Alcohol use during pregnancy causes both physical and neurodevelopmental problems in children. The relationship between the amount and timing of alcohol consumption and impact on the fetus is poorly understood. In this study, a cohort of women were surveyed about alcohol use twice during pregnancy. Authors used a cluster analysis to identify 5 distinct trajectories of prenatal alcohol exposure (PAE), varying from none to high sustained PAE.*
- Only high sustained PAE (compared with none) was associated with fetal growth retardation; high sustained PAE was also associated with neurodevelopmental deficits at 6 and 12 months.
- “Moderate”-to-high PAE with reduction early in gestation and low-to-moderate sustained PAE were also both associated with neurodevelopmental deficits at 6 and 12 months.
- Low-to-“moderate” PAE with discontinuation was not associated with neurodevelopmental deficits in infancy.
* Defined as: minimal to no PAE throughout gestation (mean oz per day = 0), low-to-“moderate” PAE with discontinuation early in gestation (mean oz per day = 0.05), low-to-“moderate” PAE sustained across gestation (mean oz per day = 0.31), “moderate”-to-high PAE with reduction early in gestation (mean oz per day = 0.26), and high PAE sustained across gestation (mean oz per day = 1.58).
Comments: Fetal alcohol syndrome has long been recognized as a constellation of growth deficits, dysmorphology, and neurodevelopmental delays. More recently, a broader spectrum of fetal alcohol effects has been recognized with alcohol-related neurodevelopmental delay the most common. The findings of this study underscore alcohol’s potential toxicity even at lower levels of exposure. While there may well be a dose level effect, there is no known “safe” level of alcohol consumption during pregnancy.
Sharon Levy, MD, MPH
Reference: Bandoli G, Coles CD, Kable JA, et al. Patterns of prenatal alcohol use that predict infant growth and development. Pediatrics. 2019;143(2):e20182399.