Brief intervention for alcohol use in pregnancy: a randomized trial

Aims . To assess the impact of a brief intervention on antepartum alcohol consumption. Design. A randomized clinical trial. Setting. The obstetrics practices of the Brigham and Women's Hospital in Boston, MA, USA. Participants. Two hundred and fifty eligible women initiating prenatal care. Intervention. A comprehensive assessment of alcohol use (assessment only, AO) or the same comprehensive assessment with a brief intervention (BI). Measurement. Demographic background and obstetric history of subjects, current and lifetime use of alcohol and substances, composite Addiction Severity Index scores, and antepartum alcohol use. Findings. Of the 250, 247 (99%) subjects provided information on their antepartum drinking. Both the AO and BI groups had reductions in antepartum alcohol consumption, but differences in reductions by group were not statistically significant ( p > 0.05).Risk of antepartum drinking after either the AO or BI was increased nearly threefold if the subject had any prenatal alcohol consumption before assessment ( p = 0.0001). For the 143 subjects who were abstinent pre-assessment, however, those who received the BI maintained higher rates of abstinence (86% versus 72%, p = 0.04). Conclusions. After a comprehensive assessment of alcohol use, subjects in both the AO and BI groups reduced their antepartum alcohol consumption. The importance of screening for prenatal alcohol use is underscored by the findings that any prenatal alcohol consumption increases the risk of continued antepartum drinking.     

A Metric of Maternal Prenatal Risk Drinking Predicts Neurobehavioral Outcomes in Preschool Children

Background: Fetal Alcohol Spectrum Disorders (FASDs), including Fetal Alcohol Syndrome, continue to be high‐incidence developmental disorders. Detection of patterns of maternal drinking that place fetuses at risk for these disorders is critical to diagnosis, treatment, and prevention, but is challenging and often insufficient during pregnancy. Various screens and measures have been used to identify maternal risk drinking but their ability to predict child outcome has been inconsistent. This study hypothesized that a metric of fetal “at‐risk” alcohol exposure (ARAE) derived from several indicators of maternal self‐reported drinking would predict alcohol‐related neurobehavioral dysfunctions in children better than individual measures of maternal alcohol consumption alone. Methods: Self‐reported peri‐conceptional and repeated maternal drinking during pregnancy were assessed with semi‐structured interviews and standard screens, i.e., the CAGE, T‐ACE, and MAST, in a prospective sample of 75 African‐American mothers. Drinking volumes per beverage type were converted to standard quantity and frequency measures. From these individual measures and screening instruments, a simple dichotomous index of prenatal ARAE was defined and used to predict neurobehavioral outcomes in the 4‐ to 5‐year‐old offspring of these women. Study outcomes included IQ, attention, memory, visual‐motor integration, fine motor skill, and behavior. Statistical analyses controlled for demographic and other potential confounders. Results: The current “at‐risk” drinking metric identified over 62% of the mothers as drinking at risk levels—23% more than the selection criterion identified—and outperformed all individual quantity and frequency consumption measures, including averages of weekly alcohol use and “binge” alcohol exposures (assessed as intake per drinking occasion), as well as an estimate of the Maternal Substance Abuse Checklist ( Coles et al., 2000 ), in predicting prenatal alcohol‐related cognitive and behavioral dysfunction in 4‐ to 5‐year‐old children. Conclusions: A metric reflecting multiple indices of “at‐risk” maternal alcohol drinking in pregnancy had greater utility in predicting various prenatal alcohol‐related neurobehavioral dysfunction and deficits in children compared to individual measures of maternal self‐reported alcohol consumption or a previous maternal substance abuse index. Assessing fetal risk drinking in pregnant women was improved by including multiple indicators of both alcohol consumption and alcohol‐related consequences and, if appropriate practical applications are devised, may facilitate intervention by health care workers during pregnancy and potentially reduce the incidence or severity of FASDs.     

Is Pregnancy the Time to Change Alcohol Consumption Habits in France?

