Alcohol consumption during pregnancy and risk of small-for-gestational-age newborn

doi:10.1016/j.wombi.2018.07.024

Women and Birth

Volume 32, Issue 3, June 2019, Pages 284-288

https://doi.org/10.1016/j.wombi.2018.07.024 Get rights and content

Abstract

Background

Contradictory results have been published on the association of alcohol consumption during pregnancy with perinatal outcomes, including the risk of small for gestational age newborn.

Aim

To determine whether alcohol consumption during pregnancy is associated with the risk of small for gestational age newborn.

Method

A case-control study with 518 pairs of pregnant Spanish women in five hospitals was conducted; cases were women with small for gestational age newborn and age-matched (±2 years) controls were women with non-small for gestational age newborn. Data were gathered on demographic characteristics, socioeconomic status, toxic habits, and diet. Alcohol intake was recorded with a self-administered 137 food frequency questionnaire and with a personal interview, Alcohol intake was categorized –. Agreement in alcohol intake results between direct interview and frequency food questionnaire was evaluated with the Kappa index. Crude and adjusted odds ratios and their 95% confidence intervals were estimated by conditional logistic regression.

Findings

Poor agreement was observed between food frequency questionnaire and personal interview results for both cases (κ = 0.23) and controls (κ = 0.14). A food frequency questionnaire-recorded intake of less than 4 g/day was associated with a significantly lower odds ratios for small for gestational age newborn (odds ratios = 0.62, 95% confidence intervals, 0.43–0.88), whereas an interview-recorded intake of <4 g/day was not related to small for gestational age newborn (odds ratios = 0.86, 95% confidence intervals, 0.49–1.54).

Conclusions

A very moderate alcohol intake during pregnancy may have a negative association with the risk of having a small for gestational age newborn.

Introduction

Alcohol consumption during pregnancy is not well regarded socially and tends to arouse negative feelings towards the women who practice it.¹ According to most clinical practice guidelines, including those of the National Institute of Health and Clinical Excellence (NICE) and main scientific societies, pregnant women should not drink alcohol at any time during pregnancy.² Nevertheless, it is estimated that between 15 and 40% of pregnant women consume alcohol at some time.2, 3, 4, 5, 6

Fear of repercussions may lead pregnant women to under-report their alcohol consumption, which may become a relevant issue in certain social or legal situations (e.g., custody cases). Pregnant women may also minimize or deny alcohol consumption due to feelings of guilt or memory issues, among other reasons. The percentage of women admitting alcohol consumption during pregnancy varies widely from 0 to 37% and is influenced by the method used to gather this information.⁷ Thus, it has been demonstrated that the use of a questionnaire can underestimate the prevalence of alcohol consumption.⁷

Inconsistent results have been published by studies on the association of alcohol consumption during pregnancy with different perinatal outcomes, including newborn weight, risk of small for gestational age (SGA) or preterm delivery, and fetal alcohol syndrome.8, 9, 10, 11, 12, 13, 14 In regard to the risk of SGA newborn, a study of women in New Zealand (n = 6822 women) reported a high risk in those consuming two or more alcoholic drinks during the second and third trimester.¹⁰ In contrast, a four-year study in the USA of a cohort of 4496 women with a live newborn from a single pregnancy reported an association between the daily consumption of 1.5 g to 7 g alcohol during the first trimester and a protective effect against the following SGA parameters: baby height ˂10th percentile (ORa = 0.56, 95% CI = 0.36–0.87), head circumference ˂10th percentile (ORa = 0.69, 95% CI = 0.50–0.96), and weight ˂10th percentile (ORa = 0.74, 95% CI = 0.56–0.97).¹¹ However, a systematic review of 24 observational and 2 quasi-experimental studies described a higher risk of SGA newborn in women who consumed ≤32 g of alcohol/week during pregnancy (ORa = 1.08, 95% CI = 1.02–1.14).¹²

Given the controversial findings to date, further research is required to elucidate the relationship between alcohol consumption during pregnancy and the risk of an SGA newborn. This is especially important because alcohol consumption is a modifiable factor and therefore a key target for health promotion and education programs against SGA newborns. The objective of this study was to determine whether alcohol consumption during pregnancy is associated with the risk of SGA newborn and to compare intake data between food frequency questionnaire (FFQ) and interview results.

Section snippets

Methods

The study population comprised women from five hospitals in Eastern Andalusia (Spain) serving 1.8 million people: University of Jaen Hospital (UJH), Ubeda Hospital (UB), University of Granada Hospital Complex (two centers) (UGH), and Poniente Hospital (PH). Case and control groups were enrolled from May 15 2012 through July 15 2015. The study was approved by the ethics committees of the participating hospitals. Written informed consent was obtained from all participants.

We estimated the

Results

The study included 1036 women, 518 cases and 518 controls. Maternal marital status influenced the risk of SGA (p = 0.036). A significant relationship with SGA newborn was observed for known risk factors, including maternal smoking, previous low birth weight and/or preterm delivery, maternal BMI, low weight gain during pregnancy, and preeclampsia (p < 0.001). There was no significant difference between cases and controls in mean alcohol intake recorded either by personal interview or by

Discussion

Low agreement was found between alcohol intake reported by FFQ and in direct interview with a midwife, observing that women under-declared their consumption in the interviews. Very moderate alcohol consumption (≤4 g/day) appeared to exert a protective effect against a SGA newborn in comparison to women reporting no alcohol intake during pregnancy. No differences were observed between cases (with SGA newborn) and controls (with non-SGA newborn) in the types of drink consumed, and no association

Conclusion

Women asked directly about alcohol consumption during pregnancy tend to under-declare their intake. Very moderate alcohol consumption during pregnancy may have a negative association with the risk of having a small for gestational age newborn.

Conflict of interests

None of the authors report any conflict of interest.

Funding

This work was supported by a grant from the Carlos III National Institute of Health [PI11/02199].

Ethical statement

The research involved the participation of human participants. The participants signed the informed consent.

Ethical approval was obtained from Research Ethics Committees of all hospitals participating in the study. The ethical approval was received on the 25th April 2012.

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View full text

Alcohol consumption during pregnancy and risk of small-for-gestational-age newborn

Abstract

Background

Aim

Method

Findings

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Conflict of interests

Funding

Ethical statement

Midwifery

Encephale

J Gynecol Obstet Biol Reprod (Paris)

Women’s knowledge and attitudes regarding alcohol consumption in pregnancy: a national survey

BMC Public Health

Fetus at risk: prevalence of alcohol consumption during pregnancy estimated with a simple screening method in Swedish antenatal clinics

Addiction

Prevalence and pattern of alcohol consumption during pregnancy in the Netherlands

BMC Public Health

Prevalence of prenatal exposure to substances of abuse: questionnaire versus biomarkers

Reprod Health

Habitual alcohol consumption during pregnancy and perinatal outcomes

J Nippon Med Sch

Alcohol consumption during pregnancy and perinatal results: a cohort study

Sao Paulo Med J

Maternal health in pregnancy and associations with adverse birth outcomes: evidence from growing up in New Zealand

Aust N Z J Obstet Gynaecol