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.     

Alcohol Use in Pregnancy and Miscarriage: A Systematic Review and Meta‐Analysis

To systematically review and critically evaluate studies reporting alcohol exposure during pregnancy and miscarriage. We searched PubMed, EMBASE, PsycINFO, and ProQuest Theses for publications from January 1970 to January 2019. We identified studies about alcohol exposure during pregnancy and miscarriage. Information about study population, alcohol exposure assessment, outcome definition, covariates, and measures of association was collected. We assessed study quality using an adapted Newcastle‐Ottawa Scale. Data were abstracted by 2 investigators independently. We conducted a random‐effects meta‐analysis to calculate the association between alcohol exposure and miscarriage risk and performed subgroup analyses to determine robustness of results to study differences. For studies reporting dose‐specific effects, a pooled dose–response association was estimated using generalized least squares regression with and without restricted cubic spline terms for number of drinks consumed per week. Of 2,164 articles identified, 24 were eligible for inclusion. Meta‐analysis of data from 231,808 pregnant women finds those exposed to alcohol during pregnancy have a greater risk of miscarriage compared to those who abstained (odds ratio [OR] 1.19, 95% confidence intervals [CI] 1.12, 1.28). Estimates did not vary by study design, study country, or method of alcohol ascertainment. For alcohol use of 5 or fewer drinks per week, each additional drink per week was associated with a 6% increase in miscarriage risk (OR 1.06, 95% CI 1.01, 1.10). Common study limitations reflect challenges inherent to this research, including difficulty recruiting participants early enough in pregnancy to observe miscarriage and collecting and quantifying information about alcohol consumption during pregnancy that accurately reflects use. This review provides evidence that alcohol consumption during pregnancy is associated with a dose‐mediated increase in miscarriage risk. Future studies evaluating change in alcohol use in pregnancy are needed to provide insight into how alcohol consumption prior to pregnancy recognition impacts risk.     

Early Measures of Maternal Alcohol Misuse as Predictors of Adverse Pregnancy Outcomes

Pregnancy outcome was studied in 531 obstetric outpatients with respect to maternal alcohol consumption prior to pregnancy recognition, (absolute alcohol per day prior to pregnancy, PPAA) and indications of problem drinking (IPD). Multiple regression was used to predict pregnancy outcome with PPAA and IPD, controlling for potentially confounding sociodemographic and health factors. PPAA predicted spontaneous abortion and lowered Apgar scores. The risk of spontaneous abortion increased an average of 25% for each additional ounce of absolute alcohol consumed per day (p less than 0.05). Adverse pregnancy outcomes related to intrauterine growth were more strongly related to IPD than PPAA, and IPD remained a significant predictor even after controlling for PPAA. The strongest association was with head circumference (p less than 0.01); logistic regression indicated that for each additional indication of problem drinking reported, risk of head circumference below the 10th percentile increased 2.77 times. Other pregnancy outcome measures negatively related to IPD were 5-min Apgar scores (p less than 0.05), birth weight (p less than 0.10), and 1-min Apgar scores (p less than 0.10). No significant curvilinear alcohol effects or interactions were observed. These findings highlight the potential clinical utility of PPAA and IPD in the early identification of women whose alcohol use puts their pregnancies at high risk.     

Fetus at risk: prevalence of alcohol consumption during pregnancy estimated with a simple screening method in Swedish antenatal clinics

Aims Maternal alcohol consumption is a major health hazard for the fetus. Sweden has an extensive system of public antenatal care clinics, whose mission is to detect and prevent this type of health hazards. However, very few cases of alcohol consumption during pregnancy are detected. The aim of this study was to examine the prevalence of hazardous or harmful alcohol consumption during pregnancy in a consecutive series of Swedish pregnant females. Design, setting, participants and measurements The Alcohol Use Disorders Identification Test (AUDIT) was used to collect anonymous data from consecutive pregnant subjects admitted during 1 year to an antenatal clinic in Stockholm, and signing up for parental education offered routinely (n = 1327). Data were obtained from 1101 subjects, typically in pregnancy week 30. A complete AUDIT form was filled out referring to alcohol use during the year prior to pregnancy. A separate form with the consumption items from AUDIT was filled out to report behaviour during pregnancy. Findings For the year preceding pregnancy, 17% of subjects reported AUDIT scores of 6 or higher, indicating hazardous or harmful alcohol use in women. Few individuals reported scores of 13 or higher (indicating abuse or dependence), but almost half the subjects (46%) reported binge drinking (six standard drinks on a single occasion) once/month or more often, and 6% reported binge drinking on every occasion of alcohol consumption. One‐third of the subjects (30%) continued regular alcohol use during pregnancy, and 6% reported consumption two to four times/month. In a logistic regression model, AUDIT scores for the year prior to pregnancy and subject age, but not education level were significant predictors of continued alcohol use during pregnancy. Conclusions Alcohol use during pregnancy is more extensive than has been presumed in Sweden. Simple, clinically useful screening methodology detects hazardous consumption during pregnancy in a manner which regular antenatal care does not. If this methodology can be shown to have similar sensitivity when administered under non‐anonymous conditions, it should be made part of routine antenatal care.     