Background:  Although it is well known that France has a cultural history of alcohol use, no recent French data on alcohol consumption during pregnancy in a large sample are available.
Methods:  To determine the alcohol consumption patterns among pregnant women in France, we analyzed data from a 1-year multicenter self-survey. Sociodemographic profile, obstetrical history, neonatal data, and a self-report for assessing drinking patterns during pregnancy including AUDIT were recorded from women who delivered recently. Cases of fetal alcohol syndrome (FAS) were also reported.
Results:  A total of 837 pregnant women have described all parameters. The mean age at delivery of our sample was 29.7 years (SD = 4.8 years). A total of 52.2% of women indicated that they had consumed alcohol at least once during their pregnancy, and among abstainers 54.5% had a positive AUDIT score. Of the pregnant women who consumed alcohol, 13.7% reported at least one binge drinking episode (5 or more drinks on 1 occasion) during pregnancy. Binge drinking is significantly more frequent than regular alcohol consumption (at least 1 drink more than 1 time per week) during pregnancy. A prevalence rate of FAS of 1.8 per 1,000 live births was observed.
Conclusions:  There is a large population of women who still drink alcohol during pregnancy, particularly in binge drinking episodes. This underlines the need to clearly inform women of childbearing age about the dangers of alcohol during pregnancy as related to all types of consumption. Moreover, acting to prevent alcohol consumption prior to pregnancy may also greatly influence prenatal drinking.     

Alcohol consumption in pregnant, black women is associated with decreased plasma and erythrocyte docosahexaenoic acid

BACKGROUND: Inner-city, black women are among those groups that are at higher risk for having infants with fetal alcohol spectrum disorders that can include life-long neurobehavioral and cognitive impairments. Chronic alcohol consumption can decrease amounts of docosahexaenoic acid (DHA), a fatty acid that is essential for optimal infant neural and retinal development in a variety of tissues. METHODS: Black women who presented at an inner-city antenatal clinic for their first prenatal visit were recruited into a longitudinal, observational study. Alcohol intake was determined by a structured interview. Participants provided blood specimens and completed food frequency surveys at 24 weeks of gestation, infant delivery, and 3 months postpartum. Fatty acid composition analyses were completed on 307, 260, and 243 for plasma and 278, 261, and 242 erythrocyte specimens at 24 weeks of gestation, delivery, and 3 months postpartum, respectively. RESULTS: Proportion of drinking days at the first prenatal visit was associated with decreased DHA in plasma and erythrocytes throughout the study. This association was the strongest at 24 weeks of gestation. In addition, an interaction between proportion of drinking days at the time of conception and ounces of absolute alcohol per drinking day at the time of conception was detected and demonstrated that, in daily drinkers, high intakes of alcohol are associated with decreased DHA and arachidonic acid (AA) concentrations in plasma. CONCLUSIONS: Frequent and high intakes of alcohol that have been previously associated with fetal alcohol spectrum disorders are also associated with decreased maternal DHA and AA plasma concentrations. The present findings indicate that maternal DHA deficiency is associated with high-risk drinking and may contribute to the mechanism(s) of alcohol-related neurodevelopmental disorders.     

Phosphatidylethanol and Alcohol Consumption in Reproductive Age Women

Background: Fetal alcohol disorders are preventable, but self‐reported alcohol consumption can be misleading and impede effective treatment. Biomarkers represent an alternative method for assessing alcohol use, and this study evaluated the relationship between blood phosphatidylethanol (PEth) and alcohol use in a sample of reproductive age women. Methods: Alcohol use was estimated by validated self‐report methods in 80 nonpregnant women ages 18 to 35. PEth was measured by a contracted laboratory using a liquid chromatography‐tandem mass spectrometry assay. Regression methods appropriate for the distribution of PEth were used to define its relationship to alcohol consumption during the prior 2 weeks and explore the effects of drinking patterns on this association. Receiver operating characteristic analysis was used to estimate the sensitivity of PEth for various drinking levels at 95% specific cutoffs. Results: PEth had a positive linear association with grams of alcohol consumed (p < 0.001), and was detectable in 93% of subjects consuming an average of 2 or more drinks per day. The relationship between total alcohol consumption and PEth may be stronger in women with recent heavy drinking days. The relationship between drinking and PEth varied considerably between individuals, and sensitivity for a certain amount of drinking was low at a highly specific cutoff concentration. Conclusions: PEth is a highly sensitive indicator of moderate and heavy alcohol consumption in reproductive age women and may complement the use of self‐report alcohol screens when additional objective markers of alcohol use are desirable. However, choosing a highly valid cutoff concentration for PEth to differentiate various levels of alcohol consumption may not be feasible.     

