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

A Population-Based Study on Women Who Used Alcohol during Pregnancy and Their Neonates in Ontario, Canada

BACKGROUND

Data from birth registries can be studied to assess the prevalence of prenatal alcohol use and associated maternal and neonatal outcomes.

METHODS

Linked maternal and neonatal data (2015-2018) for alcohol-exposed pregnancies were obtained from the Better Outcomes Registry and Network (BORN) Ontario. Descriptive statistics were generated for maternal demographics, prenatal substance use, mental health/substance use history, and neonatal outcomes. Logistic regression models were performed to assess the odds of prenatal heavy (binge or weekly) alcohol and other substance use based on mental health/substance use history and other maternal demographics, and the impacts of heavy alcohol use and other prenatal substance exposures on neonatal outcomes.

RESULTS

A total of 10,172 (2.4%) women reported alcohol use during pregnancy. One-third had pre-existing or current mental health and/or substance use problems, which was associated with significantly higher odds of heavy alcohol use during pregnancy. Prenatal exposure to heavy alcohol use was associated with increased odds of neonatal abstinence syndrome (2.5 times); respiratory distress syndrome (2.3 times); neonatal intensive care unit (NICU) admission (58%); and hyperbilirubinemia (57%). Prenatal exposure to one or more substances in addition to alcohol was associated with significantly higher odds of fetal/maternal/placental pregnancy complications; preterm birth; NICU admission; low APGAR scores; one or more confirmed congenital anomalies at birth; respiratory distress syndrome; and intrauterine growth restriction.

CONCLUSIONS

It is crucial to routinely screen childbearing-age and pregnant women for alcohol and other substance use as well as mental health problems in order to prevent adverse maternal and neonatal outcomes.

Fetal alcohol syndrome and population level health care usage in British Columbia, Canada

BACKGROUND

The literature indicates that youth with Fetal Alcohol Syndrome (FAS) may experience high rates of both physical and mental health issues compared to youth without FAS. However, there is little population level health data available for youth with FAS, particularly for youth transitioning from pediatric to adult healthcare services.

OBJECTIVE

The objective of this study was to compare health care usage of youth with Fetal Alcohol Syndrome to youth without any intellectual/developmental disabilities (IDD).

METHODS

This study used a retrospective cohort design and population-level administrative health data to examine five aspects of health care usage by youth with FAS and compare them to youth with no intellectual/developmental disability. The variables were medically required dental care, visits to emergency departments and visits for mental health issues. In addition, the study stratified data by age groups and examined the difference between youth aged 15-19 and youth aged 20-24.

RESULTS

Youth with FAS had higher adjusted odds of medically required dental care, visits to the emergency department and visits for anxiety/depression, psychotic illnesses and substance use disorders compared to youth with no IDD. The odds of a medically required dental visit, emergency department visit and visit for psychotic illness or substance use disorder were also higher for youth aged 20-24 years compared to youth aged 15-19 years.

CONCLUSIONS

These findings indicate that youth with FAS require urgent attention for each of the medically-related variables included in this study. The need for attention to their health care needs may increase as these youth transition from pediatric to adult health care services.

First Description of a Large Clinical Series of Fetal Alcohol Spectrum Disorders Children and Adolescents in Reunion Island, France

BACKGROUND

Despite several diagnostic guidelines, Fetal Alcohol Spectrum Disorders (FASDs) remain underdiagnosed or misdiagnosed, delaying the care of these patients and support for families.

OBJECTIVE

This study aims to help professionals caring for these children and their families to suspect this diagnosis earlier and to provide the most appropriate follow-up.

METHODS

A retrospective chart review with monocentric recruitment was performed at the Genetics Unit of the University Hospital of Reunion Island. A total of 147 children and adolescents with FASDs were included.

RESULTS

Prenatal alcohol exposure was associated with paternal alcohol consumption in 42.9%, and a high rate of prematurity (33.3%) was observed. Sixty percent of children or adolescents were placed in foster families. Learning difficulties without cognitive deficits were found in 65.8% of cases (50/76). Postural control and fine motor skills disabilities were described, respectively, in 54.7% (35/64) and 72.5% (50/69) of cases. A systematic genetic assessment was carried out, identifying in these FASD patients an associated Copy Number Variation (CNVs) in 22.6% of cases.

