A Metric of Maternal Prenatal Risk Drinking Predicts Neurobehavioral Outcomes in Preschool Children

Background: Fetal Alcohol Spectrum Disorders (FASDs), including Fetal Alcohol Syndrome, continue to be high‐incidence developmental disorders. Detection of patterns of maternal drinking that place fetuses at risk for these disorders is critical to diagnosis, treatment, and prevention, but is challenging and often insufficient during pregnancy. Various screens and measures have been used to identify maternal risk drinking but their ability to predict child outcome has been inconsistent. This study hypothesized that a metric of fetal “at‐risk” alcohol exposure (ARAE) derived from several indicators of maternal self‐reported drinking would predict alcohol‐related neurobehavioral dysfunctions in children better than individual measures of maternal alcohol consumption alone. Methods: Self‐reported peri‐conceptional and repeated maternal drinking during pregnancy were assessed with semi‐structured interviews and standard screens, i.e., the CAGE, T‐ACE, and MAST, in a prospective sample of 75 African‐American mothers. Drinking volumes per beverage type were converted to standard quantity and frequency measures. From these individual measures and screening instruments, a simple dichotomous index of prenatal ARAE was defined and used to predict neurobehavioral outcomes in the 4‐ to 5‐year‐old offspring of these women. Study outcomes included IQ, attention, memory, visual‐motor integration, fine motor skill, and behavior. Statistical analyses controlled for demographic and other potential confounders. Results: The current “at‐risk” drinking metric identified over 62% of the mothers as drinking at risk levels—23% more than the selection criterion identified—and outperformed all individual quantity and frequency consumption measures, including averages of weekly alcohol use and “binge” alcohol exposures (assessed as intake per drinking occasion), as well as an estimate of the Maternal Substance Abuse Checklist ( Coles et al., 2000 ), in predicting prenatal alcohol‐related cognitive and behavioral dysfunction in 4‐ to 5‐year‐old children. Conclusions: A metric reflecting multiple indices of “at‐risk” maternal alcohol drinking in pregnancy had greater utility in predicting various prenatal alcohol‐related neurobehavioral dysfunction and deficits in children compared to individual measures of maternal self‐reported alcohol consumption or a previous maternal substance abuse index. Assessing fetal risk drinking in pregnant women was improved by including multiple indicators of both alcohol consumption and alcohol‐related consequences and, if appropriate practical applications are devised, may facilitate intervention by health care workers during pregnancy and potentially reduce the incidence or severity of FASDs.