Alcohol in Pregnancy: patterns and association with socio-economic, psychological and behavioural factors

This study investigated alcohol consumption during pregnancy and its relationships with socio-economic, psychological and behavioural factors in 1463 women. Information about alcohol consumption in the preceding 7 days was obtained by structured interview at booking, 28 and 36 weeks gestation. The prevalence of current drinking was about 50% at each interview. Combining the three interviews, the cumulative prevalence of drinking was 71%. Six per cent reported drinking l00g/wk or more at at least one interview, a level of consumption which has been reported to be associated with adverse foetal outcome. Higher proportions of drinkers than non-drinkers were married, better educated, of higher social class and financial status. These factors were also associated with higher levels of consumption amongst those who drank. There was little evidence of an association between drinking and psychiatric state. Smoking was not associated with drinking status but was strongly related to the amount drunk by drinkers. Cluster analysis of heavier drinkers indicated the presence of a small sub-group of socially disadvantaged women. These findings carry implications for both prevention and perinatal epidemiology.     

Maternal Alcohol Use During Pregnancy Causes Systemic Oxidation of the Glutathione Redox System

Background: Increased systemic oxidant stress contributes to a variety of maternal complications of pregnancy. Although the antioxidant glutathione (GSH) and its oxidized component glutathione disulfide (GSSG) have been demonstrated to be significantly altered in the adult alcoholic, the effects of maternal alcohol use during pregnancy on oxidant stress in the postpartum female remain under investigation. We hypothesized that maternal alcohol use would increase systemic oxidant stress in the pregnant female, evidenced by an oxidized systemic GSH redox potential. Methods: As a subset analysis of a larger maternal language study, we evaluated the effects of alcohol consumption during pregnancy on the systemic GSH redox status of the postpartum female. Using an extensive maternal questionnaire, postpartum women where queried regarding their alcohol consumption during pregnancy. Any drinking, the occurrence of drinking >3 drinks/occasion, and heavy drinking of >5 drinks/occasion during pregnancy were noted. Using HPLC, maternal plasma samples were analyzed for GSH, oxidized GSSG and the redox potential of the GSH/GSSG antioxidant pair calculated. Results: Maternal alcohol use occurred in 25% (83/321) of our study sample. Two in ten women reported consuming >3 drinks/occasion during pregnancy, while 1 in 10 women reported consuming alcohol at >5 drinks/occasion. Any alcohol use during pregnancy significantly decreased plasma GSH (p < 0.05), while alcohol at >3 drinks/occasion or >5 drinks/occasion significantly decreased plasma GSH concentration (p < 0.05), increased the percent of oxidized GSSG (p < 0.05), and substantially oxidized the plasma GSH redox potential (p < 0.05). Conclusions: Alcohol use during pregnancy, particularly at levels >3 drinks/occasion, caused significant oxidation of the systemic GSH system in the postpartum women. The clinical ramifications of the observed alcohol‐induced oxidation of the GSH redox system on high risk pregnancies or on the exposed offspring require more accurate identification and further investigation.     

Adverse Effects of Alcohol in Pregnancy

Alcohol consumption in pregnancy can produce a spectrum of abnormalities in the developing foetus, ranging from minor retardation of growth to the fully developed ‘foetal alcohol syndrome’. This syndrome comprises a constellation of physical and mental defects associated with a charateristic facial appearance that is found in children: born to chronic alcoholic women. Although it was thought to be extremely rare in the U.K., several case studies have recently appeared in the literature, and its incidence is probably increasing. In moderately drinking pregnant women increased rates of spontaneous abortion, stillbirth and congenital malformation as well as growth retardation have been reported, though some of these findings await confurmation. It is likely also that certain behavioural abnormalities are consequent on maternal alcohol intake. The major U.K. finding so far is that consumption of more than 100g alcohol per week in the early stages of pregnancy is associated with reduced birth weight. There is no doubt that alcohol is teratogenic in laboratory animals and that the effects are dose-related. In humans the threshold dose necessary to produce damage to the foetus and the time in pregnancy that alcohol is particularly likely to have deleterious effects have not yet been established. In the present state of knowledge there are difficulties in recommending safe limits. It is obvious that abstinence before and during pregancy is the safest course, but one drink a day is unlikely to be harmful. Greater efforts are needed to educate women about the dangers of alcohol consumption in pregnancy.     

