Poster Presentation Women's Health Forum 2021

The effects of prenatal alcohol consumption on placental outcomes: a systematic review of clinical studies (#65)

Sarah E Steane 1 , Sophia L Young 1 2 , James SM Cuffe 1 , Vicki L Clifton 3 , Lisa K Akison 1 2 , Linda A Gallo 1 , Karen M Mortiz 4
  1. School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia
  2. Child Health Research Centre, The University of Queensland, St Lucia, QLD, Australia
  3. Mater Medical Research Institute, The University of Queensland, Woolloongabba, QLD, Australia
  4. Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia

Background:

Fetal alcohol spectrum disorder (FASD) describes life-long disabilities, including neurodevelopmental and physical abnormalities, resulting from prenatal alcohol exposure (PAE). PAE is also associated with increased risk of miscarriage, stillbirth, preterm birth and low birthweight. However, there has been relatively little clinical research on the effect of PAE on placental morphology or function, which potentially mediate these pregnancy and fetal complications.

 

Objective: 

To summarise current clinical data investigating the relationship between PAE and placental outcomes using a systematic review and meta-analyses. 

 

Methods:

A literature search was conducted across five bibliographic databases (PubMed, EMBASE, Cochrane, Web of Science and CINAHL) from inception to November 2020. Inclusion criteria were a) studies of human placentas, b) exposure to alcohol during pregnancy, c) comparison with a control group and d) published in English.

 

Results:

Thirty-three studies satisfied the inclusion criteria and examined the impact of PAE on placentation, placental weight, morphology and/or function. There were sufficient studies reporting adjusted odds ratios for abruption and previa to allow meta-analyses of these outcomes, indicating that PAE significantly increased the odds of placental abruption (P<0.00001) but not placenta previa (P=0.39). There was also evidence to suggest that PAE altered placental morphology/vasculature (6 studies) and molecular function (10 studies), using a narrative synthesis. Only studies examining high-dose PAE reported effects on placental weight, with an ~50g reduction compared to controls (P=0.002).

 

Conclusions:

This evidence suggests PAE alters placental structure and function, which may affect fetal growth and development. Frequency and dose of prenatal alcohol varied considerably amongst the exposure groups in the included studies. Similarly, the control groups ranged from abstinent to low-level alcohol exposure, with the latter potentially resulting in an underestimate of the effects of PAE. Further studies are urgently required, given the paucity of data and the critical role of the placenta in pregnancy outcomes.