CONCLUSION

Children with FASDs combine significant vulnerabilities, associating exposure to alcohol during the preconception and/or the prenatal period, prematurity, complex familial and sociocultural living conditions, and a genetic anomaly in almost a quarter of cases.

The longitudinal assessment of prenatal cannabis use on neonatal outcomes

OBJECTIVE

To investigate the association between prenatal cannabis use and perinatal outcomes using longitudinal data from pregnant individuals.

STUDY DESIGN

This secondary-data analysis study utilized data collected from 894 pregnant individuals followed in the Stress in Pregnancy longitudinal study, conducted between 2009 and 2013. The status of cannabis use was ascertained through interviews and electronic medical record reviews to evaluate the effect of cannabis use on perinatal outcomes (NICU admission, preterm delivery, low birth weight, fetal death).

RESULTS

Among participants analyzed, 13.1% used cannabis, who were generally younger (25.9 vs 27.9 years). There was a sevenfold increased risk of fetal death (OR 7.30) among cannabis users relative to non-users. Elevated risk persisted after adjustments of potential confounders (aOR 6.31). Adjusted models also suggested increased low birth weight risk (aOR 1.67).

CONCLUSION

This study highlights an association between prenatal cannabis use and elevated risks for fetal death and low birth weight.

Impact of Exogenous Factors and Anesthetic Risk in Premature Birth during the Pandemic Period

BACKGROUND

Premature birth remains a public health problem worldwide, involving a broader context and a multidisciplinary team aimed at combating this phenomenon as much as possible. The consumption of addictive substances by women who are pregnant can occur in different social contexts and at different stages of their lives, which modulate its extent. Obstetricians and anesthetists should consider the anesthetic maternal risks that may arise due to these addictive behaviors. The maternal anesthetic risk is higher in women who are pregnant with a medium-level of education, imbalanced nutrition, stress associated with physical or mental activity, affected sleep hygiene, and failed marriages.

OBJECTIVES

The objectives of the study refer to analyzing the impact of exogenous factors and the anesthetic risk on premature birth for women who were pregnant during the pandemic period and in women who were pregnant without COVID-19 infection. The authors studied a significant sample of 3588 women who were pregnant without COVID-19 infection, among whom 3291 gave birth at term and 297 gave birth prematurely.

METHODS

The methods analyzed consist of studying the specialized literature regarding the impact of exogenous factors and parturient's anesthetic risk on premature birth and identifying the regional risk profile of women who are pregnant in the southeast region of Romania compared to that identified in the specialized literature. In the analytical methods, we used a linear regression to study the incidence of exogenous risk factors on anesthetic risk in women who were pregnant with premature births compared to those with full-term births.

RESULTS

The results confirm the significant impact of exogenous factors on anesthetic risk and the significant impact of anesthetic risk on premature births. The novelty of the study lies in highlighting the modification of the regional exogenous risk profile during the pandemic period in southeast Romania due to unfavorable socio-economic causes and the translation of grade I and II prematurity events to higher frequencies with an increased level of maternal anesthetic risk.

CONCLUSIONS

The study findings show that the anesthetic risk is maximized in parturients with a middle school education. Additionally, the anesthetic risk of patients who are pregnant increases with the intensification of smoking adherence and its maintenance throughout the pregnancy at the same intensity. Our study aims to provide a basis for the diversification and development of community intervention programs in the post-COVID-19 era, considering the reshaping of social models and the repositioning of social principles and values. Obstetricians and anesthetists must know and promote family values to harmonize the lives of family members and provide a better life for the mother and child.

Digital health utilization during pregnancy and the likelihood of preterm birth

Objective

Given the complex nature of preterm birth, interventions to reduce rates of preterm birth should be multifaceted. This analysis aimed to explore the association between the duration of using Maven, a digital health platform for women's and family health, and the odds of preterm birth.

Methods

Data came from 3326 pregnant, nulliparous Maven users who enrolled in Maven during their pregnancy between January 2020 and September 2022. Chi-square and Fisher's exact tests compared characteristics between users who developed gestational conditions and users who did not. This retrospective cohort study used logistic regression models to estimate the association between the duration of Maven use and odds of preterm birth, stratified by the presence of gestational conditions.

