Alcohol Consumption in Pregnant Women and the Outcome of Pregnancy M. Kaminski, C. Rumeau, and D. Schwartz This article presents the results of a study of the outcome of pregnancy and its relationship to alcohol use. The results are based on a prospective investigation of more than 9000 births.
number in the sample was 9236. Not all information was available on all women, however, so the number of subjects may vary depending on the variable being considered.
M
Alcohol Consuniption and the Outcome of Pregnancy
ANY epidemiologic investigations have been undertaken to study the role of multiple risk factors during pregnancy, especially the use of tobacco and of other drugs. But few of them have taken account of a drug used widely in the world-alcohol, as stressed in the report Alcohol and H e a l t h , ' and Green's review.' Here, w e present the results of a study of the outcome of pregnancy and its relationship to alcohol use. The results are based on a prospective investigation of more than 9000 births. MATERIALS AND METHODS This work is based on data collected in a prospective investigation at 12 maternity hospitals of Paris and at the Foundation Foch (Foch Foundation), by the Section Maternite-Pidiatrie and I'Unite de Recherches Statistiques (Maternity-Pediatric Section and Statistical Research Unit) of INSERM, from 1963 to 1969. The principal aim of the investigation was the study of the etiology of congenital malformations, and its protocol has been described previously.3 For this study, 18,275 women were interviewed in detail and examined during the first trimester of pregnancy; there was also a report of the delivery and of the infant at birth and during the first 6 days of life. In the interview, information was obtained on the sub jects' prepregnancy drinking habits and on alcohol use after conception. These data included the number of liters of wine, beer, and cider drunk per week, but not alcohol in the form of "aperitifs" or "digestifs."* For this analysis. total alcohol consumption has been evaluated and expressed in liters of wine (at I I % ethanol). Data are for consumption since the beginning of pregnancy only. Only women who delivered in the participating hospitals have been included in the analysis. Excluded were 551 1 women who delivered elsewhere or who aborted; for purposes of homogeneity, 3483 women born outside of France were also excluded. Alcohol consumption was unknown in an additional 45 cases, which were also excluded. The final
,
*Translators' note: These are essentially before and after dinner drinks. The "digestif," or after-dinner drink, is usually brandy or some liqueur. The "aperitif," or beforedinner drink, is often Pernod, port wine, or whiskey. The aperitif is not a substitute for a "cocktail"; the American cocktail is a curiosity in France. Aperitifs, digestifs, and other beverages with high ethanol content probably account for a minor part of the alcohol consumption of French females.
RESULTS
For the first part of the analysis, subjects have been divided into two groups: those consuming less than or equal to 40 cl wine per day at 1 1 % alcohol ( N = 8727), and those consuming more than 40 cl per day (A'= 509).t In the second part of the analysis, additional subdivisions will be made. Table 1 shows that women consuming over 40 cl of wine daily had an excess of stillbirths: 2.6% compared to 1.0% for the lighter drinking groups ( p 5 O . O O l ) . They also had more smallfor-date infants: 4.8% had infants below the third percentile in weight as compared to 2.5% (p ~0.01).In addition, mean birth weight of children born to the heavier drinkers was lower: 3255 g compared to 3313 g for infants of lighter drinkers ( p 10.05). Similarly, the mean weight of the placentae for heavier drinkers was 589 g as compared to 611 g ( p 10.01) for lighter drinkers. On the other hand, there was no apparent difference between the two groups with respect to rates of congenital malformations, neonatal mortality, or prematurity, nor was there a difference in mean gestational age of their infants. There was no relationship between al+Translators' note: 40 cl of wine is equivalent to about 1.6 oz absolute alcohol. From rhe Unite d e Recherches Statisriques d e I'INSERM. Villejuif and the Section Marernitt-Ptdiatrie deI'INSERM, Le Vivinet. France. Originally published in La Revue d'EpidCmiologie et d e S a n t t Publique 24:27-40, 1976. An ourhorized rranslation by Ruth E. Little, Sc.D., Departmenr of Psychiatry and Behavioral Sciences and Departmenr of Epidemiology and A. Schinzel, M.D., Dvsmorphology Unit. Deparrment of Pediatrics, University of Washington, Seattle, Wash. Reprint requests should be addressed 10 Ruth E. Lirrle. Sc. D.. Deparrmenr of Psychiatry and Behavioral Sciences (GI-80). Universiry of Washington. Seartle. Wash. 98/95, gj 1978 by Grune di Stratton. Inc. 0145-6008/78/0202-0023$0l.00/0
Alcoholism: Clinical and Experimental Research, Vol. 2 , No. 2 (April). 1978
155
156
KAMINSKI, RUMEAU. AND SCHWARTZ
Table 1. Outcome of Pregnancy by Maternal Alcohol Consumption Consumption Equivalent to CIWine per Day' ~
Pregnancy Outcome Stillbirth rate (per 1OOO) Congenital malformations (per 1000)
5 40
>40
Significance
9.9 (8727) 17.2 (8727)
25.5 1509) 13.8 (509)
p 5 0.001
After exclusion of twins, stillbirths, and congenital malformations: Neonatalmortality (per 1000) 8.1
(8414) 7.0 (5302) 279.1 (5302) 3313 (8412) 2.5 (7644) 8.8 (8058) 61 1 14974)
Prematurity (5 36 wk: per 100) Mean gestational age (days) Mean birth weight (9) Birth weight 5 third percentile for gestational age (per 100) Birth weight 5 tenth percentile for gestational age (per 100) Mean placental weight (g)
10.2 (489) 6.2
-
(273) 279.2
-
(273) 3255 (489) 4.8 (496) 12.6 (446) 589 (236)
P 5 01.05 p
_
number in the sample was 9236. Not all information was available on all women, however, so the number of subjects may vary depending on the variable being considered.
