Alcohol exposure before and during pregnancy is associated with reduced fetal growth: the Safe Passage Study

Abstract

Background Prenatal alcohol exposure (PAE) is a worldwide public health concern. While PAE is known to be associated with low birth weight, little is known about timing and quantity of PAE on fetal growth. This study investigated the association between periconceptional and prenatal alcohol exposure and longitudinal fetal growth, focusing on timing and quantity in a high exposure cohort. Methods The Safe Passage Study was a prospective cohort study, including 1698 pregnant women. Two-dimensional transabdominal ultrasound examinations were performed to measure fetal femur length, abdominal and head circumference, and biparietal diameter, at three time points during pregnancy. Estimated fetal weight and Z-scores of all parameters were calculated. Trimester-specific alcohol exposure was assessed using the Timeline Followback method. To investigate the associations of specific timing of PAE and fetal growth, two models were built. One with alcohol exposure as accumulative parameter over the course of pregnancy and one trimester specific model, in which PAE was separately analyzed. Linear mixed models adjusted for potential confounders were applied with repeated assessments of both alcohol exposure and fetal growth outcomes. Results This study demonstrated that periconceptional and prenatal alcohol exposure were associated with reduced fetal growth. Effect sizes are displayed as estimated differences (ED) in Z-score and corresponding 95% confidence intervals (95% CIs). When investigated as accumulative parameter, PAE was related to a smaller femur length (ED30; − 0.13 (95% CI; − 0.22; − 0.04), ED36; − 0.14 (95% CI; − 0.25; − 0.04)) and a smaller abdominal circumference (ED36; − 0.09 (95% CI; − 0.18; − 0.01)). Periconceptional alcohol exposure was associated with a smaller abdominal circumference (ED30; − 0.14 (95% CI; − 0.25; − 0.02), ED36; − 0.22 (95% CI; − 0.37; − 0.06)) and a smaller estimated fetal weight (ED36; − 0.22 (95% CI; − 0.38; − 0.05)). Second trimester alcohol exposure was associated with a smaller abdominal circumference (ED30; − 0.49 (95% CI; − 0.86; − 0.12), ED36; − 0.70 (95% CI; − 1.22; − 0.17)) and estimated fetal weight (ED30; − 0.54 (95% CI; − 0.94; − 0.14), ED36; − 0.69 (95% CI; − 1.25; − 0.14)). No additional association of binge drinking was found besides the already observed association of PAE and fetal growth. Conclusions This study demonstrated that PAE negatively affects fetal growth, in particular when exposed during the periconception period or in second trimester. Our results indicate that potential negative consequences of PAE are detectable already before birth. Therefore, healthcare providers should actively address and discourage alcohol use during pregnancy.

An incentive‐based text‐messaging intervention to reduce maternal alcohol use during pregnancy and lactation in South Africa (MaRISA study): Findings from a single‐arm pilot study

“…2791 g in our study) (Pielage et al, 2023), and the rate of low birth weight babies was higher than the recent national prevalence (i.e., 15% as compared with 20% in our study) (South African Department of Health, 2023). Prenatal tobacco and other substance use often co-occur with prenatal alcohol use, which exacerbates these adverse outcomes (Cannon et al, 2012;Elliott et al, 2020;Odendaal et al, 2009;Vanker et al, 2016).…”

“…Adverse birth outcomes as a result of prenatal alcohol use include preterm birth, low birth weight, and stillbirth (Lundsberg et al, 2015;Odendaal et al, 2021). The rate of preterm birth in this study population was 12%, which is the same rate as nonalcohol exposed infants in a recent study from South Africa (Pielage et al, 2023). Three incidents of miscarriage and stillbirth occurred among 25 participants who were enrolled while pregnant and delivered during the study period.…”

Dose–response effect of prenatal alcohol exposure on perinatal outcomes

“…Short stature is one of the cardinal features of FASD (Hoyme et al., 2016), and previous prospective cohorts have demonstrated the effect of PAE on reduced birth length (Bandoli et al., 2019; Day et al., 1989; Pielage et al., 2023). While absolute anthropometric measures are confounded by gestational age at delivery making it difficult to separate antecedent causes of growth restriction from reduced gestation, birth percentiles are sex‐ and gestational‐age specific.…”

The Population-Attributable Fractions of Small-for-Gestational-Age Births: Results from the Japan Birth Cohort Consortium

“…Importantly, prenatal alcohol exposure can alter placental function and trigger sustained stress responses in the placenta [ 49 ]. This exposure may also lead to epigenetic modifications that impact embryonic and placental development [ 50 ]. In our recent meta-analysis, neither cessation of alcohol consumption after pregnancy recognition nor ongoing alcohol use was linked to a significantly increased risk of SGA infants.…”