Alcohol Consumption During Pregnancy: Baseline Data from a Scottish Prospective Study

The results are reported from the first of four phases of a prospective study on the association between alcohol consumption during pregnancy and fetal harm. These data revealed a generally low level of alcohol consumption amongst the 1,008 respondents. Self-reported alcohol consumption was slightly, but significantly, positively correlated with previous obstetric problems. Evidence from other studies indicates that between 1.8 per cent and 4.8 per cent of the study group may run an enhanced risk of producing damaged babies.     

Cigarette Smoking and Alcohol Consumption during Pregnancy by Danish Women and Their Spouses—A Potential Source of Fetal Morbidity

The relationship between cigarette smoking and alcohol consumption behavior during pregnancy was examined in a select group of Danish women and their spouses. Five-hundred consecutive women who had uncomplicated pregnancies and delivered full-term babies were interviewed 3 + days postpartum. Information was collected about smoking and drinking behavior of all household members during pregnancy. Weg found (1) a high percentage of Danish women (70%) and their spouses (80%) consume alcohol during pregnancy, and (2) a significant correlation between maternal and paternal smoking (r =. 25, P*. 0001) and maternal and paternal drinking (r =. 35, P*. 0001). These data suggest that even though the potential dangers of cigarette smoking and alcohol consumption during pregnancy have been well publicized, there is still a high percentage of women who participate in such behaviors. There may also exist an important role for the father in affecting these two behaviors and therefore indirectly affecting fetal development.     

Alcohol Consumption During Pregnancy: Baseline Data from a Scottish Prospective Study

The results are reported from the first of four phases of a prospective study on the association between alcohol consumption during pregnancy and fetal harm. These data revealed a generally low level of alcohol consumption amongst the 1, 008 respondents. Self–reported alcohol consumption was slightly, but significantly, positively correlated with previous obstetric problems. Evidence from other studies indicates that between 1.8 per cent and 4.8 per cent of the study group may run an enhanced risk of producing damaged babies.     

Alcohol Consumption in Emergency Room Patients and the General Population: A Population-Based Study

Our purpose was to obtain epidemiological measures of the association between habitual alcohol consumption, alcohol consumption before the event and alcohol abuse/dependence, and emergency room (ER) attendance compared to the general population in Pachuca-Hidalgo, a city located in the central area of Mexico. The study was a population based case-control design. Data consisted of breath samples to estimated blood alcohol concentration, as well as an interviewer-administered questionnaire, collected on a 24-hr basis, during the entire week, in each of the three main ERs of Pa-chuca. Cases were all patients who visited the three main hospitals ERs during the study period, classified according to their status as an injured or noninjured (medically ill) patient ( n = 1511). The general population sample (n = 920) serves as a comparison group for both types of patients. Injured patients in the ER sample were significantly more likely to report high frequency/high quantity of drinking during the last 12 months than the general population [odds ratio and 95% confidence intervals = 5.55 (1.72–17.97)] and to report drinking within 6 hr before the injury. These relationships did not hold for noninjured patients. Both types of patients were more likely to report high frequency of drunkenness during the preceding 12 months, to be positive for alcohol dependence and to report drug use. We found in the city of Pachuca, a large relationship between habitual alcohol consumption and ER injuries. These findings support associations of alcohol consumption and admission to an emergency room found in ER and general population studies in other countries. Due to the increases in the risk found for abuse/dependent in both injured and noninjured patients, they both would benefit with a brief intervention strategy for reducing their alcohol consumption.     

Prenatal maternal alcohol consumption and hospitalization with asthma in childhood: a population-based follow-up study

BACKGROUND: Asthma may have a prenatal origin. We examined whether maternal alcohol consumption during pregnancy increases the risk of hospitalization with asthma in children. METHODS: We conducted a follow-up study on 10,440 singletons born at approximately 36 weeks of gestation or later to mothers attending midwife centers between April 1984 and April 1987 in Denmark. The mothers completed a questionnaire regarding lifestyle and socioeconomic factors, including alcohol consumption. The children were followed up through the Danish Hospital Discharge Registry. We determined the first hospitalization with a discharge diagnosis of asthma as recorded in the Danish Hospital Discharge Registry. RESULTS: Most pregnant women (81.5%) drank at least some alcohol during pregnancy, but only a few (2.1%) consumed 120 g or more per week. In total, 307 children were hospitalized at least once with a discharge diagnosis of asthma during follow-up (the cumulative incidence risk was 3.5% from birth to 12 years of age or the end of follow-up). After adjusting for maternal socioeconomic factors, dietary components, and other lifestyle factors, children whose mothers drank alcohol during pregnancy did not have an increased risk of hospitalization with asthma compared with the children of mothers who reported no alcohol consumption during pregnancy (adjusted incidence rate ratio, 0.95; 95% confidence interval, 0.70-1.29). Further analyses showed no association with the dose and type of alcohol or with binge drinking. CONCLUSIONS: The study provides no support for a causal link between maternal alcohol intake during pregnancy and asthma in childhood.     

