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A Prospective Cohort Study of the Prevalence of Growth, Facial, and Central Nervous System Abnormalities in Children with Heavy Prenatal Alcohol Exposure

Authors

  • Devon Kuehn,

    1. Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
    2. Bethesda, Maryland Department of Pediatrics, National Capital Consortium, Bethesda, Maryland
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    • The first two authors contributed equally to the article.
  • Sofía Aros,

    1. Department of Pediatrics, San Borja Arriarán Clinical Hospital Santiago, Chile, University of Chile, Santiago, Chile
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    • The first two authors contributed equally to the article.
  • Fernando Cassorla,

    1. Department of Pediatrics, San Borja Arriarán Clinical Hospital Santiago, Chile, University of Chile, Santiago, Chile
    2. Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santiago, Chile
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  • Maria Avaria,

    1. Department of Pediatrics, San Borja Arriarán Clinical Hospital Santiago, Chile, University of Chile, Santiago, Chile
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  • Nancy Unanue,

    1. Department of Pediatrics, San Borja Arriarán Clinical Hospital Santiago, Chile, University of Chile, Santiago, Chile
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  • Cecilia Henriquez,

    1. Department of Pediatrics, San Borja Arriarán Clinical Hospital Santiago, Chile, University of Chile, Santiago, Chile
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  • Karin Kleinsteuber,

    1. Department of Pediatrics, San Borja Arriarán Clinical Hospital Santiago, Chile, University of Chile, Santiago, Chile
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  • Barbara Conca,

    1. Department of Pediatrics, San Borja Arriarán Clinical Hospital Santiago, Chile, University of Chile, Santiago, Chile
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  • Alejandra Avila,

    1. Department of Pediatrics, San Borja Arriarán Clinical Hospital Santiago, Chile, University of Chile, Santiago, Chile
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  • Tonia C. Carter,

    1. Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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  • Mary R. Conley,

    1. Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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  • James Troendle,

    1. Division of Cardiovascular Sciences , National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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  • James L. Mills

    Corresponding author
    • Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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Reprint requests: James L. Mills, MD, MS, Room 7B03, 6100 Executive Blvd, NICHD NIH, Bethesda, MD 20892; Tel.: 301-496-5394; Fax: 301-402-2084; E-mail: millsj@mail.nih.gov

Abstract

Background

Most children who are exposed to large quantities of alcohol in utero do not develop fetal alcohol syndrome (FAS). Population-based prospective data on the risk of developing components of fetal alcohol spectrum disorders (FASD), however, are limited.

Methods

This was a prospective cohort study of 9,628 women screened during their first prenatal appointment in Chile, which identified 101 who consumed at least 4 drinks/d (exposed) matched with 101 women with no reported alcohol consumption during pregnancy (unexposed). Detailed alcohol consumption data were collected during the pregnancy. Children were evaluated up to 8.5 years of age by clinicians masked to exposure status.

Results

One or more functional central nervous system abnormalities were present in 44.0% (22/50) of the exposed children compared to 13.6% (6/44) of the unexposed (p = 0.002). Growth restriction was present in 27.2% (25/92) of the exposed and 12.5% (12/96) of the unexposed (p = 0.02). Abnormal facial features were present in 17.3% (14/81) of the exposed children compared to 1.1% (1/89) of the unexposed children (p = 0.0002) by direct examination. Of the 59 exposed children with data available to detect at least 1 abnormality, 12 (20.3%) had no abnormalities. Binge drinking from conception to recognition of pregnancy (OR = 1.48 per day, 95% CI: 1.15 to 1.91, p = 0.002) and after recognition of pregnancy (OR= 1.41 per day, 95% CI: 1.01 to 1.95, p = 0.04) and total number of drinks consumed per week from conception to recognition of pregnancy (OR = 1.02 per drink, 95% CI: 1.01 to 1.04, p = 0.0009) were significantly associated with abnormal child outcome.

Conclusions

After exposure to heavy alcohol consumption during pregnancy, 80% of children had 1 or more abnormalities associated with alcohol exposure. Patterns of alcohol use that posed the greatest risk of adverse outcomes were binge drinking and high total weekly intake. Functional neurologic impairment occurred most frequently and may be the only sign to alert physicians to prenatal alcohol exposure.

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