) | 0.87 (0.38–1.99) | 18 (8.4%) | 2.24 (0.92–5.50) | 2.37 (0.95–5.95) | 6 (2.8%) | 1.68 (0.41–6.83) | 1.71 (0.41–7.12) | ||||||
Other provider involved | 5 (15.6%) | 2.56 (0.84–7.85) | 1.64 (0.48–5.63) | 8 (25.0%) | 8.14 (2.71–24.48) | 6.17 (1.83–20.82) | 3 (9.4%) | 6.03 (1.16–31.35) | 3.35 (0.54–20.60) | ||||||
Doctor only (referent) | 12 (6.7%) | 7 (3.9%) | 3 (1.7%) |