Alcohol During Pregnancy and Risk of Placenta Previa

Abstract and Introduction

Abstract

The purpose of this study was to examine the association between prenatal alcohol consumption and the occurrence of placental abruption and placenta previa in a population-based sample. We used linked birth data files to conduct a retrospective cohort study of singleton deliveries in the state of Missouri during the period 1989 through 2005 (n = 1,221,310). The main outcomes of interest were placenta previa, placental abruption and a composite outcome defined as the occurrence of either or both lesions. Multivariate logistic regression was used to generate adjusted odd ratios, with non-drinking mothers as the referent category. Women who consumed alcohol during pregnancy had a 33% greater likelihood for placental abruption during pregnancy (adjusted odds ratio (OR), 95% confidence interval (CI) = 1.33 [1.16–1.54]). No association was observed between prenatal alcohol use and the risk of placenta previa. Alcohol consumption in pregnancy was positively related to the occurrence of either or both placental conditions (adjusted OR [95% CI] = 1.29 [1.14–1.45]). Mothers who consumed alcohol during pregnancy were at elevated risk of experiencing placental abruption, but not placenta previa. Our findings underscore the need for screening and behavioral counseling interventions to combat alcohol use by pregnant women and women of childbearing age.

Introduction

Maternal alcohol use during pregnancy is a leading preventable cause of fetal malformations, neurodevelopmental abnormalities and perinatal mortality.^[1–3] One of the pathways by which alcohol is postulated to exert its inhibitory effects on fetal development is via impaired placentation.^[4] The two important placental pathologies include placenta previa and placental abruption, both of which are precursors of perinatal mortality and morbidity. Placental abruption accounts for up to a third of all perinatal deaths,^[5,6] mostly due to its detrimental effects on length of gestation and fetal growth.^[7,8] Similarly, placenta previa is a major contributor to fetal growth restriction, preterm delivery and perinatal mortality.^[9,10]

There is lack of consensus regarding the association between maternal alcohol use and placental abruption. Whereas some published reports suggest a positive association,^[11–14] others do not.^[15] In the case of placenta previa, a lack of association with maternal alcohol use has been the usual finding.^[10,16] Few studies have analyzed the association between prenatal alcohol use and placental abruption and placenta previa together within the same cohort. These two placental pathologies are believed to have a shared etiology,^[14] as mothers with a prior history of placental abruption have an increased predisposition to developing placenta previa in subsequent pregnancies,^[17] and vice versa.^[18,19] In consideration of this common origin theory, we set out to examine the association between prenatal alcohol consumption and the occurrence of placental abruption and placenta previa among a large representative sample of singleton births to mothers in the state of Missouri during the period 1989 through 2005.

Table 1. Comparison of selected socio-demographic characteristics by prenatal drinking status, Missouri, 1989–2005
	Non-drinker (N = 1,205,399)%	Drinker (N = 15,911)%	P-value
Maternal age
≥35 years	9.83	18.47	<0.0001
Parity
Multiparous	58.80	68.66	<0.0001
Race
Black	14.99	21.24	<0.0001
White	82.58	77.54
Education
≥12 years	80.49	78.05	<0.0001
Smoking
Yes	19.42	52.44	<0.0001
Married
Yes	67.84	59.54	<0.0001
Adequate prenatal care
Yes	50.94	39.40	<0.0001

Table 1. Comparison of selected socio-demographic characteristics by prenatal drinking status, Missouri, 1989–2005