Development of resistance mutations in women receiving standard antiretroviral therapy who received intrapartum nevirapine to prevent perinatal human immunodeficiency virus type 1 transmission: a substudy of pediatric AIDS clinical trials group protocol 316

Pediatric AIDS Clinical Trials Group protocol 316 was an international, multicenter, placebo-controlled trial comparing single-dose oral nevirapine (200 mg to mother and 2 mg/kg to infant) with placebo in human immunodeficiency virus (HIV)-infected pregnant women receiving standard antiretroviral therapy. This substudy evaluated the emergence of nevirapine-resistance mutations at 6 weeks postpartum in a subgroup of participants. Maternal risk factors for the emergence of nevirapine-resistance mutations were evaluated. Mutations associated with nevirapine resistance were detectable at delivery, prior to receipt of study drug, in 5 (2.3%) of 217 women. Fourteen (15%; 95% confidence interval, 8%-23%) of 95 women who received intrapartum nevirapine developed a nevirapine-resistance mutation 6 weeks postpartum. The most common mutation was K103N, which was present in 10 women. The risk for development of a new nevirapine-resistance mutation did not correlate with CD4 cell count or HIV-1 RNA load at delivery or with type of antepartum antiretroviral therapy. The risk of nevirapine resistance should be considered when determining the risks or benefits of intrapartum nevirapine in women receiving antepartum antiretroviral therapy.     

Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. II. Predictive value of prenatal cultures

To determine the value of prenatal cultures in defining maternal colonization status at delivery, 5,586 pregnant women were screened at prenatal visits for vaginal and rectal carriage of group B streptococci (GBS). GBS were isolated from 1,272 (22.8%). At delivery, semiquantitative cultures were obtained from 393 prenatal carriers, of whom 264 (67.2%) retained carriage at delivery. Seventeen (8.5%) of 200 women with negative prenatal cultures acquired carriage. The predictive value of a positive prenatal culture was highest (72.5%) in women with prenatal vaginal and rectal colonization and lowest (59.7%) in women with only rectal colonization. The predictive value varied inversely with the interval between prenatal sampling and delivery. In mothers with prenatal carriage, density of colonization at parturition was not predicted by the sites of prenatal colonization. Density of colonization, however, strongly influenced rates of vertical transmission to neonates and rates of heavy infant colonization. Ten infants born to prenatally cultured mothers developed group B streptococcal early-onset disease; the mothers of eight (80%) of the 10 had prenatal colonization with the homologous GBS serotype.     

Participation of HIV-infected pregnant women in research in the United States

Previous studies suggested that some groups of HIV-infected women were underrepresented in studies of antiretrovirals (ARVs). We assessed rates of and reasons for nonenrollment in a U.S. prospective cohort study (protocol P1025), and differences in the characteristics of HIV-infected pregnant women who were and were not enrolled. Forty-one percent of women invited to participate were not enrolled. Clinic-related reasons for nonenrollment included staffing or site resources (26.7% of women) and clinician refusal because of the woman's nonadherence to prenatal care and/or poor research candidacy (10.8%). Patient-related reasons for nonenrollment included unavailability of women for enrollment (e.g., difficulty enrolling during labor/delivery, loss of clinic contact) (20.3%), refusal because of mistrust (10.1%), refusal because of time requirements (8.3%), refusal because of distance to the clinic (4.7%), and spontaneous abortion (4.7%). P1025 participants (N = 530) were significantly more likely to be Hispanic (32.1% vs. 19.8%), and less likely to be non-Hispanic black), to present in the first or second trimester for prenatal care (91.5% vs. 77.6%), and to be ARV-naive (32.8% vs. 23.0%) than nonparticipants (N = 2222). This high rate of nonenrollment can bias study results and generate findings that are applicable only to particular groups of women. Efforts should be taken to design protocols that facilitate enrollment of HIV-infected pregnant women.     

