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Systematic literature review on which maternal alcohol behaviours are related to fetal alcohol spectrum disorders (FASD)
  1. Sylvia Roozen1,2,
  2. Gjalt-Jorn Ygram Peters2,3,
  3. Gerjo Kok1,2,
  4. David Townend1,4,
  5. Jan Nijhuis1,5,
  6. Ger Koek1,6,
  7. Leopold Curfs1
  1. 1 Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
  2. 2 Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
  3. 3 Faculty of Psychology and Education Science, Open University of The Netherlands, Heerlen, The Netherlands
  4. 4 Department of Health, Ethics & Society, Maastricht University, Maastricht, The Netherlands
  5. 5 Department of Obstretrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
  6. 6 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
  1. Correspondence to Sylvia Roozen; sylvia.roozen{at}


Objectives Fetal alcohol spectrum disorders (FASD) is a worldwide problem. Maternal alcohol consumption is an important risk factor for FASD. It remains unknown which alcohol consumption patterns most strongly predict FASD. The objective of this study was to identify these.

Design Systematic literature review.

Methods We searched in PubMed, PsychINFO, PsycARTICLES, ERIC, CINAHL, Embase and MEDLINE up to August 2018. The query consisted of keywords and their synonyms related to FASD, pregnancy and behaviour. Studies were excluded when not published in English, were reviews or involved non-human subjects. Substantial heterogeneity precluded aggregation or meta-analysis of the data. Instead, data were qualitatively inspected.

Results In total, 21 studies were eligible for further data analysis. All studies that measured both maternal alcohol drinking behaviours and FASD reported retrospective data on maternal drinking patterns, employing both continuous and categorical measures and exhibiting substantial heterogeneity in measures of alcohol consumption (eg, timing of exposure, quantification of alcohol measure and definition of a standard drink). Study quality improved over time and appeared higher for studies based on active case ascertainment, especially when conducted in schools and when behaviour was assessed through interviews.

Conclusions We aimed to identify specific maternal drinking behaviour(s) related to FASD. The state of the literature precludes such conclusions. Evidence-based preventive measures necessitate identifying which prenatal alcohol drinking behaviour(s) are most in need of intervention. Therefore, we formulate three recommendations for future research. First, future studies can optimise the value of the collected dataset through specifying measurements and reporting of maternal drinking behaviours and avoiding categorised measures (nominal or ordinal) whenever possible. Second, samples should not be selected based on FASD status, but instead, FASD status as well as maternal alcohol consumption should both be measured in a general population sample. Finally, we provide 10 reporting guidelines for FASD research.

  • prenatal diagnosis
  • substance misuse
  • preventive medicine

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  • Patient consent for publication Not required.

  • Contributors SR, G-JYP, GerjK and LC designed the study and directed its implementation, including quality assurance and control. Authors DT, JN and GerK helped supervising the field activities. SR and G-JYP conducted the literature review and analyses and prepared the Materials and Methods and the Discussion sections of the text. All other coauthors contributed to successive drafts. All authors gave significant input in preparation of the article and approved the manuscript and submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data, analysis scripts and other materials are publicly available at the Open Science Framework repository for this study (