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Meta-Analysis
. 2017 Aug 3;7(7):e015410.
doi: 10.1136/bmjopen-2016-015410.

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

Loubaba Mamluk  1   2   3 , Hannah B Edwards  2   3 , Jelena Savović  2   3 , Verity Leach  2   3 , Timothy Jones  2   3 , Theresa H M Moore  2   3 , Sharea Ijaz  2   3 , Sarah J Lewis  2 , Jenny L Donovan  2   3 , Debbie Lawlor  1   2   3 , George Davey Smith  1   2 , Abigail Fraser  1   2 , Luisa Zuccolo  1   2
Affiliations
Meta-Analysis

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

Loubaba Mamluk et al. BMJ Open. .

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.

Keywords: epidemiology; obstetrics; paediatrics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart of search strategy including primary reasons for article exclusion.
Figure 2
Figure 2
Pooled mean difference for birth weight comparing low alcohol consumption (up to 32 g/week) with no alcohol consumption (seven studies). ‘Adjusted’ refers to adjusted for both smoking and a measure of socioeconomic status.
Figure 3
Figure 3
(A) ORs for preterm birth comparing low alcohol consumption (up to 32 g/week) with no alcohol consumption (nine studies); (B) ORs for small for gestational age comparing low alcohol consumption (up to 32 g/week) with no alcohol consumption (seven studies); (C) ORs for low birth weight comparing low alcohol consumption (up to 32 g/week) with no alcohol consumption (six studies). Pooled OR includes both adjusted and unadjusted estimates from studies, ‘Adjusted’ refers to adjusted for both smoking and a measure of socioeconomic status.
See this image and copyright information in PMC

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