Alcohol Use in Pregnancy and Miscarriage: A Systematic Review and Meta‐Analysis

Abstract

To systematically review and critically evaluate studies reporting alcohol exposure during pregnancy and miscarriage. We searched PubMed, EMBASE, PsycINFO, and ProQuest Theses for publications from January 1970 to January 2019. We identified studies about alcohol exposure during pregnancy and miscarriage. Information about study population, alcohol exposure assessment, outcome definition, covariates, and measures of association was collected. We assessed study quality using an adapted Newcastle-Ottawa Scale. Data were abstracted by 2 investigators independently. We conducted a random-effects meta-analysis to calculate the association between alcohol exposure and miscarriage risk and performed subgroup analyses to determine robustness of results to study differences. For studies reporting dose-specific effects, a pooled dose-response association was estimated using generalized least squares regression with and without restricted cubic spline terms for number of drinks consumed per week. Of 2,164 articles identified, 24 were eligible for inclusion. Meta-analysis of data from 231,808 pregnant women finds those exposed to alcohol during pregnancy have a greater risk of miscarriage compared to those who abstained (odds ratio [OR] 1.19, 95% confidence intervals [CI] 1.12, 1.28). Estimates did not vary by study design, study country, or method of alcohol ascertainment. For alcohol use of 5 or fewer drinks per week, each additional drink per week was associated with a 6% increase in miscarriage risk (OR 1.06, 95% CI 1.01, 1.10). Common study limitations reflect challenges inherent to this research, including difficulty recruiting participants early enough in pregnancy to observe miscarriage and collecting and quantifying information about alcohol consumption during pregnancy that accurately reflects use. This review provides evidence that alcohol consumption during pregnancy is associated with a dose-mediated increase in miscarriage risk. Future studies evaluating change in alcohol use in pregnancy are needed to provide insight into how alcohol consumption prior to pregnancy recognition impacts risk.

Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis

“…Other factors taken into account by several authors in the statistical adjustments were maternal smoking and alcohol consumption. The association of these maternal behaviours with spontaneous miscarriage is well-established ( DiFranza and Lew, 1995 ; Nielsen et al ., 2006 ; Pineles et al ., 2014 ; Sundermann et al ., 2019 ; Andersen et al ., 2012 ). It is debatable to what extent maternal smoking and alcohol consumption are correlated with paternal age, which is another criterion for considering these factors as confounding factors.…”

“…Besides maternal age, other factors such as uterine anomalies, poorly controlled diabetes and thyroid autoimmunity are related to miscarriage ( Dorman et al ., 1999 ; Saravelos, Cocksedge, and Li, 2008 ; Maraka et al ., 2016 ; Magnus et al ., 2019 ). In addition, associations have been found with behavioural and environmental factors including maternal obesity, smoking, alcohol and caffeine consumption, the use of non-steroidal anti-inflammatory drugs and acute and chronic stress ( Metwally et al ., 2008 ; Pineles et al ., 2014 ; Hahn et al ., 2015 ; Qu et al ., 2017 ; Li et al ., 2018 ; Sundermann et al ., 2019 ).…”

Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study: a before−after study protocol

“…Alcohol is another toxic substance that is commonly used and its consumption is socially acceptable in many cultures. Alcohol consumption during pregnancy is associated with an increased risk of miscarriages, fetal growth restriction, preterm delivery and Fetal Alcohol Spectrum Disorders (FASD) 11,12 . FASD include a range of (developmental) disorders and constitute a major cause of preventable intellectual disability in children 13 .…”

Alcohol Use Disorders and Increased Risk of Adverse Birth Complications and Outcomes: An 11-Year Nationwide Cohort Study

“…For women who suffer from AUDs, the use of alcohol before and/or during pregnancy can result in various pregnancy and birth complications, including miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome [ 7 ]. In one study of more than 3000 deliveries in the U.S., it was found that for every unit increase in alcohol exposure, the risk of preterm delivery increased by 34-fold [ 8 ]. In a meta-analysis study of 231,808 pregnant women, those exposed to alcohol during pregnancy had a greater risk of miscarriage (Odds Ratio [OR]: 1.19, 95% CI: 1.12–1.28), with each additional alcoholic drink consumed during pregnancy being associated with a 6% increase in miscarriage risk (OR: 1.06, 95% CI: 1.01–1.10) [ 8 ].…”

“…In one study of more than 3000 deliveries in the U.S., it was found that for every unit increase in alcohol exposure, the risk of preterm delivery increased by 34-fold [ 8 ]. In a meta-analysis study of 231,808 pregnant women, those exposed to alcohol during pregnancy had a greater risk of miscarriage (Odds Ratio [OR]: 1.19, 95% CI: 1.12–1.28), with each additional alcoholic drink consumed during pregnancy being associated with a 6% increase in miscarriage risk (OR: 1.06, 95% CI: 1.01–1.10) [ 8 ]. In an Ethiopian case-control study, mothers who drank alcohol during pregnancy were 7.56 times more likely to have a stillbirth compared to abstainers (OR: 7.56, 95% CI: 1.68–34.04) [ 9 ].…”