Patterns of Prenatal Alcohol Use That Predict Infant Growth and Development

Abstract

a, b the CIFASD BACKGROUND: Previous studies have had inconsistent findings regarding the quantity and frequency of prenatal alcohol exposure (PAE) that lead to deficits in growth and neurodevelopment. This may be due to imprecise methods of exposure classification. Our objective in this study was to employ longitudinal trajectory modeling of maternal drinking patterns associated with infant growth or neurodevelopmental deficits to a homogenous sample of mothers and infants. METHODS: From a sample of 471 pregnant women prospectively enrolled in a longitudinal study in the Ukraine, we performed a longitudinal cluster analysis of drinking patterns across gestation. We employed multivariable regression analyses to determine if each trajectory group was associated with infant weight, length, or head circumference at birth or psychomotor or mental deficits in infancy. RESULTS: We identified 5 distinct PAE trajectory groups: minimal or no PAE throughout gestation, low-to-moderate PAE with discontinuation early in gestation, low-to-moderate PAE sustained across gestation, moderate-to-high PAE with reduction early in gestation, and high PAE sustained across gestation. The highest-trajectory group was associated with deficits in infant weight and length at birth and deficits in psychomotor and mental performance at 6 to 12 months of age. Although confidence intervals overlapped, low-tomoderate sustained use was more strongly associated with most negative infant outcomes than moderate-to-high PAE with early reduction. CONCLUSIONS: With these findings, we confirm that high, sustained PAE confers the highest risk for adverse infant outcomes but demonstrate that even low-to-moderate PAE continued across gestation is associated with certain deficits. This approach may be used to help clinicians identify high-risk infants for targeted early intervention.

Patterns of Prenatal Alcohol Exposure and Alcohol‐Related Dysmorphic Features

“…Infants without exposure trajectories had mothers that were enrolled later in gestation and did not have the second prenatal visit necessary for creating trajectories. As previously reported (Bandoli et al, 2019), women who completed both pregnancy visits were more likely to have higher socioeconomic status (SES), have attended college, realized they were pregnant approximately 1 week earlier in gestation (mean: 5.6 weeks), and were less likely to have a preterm delivery than women who only completed 1 pregnancy visit. They did not differ on maternal smoking behaviors, vitamin use, cohabitation status, age, or amount of alcohol consumption reported at the enrollment visit.…”

“…For rare outcomes with very few cases per trajectory, we collapsed trajectories into a 3-level variable (A: minimal/none; B/D: decreasing; and C/E: sustained exposure) for analyses. The decision to group the decreasing trajectories (B, D) and sustaining trajectories (C, E) together was done based on similar maternal characteristics in those pairings (Bandoli et al, 2019). Models were adjusted with propensity scores (created by regressing the exposure trajectory variable on potential confounders with multinomial logistic regression) for prenatal vitamin use, maternal age and SES, maternal pregnancy smoking, and offspring age at dysmorphology examination.…”

Fifty Years of Research on Prenatal Substances: Lessons Learned for the Opioid Epidemic

“…Considering maximum and minimum levels of consumption contributed an additional 45% and 17%, respectively, to overall total use estimates in one study of marijuana use during pregnancy (Day & Robles, 1989). Employing longitudinal trajectory modeling across all trimesters of pregnancy detected different risk patterns for adverse infant outcomes in one study of prenatal alcohol exposure (Bandoli et al, 2019). Likewise, different patterns of substance use have been associated with varying birth outcomes (Shankaran et al, 2004).…”

“…For example, studies of cocaine-exposed infants in the USA were primarily carried out in samples of unmarried, urban, African-American women of low-socioeconomic status, lower IQ, and low levels of education, with a high incidence of depressive symptoms, inadequate prenatal care, and exposure to violence (Bendersky, Alessandri, Gilbert, & Lewis, 1996;Coles, Platzman, Smith, James, & Falek, 1992;Richardson, Hamel, Goldschmidt, & Day, 1996). Although these studies employed appropriate contrast groups, social and psychological factors were often confounded with drug use and related to child outcomes (Bandoli et al, 2016;Salisbury et al, 2007;Singer et al, 2002). As a result, to date, virtually, nothing is known about the use of cocaine by women of middle or higher socioeconomic (SES) during pregnancy and its effects on offspring.…”

Social and Economic Effect of Comprehensive Prevention of Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders in Children: A Review

“…According to studies, prenatal alcohol exposure does irreparable harm to the human body, causing inborn lifelong mental and physical disorders [7][8][9][10][11][12]. FAS has three diagnostic criteria: clearly defined facial dysmorphology, prenatal and postnatal growth deficiencies, and cerebrospinal dysfunction [8,[13][14][15].…”