Background:
Rates of fetal alcohol syndrome (FAS) are higher in the Black population than among Whites in the United States. Epidemiological data indicate that White women are more likely to drink alcohol before pregnancy, but a greater percentage of pregnant Black women report some alcohol consumption throughout the pregnancy. These findings suggest that racial differences exist in drinking cessation among women who become pregnant which may help explain the disparity in FAS rates.

Objectives:
The objective of this study was to examine differences in drinking cessation before and after becoming pregnant among Black and White women using PRAMS data for the years 2001-2005.

Methods:
The study sample was comprised of 53,426 non-Hispanic Black and White women, ages 18-44, from the Pregnancy Risk Assessment and Monitoring System (PRAMS) 2001-2005 data sets, who consumed some amount of alcohol in the three months before becoming pregnant. Categories of alcohol consumption were low level drinking (<1 drink per week), moderate drinking (2-7 drinks per week) and heavy drinking (7 or more drinks per week). Based on pre-pregnancy drinking, quit rates for Black and White women were identified with logistic regression, adjusting for age, education, marital status, and Medicaid status.

Results:
Among women drinking at low levels before pregnancy, adjusted odds ratios showed that Black women were 34% less likely than White women to quit drinking after becoming pregnant. For women who drank at moderate or heavy levels before pregnancy, racial differences in quit rates were not significant. For moderate drinkers, age, education and marital status were significant predictors of drinking cessation, while for heavy drinkers, age, marital and Medicaid status predicted cessation.

Conclusion and implications for practice:
As FAS is attributed to heavy drinking, the current emphasis on racial disparities in FAS may underestimate more important factors. Though race was a predictor of drinking cessation for women consuming low levels of alcohol before pregnancy, it was not significant for women drinking at moderate or heavy levels. For these women, age was the most important predictor of drinking cessation. This finding should help guide FAS prevention efforts.