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Dose-response relationship of alcohol in adverse pregnancy outcomes

Clinical Question:
Is there a dose-response gradient in the association between alcohol consumption in pregnancy and low birthweight, premature birth, or small-for-gestational age infants?

Bottom Line:
Light alcohol consumption (up to 10 g, about 1 drink) daily does not affect the risk of low birthweight or small-for-gestational age (SGA) infants. Intake of up to 18 g daily does not affect the risk of prematurity. Dose-response gradients for low birthweight, premature birth, and SGA infants are seen beyond those amounts. (LOE = 2a)

Reference:
Patra J, Bakker R, Irving H, Jaddoe V, Malini S, Rehm J. Dose-response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA) -- a systematic review and meta-analyses. BJOG 2011;118:(12)1411-1421.  [PMID:21729235]

Study Design:
Meta-analysis (other)

Funding:
Government

Setting:
Various (meta-analysis)

Synopsis:
Alcohol consumption in pregnancy is not suitable for testing in randomized controlled trials. The authors conducted meta-analyses of observational cohort and case-control studies of birth outcomes related to low birthweight and prematurity to assess whether a dose-response gradient to alcohol consumption exists. The authors included 36 studies, 24 of which categorized alcohol consumption in at least 3 groups, the minimum considered sufficient for the dose-response analysis. The remaining 12 studies categorized consumption and drinking versus not drinking. Analyses of any drinking versus not drinking showed modest association with low birthweight (ie, less than 2500 g [relative risk = RR 1.12; 95% CI, 1.04-1.20]). Associations with preterm birth at less than 37 weeks' gestation and SGA infants were nonsignificant. In the dose-response analysis, the association with low birthweight was not apparent until consumption was higher than 10 g daily, the association doubles at 52 g per day and reaches 7-fold at 120g per day. Drinking up to 19 g daily is not associated with preterm birth and the risk rises moderately at 36 g per day (RR = 1.23; 1.05-1.44). The risk of an SGA infant is not evident with consumption of up to 10 g per day and rises in similar magnitude as preterm birth with 3 drinks or more daily.

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