A Prospective Cohort Study of the Prevalence of Growth, Facial, and Central Nervous System Abnormalities in Children with Heavy Prenatal Alcohol Exposure

Abstract

Background:Most children who are exposed to large quantities of alcohol in utero do not developfetal alcohol syndrome (FAS). Population-based prospective data on the risk of developing componentsof fetal alcohol spectrum disorders (FASD), however, are limited.Methods:This was a prospective cohort study of 9,628 women screened during their first prenatalappointment in Chile, which identified 101 who consumed at least 4 drinks/d (exposed) matched with101 women with no reported alcohol consumption during pregnancy (unexposed). Detailed alcoholconsumption data were collected during the pregnancy. Children were evaluated up to 8.5 years of ageby clinicians masked to exposure status.Results:One or more functional central nervous system abnormalities were present in 44.0% (22/50) of the exposed children compared to 13.6% (6/44) of the unexposed (p=0.002). Growth restrictionwas present in 27.2% (25/92) of the exposed and 12.5% (12/96) of the unexposed (p=0.02). Abnormalfacial features were present in 17.3% (14/81) of the exposed children compared to 1.1% (1/89) of theunexposedchildren(p=0.0002) by direct examination. Of the 59 exposed children with data availableto detect at least 1 abnormality, 12 (20.3%) had no abnormalities. Binge drinking from conception torecognition of pregnancy (OR=1.48 per day, 95% CI: 1.15 to 1.91,p=0.002) and after recognition ofpregnancy (OR= 1.41 per day, 95% CI: 1.01 to 1.95,p=0.04) and total number of drinks consumedper week from conception to recognition of pregnancy (OR=1.02 per drink, 95% CI: 1.01 to 1.04,p=0.0009) were significantly associated with abnormal child outcome.Conclusions:After exposure to heavy alcohol consumption during pregnancy, 80% of children had1 or more abnormalities associated with alcohol exposure. Patterns of alcohol use that posed the great-est risk of adverse outcomes were binge drinking and high total weekly intake. Functional neurologicimpairment occurred most frequently and may be the only sign to alert physicians to prenatal alcoholexposure.Key Words:Alcohol, Pregnancy, Fetal Alcohol Spectrum Disorders, Growth Restriction,Neurodevelopment.