Causal Inferences Regarding Prenatal Alcohol Exposure and Childhood Externalizing Problems

Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA.
Archives of general psychiatry (Impact Factor: 14.48). 12/2007; 64(11):1296-304. DOI: 10.1001/archpsyc.64.11.1296
Source: PubMed


Existing research on the neurobehavioral consequences of prenatal alcohol exposure (PAE) has not adequately accounted for genetic and environmental confounds.
To examine the association between PAE and offspring externalizing problems in a large representative sample of families in the United States using measured covariates and a quasi-experimental design to account for unmeasured genetic and environmental confounds.
This study combines information from the National Longitudinal Survey of Youth and the Children of the National Longitudinal Survey of Youth. The analyses statistically controlled for measured characteristics of the mothers and families and exposure to other prenatal psychoactive substances. In the primary analyses, siblings differentially exposed to prenatal alcohol were compared.
Women were recruited from the community using a stratified and clustered probability sample and were followed longitudinally. The sample included 8621 offspring of 4912 mothers.
Maternal report of conduct problems (CPs) and attention/impulsivity problems (AIPs) during childhood (ages 4-11 years) using standardized assessments related to psychiatric diagnoses.
There was an association between PAE and offspring CPs that was independent of confounded genetic and fixed environmental effects and the measured covariates. The CPs in children of mothers who drank daily during pregnancy were 0.35 SD greater than those in children whose mothers never drank during pregnancy. Although AIPs were associated with PAE when comparing unrelated offspring, children whose mothers drank more frequently during pregnancy did not have more AIPs than siblings who were less exposed to alcohol in utero. Additional subsample analyses suggested that maternal polysubstance use during pregnancy may account for the associations between PAE and AIPs.
These results are consistent with PAE exerting an environmentally mediated causal effect on childhood CPs, but the relation between PAE and AIPs is more likely to be caused by other factors correlated with maternal drinking during pregnancy.

