Intellectual disability: population‐based estimates of the proportion attributable to maternal alcohol use disorder during pregnancy

Abstract

Aim The aim of this study was to examine the association between maternal alcohol use disorder and intellectual disability in children. Method All mothers with an International Classification of Diseases (ICD) 9 and/or 10 alcohol‐related diagnosis, a proxy for alcohol use disorder, recorded on the Western Australian health, mental health, and drug and alcohol data sets were identified through the Western Australian Data Linkage Unit (n=5614 non‐Aboriginal; n=2912 Aboriginal). A comparison cohort of mothers without an alcohol‐related diagnosis was frequency matched on maternal age within maternal Aboriginal status and year of birth of their children. Linkage with the Western Australian Midwives Notification System (1983–2001) identified all births to these mothers (n=10 664 and 7907 respectively). Linkage to the Western Australian Intellectual Disability Database and Register of Developmental Anomalies identified cases of intellectual disability with no identified genetic origin (intellectual disability) (n=1487) and fetal alcohol syndrome (n=66). Odds ratios (ORs) and 95% confidence intervals (CIs) for intellectual disability were calculated using logistic regression incorporating generalized estimating equations and used to estimate population‐attributable fractions. Results At least 3.8% (95% CI 2.84–4.89%) of cases of intellectual disability could be avoided by preventing maternal alcohol use disorder: 1.3% (95% CI 0.81–1.86%) in non‐Aboriginal and 15.6% (95% CI 10.85–20.94%) in Aboriginal children. We observed a three‐fold increase in the adjusted odds of intellectual disability in children of mothers with an alcohol‐related diagnosis recorded during pregnancy (non‐Aboriginal OR 2.89, 95% CI 1.62–5.18; Aboriginal OR 3.12, 95% CI 2.13–4.56), with a net excess proportion of 3.7% and 5.5% respectively. One‐third (32%) of children diagnosed with fetal alcohol syndrome had intellectual disability. Interpretation Maternal alcohol use disorder is the leading known risk factor for intellectual disability with no identified genetic origin.

Pregnancy outcomes of mothers with an alcohol‐related diagnosis: a population‐based cohort study for the period 1983–2007

“…30 Asking pregnant women about their alcohol consumption is key to reducing alcohol-related harm; however, poverty is also associated with poor access to antenatal services, 31 so policies should ensure that disadvantaged pregnant women have equal access to antenatal services, ideally early in pregnancy. 32 When a maternal alcohol diagnosis was recorded during pregnancy, the attributable fractions for Aboriginal and non-Aboriginal neonates declined compared with the fractions reported when the exposure variable was any alcoholrelated diagnosis. 33 This contrasts with the finding that the risk of poor fetal and pregnancy outcomes was greater when the alcohol diagnosis was recorded during pregnancy than when any alcohol diagnosis was used as the exposure variable.…”

“…These results indicate the under-recognition of alcohol-use disorders during pregnancy in the health setting, and give further support to our previous studies indicating the under-recognition of alcohol problems during pregnancy. 32,34,35 The population-attributable fraction provides an assessment of the public health impact of having a mother with an alcohol diagnosis, and is based on an estimate of the proportion of cases resulting from exposure to heavy levels of alcohol during pregnancy. The measure uses the frequency of occurrence of the exposure as well as the strength of association with the outcome of interest.…”

Teratogens: a public health issue – a Brazilian overview

“…Alcohol abuse during pregnancy can lead to Neonatal Abstinence Syndrome in babies. Alcohol is the teratogenic agent responsible for the Fetal Alcohol Syndrome (FAS), as well as Fetal Alcohol Spectrum Disorders (FASD), being a major non-genetic cause of intellectual disability and behavioral problems (Abel and Sokol, 1987; Momino et al , 2012; Chapman and Wu, 2013; O’Leary et al , 2013). …”

Midwives' knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder

“…FASDs are under-diagnosed and under-reported in Australia [20] where the prevalence is reported as 1.7/1,000 live births and 4.7/1,000 Indigenous live births [21]. Children with FASDs may experience developmental delay, deficits in intellectual functioning [22,23] and difficulties with learning, memory [24–28] and attention [24]; may have poor executive functioning [27,29] and deficits in social and adaptive functioning [27]. Prenatal alcohol exposure may also result in secondary disabilities [29–31], for example, limited opportunities for work and mental health problems such as depression and self-injury.…”