Fathers and alcohol. Implications for preconception, pregnancy, infant and childhood health outcomes
Alcohol consumption during preconception and pregnancy is generally considered to be the prospective mother’s responsibility, with many current international alcohol policy guidelines recommending the reduction or non-use of alcohol by pregnant women1-4. However, research suggests that decisions about alcohol use can often be influenced by others, in particular the prospective father.
Why did we undertake this research?
Four key factors initiated interest by NDRI’s Prevention and Early Intervention research team into fathers’ involvement in alcohol exposed pregnancies. The first two factors, the Australian Alcohol Guidelines and ‘Mother’s Guilt’, stem from an overt focus on women, and an inherent assumption that women are solely responsible for alcohol exposed pregnancies. This rhetoric takes women out of the society in which they live, and isolates men - as women’s live-in partners and biological fathers - from the equation. This position seems to be supported by the Australian Alcohol Guidelines for pregnant women which in their current form state that not drinking is the safest option for the fetus (NB: fine print comment that drinking one or two drinks per week is low risk). Prior to 2009, the guidelines stated that it was safe for pregnant women to drink 6 drinks per week or two drinks per day. Therefore even at a national policy level the history of messages in this field have been mixed, focused only on women, and do not take into account the social determinates that support alcohol consumption during pregnancy.
The second issue, ‘Mother’s Guilt’ is based on Nyanda McBride’s attendance at an International FASD Conference session with birth mothers of children with FASD. The emotional trauma and level of guilt emanating from this panel of mothers who were discussing their background in drinking showed that this was an issue that was beyond their individual control. Rather, a comprehensive approach would require whole community involvement (every one of us is a family member, partner, friend, work colleague, possible supplier and supporter of alcohol use in a variety of situations), behaviourally effective policies and programs, and initiatives provided prior to conception to assist in reducing the number of children and families whose lives are negatively affected by fetal (and perinatal) alcohol exposure.
The second two factors that motivated interest in this research area are based on the team's research philosophy. That is, to identify gaps in evidence-based research and policy and practice; and prioritise research that has potential to lead to individual and societal change. Both these issues contributed to an earlier formative research study with women to identify possible intervention strategies to reduce alcohol use during pregnancy5. This study found that women are most likely to drink in their own home; that over 75% of women who drink during pregnancy usually drink with their partner, and that male partners initiate a drinking occasion nearly 40% of the time. It is therefore important to recognise that decisions about alcohol use during pregnancy are often family decisions, occurring within the context of the family environment. This work identified that male partners are often social facilitators of alcohol drinking sessions during their partner’s pregnancy, thereby further justifying the inclusion of male partners in policy and practice to reduce alcohol exposed pregnancies and FASD, from a social facilitation perspective.
What did we do?
The aim of this research was to explore the impact of fathers’ alcohol consumption during both preconception and pregnancy on their partners’ alcohol consumption during pregnancy, on their partner’s pregnancy health, and on their child’s health outcomes.
A systematic literature review was carried out with the aim of identifying well-conducted primary studies in human populations. The review accessed articles from several scientific databases, and included medium and large-scale studies that provided separate results for paternal alcohol use. Included studies had a non-respondent rate ≤20%, an attrition rate ≤10% per year of data collection up to 30%, and were published between 1990 and 2014.
What did we find out?
Studies included in the review (11 studies, N= 41,062)6-16 provided evidence that paternal alcohol consumption during preconception or during pregnancy has an impact on pregnancy health, on maternal alcohol consumption during pregnancy, on fetal outcomes, and on infant health outcomes.
Impact on sperm
Spontaneous abortion and failure of live birth is associated with paternal preconception alcohol use during sperm development. Men who drank ten or more drinks per week during preconception had a two to five times increased risk of spontaneous abortion9. Of particular note in this single study conducted with couples undergoing in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) is that live birth and spontaneous miscarriage were associated with alcohol consumption in the week before sperm collection. The effect size of this association was notably high, with an increased adjusted odds ratio of AOR 45.6 with an increase of one can of beer in the week prior to sperm collection, and AOR 38 with an increase of 12 grams of alcohol per day. These high adjusted odds ratios with small increases in alcohol consumption are indicative of the importance of biological fathers limiting alcohol intake during preconception. Replication of this study will provide information about the strength of impact, however, proactive public health messages of this issue to couples planning pregnancy should be considered.
Paternal preconception alcohol consumption is associated with several measured fetal/infant health indicators, particularly with replicated evidence on spontaneous abortion at both low and moderate levels of paternal preconception alcohol use9, 14-16. Single study findings provide some evidence that paternal preconception alcohol use is associated with acute lymphoblastic leukaemia at high-level use (without maternal use)10, ventricle malformation with daily use13, low birth weight16, and low gestational age16 with low and moderate patterns of paternal preconception alcohol use.
