Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Room Sp-4469, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Sophia Children's Hospital, 3000 CB, Rotterdam, the Netherlands.
BMC Med. 2023 Aug 23;21(1):318. doi: 10.1186/s12916-023-03020-4.
Prenatal alcohol exposure (PAE) is a worldwide public health concern. While PAE is known to be associated with low birth weight, little is known about timing and quantity of PAE on fetal growth. This study investigated the association between periconceptional and prenatal alcohol exposure and longitudinal fetal growth, focusing on timing and quantity in a high exposure cohort.
The Safe Passage Study was a prospective cohort study, including 1698 pregnant women. Two-dimensional transabdominal ultrasound examinations were performed to measure fetal femur length, abdominal and head circumference, and biparietal diameter, at three time points during pregnancy. Estimated fetal weight and Z-scores of all parameters were calculated. Trimester-specific alcohol exposure was assessed using the Timeline Followback method. To investigate the associations of specific timing of PAE and fetal growth, two models were built. One with alcohol exposure as accumulative parameter over the course of pregnancy and one trimester specific model, in which PAE was separately analyzed. Linear mixed models adjusted for potential confounders were applied with repeated assessments of both alcohol exposure and fetal growth outcomes.
This study demonstrated that periconceptional and prenatal alcohol exposure were associated with reduced fetal growth. Effect sizes are displayed as estimated differences (ED) in Z-score and corresponding 95% confidence intervals (95% CIs). When investigated as accumulative parameter, PAE was related to a smaller femur length (ED; - 0.13 (95% CI; - 0.22; - 0.04), ED; - 0.14 (95% CI; - 0.25; - 0.04)) and a smaller abdominal circumference (ED; - 0.09 (95% CI; - 0.18; - 0.01)). Periconceptional alcohol exposure was associated with a smaller abdominal circumference (ED; - 0.14 (95% CI; - 0.25; - 0.02), ED; - 0.22 (95% CI; - 0.37; - 0.06)) and a smaller estimated fetal weight (ED; - 0.22 (95% CI; - 0.38; - 0.05)). Second trimester alcohol exposure was associated with a smaller abdominal circumference (ED; - 0.49 (95% CI; - 0.86; - 0.12), ED; - 0.70 (95% CI; - 1.22; - 0.17)) and estimated fetal weight (ED; - 0.54 (95% CI; - 0.94; - 0.14), ED; - 0.69 (95% CI; - 1.25; - 0.14)). No additional association of binge drinking was found besides the already observed association of PAE and fetal growth.
This study demonstrated that PAE negatively affects fetal growth, in particular when exposed during the periconception period or in second trimester. Our results indicate that potential negative consequences of PAE are detectable already before birth. Therefore, healthcare providers should actively address and discourage alcohol use during pregnancy.
产前酒精暴露（PAE）是一个全球性的公共卫生问题。虽然已知 PAE 与低出生体重有关，但关于 PAE 对胎儿生长的时间和数量的了解甚少。本研究调查了围孕期和产前酒精暴露与纵向胎儿生长之间的关系，重点关注高暴露队列中的时间和数量。
Safe Passage 研究是一项前瞻性队列研究，包括 1698 名孕妇。在妊娠三个时间点，通过二维经腹超声检查测量胎儿股骨长度、腹围和头围、双顶径。计算所有参数的估计胎儿体重和 Z 分数。使用 Timeline Followback 方法评估特定孕期的酒精暴露情况。为了研究特定时期的 PAE 与胎儿生长的关系，建立了两个模型。一个是将酒精暴露作为整个孕期的累积参数，另一个是特定孕期的模型，其中分别分析 PAE。应用线性混合模型调整潜在混杂因素，对酒精暴露和胎儿生长结果进行重复评估。
本研究表明，围孕期和产前酒精暴露与胎儿生长受限有关。效应大小显示为 Z 分数的估计差异（ED）和相应的 95%置信区间（95%CI）。当作为累积参数进行研究时，PAE 与股骨长度较小有关（ED；-0.13（95%CI；-0.22；-0.04），ED；-0.14（95%CI；-0.25；-0.04））和腹围较小（ED；-0.09（95%CI；-0.18；-0.01））。围孕期的酒精暴露与腹围较小有关（ED；-0.14（95%CI；-0.25；-0.02），ED；-0.22（95%CI；-0.37；-0.06））和估计胎儿体重较小（ED；-0.22（95%CI；-0.38；-0.05））。孕中期的酒精暴露与腹围较小有关（ED；-0.49（95%CI；-0.86；-0.12），ED；-0.70（95%CI；-1.22；-0.17））和估计胎儿体重较小（ED；-0.54（95%CI；-0.94；-0.14），ED；-0.69（95%CI；-1.25；-0.14））。除了已经观察到的 PAE 与胎儿生长之间的关联外，没有发现 binge drinking 的额外关联。
本研究表明，PAE 对胎儿生长有负面影响，特别是在围孕期或孕中期暴露时。我们的研究结果表明，PAE 的潜在负面影响在出生前就已经可以检测到。因此，医疗保健提供者应积极解决并劝阻孕妇饮酒。
