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Prenatal alcohol exposure and adverse fetal growth restriction: findings from the Japan Environment and Children’s Study



Japanese studies on the association between maternal alcohol consumption and fetal growth are few. This study assessed the effect of maternal alcohol consumption on fetal growth.


This prospective birth cohort included 95,761 participants enrolled between January 2011 and March 2014 in the Japan Environment and Children’s Study. Adjusted multiple linear and logistic regression models were used to assess the association between prenatal alcohol consumption and infant birth size.


Consumption of a weekly dose of alcohol in the second/third trimester showed a significant negative correlation with standard deviation (SD; Z) scores for body weight, body length, and head circumference at birth, respectively. Consumption of a weekly dose of alcohol during the second/third trimester had a significant positive correlation with incidences of Z-score ≤ −1.5 for birth head circumference. Associations between alcohol consumption in the second/third trimester and Z-score ≤ −1.5 for birth weight or birth length were not significant. Maternal alcohol consumption in the second/third trimester above 5, 20, and 100 g/week affected body weight, body length, and head circumference at birth, respectively.


Low-to-moderate alcohol consumption during pregnancy might affect fetal growth. Public health policies for pregnant women are needed to stop alcohol consumption during pregnancy.


  • This study examined the association between maternal alcohol consumption and fetal growth restriction in 95,761 pregnant Japanese women using the prospective birth cohort.

  • Maternal alcohol consumption in the second/third trimester more than 5, 20, and 100 g/week might affect fetal growth in body weight, body length, and head circumference, respectively.

  • The findings are relevant and important for educating pregnant women on the adverse health effects that prenatal alcohol consumptions have on infants.

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Fig. 1


  1. 1.

    Ikeda-Sakai, Y. et al. Inadequate folic acid intake among women taking antiepileptic drugs during pregnancy in Japan: a cross-sectional study. Sci. Rep. 9, 13497 (2019).

    Article  Google Scholar 

  2. 2.

    Yamamoto, Y. et al. Alcohol consumption and abstention among pregnant Japanese women. J. Epidemiol. 18, 173–182 (2008).

    Article  Google Scholar 

  3. 3.

    Ministry of Health, Labour and Welfare. Japan 2010 e-health net (in Japanese; cited 2019.10.11);

  4. 4.

    Ishitsuka, K. et al. Determinants of alcohol consumption in women before and after awareness of conception. Matern. Child Health J. 24, 165–176 (2020).

    Article  Google Scholar 

  5. 5.

    Pereira, P. P. D. S., Mata, F. A. F. D., Figueiredo, A. C. M. G., Silva, R. B. & Pereira, M. G. Maternal exposure to alcohol and low birthweight: a systematic review and meta-analysis. Rev. Bras. Ginecol. Obstet. 41, 333–347 (2019).

    Article  Google Scholar 

  6. 6.

    Oster, R. T. & Toth, E. L. Longitudinal rates and risk factors for adverse birth weight among first nations pregnancies in Alberta. J. Obstet. Gynaecol. Can. 38, 29–34 (2016).

    Article  Google Scholar 

  7. 7.

    Silva, I. D., Quevedo Lde, A., Silva, R. A., Oliveira, S. S. & Pinheiro, R. T. Association between alcohol abuse during pregnancy and birth weight. Rev. Saude Publ. 45, 864–869 (2011).

    Article  Google Scholar 

  8. 8.

    Witt, W. P. et al. Infant birthweight in the US: the role of preconception stressful life events and substance use. Arch. Womens Ment. Health 19, 529–542 (2016).

    Article  Google Scholar 

  9. 9.

    Mariscal, M. et al. Pattern of alcohol consumption during pregnancy and risk for low birth weight. Ann. Epidemiol. 16, 432–438 (2006).

    Article  Google Scholar 

  10. 10.

    Bandoli, G. et al. Patterns of prenatal alcohol use that predict infant growth and development. Pediatrics 143, e20182399 (2019).

    Article  Google Scholar 

  11. 11.

    Maruoka, K. et al. Risk factors for low birthweight in Japanese infants. Acta Paediatr. 87, 304–309 (1998).

    CAS  Article  Google Scholar 

  12. 12.