Antenatal risk factors associated with postpartum comorbid alcohol use and depressive symptomatology

BACKGROUND: High rates of comorbid depression and alcohol use disorders have been reported in epidemiological studies; little work has considered comorbidity in women during the perinatal period. The goal of this work was to identify prenatal factors (at each trimester) that predicted postpartum comorbid depressive symptoms and alcohol use in women. METHODS: The data are from an ongoing longitudinal study of pregnancy outcome that is now in its 16th year of follow-up. The first four assessments were used in this study (fourth and seventh prenatal months, delivery, and 8 months after delivery; n = 595). Prenatal variables in five domains (psychological, substance use, social, obstetrical, and demographic) were considered in analyses to predict postpartum comorbid depressive symptoms and alcohol use in women. RESULTS: At each trimester, higher rates of depressive symptoms, binge drinking (four or more drinks per occasion), and tobacco use were significantly associated with comorbidity at the eighth postpartum month. Third-trimester anxiety was also significantly associated with postpartum comorbidity. Prenatal social support, obstetrical complications, and demographic factors were not related to an increased risk for postpartum comorbidity. CONCLUSIONS: Women with more depressive symptoms, who binge-drink, or who smoke cigarettes at any time during their pregnancies are at risk for postpartum comorbidity. Women should be screened for depressive symptoms and substance use, and treatment should be initiated when women exhibit the risk factors described.     

Domestic violence during pregnancy and risk of low birthweight and maternal complications: a prospective cohort study at Mulago Hospital, Uganda

OBJECTIVES: To investigate whether domestic violence during pregnancy is a risk factor for antepartum hospitalization or low birthweight (LBW) delivery. METHODS: A prospective cohort study was conducted in Mulago hospital, Kampala, Uganda, among 612 women recruited in the second pregnancy trimester and followed up to delivery, from May 2004 through July 2005. The exposure (physical, sexual or psychological violence during pregnancy) was assessed using the Abuse Assessment Screen. The relative and attributable risks of LBW and antepartum hospitalization were estimated using multivariate logistic regression analysis. RESULTS: The 169 women [27.7% 95% CI (24.3-31.5%)] who reported domestic violence during pregnancy did not differ significantly from the unexposed regarding sociodemographic characteristics, but differed significantly (P < 0.05) regarding domicile variables (had less household decision-making power, more resided in extended families and more had unplanned pregnancy). They delivered babies with a mean birthweight 2647.5 +/- 604 g, on average 186 g [(95% CI 76-296); P = 0.001] lower than those unexposed. After adjusting for age, parity, number of living children, pregnancy planning, domicile and number of years in marriage, the relative risk (RR) of LBW delivery among women exposed to domestic violence was 3.78 (95% CI 2.86-5.00). Such women had a 37% higher risk of obstetric complications (such as hypertension, premature rupture of membranes and anaemia) that necessitated antepartum hospitalization [RR 1.37 (95% CI 1.01-1.84)]. CONCLUSION: In this pregnancy cohort, domestic violence during pregnancy was a risk factor for LBW delivery and antepartum hospitalization.     