Results

Compared to those without gestational conditions, individuals who developed gestational conditions were more likely to have a preterm birth (8.7% vs. 3.4%; p < 0.001). For every 1 h of Maven use, users experienced a 2% reduction in their odds of experiencing a preterm birth [adjusted odds ratio (AOR) (95% confidence interval (CI)) = 0.98 (0.95, 0.998), p = 0.04]. Among individuals who developed gestational conditions, every 1 h increase in Maven use was associated with a 5% reduction in the odds of experiencing a preterm birth [AOR (95% CI) = 0.95 (0.91, 0.99), p = 0.037]. There was no statistically significant association between Maven use and preterm birth in individuals without gestational conditions.

Conclusion

Among those who developed gestational conditions, use of a digital health platform was associated with a decreased likelihood of preterm birth.

Fetal alcohol spectrum disorders

Alcohol readily crosses the placenta and may disrupt fetal development. Harm from prenatal alcohol exposure (PAE) is determined by the dose, pattern, timing and duration of exposure, fetal and maternal genetics, maternal nutrition, concurrent substance use, and epigenetic responses. A safe dose of alcohol use during pregnancy has not been established. PAE can cause fetal alcohol spectrum disorders (FASD), which are characterized by neurodevelopmental impairment with or without facial dysmorphology, congenital anomalies and poor growth. FASD are a leading preventable cause of birth defects and developmental disability. The prevalence of FASD in 76 countries is >1% and is high in individuals living in out-of-home care or engaged in justice and mental health systems. The social and economic effects of FASD are profound, but the diagnosis is often missed or delayed and receives little public recognition. Future research should be informed by people living with FASD and be guided by cultural context, seek consensus on diagnostic criteria and evidence-based treatments, and describe the pathophysiology and lifelong effects of FASD. Imperatives include reducing stigma, equitable access to services, improved quality of life for people with FASD and FASD prevention in future generations.

Cigarette smoking during pregnancy and adverse perinatal outcomes: a cross-sectional study over 10 years

BACKGROUND

It has been shown that active exposure to tobacco is associated with adverse pregnancy outcomes including, but not limited to, intrauterine fetal death, reduced fetal weight, and higher risk of preterm birth. We want to investigate these effects in a high-income country.

METHODS

This cross-sectional study examined 20,843 pregnant women who delivered over 10 years at the Maternity Hospital of the Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland. The objective was to evaluate a dose-response relationship between daily cigarette use during pregnancy and possible adverse perinatal outcomes. The social and clinical characteristics as well as obstetric and neonatal outcomes were compared between the smoking and the non-smoking groups. Adjusted odds ratios (aOR) and trend analyses (p_trend) were calculated.

RESULTS

Nineteen thousand five hundred fifty-four pregnant women met the inclusion criteria and 2,714 (13.9%) of them were smokers. Even after adjusting for confounding factors, smoking during pregnancy was associated with preterm birth, birthweight < 2500 g, intrauterine growth restriction, neonatal respiratory and gastrointestinal diseases, transfer to the neonatal intensive care unit, and neonatal intensive care unit admissions > 7 days. Intrauterine death and neonatal infection were associated with heavy smoking (≥ 20 cigarettes/day). Smoking appeared to be a protective factor for pre-eclampsia and umbilical cord arterial pH below 7.1. A significant trend (p_trend < 0.05) was identified for preterm birth, intrauterine growth restriction, birthweight < 2500 g, umbilical cord arterial pH below 7.1, transfers to our neonatal intensive care unit, and neonatal intensive care unit admissions more than 7 days.

CONCLUSION

Cigarette smoking is associated with several adverse perinatal outcomes of pregnancy with a dose-dependent effect.

Responding to the Unique Complexities of Fetal Alcohol Spectrum Disorder

Fetal alcohol spectrum disorder (FASD) is a multifaceted disability, characterized not only by brain- and body-based challenges, but also high rates of environmental adversity, lifelong difficulties with daily living, and distinct sociocultural considerations. FASD is one of the most common neurodevelopmental disabilities in the Western world and associated with significant social and economic costs. It is important to understand the complexities of FASD and the ways in which FASD requires unique consideration in research, practice, and policy. In this article, we discuss our perspectives on factors that distinguish FASD from other disabilities in terms of complexity, co-occurrence, and magnitude. We provide an overview of select literature related to FASD as a socially rooted disability with intergenerational impacts and multiple layers of stigma. These social issues are intertwined with notable experiences of adversity across the lifespan and high rates of co-occurring health concerns for individuals with FASD, all of which present unique challenges for individuals, caregivers, families, service providers, and policy makers. Understanding these factors is the first step in developing and implementing specialized initiatives in support of positive outcomes for individuals with FASD and their families. Future directions are proposed for advancing research, practice, and policy, and responding to the unique complexities of FASD.