    Ogawa, H. et al. Passive smoking by pregnant women and fetal growth. J. Epidemiol. Community Health 45, 164–168 (1991).

    CAS  Article  Google Scholar 

  13. 13.

    Nagata, C., Iwasa, S., Shiraki, M., Sahashi, Y. & Shimizu, H. Association of maternal fat and alcohol intake with maternal and umbilical hormone levels and birth weight. Cancer Sci. 98, 869–873 (2007).

    CAS  Article  Google Scholar 

  14. 14.

    Miyake, Y., Tanaka, K., Okubo, H., Sasaki, S. & Arakawa, M. Alcohol consumption during pregnancy and birth outcomes: the Kyushu Okinawa maternal and child health study. BMC Pregnancy Childbirth 14, 79 (2014).

    Article  Google Scholar 

  15. 15.

    Tamura, N. et al. Different risk factors for very low birth weight, term-small-for-gestational-age, or preterm birth in Japan. Int. J. Environ. Res. Public Health 15, E369 (2018).

    Article  Google Scholar 

  16. 16.

    Cederbaum, A. I. Alcohol metabolism. Clin. Liver Dis. 16, 667–685 (2012).

    Article  Google Scholar 

  17. 17.

    Cooper, D. L., Petherick, E. S. & Wright, J. The association between binge drinking and birth outcomes: results from the born in Bradford cohort study. J. Epidemiol. Community Health 67, 821–828 (2013).

    Article  Google Scholar 

  18. 18.

    Ikehara, S. et al. Association between maternal alcohol consumption during pregnancy and risk of preterm delivery: the Japan environment and children’s study. BJOG 126, 1448–1454 (2019).

    CAS  Article  Google Scholar 

  19. 19.

    Feldman, H. S. et al. Prenatal alcohol exposure patterns and alcohol-related birth defects and growth deficiencies: a prospective study. Alcohol Clin. Exp. Res. 36, 670–676 (2012).

    Article  Google Scholar 

  20. 20.

    Auty, R. M. & Branch, R. A. Pharmacokinetics and pharmacodynamics of ethanol, whiskey, and ethanol with n-propyl, n-butyl, and iso-amyl alcohols. Clin. Pharmacol. Ther. 22, 242–249 (1977).

    CAS  Article  Google Scholar 

  21. 21.

    Ohlin, H., Brattström, L., Israelsson, B., Bergqvist, D. & Jerntorp, P. Atherosclerosis and acetaldehyde metabolism in blood. Biochem. Med. Metab. Biol. 46, 317–328 (1991).

    CAS  Article  Google Scholar 

  22. 22.

    Kawamoto, T. et al. Rationale and study design of the Japan environment and children’s study (JECS). BMC Public Health 14, 25 (2014).

    Article  Google Scholar 

  23. 23.

    Michikawa, T. et al. Baseline profile of participants in the Japan environment and children’s study (JECS). J. Epidemiol. 28, 99–104 (2018).

    Article  Google Scholar 

  24. 24.

    Yokoyama, Y. et al. Validity of short and long self-administered food frequency questionnaires in ranking dietary intake in middle-aged and elderly Japanese in the Japan public health center-based prospective study for the next generation (JPHC-NEXT) protocol area. J. Epidemiol. 26, 420–432 (2016).

    Article  Google Scholar 

  25. 25.

    Itabashi, K., Miura, F., Uehara, R. & Nakamura, Y. New Japanese neonatal anthropometric charts for gestational age at birth. Pediatr. Int. 56, 702–708 (2014).

    Article  Google Scholar 

  26. 26.

    Itabashi, K. et al. Introduction of the new standard for birth size by gestational ages. (in Japanese). J. Jpn Pediatr. Soc. 114, 1271–1293 (2010).

    Google Scholar 

  27. 27.

    Patra, J. et al. Dose-response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA)—a systematic review and meta-analyses. BJOG 118, 1411–1421 (2011).

    CAS  Article  Google Scholar 

  28. 28.

    Strandberg-Larsen, K. et al. Association of light-to-moderate alcohol drinking in pregnancy with preterm birth and birth weight: elucidating bias by pooling data from nine European cohorts. Eur. J. Epidemiol. 32, 751–764 (2017).

