Study highlights impact of prenatal exposure to alcohol and informs prevention efforts

Drinking in pregnancy can harm a developing baby. The term fetal alcohol spectrum disorders (FASDs) describes the range of effects that can be caused by prenatal exposure to alcohol. Children with fetal alcohol syndrome (FAS), the most severe form, have poor growth, atypical facial features, and central nervous system problems. Less severe forms include partial fetal alcohol syndrome (pFAS) and alcohol-related neurodevelopmental disorder (ARND). However, all three require evidence of neurobehavioral impairment affecting cognition or behavior (or both). A recent study in a US Pacific Southwest city estimated that, at a minimum, 2% of first-grade schoolchildren had an FASD. A new report in the journal Alcoholism: Clinical & Experimental Research describes the range of FASD among these children and the characteristics of their mothers.

In the initial study, first-grade children whose parents had accepted an invitation to participate were screened on growth and parent-reported developmental concerns. Children with low growth or developmental concerns, as well as a random sample of children with a negative screen, were selected for a full FASD evaluation. This involved detailed physical and facial assessments, neurobehavioral tests, and parental/ teacher reports on behavior and functioning. The mothers also provided information on their alcohol use when they were pregnant with the child.

Of 854 children who were fully evaluated, 93 were classed as having FASD based on pre-determined criteria ─ five with FAS, 44 with pFAS, and 44 with ARND. Children with FAS or pFAS were more likely to have low growth, alcohol-related facial features and other minor physical anomalies than those with ARND or no FASD. Most children with FAS or pFAS showed evidence of cognitive impairment, whereas most with ARND showed behavioral but not cognitive deficits. However, there was wide variation in the specific neurobehavioural effects.

In this community, mothers of children with FASD were more likely to have recognized their pregnancy later, delivered pre-term, be unmarried, report other substance use, and have a history of diagnosis of psychiatric disorders; however, they did not differ from moms of children without FASD in age, socioeconomic status or education. More mothers of children with (than without) FASD reported drinking in pregnancy, including before they knew they were pregnant. Prior to pregnancy recognition, the risk of FASD increased in line with the number of drinks consumed per drinking day, with even one drink per drinking day increasing the risk compared with not drinking.

The data provide a better understanding of the variability of FASD in a large urban community, and will inform prevention efforts in the region. Drinking before pregnancy recognition is common, and the results of this study suggest this carries a risk for FASD. Interventions are available to help women modify their drinking patterns before conception, even ─ and especially ─ if pregnancy is not planned. In this specific community, women who drink and have a history of psychiatric problems, tobacco and other substance use may be a particularly vulnerable group. The researchers stress, however, that prevention should focus on assisting all at-risk women, irrespective of age, race/ethnicity, socioeconomic status and education, and regardless of their intention to become pregnant.