An examination of child outcomes and predictors of severity when prenatal alcohol exposure is frequent and heavy.

Overview

abstract

BACKGROUND: Prenatal alcohol exposure (PAE) results in a range of adverse outcomes in children. This study examines predictive factors relating to child outcomes from pregnancies characterized by PAE. METHODS: Data originated from seven cross-sectional, population-based, in-school studies of fetal alcohol spectrum disorders (FASD) in South Africa. Data analysis was limited to mothers who reported consuming five or more drinks per drinking day (DDD) and three or more drinking days per week (DDW) during two or more trimesters of pregnancy. RESULTS: Of 225 mother/child dyads, 53.3% of children had fetal alcohol syndrome (FAS); 16.9% partial FAS (PFAS); 17.3% alcohol-related neurodevelopmental disorder (ARND); and 12.4% "not FASD." Child growth and dysmorphology measures varied significantly among diagnostic groups: height, weight, head circumference, body mass index (BMI), palpebral fissure length, smooth philtrum, narrow vermilion border of the upper lip, total dysmorphology, and nonverbal and verbal IQ. Predictors of child outcomes were explored for an FASD diagnosis, FAS only, and total dysmorphology score. Children with FAS and ARND generally performed most poorly. Mothers of children with FAS drank more DDD in second and third trimesters and more DDW in third trimester than other mothers. Significant, distal, negative influences were as follows: low maternal weight, older age at pregnancy, and fewer years of formal education. Regression models, with DDD and DDW in third trimester as predictors, indicated that all FASD diagnoses were associated with lower maternal BMI (OR = 0.896, p = 0.022) and higher DDW (OR = 1.807, p = 0.020), but not DDD. When DDW was excluded from the model, DDD in third trimester was associated with an FAS (the most severe) diagnosis (OR = 1.082, p = 0.047). CONCLUSION: Higher maternal body weight and a BMI between 25 and 29 appear to be protective for the offspring. Long-term adequate nutrition and less alcohol consumption in the third trimester may protect highly exposed children from the most severe and negative outcomes.