    CAS  Article  Google Scholar 

  29. 29.

    Jensen, R. B., Juul, A., Larsen, T., Mortensen, E. L. & Greisen, G. Cognitive ability in adolescents born small for gestational age: associations with fetal growth velocity, head circumference and postnatal growth. Early Hum. Dev. 91, 755–760 (2015).

    Article  Google Scholar 

  30. 30.

    Sanou, A. S. et al. Maternal alcohol consumption during pregnancy and child’s cognitive performance at 6-8 years of age in rural Burkina Faso: an observational study. PeerJ 5, e3507 (2017).

    Article  Google Scholar 

  31. 31.

    Chiaffarino, F. et al. Alcohol drinking and risk of small for gestational age birth. Eur. J. Clin. Nutr. 60, 1062–1066 (2006).

    CAS  Article  Google Scholar 

  32. 32.

    Kobayashi, S. et al. Dose-dependent associations between prenatal caffeine consumption and small for gestational age, preterm birth, and reduced birthweight in the Japan environment and children’s study. Paediatr. Perinat. Epidemiol. 33, 185–194 (2019).

    Article  Google Scholar 

  33. 33.

    Kobayashi, S. et al. Association of blood mercury levels during pregnancy with infant birth size by blood selenium levels in the Japan environment and children’s study: a prospective birth cohort. Environ. Int. 125, 418–429 (2019).

    CAS  Article  Google Scholar 

  34. 34.

    O’Leary, C. M., Nassar, N., Kurinczuk, J. J. & Bower, C. The effect of maternal alcohol consumption on fetal growth and preterm birth. BJOG 116, 390–400 (2009).

    Article  Google Scholar 

  35. 35.

    Bhatia, S., Drake, D. M., Miller, L. & Wells, P. G. Oxidative stress and DNA damage in the mechanism of fetal alcohol spectrum disorders. Birth Defects Res. 111, 714–748 (2019).

    CAS  Article  Google Scholar 

  36. 36.

    Stockwell, T. et al. Estimating under- and over-reporting of drinking in national surveys of alcohol consumption: identification of consistent biases across four English-speaking countries. Addiction 111, 1203–1213 (2016).

    Article  Google Scholar 

  37. 37.

    Nam, H. K. & Lee, K. H. Small for gestational age and obesity: epidemiology and general risks. Ann. Pediatr. Endocrinol. Metab. 23, 9–13 (2018).

    Article  Google Scholar 

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We thank all the individuals who participated in the Japan Environment and Children’s Study. We express our sincere appreciation to the collaborating hospitals and clinics. We also express our gratitude to the members of staff of the Hokkaido, Miyagi, Fukushima, Chiba, Kanagawa, Koshin, Toyama, Aichi, Kyoto, Osaka, Hyogo, Tottori, Kochi, Fukuoka, and Minami-Kyushu and Okinawa Regional Centers, Program Office, and Medical Support Center for the Japan Environment and Children’s Study (Appendix 1). The Japan Environment and Children’s Study is funded by the operating budget of the Ministry of the Environment, Japan. The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of the Ministry of the Environment of the Japanese government.

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K.C., S.K., A.A., S.I., H.M., and R.K. conceived and designed the study. K.C., S.K., A.A., C.M., S.I., Y.S., Y.I., K.S., T.B., H.M., and R.K. performed the data collection. K.C., S.K., A.A., S.I., and R.K. performed the statistical analysis and contributed the manuscript preparation and literature search. S.K., A.A., S.I., H.M., and R.K. interpreted the data. S.K., A.A., C.M., S.I., Y.S., Y.I., Y.N., and R.K. contributed the critical revision of the manuscript for important intellectual content. Y.S., Y.I., K.S., and R.K. contributed the funds collection and was supervisor of the study. All authors approved the version of the manuscript to be published.

Corresponding author

Correspondence to Sumitaka Kobayashi.

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The authors declare no competing interests.

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Informed consent was obtained from all participants (patients).

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Cho, K., Kobayashi, S., Araki, A. et al. Prenatal alcohol exposure and adverse fetal growth restriction: findings from the Japan Environment and Children’s Study. Pediatr Res (2021).

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