M
Alcohol Consuniption and the Outcome of Pregnancy
ANY epidemiologic investigations have been undertaken to study the role of multiple risk factors during pregnancy, especially the use of tobacco and of other drugs. But few of them have taken account of a drug used widely in the world-alcohol, as stressed in the report Alcohol and H e a l t h , ' and Green's review.' Here, w e present the results of a study of the outcome of pregnancy and its relationship to alcohol use. The results are based on a prospective investigation of more than 9000 births. MATERIALS AND METHODS This work is based on data collected in a prospective investigation at 12 maternity hospitals of Paris and at the Foundation Foch (Foch Foundation), by the Section Maternite-Pidiatrie and I'Unite de Recherches Statistiques (Maternity-Pediatric Section and Statistical Research Unit) of INSERM, from 1963 to 1969. The principal aim of the investigation was the study of the etiology of congenital malformations, and its protocol has been described previously.3 For this study, 18,275 women were interviewed in detail and examined during the first trimester of pregnancy; there was also a report of the delivery and of the infant at birth and during the first 6 days of life. In the interview, information was obtained on the sub jects' prepregnancy drinking habits and on alcohol use after conception. These data included the number of liters of wine, beer, and cider drunk per week, but not alcohol in the form of "aperitifs" or "digestifs."* For this analysis. total alcohol consumption has been evaluated and expressed in liters of wine (at I I % ethanol). Data are for consumption since the beginning of pregnancy only. Only women who delivered in the participating hospitals have been included in the analysis. Excluded were 551 1 women who delivered elsewhere or who aborted; for purposes of homogeneity, 3483 women born outside of France were also excluded. Alcohol consumption was unknown in an additional 45 cases, which were also excluded. The final
,
*Translators' note: These are essentially before and after dinner drinks. The "digestif," or after-dinner drink, is usually brandy or some liqueur. The "aperitif," or beforedinner drink, is often Pernod, port wine, or whiskey. The aperitif is not a substitute for a "cocktail"; the American cocktail is a curiosity in France. Aperitifs, digestifs, and other beverages with high ethanol content probably account for a minor part of the alcohol consumption of French females.
RESULTS
For the first part of the analysis, subjects have been divided into two groups: those consuming less than or equal to 40 cl wine per day at 1 1 % alcohol ( N = 8727), and those consuming more than 40 cl per day (A'= 509).t In the second part of the analysis, additional subdivisions will be made. Table 1 shows that women consuming over 40 cl of wine daily had an excess of stillbirths: 2.6% compared to 1.0% for the lighter drinking groups ( p 5 O . O O l ) . They also had more smallfor-date infants: 4.8% had infants below the third percentile in weight as compared to 2.5% (p ~0.01).In addition, mean birth weight of children born to the heavier drinkers was lower: 3255 g compared to 3313 g for infants of lighter drinkers ( p 10.05). Similarly, the mean weight of the placentae for heavier drinkers was 589 g as compared to 611 g ( p 10.01) for lighter drinkers. On the other hand, there was no apparent difference between the two groups with respect to rates of congenital malformations, neonatal mortality, or prematurity, nor was there a difference in mean gestational age of their infants. There was no relationship between al+Translators' note: 40 cl of wine is equivalent to about 1.6 oz absolute alcohol. From rhe Unite d e Recherches Statisriques d e I'INSERM. Villejuif and the Section Marernitt-Ptdiatrie deI'INSERM, Le Vivinet. France. Originally published in La Revue d'EpidCmiologie et d e S a n t t Publique 24:27-40, 1976. An ourhorized rranslation by Ruth E. Little, Sc.D., Departmenr of Psychiatry and Behavioral Sciences and Departmenr of Epidemiology and A. Schinzel, M.D., Dvsmorphology Unit. Deparrment of Pediatrics, University of Washington, Seattle, Wash. Reprint requests should be addressed 10 Ruth E. Lirrle. Sc. D.. Deparrmenr of Psychiatry and Behavioral Sciences (GI-80). Universiry of Washington. Seartle. Wash. 98/95, gj 1978 by Grune di Stratton. Inc. 0145-6008/78/0202-0023$0l.00/0
Alcoholism: Clinical and Experimental Research, Vol. 2 , No. 2 (April). 1978
155
156
KAMINSKI, RUMEAU. AND SCHWARTZ
Table 1. Outcome of Pregnancy by Maternal Alcohol Consumption Consumption Equivalent to CIWine per Day' ~
Pregnancy Outcome Stillbirth rate (per 1OOO) Congenital malformations (per 1000)
5 40
>40
Significance
9.9 (8727) 17.2 (8727)
25.5 1509) 13.8 (509)
p 5 0.001
After exclusion of twins, stillbirths, and congenital malformations: Neonatalmortality (per 1000) 8.1
(8414) 7.0 (5302) 279.1 (5302) 3313 (8412) 2.5 (7644) 8.8 (8058) 61 1 14974)
Prematurity (5 36 wk: per 100) Mean gestational age (days) Mean birth weight (9) Birth weight 5 third percentile for gestational age (per 100) Birth weight 5 tenth percentile for gestational age (per 100) Mean placental weight (g)
10.2 (489) 6.2
-
(273) 279.2
-
(273) 3255 (489) 4.8 (496) 12.6 (446) 589 (236)
P 5 01.05 p
_
