Alcohol Consumption Prior to Conception Raises Congenital Heart Disease Risk

Aspiring parents should both avoid alcohol consumption prior to conception to protect against congenital heart defects for both their baby and parents, according to research published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).

Alcohol consumption three months before pregnancy or during the first trimester was associated with a 44% raised risk of congenital heart disease for fathers and 16% for mothers, compared to not drinking. Binge drinking, defined as five or more drinks per sitting, was related to a 52% higher likelihood of these birth defects for men and 16% for women.

‘Binge drinking by would-be parents is a high risk and dangerous behavior that not only may increase the chance of their baby being born with a heart defect, but also greatly damages their own health,’ said study author Dr Jiabi Qin, of Xiangya School of Public Health, Central South University, Changsha, China.

Dr. Qin said the results suggest that when couples are trying for a baby, men should not consume alcohol for at least six months before fertilization while women should stop alcohol one year before and avoid it while pregnant.

Congenital heart diseases are the most common birth defects, with approximately 1.35 million babies affected every year. These conditions can increase the likelihood of cardiovascular disease later life, even after surgical treatment, and are the main cause of perinatal death. Alcohol is a known teratogen and has been connected with fetal alcohol spectrum disorder (FASD). Around one in four children with FASD have congenital heart disease, indicating that alcohol might also be implicated in these disorders.

• A total of 55 studies involving 41,747 CHD cases and 297,587 controls were identified. Overall, both maternal (odds ratio (OR) = 1.16; 95% confidence interval (CI): 1.05–1.27) and paternal (OR = 1.44; 95% CI: 1.19–1.74) alcohol exposures were significantly associated with risk of total CHDs in offspring.
• Additionally, a nonlinear dose-response relationship between parental alcohol exposure and risk of total CHDs was observed. With an increase in parental alcohol consumption, the risk of total CHDs in offspring also gradually increases.
• For specific CHD phenotypes, a statistically significant association was found between maternal alcohol consumption and risk of tetralogy of fallot (OR = 1.20; 95% CI: 1.08–1.33).
• Relevant heterogeneity moderators have been identified by subgroup analysis, and sensitivity analysis yielded consistent results.

Previous studies investigating the link between alcohol and congenital heart disease have focused on prospective mothers, with inconclusive results. This is the first meta-analysis to examine the role of paternal alcohol drinking.

The researchers compiled the best data published between 1991 and 2019, which amounted to 55 studies including 41,747 babies with congenital heart disease and 297,587 without. The analysis showed a nonlinear dose-response relationship between parental alcohol drinking and congenital heart diseases.

Dr Qin said: ‘We observed a gradually rising risk of congenital heart diseases as parental alcohol consumption increased. The relationship was not statistically significant at the lower quantities.’

Regarding specific defects, the study found that compared to abstinence, maternal drinking was correlated to a 20% greater risk of tetralogy of Fallot, a combination of four abnormalities in the heart’s structure.

“The underlying mechanisms connecting parental alcohol and congenital heart diseases are uncertain and warrant further research. Although our analysis has limitations — for example the type of alcohol was not recorded — it does indicate that men and women planning a family should give up alcohol,” said Dr. Qin.

Conclusion / Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, our review indicates that parental alcohol exposures are significantly associated with the risk of CHDs in offspring, which highlights the necessity of improving health awareness to prevent alcohol exposure during preconception and conception periods.

The authors noted that this was an observational study and does not prove a causal effect, nor does it prove that paternal drinking is more harmful to the fetal heart than maternal drinking. The data cannot be used to define a cut-off of alcohol consumption that might be considered safe.

Information from European Society of Cardiology.

Source: Senmao Zhang, Lesan Wang, Tubao Yang, Lizhang Chen, Lijuan Zhao, Tingting Wang, Letao Chen, Ziwei Ye, Zan Zheng, Jiabi Qin. Parental alcohol consumption and the risk of congenital heart diseases in offspring: An updated systematic review and meta-analysis. European Journal of Preventive Cardiology, 2019; 204748731987453 DOI: 10.1177/2047487319874530