1. INDIANA UNIVERSITY BLOOMINGTON D.T. Dibaba MPH, S. Horbal MPH, M. A. Sayegh PhD, MPH Indiana University School of Public Health- Bloomington Department of Epidemiology and Biostatistics Bloomington, IN USA The association between maternal alcohol intake during pregnancy and the risk of intrauterine growth restriction, low birth weight, preterm birth and small for gestational age: A Meta-analysis

2. INDIANA UNIVERSITY BLOOMINGTON  The prevalence of alcohol use during pregnancy in the USA is about 12.5%, in 2011.  (CDC, 2012).  Maternal alcohol use during pregnancy is one of the major risk factors related with adverse birth outcomes. Introduction

3. INDIANA UNIVERSITY BLOOMINGTON  Conditions related to preterm birth and low birth weight are the second leading cause of infant death (after birth defects).  Mathews T.J. & MacDorman M.F. (2008)  In 2012, 1 of every 9 infant was born premature.  CDC (2014) Introduction

4. INDIANA UNIVERSITY BLOOMINGTON  Inconsistent epidemiological research findings  Chen J.H. (2012), Kesmodel U. et al( 2000), McCarthy F.P. et al (2013), Pfinder M. et al (2013), Patra et al (2011  No other recent meta-analysis on the association between drinking of different levels and the risk of IUGR, LBW, preterm birth or SGA separately  New studies have been conducted since previous meta- analyses Background

5. INDIANA UNIVERSITY BLOOMINGTON  Investigate the association of alcohol intake by category (moderate, and heavy intake) during pregnancy with risk of IUGR, LBW, preterm birth and SGA birth by doing meta-analyses of original studies Objective

6. INDIANA UNIVERSITY BLOOMINGTON  Drinking  Abstinent: no alcoholic drink during pregnancy  Light drinking: <1 drink/day or <5 drinks/week  Moderate drinking : 1 drink/day or 5-7 drinks/week  Heavy drinking: ≥3 drinks/day or >7 drinks/week Methods: Measures

7. INDIANA UNIVERSITY BLOOMINGTON  Outcomes  LBW: birth weight<2500g  SGA: birth weight <10 th percentile of babies with the same gestational age  IUGR: birth weight<10 th percentile for birth weight and <2.5 th percentile for abdominal circumference  Preterm: birth<37 th weeks of gestation Methods: Measures

8. INDIANA UNIVERSITY BLOOMINGTON  Searched online original studies indexed in PubMed, ScienceDirect, and Google Scholar  Used key words and medical subject headings  Retrieved additional articles through hand search of reference lists in relevant articles Methods: Literature Search

9. INDIANA UNIVERSITY BLOOMINGTON  Used  Fixed and random effects meta-analysis models in STATA to pool OR and 95%CIs.  Used I 2 to assess heterogeneity  Used Egger’s test and funnel plot to assess publication bias Methods: Analysis

10. INDIANA UNIVERSITY BLOOMINGTON  A total of 208,519 mother-infant dyads including:  89,763 participants from 7 cohort studies  9,262 from 5 case-control studies, and  109,494 participants from 8 cross-sectional studies Results

11. INDIANA UNIVERSITY BLOOMINGTON In the cohort studies, compared to abstainers, heavy alcohol intake during pregnancy is directly associated with increased risk of preterm birth. Results

12. INDIANA UNIVERSITY BLOOMINGTON  In cohort studies, heavy alcohol intake is not significantly associated with the following outcomes:  IUGR, OR = 1.14 (0.48, 2.70)  LBW, OR = 1.51 (0.67, 3.39)  SGA, OR = 0.95 (0.59, 1.53 ) Results

13. INDIANA UNIVERSITY BLOOMINGTON Heavy alcohol intake is directly associated with the risk of LBW in cross-sectional studies. Results

14. INDIANA UNIVERSITY BLOOMINGTON Results In case-control studies, moderate alcohol intake is inversely associated with risk of SGA.

15. INDIANA UNIVERSITY BLOOMINGTON  In case-control studies, moderate alcohol intake is inversely associated with risk of preterm birth.  OR = 0.80 (0.66, 0.97)  In cross-sectional studies, moderate alcohol intake showed borderline inverse association with risk of low birth weight and preterm birth.  LBW, OR = 0.87 (0.75, 1.02)  Preterm birth, OR = 0.89 (0.78, 1.02) Results

16. INDIANA UNIVERSITY BLOOMINGTON  Heavy alcohol intake during pregnancy is directly associated with risk of LBW and preterm birth.  While analyses showed an association between moderate alcohol intake and lowered risk of preterm birth and SGA, these results do not indicate that pregnant women should consume alcohol in any quantity, but only indicate associations that need to be investigated further.  Future studies are needed to understand the effect of moderate and light alcohol intake during pregnancy and adverse birth outcomes. Conclusion

17. INDIANA UNIVERSITY BLOOMINGTON  Thank you!  Questions?  Email: dtdibaba@indiana.edudtdibaba@indiana.edu The End!