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Tim Van Mieghem – Gynecologie Verloskunde – UZ Leuven
Alcohol in de zwangerschap: mag 1 glaasje?
In 2009 dronk de Belg gemiddeld 8,1 liter pure alcohol. Dat kwam neer op 81 liter bier, 25 liter wijn en 3,4 liter sterkedrank
Epidemiologie
Alcohol en fertiliteit
• abnormal spermatozoa• decrease seminal fluid• increased leucocyte count• hypotestosteronemia
• higher estradiol and estrone• decreased progesterone?• more anovulation
Alcohol en fertiliteit
Chiodo et al. Alcohol 2012
simple diffusionfetal concentration = maternal concentration
Fetal alcohol syndrome
• growth restriction• microcephaly• developmental delay• ADHD
Neuroimaging in FAS
• cerebellar hypoplasia• migration disorders• gray matter density• (partial) agenesis corpus callosum
Fertility in offspring
Ramlau-Hansen Hum Reprod 2010
FAS
pFASARBD
ARNDSubtle
How much is too much?
May et al. 2013
Especially bingeingassociated with
dysmorphology andcognitive dysfunction
N = 357 – case control
N=607 – prospective cohortAlcohol Clin Exp Res 2013
• low doses matter• duration !• total daily volume• binge no effect
BJOG 2013
strengths and difficulties questionnaire reading maths
<1-2 units / day or per occasion
N = 10 534
BJOG 2012
no statistically significant effect from average weekly
alcohol consumption or binge drinking
N = 1628 - Denmark
Binge drinking?al
coho
l int
ake
weekdayal
coho
l int
ake
weekday
Obstetric outcomes
BJOG 2011
• low birthweight OR 1.12 (1.04 - 1.20)• small for gestation OR 1.11 (0.95 - 1.30)• preterm birth OR 1.03 (0.91 - 1.16)
low birthweight preterm birthSGA
Dose – response curve
BJOG 2011
Obstet Gynecol 2013
N = 5628
no impact of drinking < 15 weeks on SGA, PET, Preterm birth
It can’t be that easy…
Best GEEN alcoholmaar als je toch drinkt:niet meer dan 1-2 units 1-2x/week
Best GEEN alcoholmaar als je toch drinkt:niet meer dan 1 glas/dag niet elke dag
Borstvoeding
Alcohol content melk = bloed
1 pintje (5%) -> 0.25‰ bloed = 1/200ste
250 mL melk = 1/200ste pintje
Correctie lichaamsgewicht≈
Volwassene 1/20ste pintje (12 mL)
Prevention
- screen: 70% unrecognized- TWEAK / ACE-T / 4P - prepregnancy diagnosis- prepregnancy intervention- public health
Summary
• hoge dosis alcohol is teratogeen• mag 1 glaasje ??• no alcohol is safest• borstvoeding ???• prevention: public health strategies
Pregnancy outcome alcohol
Gundogan et al, Placenta 2008
• reduced placental thickness• placental necrosis• less trophoblast giant cells• less arterial transformation
