Prenatal alcohol exposure another risk for conduct disorder

Alcohol use during pregnancy is common and is associated with significant threats to the health and development of exposed offspring. Despite warnings from the Surgeon General to limit alcohol use if pregnant or contemplating pregnancy, a recent survey by the National Birth Defects Prevention Study found that nearly one-third of women drank alcohol at some time during their pregnancy, with one-fourth of the women surveyed having drunk during the first trimester.

Heavy use of alcohol during pregnancy may lead to fetal alcohol syndrome which includes deficits in growth and central nervous system development. Fortunately, most women who drink alcohol during pregnancy are light to moderate drinkers, although consequences to the developing fetus still are of concern. The deleterious effect of prenatal alcohol exposure on 16 year old offspring is the subject of the article by Cynthia A. Larkby and colleagues in the March 2011 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).

In the article titled "Prenatal Alcohol Exposure Is Associated With Conduct Disorders in Adolescence:  Findings From a Birth Cohort," researchers from the University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center examined 592 adolescents and their mothers or caretakers, utilizing data from a longitudinal study that evaluated prenatal substance exposure. The study began in 1982, and women were evaluated at their fourth and seventh prenatal months and with their children at birth, eight and eighteen months, and 3, 6, 10, 14, and 16 years postpartum. The quantity, frequency and pattern of alcohol use was summarized as average daily alcohol consumption and included beer, wine, and liquor. The study participants were 50% African American and 50% white. 

Dr. Larkby and colleagues found that adolescents exposed to an average of one or more drinks of alcohol per day in the first trimester of pregnancy were three times more likely to meet criteria for a lifetime diagnosis of conduct disorder than were adolescents whose mothers drank less than that amount or abstained. The association of prenatal alcohol exposure and conduct disorder was not linear and the association was significant only at or above the level of one alcohol drink per day during the first trimester.

By the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria, conduct disorder is a pattern of severe behavior problems persisting for month than 12 months that include aggression toward persons and animals, destruction of property, deceitfulness or theft, and serious rule violations.

In conclusion, Larkby and colleagues state, "From a clinical perspective, prenatal alcohol exposure should be considered as another risk for conduct disorder. The next steps in research should be to define the interactions between prenatal exposures, environmental factors, and heritability. This would allow a more complete picture of the relations between prenatal alcohol exposure and conduct disorder."