Non-drinker (N = 1,205,399)%

Drinker (N = 15,911)%

P-value

Maternal age

≥35 years

9.83

18.47

<0.0001

Parity

Multiparous

58.80

68.66

<0.0001

Race

Black

14.99

21.24

<0.0001

White

82.58

77.54

Education

≥12 years

80.49

78.05

<0.0001

Smoking

Yes

19.42

52.44

<0.0001

Married

Yes

67.84

59.54

<0.0001

Adequate prenatal care

Yes

50.94

39.40

<0.0001

Table 2. Prevalence of common medical/obstetric complications among mothers by prenatal drinking status, Missouri, 1989–2005
	Non-drinker (N = 1,205,399) n (%)	Drinker (N = 15,911) n (%)	P-value
Anemia
Yes	17,420(1.45)	252(1.58)	<0.0029
Insulin-dependent diabetes
Yes	8,862(0.74)	49(0.31)	<0.0001
Other forms of diabetes
Yes	27,363(2.27)	258(1.62)	<0.0001
Chronic hypertension
Yes	11,421(0.95)	119(0.75)	<0.0003
Pre-eclampsia
Yes	55,600(4.61)	473(2.97)	<0.0001
Eclampsia
Yes	1,194(0.10)	10(0.06)	<0.0029
Placental abruption
Yes	9,152(0.76)	197(1.24)	<0.0001
Placenta previa
Yes	4,496(0.37)	86(0.54)	<0.0006

Table 2. Prevalence of common medical/obstetric complications among mothers by prenatal drinking status, Missouri, 1989–2005

Non-drinker (N = 1,205,399) n (%)

Drinker (N = 15,911) n (%)

P-value

Anemia

Yes

17,420(1.45)

252(1.58)

<0.0029

Insulin-dependent diabetes

Yes

8,862(0.74)

49(0.31)

<0.0001

Other forms of diabetes

Yes

27,363(2.27)

258(1.62)

<0.0001

Chronic hypertension

Yes

11,421(0.95)

119(0.75)

<0.0003

Pre-eclampsia

Yes

55,600(4.61)

473(2.97)

<0.0001

Eclampsia

Yes

1,194(0.10)

10(0.06)

<0.0029

Placental abruption

Yes

9,152(0.76)

197(1.24)

<0.0001

Placenta previa

Yes

4,496(0.37)

86(0.54)

<0.0006

Table 3. Adjusted odd ratio for the association between prenatal alcohol ingestion and placenta previa and placental abruption
	Placenta previa (N = 4,582)	Placental abruption (N = 9,349)	Composite outcome (N = 13,718)
Number of cases	Adj. OR (95% CI)^a	Number of cases	Adj. OR (95% CI)	Number of cases	Adj. OR (95% CI)
Non-drinker	N = 4,496	Referent	N = 9,152	Referent	N = 13,439	Referent
Drinker	N = 86	1.19 (0.95–1.47)	N = 197	1.33 (1.16–1.54)	N = 279	1.29 (1.14–1.45)
Class 1 (1–2 drinks/week)	N = 64	1.11 (0.87–1.43)	N = 144	1.28 (1.08–1.51)	N = 205	1.22 (1.06–1.41)
Class 2 (3–4 drinks/week)	N = 11	1.37 (0.76–2.49)	N = 19	1.09 (0.69–1.72)	N = 29	1.15 (0.80–1.67)
Class 3 (≥5 drinks/week)	N = 11	1.58 (0.87–2.86)	N = 34	1.98 (1.40–2.80)	N = 45	1.89 (1.40–2.56)

Table 3. Adjusted odd ratio for the association between prenatal alcohol ingestion and placenta previa and placental abruption

Placenta previa (N = 4,582)

Placental abruption (N = 9,349)

Composite outcome (N = 13,718)

Number of cases

Adj. OR (95% CI)^a

Number of cases

Adj. OR (95% CI)

Number of cases

Adj. OR (95% CI)

Non-drinker

N = 4,496

Referent

N = 9,152

Referent

N = 13,439

Referent

Drinker

N = 86

1.19 (0.95–1.47)

N = 197

1.33 (1.16–1.54)

N = 279

1.29 (1.14–1.45)

Class 1 (1–2 drinks/week)

N = 64

1.11 (0.87–1.43)

N = 144

1.28 (1.08–1.51)

N = 205

1.22 (1.06–1.41)

Class 2 (3–4 drinks/week)

N = 11

1.37 (0.76–2.49)

N = 19

1.09 (0.69–1.72)

N = 29

1.15 (0.80–1.67)

Class 3 (≥5 drinks/week)

N = 11

1.58 (0.87–2.86)

N = 34

1.98 (1.40–2.80)

N = 45

1.89 (1.40–2.56)

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