Why do women consume alcohol during pregnancy or while breastfeeding?

Issue

Alcohol consumption during pregnancy and breastfeeding cause adverse health outcomes to the mother and child, including Fetal Alcohol Spectrum Disorder (FASD).

Approach

Systematic literature review and thematic synthesis. Original studies that contained reasons for alcohol consumption in pregnancy and while breastfeeding were included. The Mixed Methods Appraisal Tool (MMAT) and the Confidence in the Evidence of Reviews of Qualitative Research (CerQUAL) approach were utilised. The review protocol is available on PROSPERO (registration number: CRD42018116998).

Key Findings

Forty‐two eligible studies comprising women from 16 countries were included. Most commonly reported reasons of alcohol use in pregnancy were societal pressure and the belief that only “strong” alcohol and alcohol in large quantities is harmful. Other reasons were: a lack of awareness of adverse effects on the fetus; coping with adverse life experiences; consumption based on intuitive decision‐making and influenced by personal/peer experiences; belief in the beneficial properties of alcohol; advice from medical practitioners; unwanted or unplanned pregnancy; alcohol dependence; and consumption as a cultural/traditional custom. Reasons for alcohol use during breastfeeding included the belief that alcohol stimulates breast milk production, unclear advice from medical practitioners, unawareness of the risks of infant exposure and to improve mood and celebrate events.

Implications

Understanding the context of reasons for alcohol use in pregnancy is crucial for implementing prenatal health education, and preventing FASD and other adverse maternal and child health outcomes.

Conclusion

Individual beliefs, knowledge/advice, culture and personal circumstances influence alcohol use in pregnancy. Data are limited for reasons surrounding alcohol use while breastfeeding.

The effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes among pregnant women attending antenatal care at public health facilities in Gondar town, Northwest Ethiopia: a prospective cohort study

BACKGROUND

The teratogenic effect of fetal alcohol exposure may lead to actual and potential problems, instantly after birth, at infancy; or even later, and mental impairment in life. This study aimed to investigate the effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes at Gondar town public health facilities, Northwest Ethiopia.

METHODS

A facility-based prospective cohort study was performed among 1778 pregnant women who were booked for antenatal care in selected public health facilities from 29 October 2019 to 7 May 2020 in Gondar town. We used a two-stage random sampling technique to recruit and include participants in the cohort. Data were collected using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) standardized and pre-tested questionnaire. Multivariable analysis was performed to examine the association between reported prenatal alcohol exposure (non-hazardous and hazardous) and interested adverse birth outcomes using log-binomial regression modeling. The burden of outcomes was reported using the adjusted risk ratio and population-attributable risk (PAR).

RESULTS

A total of 1686 pregnant women were included in the analysis, which revealed that the incidences of low birth weight, preterm, and stillbirth were 12.63% (95% CI: 11.12, 14.31), 6.05% (95% CI: 5.00, 7.29) and 4.27% (95% CI: 3.4, 5.35), respectively. Non-hazardous and hazardous alcohol consumption during pregnancy was significantly associated with low birth weight (ARR = 1.50; 95% CI: 1.31, 1.98) and (ARR = 2.34; 95% CI: 1.66, 3.30), respectively. Hazardous alcohol consumption during pregnancy was also significantly associated with preterm birth (ARR = 2.06; 95% CI: 1.21, 3.52). The adjusted PAR of low birth weight related to non-hazardous and hazardous alcohol drinking during pregnancy was 11.72 and 8.44%, respectively. The adjusted PAR of hazardous alcohol consumption was 6.80% for preterm.

CONCLUSIONS

Our findings suggest that there is an increasing risk of adverse birth outcomes, particularly preterm delivery and low birth weight, with increasing levels of alcohol intake. This result showed that the prevention of maternal alcohol use during pregnancy has the potential to reduce low birth weight and preterm birth. Hence, screening women for alcohol use during antenatal care visits and providing advice with rigorous follow-up of women who used alcohol may save the fetus from the potential risks of adverse birth outcomes.