Original articleLow-to-moderate prenatal alcohol consumption and the risk of selected birth outcomes: a prospective cohort study
Introduction
Alcohol use during pregnancy has historically been associated with a range of negative birth outcomes and developmental effects that include fetal alcohol syndrome (FAS), alcohol-related birth defects, and alcohol-related neurodevelopmental disorders [1], [2], often characterized at birth by facial dysmorphology, poor growth, and neurologic functional and structural abnormalities, including reduced head circumference [3]. Although epidemiologic research has delineated adverse effects of heavy or chronic drinking on the fetus, reported effects of low to moderate prenatal alcohol, which represents the majority of exposures, are inconsistent. Previous studies have documented increased risks between alcohol and infertility [4], miscarriage [5], stillbirth and infant mortality [6], [7], congenital anomalies [8], low birthweight [9], reduced gestational age [10], preterm delivery [11], and intrauterine growth restriction (IUGR) or small-for-gestational age [8], [12], [13], but at relatively higher consumption levels. Conversely, other research demonstrated no increase in risk from light-to-moderate alcohol consumption for selected perinatal or developmental outcomes [14], [15], [16], [17], [18], and several studies have reported reductions in risk of adverse pregnancy outcomes, including a curvilinear effect for increasing levels of prenatal alcohol exposure [9], [19], [20], [21]. A systematic review of low-to-moderate prenatal drinking reported lacking evidence of increased risk for selected birth outcomes including IUGR, prematurity, birthweight, and malformations [22]; yet, results overall were inconclusive.
Methodologic difficulties related to study design, including retrospective exposure assessment, potential exposure misclassification, and inadequate control for potential confounders have resulted in limited high-quality analyses of low-to-moderate prenatal alcohol drinking. The present study is a prospective investigation of alcohol use during pregnancy and IUGR, low birthweight, preterm delivery, and other selected neonatal outcomes among a cohort of 4496 women and their newborns.
Section snippets
Sample
The study population included women enrolled in two related and almost concurrent prospective longitudinal cohorts: one examining prenatal caffeine exposure and the other investigating asthma in pregnancy (Fig. 1). Pregnant women were recruited from 56 obstetric practices and 15 clinics associated with six hospitals in Connecticut and Massachusetts during the period of September 1996 to June 2000. Study design for each cohort was similar with respect to methodology, timing, and content of
Results
Maternal alcohol exposure was most prevalent during the first month of pregnancy (29%) and declined in the second and third months to 9% and 7%, respectively; median exposure among women who drank during months 1, 2, and 3 was 0.07 oz AA/d (about 1 drink/wk), 0.03 oz AA/d (slightly less half a drink per week), and 0.02 oz AA/d (slightly less than one-third of a drink per week), respectively. Alcohol consumption demonstrated a curvilinear pattern, becoming less frequent after recognition of
Discussion
Our findings provide no support for an increased risk for low birthweight, preterm delivery, IUGR, and selected birth outcomes, consistent with earlier studies of low-to-moderate alcohol exposure [14], [16], [17], [30] and a systematic review of low-to-moderate drinking [22]. Similar to a previous meta-analysis of low-to-moderate prenatal drinking and malformations [30], we did not observe an increase in the risk for major congenital malformations. Risks for reduced birth length, reduced head
Conclusions
National and international guidelines advise women to abstain from drinking during pregnancy [40], [41], [42], [43]. As lower level drinking represents a more prevalent exposure among pregnant women especially before pregnancy recognition, scientific research regarding lower level exposures is a priority; yet published study findings remain inconsistent and qualitatively varied. This study adds to accumulating evidence regarding a lack of increased risk from low to moderate maternal alcohol
Acknowledgments
Author's contributions: L.S.L. wrote the draft of the manuscript and performed the statistical analysis; J.L.I. evaluated the draft and statistical plan, providing input regarding her clinical expertise and overall analysis; K.B. was instrumental in original study design and data collection, and reviewed the article to reflect her experience with the cohort; E.W.T. advised the statistical analysis, was responsible for development of selected variable constructs, and contributed to oversight and
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The authors state no conflict of interest.
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