The Impact of Maternal Age on the Effects of Prenatal Alcohol Exposure on Attention

Background: Prenatal exposure to alcohol has a variety of morphologic and neurobehavioral consequences, yet more than 10% of women continue to drink during pregnancy, placing their offspring at risk for fetal alcohol spectrum disorders (FASD). Identification of at‐risk pregnancies has been difficult, in part, because the presence and severity of FASD are influenced by factors beyond the pattern of alcohol consumption. Establishing maternal characteristics, such as maternal age, that increase the risk of FASD is critical for targeted pregnancy intervention. Methods: We examined the moderating effect of maternal age on measures of attention in 462 children from a longitudinal cohort born to women with known alcohol consumption levels (absolute ounces of alcohol per day at conception) who were recruited during pregnancy. Analyses examined the impact of binge drinking, as average ounces of absolute alcohol per drinking day. Smoking and use of cocaine, marijuana, and opiates were also assessed. At 7 years of age, the children completed the Continuous Performance Test, and their teachers completed the Achenbach Teacher Report Form. Results: After controlling for covariates, stepwise multiple regression analyses revealed a negative relation between levels of prenatal binge drinking and several measures of attention. The interaction between alcohol consumption and maternal age was also significant, indicating that the impact of maternal binge drinking during pregnancy on attention was greater among children born to older drinking mothers. Conclusion: These findings are consistent with previous findings that children born to older alcohol‐using women have more deleterious effects of prenatal alcohol exposure on other neurobehavioral outcomes.     

Alcohol use and immune reconstitution among HIV-infected patients on antiretroviral therapy in Nairobi,Kenya

Studies on the effects of alcohol use on HIV disease progression have been contradictory, with at least one study finding a positive effect of low alcohol consumption on CD4 count. In addition, most such studies have taken place in the developed West. We investigated the association between alcohol use and immune reconstitution through CD4 count response among HIV-infected individuals on antiretroviral therapy (ART) at an urban sub-Saharan African clinic. This was a retrospective cohort study of treatment-naïve HIV-infected adults initiating ART in Nairobi, Kenya and followed for 12 months between January 2009 and December 2012. At enrollment, a standardized questionnaire was used to collect data on sociodemographic variables and alcohol consumption. CD4 count was measured every six months. Linear regression models assessed the association between CD4 count and alcohol consumption, categorized as abstinent, moderate, or hazardous. Overall, 854 participants were included, 522 of which were women, with 85 (25.6%) men and 50 (9.6%) women reporting any alcohol use, and 8 (2.4%) men and 7 (1.3%) women reporting hazardous drinking. At baseline, alcohol use was associated with higher education and socioeconomic status. Median CD4 count was higher among alcohol users compared to those who abstained at baseline and at 6 and 12 months post-ART initiation, although this was only significant at 6 months. There were no differences in adherence between abstainers and drinkers. While overall alcohol use was significantly associated with higher CD4 counts, moderate and hazardous use treated separately were not. We conclude that, while alcohol use was associated with higher CD4 counts at 12 months post-ART, the mechanism for this association is unclear but may reflect unmeasured socioeconomic or nutritional differences. Additional research is required on the specific drinking patterns of this population and the types of alcoholic beverages consumed to clarify this relationship.     

Effects of Fetal Alcohol Exposure on Infant Reaction Time

Fetal alcohol exposure is associated with slower reaction times (RTs) in children, suggesting an alcohol-related deficit in "speed of central processing." This study examined effects of prenatal alcohol exposure on a new paradigm which, for the first time, directly assesses RT in infancy. RT was assessed in 103 Black, inner-city, 6.5-montholds born to women recruited prenatally based on alcohol consumption during pregnancy. Maternal drinking was related to longer RTs and to fewer fast responses, after controlling for potential confounders. The incidence of fast performance was reduced in infants whose mothers averaged at least 0.5 oz absolute alcohol/day, indicating an impact at lower levels than those associated with fetal alcohol syndrome. The RT deficits were dose-dependent and not attributable to maternal depression, intellectual stimulation, prenatal drug exposure, or postpartum maternal drinking. This study provides the first evidence of an alcohol-related RT deficit in infancy.     

