Low–moderate prenatal alcohol exposure and risk to child behavioural development: a prospective cohort study

Abstract

Objective To examine the association of fetal alcohol exposure during pregnancy with child and adolescent behavioural development.Design The Western Australian Pregnancy Cohort (Raine) Study recruited 2900 pregnancies and the 14-year follow up was conducted between 2003 and 2006.Setting Tertiary obstetric hospital in Perth, Western Australia.Population The women in the study provided data at 18 and 34 weeks of gestation on weekly alcohol intake: no drinking, occasional drinking (up to one standard drink per week), light drinking (2-6 standard drinks per week), moderate drinking (7-10 standard drinks per week), and heavy drinking (11 or more standard drinks per week).Methods Longitudinal regression models were used to analyse the effect of prenatal alcohol exposure on Child Behaviour Checklist (CBCL) scores over 14 years, assessed by continuous z-scores and clinical cutoff points, after adjusting for confounders.Main outcome measure Their children were followed up at ages 2, 5, 8, 10 and 14 years. The CBCL was used to measure child behaviour.Results Light drinking and moderate drinking in the first 3 months of pregnancy were associated with child CBCL z-scores indicative of positive behaviour over 14 years after adjusting for maternal and sociodemographic characteristics. These changes in z-score indicated a clinically meaningful reduction in total, internalising and externalising behavioural problems across the 14 years of follow up.Conclusions Our findings do not implicate light-moderate consumption of alcohol in pregnancy as a risk factor in the epidemiology of child behavioural problems.

Research utilisation and knowledge mobilisation in the commissioning and joint planning of public health interventions to reduce alcohol-related harms: a qualitative case design using a cocreation approach

“…In the UK (Millennium Cohort Study) Kelly et al 138 suggest there is no increased risk of behavioural or cognitive deficits at the age of 3 years for children whose mothers drank within recommended limits compared with children whose mothers did not drink. Indeed, boys born to light-drinking mothers were less likely to have conduct/hyperactivity problems, showing some apparently protective effects of alcohol, with similar findings in Australia, 139 although there may be important confounding factors as light alcohol consumption is noted as a marker of relative socioeconomic advantage, which can influence children's social and emotional behaviours. These effects were shown to continue until children reached 5 years of age.…”

“…139 This makes alcohol more 'complex' than tobacco, for example, in terms of public health messages, as there is clear unambiguous evidence that all smoking is bad. This lack of clear evidence about alcohol consumption in pregnancy led some participants to express concerns about the possibilities of developing consistent messages for women, as 'getting people to make behaviour changes relies on clear, simple information about what to do' (Public Health 37).…”

Prenatal Alcohol Exposure, FASD, and Child Behavior: A Meta-analysis

“…After screening and review, 23 articles were included in qualitative or quantitative analysis, with between 2 and 8 articles (total: 16) included in various meta-analyses. Tables 3 and 4 show the characteristics of included studies, according to presence of FASD (10 studies) [13][14][15][16][17][18][19][20][21] or PAE (14 studies), respectively [22][23][24][25][26][27][28][29][30][31][32][33][34] : one study reported data for both PAE and FASD. 35 Most were from North America (n = 15; 65.2%), followed by Australia (n = 4) and Canada (n = 2), with 1 study each from Finland and Taiwan.…”

“…Only 3 studies reported OR for our primary outcomes. 29,31,32 Exploratory forest plots were created, incorporating the 3 primary "problems" scores (Total, Externalizing, and Internalizing problems) to examine whether odds of having problematic behavior ratings were higher after PAE. These primary outcomes, grouped by standardized PAE categories based on O'Leary et al, 12 indicated no increased odds for poorer behavior ratings with higher PAE levels (data not shown).…”

“…33 Additional data (eg, individual group sample size data) were requested for 3 articles, 17,23,29 but authors were unable to access archives (n = 2) or did not respond (n = 1). Sample sizes for Robinson et al 31 were estimated based on number and corresponding percentage of children scoring within "Clinical" ranges for the primary ASEBA outcomes.…”