Although there is a lack of evidence on the impact of alcohol intake specifically upon the incidence of recurrent pregnancy loss (RPL), the detrimental effect of alcohol on embryo development and sporadic miscarriage has been well established.

Introduction

Alcohol is a powerful teratogen, leading to fetal abnormalities that range from low birth weight to severe fetal alcohol syndrome (FAS). Daily alcohol use is nonetheless reported by as many as 1 in 6 pregnant women, making it the most common preventable cause of congenital malformations and intellectual impairment.1 Furthermore, there is a dose-dependent relationship between maternal alcohol consumption and the severity of fetal abnormalities, with evidence showing that doses as low as 1-2 units per week may be harmful.2

Although there is a lack of evidence on the impact of alcohol intake specifically upon the incidence of recurrent pregnancy loss (RPL), the detrimental effect of alcohol on embryo development and sporadic miscarriage has been well established. A recent systematic review of 24 studies including 231,808 pregnant women showed that those exposed to alcohol during pregnancy were more likely to miscarry (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.12 to 1.28). This review also demonstrated that in women consuming 5 or fewer drinks per week, there was a 6% increase in miscarriage risk for each additional drink (OR 1.06, 95% CI 1.01 to 1.10).3

Alcohol consumption has also been shown to negatively affect semen volume and sperm morphology.4 Evidence suggests that male alcohol intake at the time of conception may lead to a fivefold increase in the risk of miscarriage.5

Bullet point guidance

  • Women who are pregnant, and couples trying to conceive, should be advised that the safest approach is to not drink alcohol at all, in order to minimise any risks to the baby.6
  • Women who report alcohol consumption in pregnancy should be advised that consuming any amount of alcohol (even 1-2 units per week) has been linked to a higher risk of miscarriage.3
  • Men with a history of RPL should be advised that alcohol intake is known to have a negative impact on sperm quality and increase the risk of miscarriage.5
  • Clinicians caring for women and men with a history of RPL and ongoing issues with alcohol use should signpost patients to alcohol support services, or contact their general practitioners for onward referral to an appropriate agency.7
  • Useful resources:

o NHS alcohol support website: www.nhs.uk/live-well/alcohol-support

o Drinkline is the national alcohol helpline and can be contacted on 0300 123 1110.

o Alcoholics Anonymous is a free self-help group: https://www.alcoholics-anonymous.org.uk

References

  1. Ujhelyi Gomez, K., et al., Are psychosocial interventions effective in reducing alcohol consumption during pregnancy and motherhood? A systematic review and meta-analysis. Addiction 2020.
  2. Bailey, B.A. and R.J. Sokol, Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism 2011. 34(1): p. 86-91.
  3. Sundermann, A.C., et al., Alcohol Use in Pregnancy and Miscarriage: A Systematic Review and Meta-Analysis. Alcohol: Clinical and Experimental Research 2019. 43(8): p. 1606-1616.
  4. Ricci, E., et al., Semen quality and alcohol intake: a systematic review and meta-analysis. Reproductive Biomedicine Online 2017. 34(1): p. 38-47.
  5. Henriksen, T.B., et al., Alcohol Consumption at the Time of Conception and Spontaneous Abortion. American Journal of Epidemiology 2004. 160(7): p. 661-667.
  6. Rosenberg, G., et al., New national alcohol guidelines in the UK: public awareness, understanding and behavioural intentions. Journal of Public Health 2017. 40(3): p. 549-556.
  7. Schölin L, W.J., Dyson J, Smith L., Alcohol Guidelines for Pregnant Women: Barriers and Enablers for Midwives to Deliver Advice. Institute of Alcohol Studies 2019: p. 1-75.