Alcohol consumption during pregnancy and risk of 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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