Adverse Behavioral Effects of Prenatal Alcohol Exposure Still Present at 22 Years of Age

Prenatal alcohol exposure (PAE) can result in adverse behavioral and developmental effects, but it is not known how long they endure and whether there are long-term risks at a threshold below that of fetal alcohol syndrome (FAS). In this longitudinal study, researchers assessed women’s prenatal alcohol use during each trimester. The birth sample (N=763) was followed up at regular intervals to the age of 22 when the sample completed the Adult Self-Report (ASR), which assesses aspects of adaptive functioning and problems.

• Median use decreased from 0.4 drinks/day during the first trimester to 0.08 drinks/day in the third trimester.
• Exposure to at least 1 drink/day decreased from 18% in the first trimester to 3.6% in the third.
• Any heavy episodic drinking (≥4 drinks/occasion) decreased from 34% in the first trimester to 5% in the third.
• Of the birth sample, 608 (80%) completed the 22-year assessment.
• PAE was significantly associated with more behavioral problems at 22 years of age in each of the ASR scales.
• PAE had a dose-response effect on Externalizing and Internalizing (mood, somatic complaints) scales and had a greater effect if present across pregnancy.

Comments:

This long-term study shows adverse behavioral effects of PAE lasting into early adulthood in individuals without FAS. Although it cannot be ruled out, the study does not support a safe lower threshold for alcohol use during pregnancy. We should continue to advise abstinence from alcohol during pregnancy and be cognizant of behavioral and developmental problems among children with prenatal exposure.

Kevin L. Kraemer, MD, MSc

Reference:

Day NL, Helsel A, Sonon K, Goldschmidt L. The association between prenatal alcohol exposure and behavior at 22 years of age. Alcohol Clin Exp Res. 2013;37(7):1171–1178.