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Prenatal alcohol exposure patterns and alcohol-related birth defects and growth deficiencies: a prospective study
Haruna Sawada Feldman1, Kenneth Lyons Jones, Suzanne Lindsay
1Department of Pediatrics, University of California, San Diego, La Jolla, USA. sawada@ucsd.edu
Insights
Prenatal alcohol exposure, particularly in the first trimester, is linked to specific fetal alcohol syndrome features like smooth philtrum and thin vermillion border. These risks are dose-related, emphasizing the need for complete abstinence during pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Public Health
Background:
- Fetal alcohol syndrome (FAS) presents with physical features including smooth philtrum, thin vermillion border, short palpebral fissures, microcephaly, and growth deficiencies.
- The precise relationship between alcohol exposure quantities, drinking patterns, timing, and specific FAS features remains unclear.
Purpose of the Study:
- To investigate the association between patterns and timing of prenatal alcohol exposure and specific physical features of fetal alcohol syndrome.
- To quantify the risk associated with different levels and timings of alcohol consumption during pregnancy.
Main Methods:
- Prospective data from 992 subjects collected in California (1978-2005).
- Alcohol exposure patterns (drinks/day, binge episodes) and timing (postconception weeks, trimesters) were assessed.
- Physical features were evaluated by a blinded dysmorphologist.
Main Results:
- Higher prenatal alcohol exposure was significantly associated with smooth philtrum incidence, but not short palpebral fissures.
- Exposure in the second half of the first trimester showed the strongest association with smooth philtrum and thin vermillion border.
- Microcephaly and reduced birth weight were linked to specific exposure timings, while reduced birth length increased with exposure in any trimester.
- Associations were linear with no evidence of a threshold.
Conclusions:
- Reduced birth length and weight, microcephaly, smooth philtrum, and thin vermillion border are dose-related to specific gestational timing of prenatal alcohol exposure.
- Complete abstinence from alcohol conception through pregnancy is recommended for all women.
Background:
The physical features of fetal alcohol syndrome include smooth philtrum, thin vermillion border, short palpebral fissures, microcephaly, and growth deficiencies on weight and height. However, little is known about the specific quantities of alcohol exposure, pattern of drinking, timing of exposure, and magnitude of risk for each of these features.
Methods:
Using data on 992 subjects collected prospectively in California between 1978 and 2005, we examined the patterns and timing of alcohol exposure in relation to these features. Structural features were assessed by a dysmorphologist who performed a blinded physical examination of all infants. Patterns of drinking were evaluated by drinks per day, number of binge episodes, and maximum number of drinks. Timing of exposure was evaluated 0 to 6 weeks postconception, 6 to 12 weeks postconception, first trimester, second trimester, and third trimester.
Results:
Higher prenatal alcohol exposure in every pattern was significantly associated with the incidence of smooth philtrum but not with short palpebral fissures. The strongest associations were with timing of exposure in the second half of the first trimester (RR 1.25, 95% CI 1.14 to 1.36 for average number of drinks per day; RR 1.17, 95% CI 1.09 to 1.26 for maximum number of drinks in 1 episode). Similarly, thin vermillion border was most strongly associated with exposure in the second half of the first trimester. Findings with respect to timing of exposure were similar for microcephaly and reduced birth weight. However, reduced birth length was increased with exposure in any trimester. These associations were linear, and there was no evidence of a threshold.
Conclusions:
Reduced birth length and weight, microcephaly, smooth philtrum, and thin vermillion border are associated with specific gestational timing of prenatal alcohol exposure and are dose-related without evidence of a threshold. Women should continue to be advised to abstain from alcohol consumption from conception throughout pregnancy.
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