Background: Rates of prenatal alcohol use in Sub-Saharan Africa (SSA) are increasing, despite regulatory bodies urging pregnant women to abstain from alcohol. Tanzania has minimal policies, interventions, and young female education addressing alcohol consumption during pregnancy (ACDP), leading to a considerable number of pregnancies being exposed to alcohol and consequent health consequences like fetal alcohol spectrum disorder (FASD). Research investigating the prevalence of ACDP in SSA —specifically in Tanzania— is abundant. In Tanzania, there is a limited understanding of alcohol use practices among pregnant women who consume alcohol (PWCA), as well as community knowledge, attitudes, and cultural beliefs related to ACDP.    Methods: A total of 655 individuals were enrolled in this sequential, explanatory mixed-methods study using systematic random sampling between October 2020 and May 2021. Quantitative survey data from 533 female patients presenting for care at KCMC ED or RHC were analyzed to compare sociodemographics and alcohol use practices among pregnant, younger non-pregnant, and older non-pregnant women using descriptive frequencies in RStudio. Nineteen participants were purposively selected based on quantitative survey data for qualitative semi-structured IDIs exploring knowledge, attitudes, and cultural beliefs surrounding ACDP. A grounded theory approach was used to analyze in-depth interviews (IDIs) in NVivo.    Results: A large percent of pregnant women reported alcohol consumption of at least once per week (42.2%). Older non-pregnant women had the highest rates of alcohol use per week (66.0%) and were more likely to believe alcohol use was acceptable during pregnancy. Younger non-pregnant women reported the highest weekly alcohol expenses, and held the highest prevalence of harmful or hazardous drinking (HHD) (16.4%). Average [SD] AUDIT scores were 1.70 [3.28] for pregnant women, 2.94 [ 4.79] for younger non-pregnant women, and 2.51 [4.36] for older non-pregnant women. Older non-pregnant women exhibited the highest prevalence of depression (31.4%). Average [SD] PHQ-9 scores were 4.71 [3.12] for pregnant women, 5.85 [4.80] for younger non-pregnant women, and 7.29 [5.55] for older non-pregnant women. Qualitative analyses demonstrated that (1) cultural beliefs are intricately tied to perceived benefits of ACDP, (2) a history of alcohol use preceding pregnancy largely influences ACDP, and (3) community views of PWCA are negative.  Significance: Our findings demonstrate a concerning trend of ACDP in Moshi, Tanzania. Cultural and community beliefs, along with limited knowledge of ACDP, among women of all ages appear to influence ACDP and community views of PWCA. Consequently, community-wide education initiatives and pre-pregnancy interventions highlighting the dangers of ACDP are necessary. Holistic support services may help curb alcohol use and improve birth experiences. Further research is needed to explore ACDP as a form of self-medication for depression, fear, anxiety, and pain in pregnant women in SSA.

The authors have declared no competing interest.

This project was funded by the Duke Global Health Institute Graduate Student funds (AMP), and the Josiah Trent Foundation (21-06 to CAS). These two financial awards funded the salaries of JK, YS, and MMi as research assistants hired specifically for this study. No other authors received specific funding for this work. Infrastructure built by NIH grants (R01 AA027512 to CAS) was used to support the data collection and analysis processed for this grant to understand gender-related aspects of alcohol use at KCMC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Ethical approval for this study was obtained from the Duke University Institutional Review Board, the Tanzanian National Institute of Medical Research, and the Kilimanjaro Christian Medical University College Ethical Review Board prior to the onset of any data collection.

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Data are only available upon reasonable request, as participants did not consent to public data transfer and requires a written agreement approved by Kilimanjaro Christian Medical Centre Ethics Committee and the National Institute for Medical Research (Tanzania). Data inquiries can be sent to Gwamaka W. Nelson at gwamakawilliam14@gmail.com.