Social facilitation of maternal alcohol consumption
Women were more likely to drink during pregnancy if their male partner drank6, 7, 9, with maternal prevalence of drinking increasing if their partner was a frequent or heavy drinker6.
What does it mean?
Decisions about alcohol use during preconception and pregnancy are not the sole responsibility of women but occur within the context of the home and the broader social environment. More complex policy is required to assist in reducing alcohol-exposed pregnancies and increasing the potential for healthy pregnancies, and fetal and infant outcomes.
Although there were a range of well conducted studies that met the inclusion criteria for this systematic review, the date of some publications suggest benefit from more contemporary studies. Additional replication of single study findings can assist in defining strength of impact. An overt focus on prospective studies of paternal prevalence and pattern of alcohol use during preconception, pregnancy and postpartum and the impact on sperm health, women’s level of preconception, pregnancy and postpartum alcohol use; and fetal and infant health will add further understanding to this research area.
Where to next?
The next stage in this area of research will be to identify patterns of alcohol use by men during the preconception period on pregnancy, fetal and childhood outcomes in the Australian context. The NDRI Prevention and Early Intervention research team is also keen to undertake formative work with men to identify intervention strategies that resonate with them to reduce male perinatal alcohol use and to reduce social facilitation of alcohol during their partner’s pregnancy.
Much of the material presented in this article is based on the following publications:
McBride, N. and Johnson, S. (2016). Fathers role in alcohol exposed pregnancies. Australian Fatherhood Research Network bulletin, 33, pp. 11-19.
McBride, N. and Johnson, S. (2016). Fathers role in alcohol exposed pregnancies: systematic review of human studies. American Journal of Preventive Medicine, 51, (2), pp. 240-248. Link
- NHMRC. Australian Guidelines to reduce health risk from drinking alcohol. NHMRC: Canberra. 2009.
- UK House of Commons Science and Technology Committee. Alcohol Guidelines. London: The Stationary Office Limited by the authority of the House of Commons. 2012.
- US Department of Agriculture. US DHHS. Dietary Guidelines for Americans. Washington, 2010. 7th Ed. Washington, DC: US Government Printing Office. 2010.
- Butt P, Beimess D, Gilksman L, Paradis C, Stockwell T. Alcohol and Health in Canada: A summary of evidence and guidelines for low risk drinking. Ottawa: Canadian Centre on Stubstance Abuse. 2011.
- McBride N, Johnson S. Fathers role in alcohol exposed pregnancies: Systematic review of human studies. American Journal of Preventive Medicine. 2016;51(2):240-8.
- Bakhireva L, Wilsnack S, Kristjanson A, Yevtushok L, Onishenko S, Wertelecki W, et al. Paternal drinking, intimate relationship quality, and alcohol consumption in pregnant Ukrainian women. J Stud Alcohol. 2011;72(4):536-44.
- Czeizel AE, Czeizel B, Vereczkey A. The participation of prospective fathers in preconception care. Clinical medicine insights Reproductive health. 2013;7(Journal Article):1.
- Frey KA, Engle R, Noble B. Preconception healthcare: what do men know and believe? Journal of Men's Health. 2012;9(1):25-35.
- Klonoff-Cohen H, Lam-Kruglick P, Gonzalez C. Effects of maternal and paternal alcohol consumption on the success rates of in vitro fertilization and gamete intrafallopian transfer. Fertil Steril. 2003;79(2):330-9.
- Milne E, Greenop KR, Scott RJ, de Klerk NH, Bower C, Ashton LJ, et al. Parental alcohol consumption and risk of childhood acute lymphoblastic leukemia and brain tumors. Cancer Causes Control. 2013;24(2):391-402.
- Parazzini F, Bocciolone L, Lavecchia C, Negri E, Fedele L. Maternal and paternal moderate daily alcohol-consumption and unexplained miscarriages. British Journal of Obstetrics and Gynaecology. 1990;97(7):618-22.
- Roeleveld N, Vingerhoets E, Zielhuis GA, Gabreels F. Mental-retardation associated with parental smoking and alcohol-consumption before, during, and after pregnancy. Preventive Medicine. 1992;21(1):110-9.
- Steinberger EK, Ferencz C, Loffredo CA. Infants with single ventricle: a population-based epidemiological study. Teratology. 2002;65(3):106-15.
- Henriksen T, Hjollund N, Jensen T, Bonde J, Andersson A, Kolstad H, et al. Alcohol consumption at the time of conception and spontaneous abortion. American Journal of Epidemiology. 2004;160(7):661-7.
- Windham GC, Fenster L, Swan SH. Moderate maternal and paternal alcohol consumption and the risk of spontaneous abortion. Epidemiology. 1992;3(4):364-70.
- Windham GC, Fenster L, Hopkins B, Swan SH. The association of moderate maternal and paternal alcohol consumption with birthweight and gestational age. Epidemiology. 1995;6(6):591-7.