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.

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Available from: Irwin Waldman, Nov 09, 2015
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    • "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. "
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    • "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). "
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    • "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. "
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