Alcohol in de zwangerschap: mag 1 glaasje?€¦ · Tim Van Mieghem – Gynecologie Verloskunde – UZ Leuven Alcohol in de zwangerschap: mag 1 glaasje? In 2009 dronk de Belg gemiddeld

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

Dank U!

[email protected]

Pregnancy outcome alcohol

Gundogan et al, Placenta 2008

• reduced placental thickness• placental necrosis• less trophoblast giant cells• less arterial transformation