Maternal alcohol binge-drinking in the first trimester and the risk of orofacial clefts in offspring: a large population-based pooling study.

Lisa A Deroo,Paul A Romitti,Dorthe Almind Pedersen,Rolv T Lie,Lina M Moreno Uribe,George L Wehby,Ronald G Munger,Allen J Wilcox

doi:10.1007/s10654-016-0171-5

Abstract

Using individual participant data from six population-based case–control studies, we conducted pooled analyses to examine maternal alcohol consumption and the risk of clefts among >4600 infants with cleft lip only, cleft lip with cleft palate, or cleft palate only and >10,000 unaffected controls. We examined two first-trimester alcohol measures: average number of drinks/sitting and maximum number of drinks/sitting, with five studies contributing to each analysis. Study-specific odds ratios (ORs) were estimated using logistic regression and pooled to generate adjusted summary ORs. Across studies, 0.9–3.2 % of control mothers reported drinking an average of 5+ drinks/sitting, while 1.4–23.5 % reported drinking a maximum of 5+ drinks/sitting. Compared with non-drinkers, mothers who drank an average of 5+ drinks/sitting were more likely to deliver an infant with cleft lip only (pooled OR 1.48; 95 % confidence intervals 1.01, 2.18). The estimate was higher among women who drank at this level 3+ times (pooled OR 1.95; 1.23, 3.11). Ever drinking a maximum of 5+ drinks/sitting and non-binge drinking were not associated with cleft risk. Repeated heavy maternal alcohol consumption was associated with an increased risk of cleft lip only in offspring. There was little evidence of increased risk for other cleft types or alcohol measures.

Highlights

Heavy maternal alcohol consumption is associated with fetal alcohol syndrome, characterized by distinctive facial dysmorphology, prenatal and postnatal growth restriction, and central nervous system and neurodevelopmental abnormalities [1]
In 4 out of 5 studies, there was little evidence that mothers who drank an average of 5? drinks per sitting had an increased risk of delivering a child with an orofacial cleft compared with non-drinkers (Table 3)
The I2 values indicated no evidence of heterogeneity between studies in the analyses of cleft lip only and cleft lip with cleft palate (I2 = 0.0 %) and low levels of heterogeneity in the studies of cleft palate only (I2 = 27.8 %) and all clefts combined (I2 = 26.3 %)

Summary

Introduction

Heavy maternal alcohol consumption is associated with fetal alcohol syndrome, characterized by distinctive facial dysmorphology, prenatal and postnatal growth restriction, and central nervous system and neurodevelopmental abnormalities [1]. The association between maternal alcohol consumption and individual congenital malformations, such as orofacial clefts, is less clear [2]. Binge-level drinking, usually defined as 5 or more drinks per sitting [3], may be harmful to fetal development because it exposes the fetus to higher blood alcohol concentrations than does drinking the same amount of alcohol over a longer period of time [4]. The results of epidemiologic studies on alcohol consumption and clefts are difficult to summarize, in part due to differences in alcohol measures and different time points of reference across studies. We conducted a pooled analysis of individual-level data from 6 population-based studies (3 in the United States and 3 in Europe) to examine first-trimester maternal binge-level drinking and the risk of orofacial clefts in offspring

Methods

Results

Conclusion