Alcohol in pregnancy has long-lasting impact

By Michelle Rizzo

NEW YORK (Reuters Health) - The harmful effects of prenatal alcohol exposure persist into young adulthood, and lead to limited employment opportunities and ability to live independently, research shows.

"Maternal alcohol abuse during pregnancy will lead to persistent physical, cognitive, emotional, and social 'damage' not only in childhood but also in adulthood," Dr. Hans-Ludwig Spohr, of the Hospital of the German Red Cross, Berlin, said in an interview with Reuters Health. "We believe affected patients ... will suffer all their life from prenatal alcohol exposure."

Prenatal alcohol exposure is known to put babies at risk for fetal alcohol syndrome, a cluster of problems such as poor growth, delayed mental development and unusual facial features. "Fetal alcohol effect" is another term used to describe babies who display some but not all of the features of fetal alcohol syndrome.

The fetal alcohol syndrome is estimated to occur in about 1 of every 1000 births, while the fetal alcohol effect affects 3 to 5 per 1000 births, Spohr and colleagues report.

Taken together, these adverse effects are "a leading cause of marked developmental delay, including intellectual disability and other psychopathologies, such as attention deficit hyperactivity disorder," Spohr's group notes in the Journal of Pediatrics.

They tested the notion that fetal alcohol syndrome and fetal alcohol effect can be combined under the umbrella term "fetal alcohol spectrum disorder." They also examined the long-term consequences of prenatal alcohol exposure.

The researchers followed 37 individuals who were diagnosed with fetal alcohol syndrome or fetal alcohol effect in infancy or childhood.

Over a 20-year period, they found that the characteristic facial features of fetal alcohol syndrome and fetal alcohol effect diminished over time. However, microcephaly (small head size), a poorly developed groove in the upper lip, and a thin upper lip, which are also characteristic of prenatal alcohol exposure persisted.

Short stature and underweight also remained an issue for males, while increased adult body weight was observed in females.

Major outcomes included persistent intellectual disability, limited occupational options, and reduced likelihood of independent living. Test scores indicating several behavioral problems were also significantly increased.

Dr. Spohr noted that better and standardized methods of identifying patients with fetal alcohol spectrum disorder are needed. Adults with undiagnosed fetal alcohol spectrum disorder "need special care and protected living," he said.

SOURCE: Journal of Pediatrics, February 2007.