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Specific guide to this web site for:
1. Medical
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Educators
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Statistics
2. Medical Students
3. Science media writers
4. High School & College
Statistic Teachers
Misadventures:
1. Harvard led MI study
2. JACC
study
(J. of Amer. Coll.
Cardio.)
3. NEJM
cath study
4. Amer. J. of Cardio.
review of literature
5. ALLHAT
controversy
6. Oat bran study
7. Pregnancy & Alcohol
8. Are Geminis
really
different?
9. Columbia 'Miracle' Study
Additional
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Celebrex
Limitations of Meta-Analyses
Large Randomized Clinical
Trials
Tale of Two Large
Trials
Advocate
meta-analyses
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Roehm E. Letter, Maternal alcohol consumption and birth
weight. JAMA 1985:253:3551
To the Editor.-- In
the October 12, 1984 issue of JAMA, Mills et al1 have published
important prospectively gathered information on maternal alcohol consumption
and its relation to birth weight. Among
their conclusions is that the adjusted odds ratio for small-for-dates infants
is 1.1 for women drinking less than one drink per day and 1.62 for women
drinking one to two drinks per day.
However, when the women are stratified by
smoking status, it appears from their data as presented in Table 5 that the
effects of drinking less than one drink per day or one to two drinks per day
for a nonsmoking woman may not be important.
Specifically, the mean birth weight for nonsmokers is 3,468 grams
(nondrinkers), 3,500 grams (less than one drink per day), and 3,452 grams (one
to two drinks per day). Data are given for the odds ratio of a
small-for-gestational-age infant being produced from different levels of alcohol
consumption as a group but not specifically for nonsmokers.
Since 22,485 of the 31,604 pregnancies in this study were in nonsmokers, this
consideration applies to a sizable portion of those studied and, hence, a group
large enough for subgroup analysis. In addition, the authors have already
analyzed crude birth weight for various levels of alcohol consumption when
stratified by smoking status. Hence,
there is good rationale for the authors to supply further information on the
small-for-gestational-age frequency for the different levels of alcohol
consumption when stratified by smoking status.
This would help clarify further their findings for the large group of
nonsmoking pregnant females.
A somewhat different interpretation of the data
might then be made and is as follows. For nonsmokers, drinking zero, less
than one, or one to two drinks per day has negligible effect on the fetus size,
and possibly on the development of small-for-gestational-age infants.
However, with these lower levels of alcohol consumption in smokers, there may
be an effect on both crude birth weight and development of
small-for-gestational-age infants.
This raises the possibility that there is a
negative synergistic effect of smoking and low-level alcohol consumption on the
infants of pregnant females. Specifically,
the decrement in crude mean birth weight for low levels of alcohol consumption
is greater for smokers, suggesting that the combination of smoking and alcohol
consumption is more than simply additive in its negative effect. [Editor's note-
This portio
Although consumption of three drinks per day in
nonsmoking pregnancies was associated with a decrease in the crude birth
weight, consumption of lesser amounts of alcohol in the large group of
nonsmoking females was without significant effect. This contrasts with a
possible detrimental effect of low-level alcohol consumption in combination
with smoking.
Eric Roehm, M.D.
1. Mills JL,
Graubard BI, Harley EE, et al. Maternal alcohol consumption and birth
weight: How much drinking during pregnancy is safe? JAMA 1984:252:1875-1879
Web
site author's note: This letter continues considerable speculation.
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