Prenatal alcohol exposure and pregnancy and childhood outcomes: a systematic review of alternative analytical approaches

Abstract

Background Investigation of the eff ects of prenatal alcohol exposure in observational studies using standard analytical approaches such as multivariable regression can produce results that are biased by residual confounding or measurement error due to self-reported alcohol consumption. We aimed to determine the causal eff ects of maternal alcohol consumption in pregnancy on long-term outcomes in off spring. MethodsWe conducted a systematic review of studies that used alternative analytical methods. We searched Medline, Embase, Web of Science, and PsycINFO (Jan 1, 1950, to Feb 11, 2015) using a combination of MeSH terms and text words to refl ect outcomes (eg, pregnancy, fetal development), exposure (alcohol), and relevant study designs, limiting the search to publications in the English language. Study designs including Mendelian randomisation, negative control, and other family-based comparisons, and quasi and natural experiments were included. Pregnancy outcomes (such as birth weight), and features of fetal alcohol spectrum disorders (FASD) related to alcohol exposure during pregnancy were examined. Data were extracted by one of four reviewers and were checked by the lead reviewer. This study is registered with PROSPERO, number CRD4201501594.

The Victorian Intergenerational Health Cohort Study (VIHCS): Study design of a preconception cohort from parent adolescence to offspring childhood

“…For this reason, maternal and child exposures in pregnancy and the first year of life have received much attention in research and policy . Perinatal exposures, including parental mental health, substance use, and socio‐economic disadvantage, predict a range of adverse health and developmental outcomes across childhood and into adulthood . Yet increasingly we are coming to understand that determinants of early life growth and development can be identified before pregnancy .…”

Tools for assessing quality and risk of bias in Mendelian randomization studies: a systematic review

“…Five of the 45 included protocols were of published systematic reviews that were included in our sub-review of systematic reviews above. 90 , 97 , 110 , 116 , 117 Of the 45 included protocols, 35 were for systematic reviews of primary studies and 10 were for umbrella reviews. Fifteen protocols were for reviews of MR studies only and 30 planned to include other study designs.…”

“…Of the 15 protocols in which a non-MR-specific risk-of-bias assessment is reported, 14 used structural tools and Mamluk 97 planned to assess risk of bias on whether adjustment for potentially relevant confounders was conducted. Of the 14 structured tools used for non-MR-specific risk-of-bias assessment, Cheng, 117 Dack, 73 Fell, 77 Haan, 82 , 83 Lemus 94 and Suh 109 planned to use NOS 69 and Baldwin, 71 Cara 72 , 109 and Gianfredi 78 planned to use a modified version of NOS; Elsakloul 75 planned to use STROBE; 118 Fan 76 planned to use a quality-assessment tool for systematic reviews of observational studies that comprised external validity, reporting, bias and confounding factors, but a reference was not provided; Karwatowska 88 , 89 planned to use ROBINS-I; 19 Yan 54 planned to use the ROB-2 18 and the ROBINS-I 19 tools; and Wang 114 planned to use the Cochrane risk-of-bias assessment tool (no details provided).…”

Spry_VIHCS Study design_Preprint

“…1,2 Perinatal exposures, including parental mental health, substance use and socioeconomic disadvantage, predict a range of adverse health and developmental outcomes across childhood and into adulthood. [3][4][5][6] Yet increasingly we are coming to understand that determinants of early life growth and development can be identified before pregnancy. 7,8 Poor maternal nutrition prior to pregnancy predicts an increased risk of pregnancy complications and poor birth outcomes.…”