Evidence of detrimental effects of prenatal alcohol exposure on offspring birthweight and neurodevelopment from a systematic review of quasi-experimental studies.
Loubaba Mamluk,Loubaba Mamluk,Timothy Jones,Timothy Jones,Sharea Ijaz,Sharea Ijaz,Hannah B Edwards,Hannah B Edwards,Jelena Savović,Jelena Savović,Verity Leach,Verity Leach,Theresa Hm Moore,Theresa Hm Moore,Stephanie von Hinke,Sarah J Lewis,Jenny L Donovan,Jenny L Donovan,Debbie A Lawlor,George Davey Smith,George Davey Smith,Abigail Fraser,Abigail Fraser,Luisa Zuccolo +23 more
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TLDR
Based on evidence from several studies, a likely causal detrimental role of prenatal alcohol exposure on cognitive outcomes, and weaker evidence for a role in low birthweight is found.Abstract:
Background Systematic reviews of prenatal alcohol exposure effects generally only include conventional observational studies. However, estimates from such studies are prone to confounding and other biases. Objectives To systematically review the evidence on the effects of prenatal alcohol exposure from randomized controlled trials (RCTs) and observational designs using alternative analytical approaches to improve causal inference. Search strategy Medline, Embase, Web of Science, PsychINFO from inception to 21 June 2018. Manual searches of reference lists of retrieved papers. Selection criteria RCTs of interventions to stop/reduce drinking in pregnancy and observational studies using alternative analytical methods (quasi-experimental studies e.g. Mendelian randomization and natural experiments, negative control comparisons) to determine the causal effects of prenatal alcohol exposure on pregnancy and longer-term offspring outcomes in human studies. Data collection and analysis One reviewer extracted data and another checked extracted data. Risk of bias was assessed using customized risk of bias tools. A narrative synthesis of findings was carried out and a meta-analysis for one outcome. Main results Twenty-three studies were included, representing five types of study design, including 1 RCT, 9 Mendelian randomization and 7 natural experiment studies, and reporting on over 30 outcomes. One study design-outcome combination included enough independent results to meta-analyse. Based on evidence from several studies, we found a likely causal detrimental role of prenatal alcohol exposure on cognitive outcomes, and weaker evidence for a role in low birthweight. Conclusion None of the included studies was judged to be at low risk of bias in all domains, results should therefore be interpreted with caution. Systematic review registration This study is registered with PROSPERO, registration number CRD42015015941.read more
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Perinatal mental health: a review of progress and challenges
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Conceptualising Natural and Quasi Experiments in Public Health
Frank de Vocht,Srinivasa Vittal Katikireddi,Cheryl McQuire,Kate Tilling,Matthew Hickman,Peter Craig +5 more
TL;DR: Natural experiment studies should be considered a type of study design rather than a set of tools for analyses of non-randomized interventions, and alignment of NES to the Target Trial framework will clarify the strength of evidence underpinning claims about the effectiveness of public health interventions.
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TL;DR: In this article, a systematic review and meta-analysis was performed to assess the associations between lifestyle factors and recurrent pregnancy loss (RPL) in the context of BMI, smoking, alcohol and caffeine intake.
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