Prenatal Alcohol Exposure Patterns and Alcohol-Related Birth Defects and Growth Deficiencies: A Prospective Study

• Published in: Alcoholism, clinical and experimental research Vol. 36; no. 4; pp. 670 - 676
• Main Authors: Sawada Feldman, Haruna, Lyons Jones, Kenneth, Lindsay, Suzanne, Slymen, Donald, Klonoff-Cohen, Hillary, Kao, Kelly, Rao, Smriti, Chambers, Christina
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2012; Wiley
• Subjects: Abnormalities, Drug-Induced - epidemiology; Addictive behaviors; Adult; Adult and adolescent clinical studies; Alcohol Drinking - epidemiology; Alcohol-Related Facial Features; Alcohol-Related Growth Deficiency; Alcoholism; Alcoholism - complications; Alcoholism and acute alcohol poisoning; Biological and medical sciences; Birth Weight; Body Height; California - epidemiology; Data Collection; Embryology: invertebrates and vertebrates. Teratology; Face - abnormalities; Female; Fetal Alcohol Spectrum Disorders; Fetal Alcohol Spectrum Disorders - pathology; Fetal Alcohol Syndrome; Fundamental and applied biological sciences. Psychology; Gestational Age; Growth Disorders - chemically induced; Head - anatomy & histology; Humans; Infant, Newborn; Lip - abnormalities; Logistic Models; Medical sciences; Microcephaly - chemically induced; Microcephaly - epidemiology; Pregnancy; Pregnancy Outcome; Prenatal Alcohol Exposure; Prenatal Exposure Delayed Effects; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Socioeconomic Factors; Teratology. Teratogens; Toxicology; California; Fetal alcohol syndrome; Congenital; Ethanol; Growth; Alcoholism; Deficiency; Fetal Alcohol Spectrum Disorders; Exposure; Teratology; Alcohol-Related Growth Deficiency; Prenatal; Alcohol-Related Facial Features; Alcoholic beverage; Newborn diseases; Follow up study; Face; Morphometry; Prenatal Alcohol Exposure
• ISSN: 0145-6008; 1530-0277; 1530-0277
• DOI: 10.1111/j.1530-0277.2011.01664.x

Background:  The physical features of fetal alcohol syndrome include smooth philtrum, thin vermillion border, short palpebral fissures, microcephaly, and growth deficiencies on weight and height. However, little is known about the specific quantities of alcohol exposure, pattern of drinking, timing of exposure, and magnitude of risk for each of these features. Methods:  Using data on 992 subjects collected prospectively in California between 1978 and 2005, we examined the patterns and timing of alcohol exposure in relation to these features. Structural features were assessed by a dysmorphologist who performed a blinded physical examination of all infants. Patterns of drinking were evaluated by drinks per day, number of binge episodes, and maximum number of drinks. Timing of exposure was evaluated 0 to 6 weeks postconception, 6 to 12 weeks postconception, first trimester, second trimester, and third trimester. Results:  Higher prenatal alcohol exposure in every pattern was significantly associated with the incidence of smooth philtrum but not with short palpebral fissures. The strongest associations were with timing of exposure in the second half of the first trimester (RR 1.25, 95% CI 1.14 to 1.36 for average number of drinks per day; RR 1.17, 95% CI 1.09 to 1.26 for maximum number of drinks in 1 episode). Similarly, thin vermillion border was most strongly associated with exposure in the second half of the first trimester. Findings with respect to timing of exposure were similar for microcephaly and reduced birth weight. However, reduced birth length was increased with exposure in any trimester. These associations were linear, and there was no evidence of a threshold. Conclusions:  Reduced birth length and weight, microcephaly, smooth philtrum, and thin vermillion border are associated with specific gestational timing of prenatal alcohol exposure and are dose‐related without evidence of a threshold. Women should continue to be advised to abstain from alcohol consumption from conception throughout pregnancy.