Dataset Information

Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently 'safe' levels of alcohol during pregnancy? A systematic review and meta-analyses.

ABSTRACT:

Objectives

To determine the effects of low-to-moderate levels of maternal alcohol consumption in pregnancy on pregnancy and longer-term offspring outcomes.

Search strategy

Medline, Embase, Web of Science and Psychinfo from inception to 11 July 2016.

Selection criteria

Prospective observational studies, negative control and quasiexperimental studies of pregnant women estimating effects of light drinking in pregnancy (?32?g/week) versus abstaining. Pregnancy outcomes such as birth weight and features of fetal alcohol syndrome were examined.

Data collection and analysis

One reviewer extracted data and another checked extracted data. Random effects meta-analyses were performed where applicable, and a narrative summary of findings was carried out otherwise.

Main results

24 cohort and two quasiexperimental studies were included. With the exception of birth size and gestational age, there was insufficient data to meta-analyse or make robust conclusions. Odds of small for gestational age (SGA) and preterm birth were higher for babies whose mothers consumed up to 32?g/week versus none, but estimates for preterm birth were also compatible with no association: summary OR 1.08, 95% CI (1.02 to 1.14), I² 0%, (seven studies, all estimates were adjusted) OR 1.10, 95%?CI (0.95 to 1.28), I² 60%, (nine studies, includes one unadjusted estimates), respectively. The earliest time points of exposure were used in the analysis.

Conclusion

Evidence of the effects of drinking ?32?g/week in pregnancy is sparse. As there was some evidence that even light prenatal alcohol consumption is associated with being SGA and preterm delivery, guidance could advise abstention as a precautionary principle but should explain the paucity of evidence.

SUBMITTER: Mamluk L

PROVIDER: S-EPMC5642770 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently 'safe' levels of alcohol during pregnancy? A systematic review and meta-analyses.

Mamluk Loubaba L Edwards Hannah B HB Savović Jelena J Leach Verity V Jones Timothy T Moore Theresa H M THM Ijaz Sharea S Lewis Sarah J SJ Donovan Jenny L JL Lawlor Debbie D Smith George Davey GD Fraser Abigail A Zuccolo Luisa L

BMJ open 20170803 7

<h4>Objectives</h4>To determine the effects of low-to-moderate levels of maternal alcohol consumption in pregnancy on pregnancy and longer-term offspring outcomes.<h4>Search strategy</h4>Medline, Embase, Web of Science and Psychinfo from inception to 11 July 2016.<h4>Selection criteria</h4>Prospective observational studies, negative control and quasiexperimental studies of pregnant women estimating effects of light drinking in pregnancy (≤32 g/week) versus abstaining. Pregnancy outcomes such as ...[more]

PMID: 28775124

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Project description:ObjectivesTo examine the suitability of age specific limits for alcohol consumption and to explore the association between alcohol consumption and mortality in different age groups.DesignPopulation based data from Health Survey for England 1998-2008, linked to national mortality registration data and pooled for analysis using proportional hazards regression. Analyses were stratified by sex and age group (50-64 and ≥ 65 years).SettingUp to 10 waves of the Health Survey for England, which samples the non-institutionalised general population resident in England.ParticipantsThe derivation of two analytical samples was based on the availability of comparable alcohol consumption data, covariate data, and linked mortality data among adults aged 50 years or more. Two samples were used, each utilising a different variable for alcohol usage: self reported average weekly consumption over the past year and self reported consumption on the heaviest day in the past week. In fully adjusted analyses, the former sample comprised Health Survey for England years 1998-2002, 18,368 participants, and 4102 deaths over a median follow-up of 9.7 years, whereas the latter comprised Health Survey for England years 1999-2008, 34,523 participants, and 4220 deaths over a median follow-up of 6.5 years.Main outcome measureAll cause mortality, defined as any death recorded between the date of interview and the end of data linkage on 31 March 2011.ResultsIn unadjusted models, protective effects were identified across a broad range of alcohol usage in all age-sex groups. These effects were attenuated across most use categories on adjustment for a range of personal, socioeconomic, and lifestyle factors. After the exclusion of former drinkers, these effects were further attenuated. Compared with self reported never drinkers, significant protective associations were limited to younger men (50-64 years) and older women (≥ 65 years). Among younger men, the range of protective effects was minimal, with a significant reduction in hazards present only among those who reported consuming 15.1-20.0 units/average week (hazard ratio 0.49, 95% confidence interval 0.26 to 0.91) or 0.1-1.5 units on the heaviest day (0.43, 0.21 to 0.87). The range of protective effects was broader but lower among older women, with significant reductions in hazards present ≤ 10.0 units/average week and across all levels of heaviest day use. Supplementary analyses found that most protective effects disappeared where calculated in comparison with various definitions of occasional drinkers.ConclusionsBeneficial associations between low intensity alcohol consumption and all cause mortality may in part be attributable to inappropriate selection of a referent group and weak adjustment for confounders. Compared with never drinkers, age stratified analyses suggest that beneficial dose-response relations between alcohol consumption and all cause mortality may be largely specific to women drinkers aged 65 years or more, with little to no protection present in other age-sex groups. These protective associations may, however, be explained by the effect of selection biases across age-sex strata.

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Dataset Information

Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently 'safe' levels of alcohol during pregnancy? A systematic review and meta-analyses.

Objectives

Search strategy

Selection criteria

Data collection and analysis

Main results

Conclusion

Publications

Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently 'safe' levels of alcohol during pregnancy? A systematic review and meta-analyses.

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