Prenatal Alcohol Exposure and Academic Achievement at Age Six: A Nonlinear Fit

This is a report on the effects of prenatal alcohol exposure on the academic achievement of children at 6 years of age. In this longitudinal study, women were interviewed at the end of each trimester of pregnancy, at delivery, and at 8, 18, 36, and 72 months postpartum. The women were of lower socioeconomic status, high school-educated, and moderate users of alcohol. The offspring received age-appropriate physical and developmental assessments at each follow-up. Linear regression and nonlinear curve fitting were used to investigate the nature and shape of the relationship between prenatal alcohol exposure and achievement. In addition, the role of child IQ in this relationship was explored. Alcohol exposure during the second trimester predicted deficits in each of the three subtests of the Wide Range Achievement Test-Revised (WRAT-R): reading, spelling, and arithmetic. The relationship was partially reduced by the addition of IQ to the model, but prenatal alcohol exposure still predicted significant deficits in achievement, even after controlling for IQ. Tests for the shape of the relationship demonstrated that the effect of prenatal exposure on the arithmetic subtest of the WRAT-R was a linear or dose-response relationship. By contrast, the relationships between prenatal alcohol exposure and performance on the spelling and reading subtests of the WRAT-R were better modeled as threshold effects. The thresholds for both were ˜1 drink/day in the second trimester.     

The effects of social support on alcohol consumption during pregnancy: situational and ethnic/cultural considerations

While the effects of alcohol consumption during pregnancy have been well documented, variables associated with drinking during pregnancy have received little attention. This study sought to determine the importance of situational and ethnic/cultural-specific support on alcohol consumption during pregnancy among Black and White women in a U.S. southern urban prenatal population. A consecutive sample of 311 prenatal patients were interviewed during both the fourth month and the eighth month of pregnancy. Using standard regressions, the two components of expressive support--general support and pregnancy support--were found to be working in opposite directions, with pregnancy support showing a negative association with alcohol consumption during pregnancy. Pregnancy support was found to contribute significantly to the variance in alcohol consumption among Whites but was not found to be a significant contributor among Blacks. These findings suggest that social support, specifically pregnancy support, is a significant variable in accounting for alcohol consumption during pregnancy, but this association may not be consistent across ethnic groups.     

Prior illicit drug use and missed prenatal vitamins predict nonadherence to antiretroviral therapy in pregnancy: adherence analysis A5084

Adherence to antiretroviral therapy (ART) in pregnancy is crucial to optimize its efficacy and minimize mother-to-child transmission. Our objective was to examine adherence patterns to ART and health behaviors during and after pregnancy among HIV-positive women enrolled in A5084, a prospective, observational, multisite study. Between 2002-2005, HIV-infected women between 20 and 34 weeks'gestation completed at least 1 self-reported adherence questionnaire antepartum (AP), and were followed through 12 weeks' postpartum (PP). Questionnaires also addressed tobacco, alcohol, and illicit drugs use. Adherence was defined as reporting not having missed any doses for more than 3 months. Exact McNemar's tests were used for paired binary data and exact logistic regression was used for predictors of nonadherence. We report on 149 women (55% black, 26% Hispanic, 32% less than 25 years, 9% with AIDS, 100% on ART). PP, 31 (21%) women stopped ART and 18 (12%) withdrew from the study. AP, 57% reported adherence to ART and PP, 45% (p = 0.03, n = 87). AP, 11% reported ongoing alcohol use and 23% tobacco use compared to 37% and 30% PP (p < 0.0001, n = 103; p = 0.07, n = 99, respectively). Although 39% ever used marijuana (n = 116) and 25% used illicit drugs (n = 107), few participants reported use during the study. In multivariate analyses, those who had ever used illicit drugs had 5.95 times higher odds (p = 0.002) and those who missed prenatal vitamins had 4.84 times higher odds (p = 0.001) of ART nonadherence. Women reporting a history of illicit drug use and/or having missed prenatal vitamins should be targeted for programs to enhance adherence to ART during pregnancy.     

