Prenatal alcohol exposure and mental health at midlife: A preliminary report on two longitudinal cohorts

Abstract

Background Although the effects of prenatal alcohol exposure (PAE) have been studied extensively, there is relatively little information available on adult mental health functioning among exposed individuals. The current study compares the self‐reported midlife mental health status of individuals who were prenatally exposed to alcohol and diagnosed in childhood with the effects of this exposure with that of unexposed individuals. Methods Participants (N = 292) were recruited from two longitudinal cohorts in Atlanta and Seattle and asked to complete an Adult Health Questionnaire that surveyed their current health and mental health status. The questionnaire was completed either in‐person or remotely and included questions about current symptoms of depression and anxiety and mental health disorder diagnoses. The analysis compared a Nonexposed Contrast group to those in two exposure groups: (1) Alcohol Exposed with Fetal Alcohol Effect but not meeting criteria for Fetal Alcohol Syndrome (FAS) and (2) Alcohol Affected and meeting criteria for FAS. Results Both alcohol‐exposed groups reported higher levels of current depressive symptoms and a higher prevalence of diagnoses of depression, anxiety, bipolar disorder, and/or attention deficit/hyperactivity disorder. No differences were noted for psychotic disorders. PAE was also associated with greater environmental stressors, including higher levels of adverse childhood events and lower current socioeconomic status. Path analyses suggested that PAE was indirectly related to mood disorders with its effects being mediated by other environmental factors. Conclusions PAE is associated with greater rates of mental health disorders in middle adulthood. These outcomes appear to result from multiple stressors that affect individuals made vulnerable by their early alcohol exposure. Clinical outcomes could be improved by prevention efforts directed at preventing prenatal alcohol use and reducing environmental stressors later in life, and by the early identification of PAE and its effects.

Path analysis of the impact of prenatal alcohol on adult vascular function

“…Caution should be used in interpreting that PAE is protective against elevated arterial BP relative to a general population as both groups in this study had increased risk for hypertension when compared to large‐scale population databases. The National Health and Nutrition Examination Survey (NHANES) data collected between 2007 and 2010 indicated that 24.4% of males and 17.6% of females between 35 and 44 years have hypertension (Go et al, 2013) as compared to 70.3% of the Contrast group and 58.8% of the PAE group in this study, suggesting both groups have increased risk for vascular disease associated with their lower socioeconomic status and history of social adversity (Coles et al, 2022) when compared to the overall population of the United States. Even when the NHANES data are stratified by race (39.9% Black men and 42.7% Black women had hypertension after adjusting for age), participants in this study sample appear to carry increased risk for vascular disease.…”

“…Linking prenatal and early life exposures to later health outcomes has been a primary goal of those exploring the developmental origins of health and disease (DOHaD) hypothesis (Barker, 1990). The evidence in this study links PAE to mid-life health outcomes on vascular function using a prospective cohort initially identified while ease associated with their lower socioeconomic status and history of social adversity (Coles et al, 2022) when compared to the overall population of the United States. Even when the NHANES data are stratified by race (39.9% Black men and 42.7% Black women had hypertension after adjusting for age), participants in this study sample appear to carry increased risk for vascular disease.…”

Adverse childhood experiences in children with fetal alcohol spectrum disorders and their effects on behavior

“…Early screening and trauma‐informed intervention are especially important to prevent later adverse life experiences associated with ACEs and maladaptive behavior. Recent literature suggests that environmental influences, including ACEs, mediate the effect of PAE on mental health problems in adulthood, emphasizing the importance of the environment in outcomes in adulthood (Coles et al, 2022). Additionally, people living with FASD are at higher risk for trouble with the law (Pei et al, 2018).…”

Current considerations for fetal alcohol spectrum disorders: identification to intervention

“…developmental delay versus stable weakness) [8 ▪ ,33,47]. On the basis of the emerging findings, prenatal alcohol exposure was associated with greater rates of mental health disorders in middle adulthood [48 ▪ ], including higher rates of depression, anxiety, bipolar disorder and attention-deficit/hyperactivity disorder, as well as increased suicidality [15 ▪▪ ]. These increased rates were mediated by greater environmental stressors, adverse childhood events and lower socioeconomic status, which are common for individuals with prenatal alcohol exposure [21].…”