Greater prenatal alcohol exposure trajectories linked to impaired growth and neurodevelopment

1. Five trajectories of prenatal alcohol exposure (PAE) were described and compared; greater PAE was associated with reduced birth weight and length, as well as lower neurodevelopmental scores at 6- and 12-month follow-up.

2. Low-to-moderate sustained alcohol exposure had persistent, larger deficits compared with early moderate-to-high exposure with reduction early in gestation, though these differences were not statistically significant.

Evidence Rating Level: 2 (Good)

Study Rundown: Prenatal alcohol exposure is known to cause growth and neurodevelopmental disorders in infants, but less is known about the relationship between PAE trajectory and its harmful effects. In this prospective cohort study, researchers interviewed pregnant women in Ukraine between 2008 and 2012 on alcohol use and measured infant neurodevelopment at 6 and 12 weeks postpartum to compare growth and neurodevelopment of infants with different PAE trajectories. Researchers grouped mothers’ alcohol use into 5 trajectories, described as minimal to no PAE throughout gestation, low-to-moderate PAE with discontinuation early in gestation, low-to-moderate PAE sustained across gestation, moderate-to-high PAE with reduction early in gestation, and high PAE sustained across gestation. Greater PAE was associated with reduced birth weight and length, as well as lower neurodevelopmental scores at 6- and 12-month follow-up. These differences persisted when controlling for multiple demographic and health factors.

These findings are limited by recall bias and a high study drop-out rate. Furthermore, researchers did not collect or control for physiologic factors, such as placental functioning, and certain sociodemographic factors may vary throughout pregnancy but were only measured once. Nonetheless, the study is strengthened by its large sample and long follow-up. For physicians, these findings highlight the importance of screening for and reducing prenatal alcohol exposure, especially among women who consume high amounts of alcohol or do not reduce use early in pregnancy.

 Click to read the study, published today in Pediatrics

Relevant reading: Prenatal Alcohol Exposure and Neurodevelopmental Disorders in Children Adopted from Eastern Europe

In-Depth [prospective cohort]: Researchers used data from the Collaborative Initiative on Fetal Alcohol Spectrum Disorders to identify 471 pregnant women at 2 prenatal care facilities in Ukraine between 2008 and 2012. Women were interviewed using standardized questionnaires about alcohol use, demographics, behavior, and pregnancy characteristics at enrollment and at ~32 weeks gestation. Information on infant growth after birth was collected from medical records, and mothers were invited at 6 and 12 weeks postpartum for neurodevelopmental assessments of infants using the Mental Developmental Index (MDI) and Psychomotor Development Index (PDI). Researchers grouped mothers’ alcohol use into 5 trajectories, described as minimal to no PAE throughout gestation, low-to-moderate PAE with discontinuation early in gestation, low-to-moderate PAE sustained across gestation, moderate-to-high PAE with reduction early in gestation, and high PAE sustained across gestation. The study compared infant growth and neurodevelopmental outcomes across trajectories.

Only sustained, high use was associated with a reduced birth weight percentile (-16.5; 95% confidence interval [CI]: -28.2 to -4.9) and length percentile (-12.6; 95% CI: -22.6 to -2.5) compared with minimal or no use after adjusting for vitamin use, SES, maternal age, and smoking. There were no significant effects observed between PAE trajectories and head circumference. Greater PAE was associated with lower neurodevelopmental scores at 6 and 12 months on the PDI and MDI. Low-to-moderate, sustained use had persistent larger deficits compared with early moderate-to-high consumption with reduction early in gestation, though these differences were not statistically significant.

Image: PD

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