Maternal educational level and risk of gestational hypertension: the Generation R Study

We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrollment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrollment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrollment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrollment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy.     

Prenatal Alcohol Exposure and Development at Preschool Age: Main Results of a French Study

Very high levels of alcohol consumption during pregnancy are harmful for the central nervous system of the child and affect morphogenesis and growth. The aim of this study was to investigate the effects of moderate prenatal alcohol exposure on development at preschool age in a longitudinal study. Pregnant women were interviewed on their alcohol consumption during pregnancy at their first visit to the maternity hospital of Roubaix, France. The development of their 160 children was assessed at the age of 4½. Multiple regression analyses indicated that consumption of 1.5 oz of absolute alcohol (approximately 3 drinks) or more during pregnancy was significantly related to a decrease of 7 points on the general cognitive index of the McCarthy scales, after controlling for confounders. This level of consumption was also related to a higher score on minor neurological anomalies, a lower height of the child, and a higher score on facial features. This level of 1.5 oz of absolute alcohol/day should not be interpreted as a biological threshold, because the study does not allow conclusions to be drawn regarding the effects of lower levels of alcohol consumption. Alcohol consumption during pregnancy can affect the development of the child, at levels well below those associated with fetal alcohol syndrome.     

Low to moderate alcohol intake during pregnancy and risk of psychomotor deficits

Background: To examine the effects of low to moderate alcohol consumption during pregnancy on child motor function at age 5. Methods: A prospective follow‐up study of 685 women and their children sampled from the Danish National Birth Cohort based on maternal alcohol consumption during pregnancy. At 5 years of age, the children were tested with the “Movement Assessment Battery for Children” (MABC). Parental education, maternal IQ, prenatal maternal smoking, the child’s age at testing, and gender of child were considered core confounders, while the full model also controlled for prenatal maternal binge drinking episodes, age, maternal prepregnancy body mass index, parity, home environment, postnatal parental smoking, health status, and indicators for hearing and vision impairment. Results: There were no systematic or significant differences in motor function between children of mothers reporting low to moderate levels of average alcohol consumption during pregnancy and children of mothers who abstained. Conclusions: In this study, we found no systematic association between low to moderate maternal alcohol intake during pregnancy and child motor function at age 5.     

Alcohol consumption during pregnancy in nonindigenous west Australian women

BACKGROUND: High alcohol intake in pregnancy has been linked to abnormal fetal development. There are limited published data in Australia on standard drinks of alcohol consumed on a typical occasion during the periconceptional period or pregnancy. METHODS: During 1995 to 1997, a 10% random sample of all nonindigenous women giving birth in Western Australia was surveyed 12 weeks after delivery (N=4,839). Women were asked questions about alcohol consumption in each of the 4 time periods: the 3 months before pregnancy and each trimester of pregnancy. Questions were framed to measure volume, frequency, and type of alcoholic beverage. RESULTS: 46.7% of the women had not planned their pregnancy. Most women (79.8%) reported drinking alcohol in the 3 months before pregnancy, with 58.7% drinking alcohol in at least 1 trimester of pregnancy. The proportion of women consuming 1 to 2 drinks on a typical occasion did not change much during pregnancy, but the number of occasions declined. Although the proportion of women consuming more than 2 standard drinks on a typical occasion declined after the first trimester, 19.0% of women consumed this amount in at least 1 trimester of pregnancy and 4.3% of women consumed 5 or more standard drinks on a typical occasion in at least 1 trimester of pregnancy. In the first trimester of pregnancy, 14.8% of women drank outside the current Australian guideline for alcohol consumption in pregnancy, decreasing to 10% in the second and third trimesters. CONCLUSIONS: Women generally reduced their average alcohol consumption and the number of standard drinks on a typical occasion as their pregnancy progressed, although 10 to 14% were drinking outside current guidelines for pregnancy. It is important that all women of child-bearing age are aware, well before they consider pregnancy, of the risks of drinking alcohol during pregnancy so they can make informed decisions about their alcohol consumption in pregnancy.