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Meta-Analysis
. 2021 Jan 23;49(6):1972-1995.
doi: 10.1093/ije/dyz272.

Evidence of detrimental effects of prenatal alcohol exposure on offspring birthweight and neurodevelopment from a systematic review of quasi-experimental studies

Loubaba Mamluk  1   2   3 , Timothy Jones  2   3 , Sharea Ijaz  2   3 , Hannah B Edwards  2   3 , Jelena Savović  2   3 , Verity Leach  2   3 , Theresa H M Moore  2   3 , Stephanie von Hinke  4 , Sarah J Lewis  2 , Jenny L Donovan  2   3 , Deborah A Lawlor  1   2   3   5 , George Davey Smith  1   2   5 , Abigail Fraser  1   2   5 , Luisa Zuccolo  1   2
Affiliations
Meta-Analysis

Evidence of detrimental effects of prenatal alcohol exposure on offspring birthweight and neurodevelopment from a systematic review of quasi-experimental studies

Loubaba Mamluk et al. Int J Epidemiol. .

Abstract

Background: Systematic reviews of prenatal alcohol exposure effects generally only include conventional observational studies. However, estimates from such studies are prone to confounding and other biases.

Objectives: To systematically review the evidence on the effects of prenatal alcohol exposure from randomized controlled trials (RCTs) and observational designs using alternative analytical approaches to improve causal inference.

Search strategy: Medline, Embase, Web of Science, PsychINFO from inception to 21 June 2018. Manual searches of reference lists of retrieved papers.

Selection criteria: RCTs of interventions to stop/reduce drinking in pregnancy and observational studies using alternative analytical methods (quasi-experimental studies e.g. Mendelian randomization and natural experiments, negative control comparisons) to determine the causal effects of prenatal alcohol exposure on pregnancy and longer-term offspring outcomes in human studies.

Data collection and analysis: One reviewer extracted data and another checked extracted data. Risk of bias was assessed using customized risk of bias tools. A narrative synthesis of findings was carried out and a meta-analysis for one outcome.

Main results: Twenty-three studies were included, representing five types of study design, including 1 RCT, 9 Mendelian randomization and 7 natural experiment studies, and reporting on over 30 outcomes. One study design-outcome combination included enough independent results to meta-analyse. Based on evidence from several studies, we found a likely causal detrimental role of prenatal alcohol exposure on cognitive outcomes, and weaker evidence for a role in low birthweight.

Conclusion: None of the included studies was judged to be at low risk of bias in all domains, results should therefore be interpreted with caution.

Systematic review registration: This study is registered with PROSPERO, registration number CRD42015015941.

Keywords: Alcohol; FASD; Mendelian randomization; causal inference; negative control; neurodevelopment; pregnancy; prenatal alcohol exposure; quasi-experimental studies; systematic review.

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Figures

Figure 1
Figure 1
Flowchart of search strategy including primary reasons for article exclusion.
Figure 2
Figure 2
Co-citation of journals. Bubble size corresponds to the magnitude of each journal's citation in the other journals (limit of minimum 8 citations per journal) with a total number of 26 journals. The distance between bubbles corresponds to the number of times with which journals are cited together in other journals. The colours correspond to communities identified by the software (VOS clustering). Produced in VOSviewer version 1.6.5.
Figure 3.
Figure 3.
Pooled odds ratios for outcomes of oral cleft in two MR studies.
See this image and copyright information in PMC

Comment in

References

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