Applying the theoretical domains framework to identify determinants of alcohol consumption during pregnancy: A cross-sectional study among women of childbearing age in Southwest Germany.

Authors

Manuela Bombana, Alina Gäbele, Monika Heinzel-Gutenbrunner, Michel Wensing

Published in

Women's health (London, England). Volume 22. Pages 17455057261487125. Epub Sep 15, 2026.

Abstract

BackgroundPrenatal alcohol exposure (PAE) is a major teratogen associated with fetal alcohol spectrum disorders, yet alcohol use during pregnancy remains common in Germany. Previous interventions focusing primarily on education have shown limited effectiveness. The Theoretical Domains Framework (TDF) offers a comprehensive approach to identify psychosocial determinants of behavior, but its application to alcohol use in pregnancy has been limited.ObjectivesTo identify cognitive, emotional, social, and contextual determinants of alcohol consumption during pregnancy using a TDF-based framework, in order to inform theory-driven interventions within maternal health services.DesignCross-sectional observational multi-center study.MethodsWe conducted a self-administered questionnaire survey among consecutively recruited women (age 18-49) in 22 gynecological and obstetric institutions between October 2019 and January 2020 across Baden-Württemberg, Germany. We included a total of 201 women of childbearing age, pregnant, and breastfeeding women because alcohol consumption before pregnancy recognition contributes substantially to prenatal alcohol exposure. Participants completed a 94-item questionnaire, including 28 TDF-based items covering eight domains relevant to alcohol abstinence. Data were analyzed using exploratory factor analysis, internal consistency testing, correlation, and hierarchical regression to identify predictors of alcohol consumption.ResultsMean alcohol consumption was 75.1 glasses/year. Reliability across TDF domains varied (Cronbach's α = 0.365-0.875). Factor analysis revealed two components: (1) Motivational-Interpersonal (social influence, optimism, beliefs about capabilities) and (2) Cognitive-Role-Based (knowledge, intention, social role). Regression analyses showed that Factor 2 was a significant negative predictor of alcohol consumption (β = -0.210, p = 0.041), while Factor 1 was not. Older age predicted lower consumption (β = -0.258, p = 0.045), while urban residence predicted higher consumption (β = 0.187, p = 0.056). Neither moderation nor mediation effects of TDF factors were observed.ConclusionsCognitive-role-based determinants, particularly maternal identity and intention to abstain, are strongly associated with reduced alcohol use in pregnancy. Interventions should therefore go beyond knowledge dissemination and emphasize maternal role identity, goal setting, and intention formation. Embedding TDF-informed strategies into routine prenatal care may enhance the effectiveness and scalability of interventions to reduce PAE.

PMID:
42742112
Bibliographic data and abstract were imported from PubMed on 15 Sep 2026.

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