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Alcohol exposure before and during pregnancy is associated with reduced fetal growth: the Safe Passage Study
Marin Pielage1, Hanan El Marroun2,3, Hein J Odendaal4
1Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Room Sp-4469, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Insights
Prenatal alcohol exposure (PAE) is linked to reduced fetal growth, especially during the periconception and second trimesters. These findings highlight the importance of discouraging alcohol consumption during pregnancy for fetal well-being.
Area of Science:
- Obstetrics and Gynecology
- Fetal Medicine
- Public Health
Background:
- Prenatal alcohol exposure (PAE) is a significant global health issue.
- While PAE is known to cause low birth weight, its precise impact on fetal growth concerning timing and quantity remains under-researched.
- This study addresses the association between periconceptional and prenatal alcohol exposure and longitudinal fetal growth patterns.
Purpose of the Study:
- To investigate the relationship between the timing and quantity of alcohol exposure during pregnancy and fetal growth.
- To analyze the effects of periconceptional and trimester-specific alcohol consumption on fetal development.
- To provide evidence-based recommendations for healthcare providers regarding alcohol use during pregnancy.
Main Methods:
- A prospective cohort study involving 1698 pregnant women (Safe Passage Study).
- Fetal growth parameters (femur length, abdominal/head circumference, biparietal diameter) were measured via ultrasound at three trimesters.
- Trimester-specific alcohol exposure was quantified using the Timeline Followback method, with analyses employing linear mixed models.
Main Results:
- Prenatal alcohol exposure was significantly associated with reduced fetal growth, including smaller femur length and abdominal circumference.
- Periconceptional alcohol exposure correlated with smaller abdominal circumference and estimated fetal weight.
- Second-trimester alcohol exposure showed a strong association with reduced abdominal circumference and estimated fetal weight.
Conclusions:
- Prenatal alcohol exposure adversely impacts fetal growth, with heightened risks during the periconception and second trimesters.
- The negative effects of PAE on fetal development are detectable prior to birth.
- Healthcare providers must actively counsel pregnant individuals against alcohol consumption to mitigate potential harm.
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.