Download full-text


Available from: Irwin Waldman, Nov 09, 2015
  • Source
    • "The pattern of findings at age 11 years was similar to our earlier findings following up this cohort up till age 7. The persistence of adverse effects into mid-childhood, even with small individual effect sizes, is significant at a whole-population level. Clinicians should enquire about episodic binge drinking as well as regular drinking when taking a history of pregnancy and keep this in mind when assessing mental health and learning problems [15, 18, 27, 28]. At an individual level, pregnant women should be aware of possible risks associated with episodic binge-pattern drinking, even if this occurs on an occasional basis. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the study is to investigate whether episodic binge pattern of alcohol consumption during pregnancy is independently associated with child mental health and academic outcomes. Using data from the prospective, population-based Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated the associations between binge patterns of alcohol consumption during pregnancy (≥4 drinks per day) and child mental health [as rated by both parent (n = 4,610) and teacher (n = 4,274)] and academic outcomes [based on examination results (n = 6,939)] at age 11 years. After adjusting for prenatal and postnatal risk factors, binge pattern of alcohol consumption (≥4 drinks in a day on at least one occasion) during pregnancy was associated with higher levels of mental health problems (especially hyperactivity/inattention) in girls at age 11 years, according to parental report. After disentangling binge-pattern and daily drinking, binge-pattern drinking was independently associated with teacher-rated hyperactivity/inattention and lower academic scores in both genders. Episodic drinking involving ≥4 drinks per day during pregnancy may increase risk for child mental health problems and lower academic attainment even if daily average levels of alcohol consumption are low. Episodic binge pattern of drinking appears to be a risk factor for these outcomes, especially hyperactivity and inattention problems, in the absence of daily drinking. Electronic supplementary material The online version of this article (doi:10.1007/s00787-014-0599-7) contains supplementary material, which is available to authorized users.
    European Child & Adolescent Psychiatry 09/2014; 23(10). DOI:10.1007/s00787-014-0599-7 · 3.34 Impact Factor
  • Source
    • "Prognosis is generally poor, with more than half of affected adolescents and adults showing secondary disabilities, including increased psychiatric problems (Fryer et al., 2007; O'Connor and Paley, 2006) and behavioral dysregulation (Disney et al., 2008; Fryer et al., 2007; Mattson and Riley, 2000). In particular, AE has been associated with elevated risk of mood, anxiety, and attachment disorders (D'Onofrio et al., 2007; Fryer et al., 2007; Sayal et al., 2009; Streissguth et al., 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: This study examined prevalence of psychiatric disorders and behavioral problems in children with and without prenatal alcohol exposure (AE) and attention-deficit/hyperactivity disorder (ADHD). Methods: Primary caregivers of 344 children (8 to 16 years, M = 12.28) completed the Computerized Diagnostic Interview Schedule for Children-IV (C-DISC-4.0) and the Child Behavior Checklist (CBCL). Subjects comprised 4 groups: AE with ADHD (AE+, n = 85) and without ADHD (AE-, n = 52), and nonexposed with ADHD (ADHD, n = 74) and without ADHD (CON, n = 133). The frequency of specific psychiatric disorders, number of psychiatric disorders (comorbidity), and CBCL behavioral scores were examined using chi-square and analysis of covariance techniques. Results: Clinical groups had greater frequency of all psychiatric disorders, except for anxiety, where the AE- and CON groups did not differ. There was a combined effect of AE and ADHD on conduct disorder. For comorbidity, children with ADHD had increased psychiatric disorders regardless of AE, which did not have an independent effect on comorbidity. For CBCL scores, there were significant main effects of AE and ADHD on all scores and significant AE × ADHD interactions for Withdrawn/Depressed, Somatic Complaints, Attention, and all Summary scores. There was a combined effect of AE and ADHD on Externalizing, Total Problems, and Attention Problems. Conclusions: Findings indicate that ADHD diagnosis elevates children's risk of psychiatric diagnoses, regardless of AE, but suggest an exacerbated relation between AE and ADHD on conduct disorder and externalizing behavioral problems in children. Findings affirm a poorer behavioral prognosis for alcohol-exposed children with ADHD and suggest that more than 1 neurobehavioral profile may exist for individuals with AE.
    Alcoholism Clinical and Experimental Research 09/2012; 37(3). DOI:10.1111/j.1530-0277.2012.01953.x · 3.21 Impact Factor
  • Source
    • "By contrasting children exposed to prenatal alcohol with their siblings or cousins who were exposed to less, this approach controls for the mothers' characteristics, including genetic liabilities that are shared by mothers and offspring. However, only a few recent studies have adopted such a design in examining the behavioral consequences of prenatal alcohol consumption (for example, Knopik et al., 2006; D'Onofrio et al., 2007; Knopik et al., 2009). Results from these studies suggest that while many of the prior associations may be spurious, maternal alcohol use during pregnancy may remain a risk factor for certain behavioral problems. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine the effect of maternal alcohol use during pregnancy on infant behavioral outcomes and birth weight, and to investigate the differential susceptibility of infant behavioral outcomes and birth weight to prenatal alcohol exposure. Data on children born to women taking part in the United States National Longitudinal Survey of Youth (NLSY) (n = 1618) were analyzed using the sibling fixed-effects model, which helps adjust for maternal, genetic and social confounders when examining effects of pre-natal exposure to possible toxins such as alcohol. Mothers were classified as non-drinkers, light-to-moderate drinkers and heavy drinkers according to their frequency of alcohol use during pregnancy. Infants' behavioral outcomes were assessed using the modified Rothbart Infant Behavior Questionnaire in the NLSY, which measures three dimensions of behavioral outcomes: positive mood, fearfulness and difficultness. Estimates from the model indicated that drinking during pregnancy was positively associated with infant difficultness, but not with positive mood or fearfulness. Further analysis by frequency of alcohol use suggested that both light-to-moderate and heavy drinking were associated with an increase in infant difficultness. Additionally, while low-to-moderate drinking during pregnancy was associated with infant difficultness, drinking at this level was not associated with low birth weight. The findings suggest that maternal alcohol use during pregnancy is a risk factor for infant behavioral outcomes, after taking into account many confounding factors. Infant behavioral outcomes appear to be more vulnerable to light-to-moderate levels of alcohol use during pregnancy than birth weight is.
    Alcohol and Alcoholism 08/2012; 47(6):649-56. DOI:10.1093/alcalc/ags089 · 2.89 Impact Factor
Show more