Dose–response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA)—a systematic review and meta‐analyses

Abstract

Background The effects of moderate alcohol consumption during pregnancy on adverse pregnancy outcomes have been inconsistent. Objective To review systematically and perform meta-analyses on the effect of maternal alcohol exposure on the risk of low birth weight, preterm birth and small-size-for-gestational age (SGA). Search Strategy Using Medical Subject Headings, a literature search of MEDLINE, EMBASE, CINAHL, CABS, WHOlist, SIGLE, ETOH, and Web of Science between 1 January 1980 and 1 August 2009 was performed followed by manual searches. Selection Criteria Case control or cohort studies were assessed for quality (STROBE), 36 available studies were included. Data collection and Analysis Two reviewers independently extracted the information on low birth weight, preterm birth and SGA using a standardized protocol. Meta-analyses on dose-response relationship were performed using linear as well as first-order and second-order fractional polynomial regressions to estimate best fitting curves to the data. Main Results Compared to abstainers, the overall dose-response relationships for low birth weight and SGA had no effect up to 10 g/day (an average of about 1 drink/day) and preterm birth had no effect up to 18 g/day (an average of 1.5 drinks/day) of pure alcohol consumption; thereafter, the relationship had monotonically increasing risk for increasing maternal alcohol consumption. Moderate consumption during pre-pregnancy was associated with reduced risks for both outcomes. Conclusions Dose-response relationship indicates that heavy alcohol consumption during pregnancy increases the risks of all three outcomes while light to moderate alcohol consumption shows no effect. Preventive measures during antenatal consults should be initiated.

Social correlates of term small for gestational age babies in a Russian Arctic setting

“…The odds to have term SGA WL and SGA W boys is, respectively, 4- and 3-times higher among alcohol abusing mothers compared with those not being alcohol dependent. In contrast to our findings, the results of a meta-analysis show non-significant effect of alcohol in studies adjusted for confounders (19). The same study also reports a dose–response relationship between mother's alcohol consumption and SGA birth.…”

“…Our findings that smoking and evidence of alcohol abuse significantly associated with SGA birth are in line with other studies (13, 14, 15, 19, 25, 37). However, in contrast to results by Van den Berg et al (37), inclusion of smoking and evidence of alcohol abuse into our model did not reduce or nullify the effect of other social factors.…”

Social correlates of term small for gestational age babies in a Russian Arctic setting

“…The odds to have term SGA WL and SGA W boys is, respectively, 4- and 3-times higher among alcohol abusing mothers compared with those not being alcohol dependent. In contrast to our findings, the results of a meta-analysis show non-significant effect of alcohol in studies adjusted for confounders (19). The same study also reports a dose–response relationship between mother's alcohol consumption and SGA birth.…”

“…Our findings that smoking and evidence of alcohol abuse significantly associated with SGA birth are in line with other studies (13, 14, 15, 19, 25, 37). However, in contrast to results by Van den Berg et al (37), inclusion of smoking and evidence of alcohol abuse into our model did not reduce or nullify the effect of other social factors.…”

Maternal alcohol use during pregnancy and offspring trajectories of height and weight: A prospective cohort study

“…Our findings on birth weight and length differences among heavy drinkers are consistent with a number of large population based prospective cohort studies and results from meta-analysis showing adverse associations with growth at birth among heavy alcohol users during pregnancy (Patra et al, 2011). Similarly, our data illustrating catch up growth among heavy drinkers is compatible with evidence of associations with alcohol that are not evident at age 14 in a cohort of middle class white, married women in Seattle, a group similar to ALSPAC participants (Sampson et al, 1994).…”

“…Our findings demonstrating no evidence of adverse associations between occasional or light daily drinking and birth length and weight are consistent with evidence on the observational associations of moderate alcohol use with head circumference, abdominal circumference, femur length in utero (Bakker et al, 2010) and birth weight (McCarthy et al, 2013;Patra et al, 2011). However, evidence on the impact of occasional or light daily consumption on growth outcomes postnatally is sparse and less consistent; some studies have also shown no association between more moderate drinking levels and postnatal growth/body size (O'Callaghan et al, 2003), but some previous studies have demonstrated height and weight deficits persisting into childhood (Barr et al, 1984;Day et al, 1991Day et al, , 2002Day et al, , 1990Day et al, , 1999.…”

The Burden of Adverse Neonatal Outcome among Antenatal Substance Users in Ethiopia: A Systematic Review and Meta-Analysis

“…The prevalence of congenital anomaly among alcohol users during pregnancy was 37.10% (95% CI: 29.77%-44.43%). This finding was in accordance with other settings, 8 , 35 - 39 which may be due to the fact that alcohol can disturb fetal development especially affecting the fetal central nervous system, with potentially severe lifelong consequences. 45 , 46 The teratogenic effects of alcohol on the developing embryo have been explained to result from different mechanisms including (1) Increased oxidative stress; (2) Disturbed glucose, protein, lipid, and DNA metabolism; (3) Impaired neurogenesis and increased cellular apoptosis, especially of neural crest cells; (4) Endocrine effects; and (5) Effects on gene expression.…”

Social correlates of term small for gestational age babies in a Russian Arctic setting

“…The odds to have term SGA WL and SGA W boys is, respectively, 4- and 3-times higher among alcohol abusing mothers compared with those not being alcohol dependent. In contrast to our findings, the results of a meta-analysis show non-significant effect of alcohol in studies adjusted for confounders (19). The same study also reports a dose–response relationship between mother's alcohol consumption and SGA birth.…”

