Identification of Children With Prenatal Alcohol Exposure

Abstract

The term "fetal alcohol spectrum disorders" (FASD) denotes the broad spectrum of morphological changes and functional deficits seen in children exposed to alcohol prenatally. While some children on the spectrum show the characteristic pattern of malformations called "fetal alcohol syndrome" (FAS), a significant proportion of alcohol-exposed children do not evidence clinically identifiable morphological alterations. The term "alcohol-related neurodevelopmental disorder" (ARND) is used to label the latter group. The identification of children with ARND has proven to be challenging because of the lack of clinically discernable physical signs. Therefore, some investigators have used the strategy of assessing maternal drinking during pregnancy and then tracking developmental outcomes in offspring longitudinally. Other methods that investigators have utilized to identify children with prenatal alcohol exposure in population-based studies include multi-source surveillance and active case ascertainment. In the current review, we discuss the merits and demerits of these methodologies and then present novel methods of identifying prenatal alcohol exposure (e.g., biomarkers) and subtle effects of morphological alterations and neural effects (e.g., neuroimaging).

Fetal Alcohol Spectrum Disorders: What Pediatric Providers Need to Know

“…To provide a safety net for newborns and identify women in need of intervention, some researchers have advocated for universal screening of mothers and newborns for PAE via biomarkers. Biomarkers currently under study include fatty acid ethyl esters (products of ethanol metabolism) and micro-RNAs (tiny RNAs that repress protein translation; Balaraman et al, 2016;Coriale et al, 2014). High levels of these biomarkers correlate with moderate to heavy drinking.…”

Quantification of ethyl glucuronide, ethyl sulfate, nicotine, and its metabolites in human fetal liver and placenta

“…Tobacco and alcohol use during pregnancy are serious public health concerns, resulting in adverse obstetrical and neonatal outcomes including miscarriage, preeclampsia, low birth weight, preterm delivery, fetal growth restriction, decreased head circumference, placenta abruption, and facial abnormalities [1][2][3][4]. Fetal alcohol spectrum disorders (FASD) encompass growth retardation, cognitive impairments, and craniofacial dysmorphology associated with prenatal alcohol exposure [5][6]. Prenatal tobacco exposure also can have a profound impact on infant brain structure and function, infant irritability, and risk for child behavioral and attention disorders [7][8].…”

Preventing Alcohol‐Exposed Pregnancy Among an American Indian/Alaska Native Population: Effect of a Screening, Brief Intervention, and Referral to Treatment Intervention

“…Significant variation in FASD prevalence among populations is associated with differences in magnitude and prevailing patterns of alcohol consumption as well as variability in how prevalence is measured. ; Coriale et al, 2014;. There is no known safe level of alcohol consumption during pregnancy.…”

“…One reason for the controversy is the difficulty involved in teasing out neurobehavioral effects of a particular exposure given the myriad potential confounders (nutrition, genetics, etc. ;Coriale et al, 2014;. In 2005, the Surgeon General of the United States issued an advisory for all women who are pregnant or might become pregnant to not consume alcohol (Services, 2005).…”