Alcohol and pregnancy: policy, classification and fetal effects

Research output: ThesisDoctoral Thesis

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Abstract

[Truncated abstract] To date, there has been inconsistent and unclear evidence about the relationship between prenatal alcohol exposure (PAE) and fetal effects. The aims of this thesis were to examine alcohol and pregnancy policies, to develop a new method of alcohol classification by taking into account dose, pattern and timing of exposure ("composite" method), and to examine the association between PAE and fetal outcomes; fetal growth, preterm birth, birth defects, language delay and child behaviour(s). Government policies and guidelines on alcohol and pregnancy in English-speaking nations and Australian jurisdictions and organisations were reviewed. The data for the analytical components of the thesis are from a cohort study undertaken previously, linked to data from the Western Australia (WA) Midwives Notification System, and Birth Defects Registry, thereby providing a unique dataset. (The cohort comprised a randomly selected, population-based cohort of non-Indigenous women giving birth to a live infant in WA between 1995 and 1997 (n=4714). A 70% random sample of the 1995-96 cohorts was then invited to participate in an 8-year longitudinal survey. The response rate at year 1 was 78% n=2,224; 85% were followed-up at two-years, 73% (five-years), 61% (eight-years)). Data were collected 3-months postpartum using self-administered questionnaires that assessed maternal alcohol consumption for the three months before and in each trimester during pregnancy. ... Low levels of prenatal alcohol exposure were not associated with any of the outcomes examined. Binge drinking once to twice per week or less frequently in late pregnancy non-significantly increased the odds of language delay (adjusted Odds ratio (aOR) 3.00; 95% CI 0.90-9.93). A higher percentage of small for gestational age infants were found following heavy PAE, however results were attenuated after adjusting for covariates. Moderate and higher levels of PAE increased the odds of preterm birth for the offspring of the women who ceased drinking prior to the second trimester (aOR 1.78; 95% CI 1.01-3.14). Moderate PAE increased the odds of anxiety/depression among children (aOR 2.02; 95% CI 1.07-3.83). Heavy PAE in first trimester increased the odds of Alcohol Related Birth Defect (ARBD) (aOR 4.57; 95% CI 1.46-14.26), anxiety/depression (aOR 2.74; 95% CI 1.10-6.80) and somatic complaints (aOR 2.60; 95% CI 1.41-4.78). The odds of aggressive behaviour(s) following late pregnancy heavy alcohol exposure were elevated but imprecise, due to small numbers. Compared with the "composite" method, the effects of moderate and binge levels of PAE were not found when traditional classifications of PAE were applied. The "composite" measure of classifying maternal alcohol consumption takes into account the dose, pattern, and timing of PAE and more realistically classifies alcohol exposure. Low levels of PAE were not associated with any of the fetal effects examined in this thesis. The risk of poor fetal and child development outcomes increased following moderate and heavy PAE. Routine screening of women of childbearing age and pregnant women for alcohol use and recording of this information would enable better monitoring and evaluation of fetal effects.
Original languageEnglish
QualificationDoctor of Philosophy
Publication statusUnpublished - 2009

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