“…Our findings that smoking and evidence of alcohol abuse significantly associated with SGA birth are in line with other studies (13, 14, 15, 19, 25, 37). However, in contrast to results by Van den Berg et al (37), inclusion of smoking and evidence of alcohol abuse into our model did not reduce or nullify the effect of other social factors.…”

Maternal alcohol use during pregnancy and offspring trajectories of height and weight: A prospective cohort study

“…Our findings on birth weight and length differences among heavy drinkers are consistent with a number of large population based prospective cohort studies and results from meta-analysis showing adverse associations with growth at birth among heavy alcohol users during pregnancy (Patra et al, 2011). Similarly, our data illustrating catch up growth among heavy drinkers is compatible with evidence of associations with alcohol that are not evident at age 14 in a cohort of middle class white, married women in Seattle, a group similar to ALSPAC participants (Sampson et al, 1994).…”

“…Our findings demonstrating no evidence of adverse associations between occasional or light daily drinking and birth length and weight are consistent with evidence on the observational associations of moderate alcohol use with head circumference, abdominal circumference, femur length in utero (Bakker et al, 2010) and birth weight (McCarthy et al, 2013;Patra et al, 2011). However, evidence on the impact of occasional or light daily consumption on growth outcomes postnatally is sparse and less consistent; some studies have also shown no association between more moderate drinking levels and postnatal growth/body size (O'Callaghan et al, 2003), but some previous studies have demonstrated height and weight deficits persisting into childhood (Barr et al, 1984;Day et al, 1991Day et al, , 2002Day et al, , 1990Day et al, , 1999.…”

The Burden of Adverse Neonatal Outcome among Antenatal Substance Users in Ethiopia: A Systematic Review and Meta-Analysis

“…The prevalence of congenital anomaly among alcohol users during pregnancy was 37.10% (95% CI: 29.77%-44.43%). This finding was in accordance with other settings, 8 , 35 - 39 which may be due to the fact that alcohol can disturb fetal development especially affecting the fetal central nervous system, with potentially severe lifelong consequences. 45 , 46 The teratogenic effects of alcohol on the developing embryo have been explained to result from different mechanisms including (1) Increased oxidative stress; (2) Disturbed glucose, protein, lipid, and DNA metabolism; (3) Impaired neurogenesis and increased cellular apoptosis, especially of neural crest cells; (4) Endocrine effects; and (5) Effects on gene expression.…”

Social correlates of term small for gestational age babies in a Russian Arctic setting

“…The odds to have term SGA WL and SGA W boys is, respectively, 4- and 3-times higher among alcohol abusing mothers compared with those not being alcohol dependent. In contrast to our findings, the results of a meta-analysis show non-significant effect of alcohol in studies adjusted for confounders (19). The same study also reports a dose–response relationship between mother's alcohol consumption and SGA birth.…”

“…Our findings that smoking and evidence of alcohol abuse significantly associated with SGA birth are in line with other studies (13, 14, 15, 19, 25, 37). However, in contrast to results by Van den Berg et al (37), inclusion of smoking and evidence of alcohol abuse into our model did not reduce or nullify the effect of other social factors.…”

Maternal alcohol use during pregnancy and offspring trajectories of height and weight: A prospective cohort study

“…Our findings on birth weight and length differences among heavy drinkers are consistent with a number of large population based prospective cohort studies and results from meta-analysis showing adverse associations with growth at birth among heavy alcohol users during pregnancy (Patra et al, 2011). Similarly, our data illustrating catch up growth among heavy drinkers is compatible with evidence of associations with alcohol that are not evident at age 14 in a cohort of middle class white, married women in Seattle, a group similar to ALSPAC participants (Sampson et al, 1994).…”

“…Our findings demonstrating no evidence of adverse associations between occasional or light daily drinking and birth length and weight are consistent with evidence on the observational associations of moderate alcohol use with head circumference, abdominal circumference, femur length in utero (Bakker et al, 2010) and birth weight (McCarthy et al, 2013;Patra et al, 2011). However, evidence on the impact of occasional or light daily consumption on growth outcomes postnatally is sparse and less consistent; some studies have also shown no association between more moderate drinking levels and postnatal growth/body size (O'Callaghan et al, 2003), but some previous studies have demonstrated height and weight deficits persisting into childhood (Barr et al, 1984;Day et al, 1991Day et al, , 2002Day et al, , 1990Day et al, , 1999.…”

The Burden of Adverse Neonatal Outcome among Antenatal Substance Users in Ethiopia: A Systematic Review and Meta-Analysis

“…The prevalence of congenital anomaly among alcohol users during pregnancy was 37.10% (95% CI: 29.77%-44.43%). This finding was in accordance with other settings, 8 , 35 - 39 which may be due to the fact that alcohol can disturb fetal development especially affecting the fetal central nervous system, with potentially severe lifelong consequences. 45 , 46 The teratogenic effects of alcohol on the developing embryo have been explained to result from different mechanisms including (1) Increased oxidative stress; (2) Disturbed glucose, protein, lipid, and DNA metabolism; (3) Impaired neurogenesis and increased cellular apoptosis, especially of neural crest cells; (4) Endocrine effects; and (5) Effects on gene expression.…”