The effect of maternal alcohol consumption on fetal growth and preterm birth

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Abstract

To investigate the relationship between prenatal alcohol exposure and fetal growth and preterm birth and to estimate the effect of dose and timing of alcohol exposure in pregnancy. A population-based cohort study linked to birth information on the Western Australian Midwives Notification System. Western Australia. A 10% random sample of births restricted to nonindigenous women who had delivered a singleton infant (n= 4719) in 1995-1997. The impact of alcohol consumption in pregnancy on fetal growth (small-for-gestational-age [SGA] and large-for-gestational-age infants [LGA]) and preterm birth (<37 weeks of gestation) was assessed using multivariate logistic regression analysis and adjusting for confounding factors. Odds ratios and 95% CI, attributable risk, and population attributable risk were calculated. The percentage of SGA infants and preterm birth increased with higher levels of prenatal alcohol exposure; however, the association between alcohol intake and SGA infants was attenuated after adjustment for maternal smoking. Low levels of prenatal alcohol were not associated with preterm birth; however, binge drinking resulted in a nonsignificant increase in odds. Preterm birth was associated with moderate and higher levels of prenatal alcohol consumption for the group of women who ceased drinking before the second trimester. This group of women was significantly more likely to deliver a preterm infant than women who abstained from alcohol (adjusted OR 1.73 [95% CI 1.01-3.14]). Alcohol intake at higher levels, particularly heavy and binge drinking patterns, is associated with increased risk of preterm birth even when drinking is ceased before the second trimester. This finding, however, is based on small numbers and needs further investigation. Dose and timing of prenatal alcohol exposure appears to affect preterm delivery and should be considered in future research and health education.

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Systematic review of effects of low-moderate prenatal alcohol exposure on pregnancy outcome.

J. Henderson, R. Gray, P Brocklehurst (2007)

The aim of this study was to review systematically the available evidence on studies in humans on the effects of low-moderate levels of prenatal alcohol consumption (up to 10.4 UK units or 83 g/week) compared with consumption of no alcohol on pregnancy outcome. Systematic review. Pregnant women or women who are trying to become pregnant. The search strategy included Medline, Embase, Cinahl and PsychInfo for the years 1970-2005. Titles and abstracts were read by two researchers and inclusion/exclusion being decided according to prespecified criteria. All the included articles were then obtained and read in full by the two researchers to decide on inclusion. The articles were assessed for quality using the Newcastle-Ottawa Quality Assessment Scales. Outcomes considered were miscarriage, stillbirth, intrauterine growth restriction, prematurity, birthweight, small for gestational age at birth and birth defects including fetal alcohol syndrome. The search resulted in 3630 titles and abstracts, which were narrowed down to 46 relevant articles. At low-moderate levels of consumption, there were no consistently significant effects of alcohol on any of the outcomes considered. Many of the reported studies had methodological weaknesses. This systematic review found no convincing evidence of adverse effects of prenatal alcohol exposure at low-moderate levels of exposure. However, weaknesses in the evidence preclude the conclusion that drinking at these levels during pregnancy is safe.

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Validity of maternal report of prenatal alcohol, cocaine, and smoking in relation to neurobehavioral outcome.

Eric Jacobson, Debra J. Jacobson, L Chiodo … (2002)

Evidence that mothers report higher levels of drinking retrospectively than during pregnancy has led some investigators to suggest that women systematically underreport alcohol antenatally and that alcohol-related deficits may actually reflect heavier prenatal exposure. This study is the first to compare the validity of antenatal and retrospective reports of pregnancy drinking, drug use, and smoking in relation to effects on infant neurobehavioral outcomes. Three hundred fifty-four inner-city mothers were interviewed regarding their alcohol, drug use, and smoking during pregnancy and retrospectively at 13 months' postpartum. Their infants were assessed at 6.5, 12, and 13 months on a large battery of neurobehavioral assessments. Although higher levels of alcohol were reported retrospectively, the correlations of prenatal alcohol exposure with infant outcome were as strong or stronger for the antenatal measures and only the antenatal reports predicted poorer cognitive performance on the Bayley Scales and symbolic play, slower processing speed on the Fagan Test of Infant Intelligence and cross-modal transfer, and slower infant reaction time. Women also reported higher levels of cocaine and marijuana but not cigarette smoking retrospectively. Relations between cocaine use and smoking on birth size and gestational age were as strong for either report. No effects were detected in relation to either report of marijuana use during pregnancy. These findings suggest that antenatal alcohol interviews provide the most valid information and demonstrate the importance of assessing prenatal alcohol use during pregnancy to minimize the risk of failing to detect neurobehavioral deficits. Adverse effects were consistently seen at levels as low as 0.5 oz absolute alcohol/day (the equivalent of 7 drinks per week) based on maternal antenatal report. These data suggest that alcohol-related deficits do not reflect heavier prenatal exposure than that reported during pregnancy and that threshold values derived from antenatal reports are reasonably accurate.

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Health professionals' knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy.

Jan Payne, Colleen O’Leary, Geoff Bower … (2005)

To measure the knowledge, attitudes and practices of health professionals regarding fetal alcohol syndrome (FAS) and alcohol use during pregnancy. A postal survey of a representative random sample of health professionals was conducted in Western Australia (WA) in 2002/03. 1,143 (79%) of 1,443 eligible health professionals completed the survey (87 Aboriginal Health Workers, 286 allied health professionals, 537 community nurses, 170 general practitioners and 63 obstetricians). Of 1,143 health professionals, 12% identified all four essential diagnostic features of FAS. Most (95%) had never diagnosed FAS. Although 82% believed that making a diagnosis of FAS might improve treatment plans and 85% agreed FAS was preventable, 53% said the diagnosis might be stigmatising. Only 2% felt very prepared to deal with FAS and most wanted information for themselves and their clients. Of the 659 health professionals caring for pregnant women, only 45% routinely ask about alcohol use in pregnancy, only 25% routinely provide information on the consequences of alcohol use in pregnancy and only 13% provide advice consistent with NHMRC guidelines on alcohol consumption in pregnancy. Health professionals have identified the need for educational materials for themselves and their clients. FAS is likely to be under-ascertained in Australia due to a lack of knowledge of FAS by health professionals. Until this lack of knowledge is addressed, opportunities for diagnosis and prevention of FAS will be limited.