A Prospective Cohort Study of the Prevalence of Growth, Facial, and Central Nervous System Abnormalities in Children with Heavy Prenatal Alcohol Exposure

Abstract

Background Most children who are exposed to large quantities of alcohol in utero do not develop fetal alcohol syndrome (FAS). Population-based prospective data on the risk of developing components of fetal alcohol spectrum disorders (FASD), however, are limited. Methods This was a prospective cohort study of 9,628 women screened during their first prenatal appointment in Chile, which identified 101 who consumed at least 4 drinks/d (exposed) matched with 101 women with no reported alcohol consumption during pregnancy (unexposed). Detailed alcohol consumption data were collected during the pregnancy. Children were evaluated up to 8.5 years of age by clinicians masked to exposure status. Results One or more functional central nervous system abnormalities were present in 44.0% (22/50) of the exposed children compared to 13.6% (6/44) of the unexposed (p = 0.002). Growth restriction was present in 27.2% (25/92) of the exposed and 12.5% (12/96) of the unexposed (p = 0.02). Abnormal facial features were present in 17.3% (14/81) of the exposed children compared to 1.1% (1/89) of the unexposed children (p = 0.0002) by direct examination. Of the 59 exposed children with data available to detect at least 1 abnormality, 12 (20.3%) had no abnormalities. Binge drinking from conception to recognition of pregnancy (OR = 1.48 per day, 95% CI: 1.15 to 1.91, p = 0.002) and after recognition of pregnancy (OR= 1.41 per day, 95% CI: 1.01 to 1.95, p = 0.04) and total number of drinks consumed per week from conception to recognition of pregnancy (OR = 1.02 per drink, 95% CI: 1.01 to 1.04, p = 0.0009) were significantly associated with abnormal child outcome. Conclusions After exposure to heavy alcohol consumption during pregnancy, 80% of children had 1 or more abnormalities associated with alcohol exposure. Patterns of alcohol use that posed the greatest risk of adverse outcomes were binge drinking and high total weekly intake. Functional neurologic impairment occurred most frequently and may be the only sign to alert physicians to prenatal alcohol exposure.

Health Care for Youth Involved with the Correctional System

“…44 As the child grows, some of the classic facial stigmata associated with fetal alcohol syndrome may lessen, making diagnosis more difficult. 45 Some evidence suggests that nutritional deficiencies during pregnancy magnify the deleterious effects of alcohol on the brain.…”

The effects of prenatal exposure to alcohol and environmental tobacco smoke on risk for ADHD: A large population-based study

“…Alcohol consumption during pregnancy can cause fetal alcohol spectrum disorders, which consist of neurobehavioral disorders, psychomotor retardation, other problems, as well as various internal anomalies that may have no morphological manifestations (Mattson et al, 2011). Prenatal exposure to alcohol in humans causes brain abnormality (Sowell et al, 1996;Kuehn et al, 2012). Exposure to alcohol during the third trimester, when the brain undergoes dramatic development, results in microcephaly and the loss of Purkinje cells (Goodlett et al, 1991).…”

Fetal Alcohol Syndrome in Sudden Unexpected Death in Infancy

“…Fetal alcohol syndrome is associated with maternal ethanol consumption of more than 4 drinks per day, particularly in the first trimester. 4 The characteristics of FAS are based on 3 important clinical features: characteristic facial anomalies, growth retardation, and central nervous system involvement, together with a history of prenatal alcohol exposure. Infants with FAS have a higher tendency to die from various physical defects.…”