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.     

Role of appetite-regulating peptides in alcohol craving: an analysis in respect to subtypes and different consumption patterns in alcoholism

BACKGROUND: A role of appetite-regulating peptides like leptin and ghrelin in the neurobiology of alcohol craving has been proposed by several studies. Aim of this analysis was to search for differences regarding an association between these peptides and alcohol craving with respect to different subtypes and beverage consumption patterns in patients with alcohol dependence. METHODS: We analyzed a sample of 188 patients at admission for alcohol detoxification regarding leptin and ghrelin (n=117) serum levels. Craving was measured using the Obsessive Compulsive Drinking Scale (OCDS). Patients were classified according to Lesch's typology of alcohol dependence and according to their preferred type of alcoholic beverage (beer, wine, spirits). RESULTS: Using general linear models to analyze a possible interaction between subtypes and leptin/ghrelin levels with respect to craving, we found a significant positive association for leptin in patients of Lesch's types 1 and 2, and in patients consuming beer or wine. Ghrelin levels showed a significant trend regarding an association with craving in patients of Lesch's type 1. In the other subgroups we found no significant results. CONCLUSIONS: Our findings show that appetite-regulating peptides may be of special importance regarding alcohol craving in subtypes of patients. This may explicate at least in part previous contradictory findings.     

Effects of Moderate Alcohol Consumption During Pregnancy on Child Development at 18 and 42 Months

The aim of this study was to estimate the association between moderate alcohol consumption in pregnancy and child development to the age of 3.5 years. Furthermore, the aim was to compare development indices at 18 and 42 months of age. This study is an extension of the Danish participation in the EuroMac study. In a two-stage sampling, pregnant women in a well-defined region (Odense, Denmark) were recruited to a follow-up study according to their reported drinking habits in the first trimester of pregnancy. All among 2880 pregnant women who reported an alcohol consumption early in pregnancy (12th week of gestation) of at least 5 drinks/week were ascertained (164 women). A similar age and expected time of delivery matched group was selected from the remaining group of pregnant women. Alcohol consumption data were based on self-reported data, and child development recording was done blindly by two psychologists at 18 and 42 months after birth. Two hundred fifty-one mother-child pairs participated in all follow-up studies. None of the reported levels of alcohol intake was statistically significantly associated with any of the child development indices (including measures of binge drinking). Comparing child development indices at 18 and 42 months did, however, reveal a rather large variation over time for alcohol exposures, as well as nonexposures. A large variation in the outcome measure will tend to mask effects of any exposures, but nevertheless it is unlikely that a low alcohol intake in pregnancy has any substantial impact on child development.     

Independent Associations among Maternal Alcohol Consumption and Infant Thyroxine Levels and Pregnancy Outcome

Studies with animal models of alcohol-related birth defects (ARBDs) suggest that reductions in circulating thyroid hormones, including thyroxine (T₄), may be a persistent postnatal effect of fetal alcohol exposure. The few clinical reports of children with fetal alcohol syndrome (FAS) that address thyroid system function generally reported that FAS children have thyroid hormone levels within normal limits. For the current study, data bases from the Fetal Alcohol Research Center and the Michigan Department of Public Health Newborn Screening Program were assessed to correlate measures of maternal drug use during pregnancy and infant outcome (gestational age at birth, birthweight, “fetal growth”), with infant whole-blood T₄ levels. Multiple regression analyses accounted for demographic factors, infant age at testing, and variation in the T₄ assay. As expected, alcohol intake and smoking each had a substantial negative impact on birthweight, gestational age at birth, and fetal growth, assessed as birthweight corrected for gestational age. Infant T₄ levels were positively related to birthweight and gestational age and were more strongly related to fetal growth. Infant T₄ levels were not influenced significantly by either maternal smoking or alcohol consumption. Smoking- and alcohol-related reductions in birthweight, gestational age, or fetal growth were not associated significantly with variations in infant T₄. Interesting questions remain regarding species differences and the influences of maternal alcohol consumption on T₄ metabolism as a mechanism for ARBDs. However, the current data do not support the hypothesis that maternal alcohol consumption, or smoking, during pregnancy leads to compromised thyroid system function in newborn humans. Therefore, newborn screens for T₄ are not likely to be effective in helping to detect infants with ARBDs or FAS.     

