Prenatal alcohol exposure and risk of foetal loss

Abstract

Background: Alcohol consumption is one of the most prevalent modifiable risk factors leading to poor pregnancy outcomes (Mpelo et al., 2018). Due to the global increase in alcohol use in women, and an unrelated increase in unplanned pregnancies, the risk of prenatal alcohol exposure (PAE) is on the rise and has been classified as a public health concern (Schölin, 2016). This review aims to investigate the rates of foetal loss associated with PAE. The Research Question: Does alcohol consumption during pregnancy increase the risk of foetal loss? The PEO Elements: The population (P) studied was pregnant women. The exposure (E) was alcohol consumption during pregnancy, and the outcome (O) was foetal loss. Method: The key terms and synonyms related to the research question were identified and combined with Boolean operators and limiters to be searched in 7 health-related databases. The PRISMA checklist (2020) was used to narrow down the search, and articles related to women with alcohol addiction, preconception alcohol use, induced abortions, and in-vitro fertilisation (IVF) studies were excluded. The CASP tool for systematic reviews and meta analyses, and the CASP tool for cohort studies were used to critically appraise the seven identified studies. Results: The identified studies compromised one systematic review and meta-analysis, and six prospective cohort studies. Whilst all the studies concluded that PAE leads to an increase in foetal death, especially during the first trimester, inconsistencies were found in the factors leading to this. Three studies found a dose-related risk of foetal death, with only one study reporting a threshold of 4 drinks per week, after which women were 2.65 times more likely to miscarry. Two studies found that the gestational age at which PAE occurred was the detrimental factor, whilst another reported a frequency-dependent increase in risk of death. The effects of the type of alcohol ingested were researched in two of the studies, with spirits being the most detrimental to the foetus, compared to beer and wine. Conclusion: This review has concluded that whilst there is a definite increase in the rates of foetal death when a pregnant mother is exposed to alcohol, inconsistencies exist regarding the most detrimental factor, including the type of alcohol, amount, frequency, dose, or gestational age at exposure. No amount of alcohol has been consistently proven to be safe so far. Implications and Recommendations: Further research is required, especially locally, and increased awareness and access to education for staff and the public is essential to reduce the rates of PAE. The introduction of a generalised alcohol screening tool is highly recommended during prenatal care visits, for early identification of risky alcohol behaviours and subsequent timely interventions.