Adverse Neonatal Outcomes with Maternal Alcohol Use

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Adverse neonatal outcomes with maternal alcohol use

Maternal alcohol use, adverse neonatal outcomes and pregnancy complications in British Columbia, Canada: a population based study

A population based cross-sectional study using data from the British Columbia Perinatal Data Registry was performed to estimate the prevalence of alcohol use during pregnancy and its potential link with pregnancy complications and adverse neonatal outcomes.

Total size of the study population was 144,779 after excluding therapeutic abortions, stillbirths and unlinked or poor maternal/infant records. The average hospital stay was 61.37 hours, with 65,497 (45.9%) primiparous women who visited their antenatal provider 9.44 (mean) times before labor. During antenatal visits, consumption of 4 or more drinks per occasion was recorded along with substance use, prescription medication and smoking status.

Neonatal outcomes for this study were; Foetal Alcohol syndrome, Fetus and newborn affected by maternal use of alcohol, along 38 additional outcomes resulting from prenatal alcohol and or substance use. Pregnancy complications included bleeding < 20 weeks, bleeding ≥ 20 weeks and intrauterine growth restriction.

Initial analysis showed the prevalence of maternal alcohol use (deemed a risk factor) was 1.1, 1.1, 1.3 and 0.9% during 2015, 2016, 2107, 2018 fiscal years respectively, culminating in a total of 1569 exposed and 140,976 non exposed neonates or 1.1 cases per 100 live births during the study period.

Analysis of maternal characteristics found that alcohol use was significantly more prevalent in younger mothers (28 to 31 years old) and also those with history of mental illness.

Next analysis of newborn characteristics found that alcohol exposed neonates were significantly shorter in height and smaller head circumference. They were also less likely to be breastfeed within an hour of birth and had a higher rate of intervention (resuscitation/stabilization, oxygen resuscitation, IPPV mask resuscitation).

In depth statistical analysis confirmed that alcohol exposed neonates were more likely to be diagnosed with;

  • Fetus and newborn affected by maternal use of alcohol (P04.3)
  • Slow foetal growth, unspecified (P05.9)
  • Other low birth weight, 1000-2499g (P07.1)
  • Other respiration distress of newborn (P22.8)
  • Bacterial sepsis of newborn (P36)
  • Neonatal difficulty in feeding at breast (P92.5)
  • Feeding problems, unspecified (P92.9)
  • Neonatal withdrawal symptoms from maternal use of drugs of addiction (P96.1)
  • Other specified conditions originating in the perinatal period (P96.8)
  • Foetal alcohol syndrome, dysmorphic (Q86.0)
  • Multiple congenital malformations, not elsewhere classified (Q89.7)

Risk factors for the above diagnosis, calculated as adjusted odds ratio (1.0 = normal) is;

Adj Odds RatioDiagnosis
55.93Fetus and newborn affected by maternal use of alcohol (P04.3)
15.63Multiple congenital malformations, not elsewhere classified (Q89.7)
2.57Other respiration distress of newborn (P22.8)
2.06Feeding problems, unspecified (P92.9)
1.97Neonatal difficulty in feeding at breast (P92.5)
1.25Other low birth weight, 1000-2499g (P07.1)
0.37Neonatal withdrawal symptoms from maternal use of drugs of addiction (P96.1)

Interestingly, no statistically significant difference in the prevalence or odds of pregnancy complications was found, between both alcohol exposed and non-alcohol exposed neonates.

The authors noted that multi-substance use was more prevalent in women who consumed alcohol, and therefore results need to be interrupted cautiously.


SUMMARY: THE EFFECTS OF ALCOHOL DURING PREGNANCY

In this large study maternal use of alcohol, both moderate & heavy during pregnancy, significantly affects newborns with 55.9 times greater probability of being diagnosed with complications, other than Foetal Alcohol Syndrome, followed by a 15.6 times greater risk of multiple congenital malformations.


Limitations

  1. Prevalence of smoking prevalence between groups, significantly different (29.7% vs 5.7%)
  2. Assessment of alcohol use between antenatal providers open to variability
  3. Alcohol exposed group size too small to analyse between low and high consumption


Similar studies

Alvik A, et al. (2011). Binge alcohol exposure once a week in early pregnancy predicts temperament and sleep problems in the infant. https://doi.org/10.1016/j.earlhumdev.2011.06.009

O’Leary, et al. (2009). The effect of maternal alcohol consumption on fetal growth and preterm birth. https://doi.org/10.1111/j.1471-0528.2008.02058.x

Carter R C, et al. (2007). Fetal alcohol exposure, iron-deficiency anemia, and infant growth. https://doi.org/10.1542/peds.2007-0151


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