Reduced alcohol use in pregnancy and changed attitudes in the population

The objectives of this study were to investigate (1) changes in consumption of alcohol among pregnant women over a period of 5 years (1984/85–1990), (2) changes of attitudes towards drinking during pregnancy in the general population over the same period of time, and (3) possible connections between (1) and (2). The investigation was designed as a cross-sectional study. Our subjects were two representative samples of pregnant women in Oslo, n = 577 and 425, and two representative samples of the Norwegian population, n = 1004 and 1204. The main outcome measures were a self-completed questionnaire for the pregnant women and a personal interview for the general population sample. There was a significant reduction (50% decrease) in alcohol consumption among the second cohort of pregnant women compared with the first. Furthermore, we found an increase during the 5-year period in the number of persons with a restrictive attitude towards alcohol use during pregnancy. There seems to be a connection between these two phenomena, but with our present state of knowledge it is hard to say anything about the causal relationship between them.     

Increased Activation of the ACC During a Spatial Working Memory Task in Alcohol‐Dependence Versus Heavy Social Drinking

Background: Activation of the anterior cingulate cortex (ACC) in a spatial working memory task has been associated with risk factors for alcohol use disorders such as low alcohol effects and positive alcohol expectations in adolescents. To transfer these results into adults, we used the same task in adults. Methods: During functional magnetic resonance imaging, 12 light social, 7 heavy social, and 11 non‐abstinent‐dependent alcohol drinkers performed a spatial working memory task and completed measures of automatic alcohol‐related thoughts and behavior (Obsessive–Compulsive Drinking Scale—OCDS), alcohol use of the last 90 days, and general intelligence. Results: Behavioral performance in the spatial working memory task was not significantly different in all 3 groups. Controlling for differences in general intelligence alcohol‐dependent participants showed a higher task‐related activation of the dorsal ACC (dACC) in comparison with light and heavy social drinkers. Measures of the OCDS were positively correlated with the activation in the left hippocampus and right thalamus in all participants. Conclusions: Our results support the findings of increased dACC activation during a spatial working memory task as a risk factor for alcohol dependence. Increased task‐related activation in the dACC was only observed in alcohol‐dependent participants and not in heavy social drinkers with comparable alcohol consumption. Furthermore, the absence of behavioral performance differences between groups as well as an association between dACC activation and working memory performance indicates subtle working memory deficits. Low capacity of working memory has been linked to more automatic and less self‐regulated behavior in studies on natural reward processing. Therefore, additional neural activation during performance of the non‐alcohol‐related working memory task in participants with higher OCDS values in the left hippocampus and the right thalamus may be a consequence of decreased neural capacity because of distracting alcohol‐related thoughts.     

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 Abuse During Pregnancy: An Epidemiologic Study

In a medical-record-based prospective cohort study of 12,127 pregnancies consecutively delivered during a 52-mo period at a single institution, 204 (1.7%) were complicated by maternal alcohol abuse. A profile of these patients' concomitant risk factors and their pregnancy outcomes indicated that they tended to be older multigravidas who were not currently married. Their obstetric histories were marked by excesses of previous spontaneous abortions, low-birth-weight infants, and fetal anomalies. They were more likely to smoke cigarettes and abuse other drugs. During labor, their risks of infection and of premature placental separation were increased. Evidence of fetal distress during labor and neonatal depression were more common in their infants. Infant birth weights were lower in the alcohol-abusing group by an average of approximately 190 g. This was accounted for by intrauterine growth retardation, which was increased 2.7-fold overall; preterm delivery was not more common. The risk of intrauterine growth retardation was estimated to be increased 2.4-fold in association with alcohol abuse alone, 1.8-fold with smoking alone, and 3.9-fold with these risks together. A significant increase in congenital anomalies (38%) was also identified, though there were no differences between the mortality rates or placental pathology of the alcohol-abusing and comparison groups. These adverse infant outcomes did not appear to be related to demographic factors, the medical care, or nutritional status of the alcohol-abusing patients. Moreover, cigarette smoking did not appear to account for the congenital anomalies observed in the alcohol-abusing group. The findings of this study suggest that alcohol abuse during pregnancy constitutes a significant risk for a range of adverse perinatal outcomes in as many as 50% of the offspring, and hence, should be considered a major public health concern.