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Published on: July 13, 2014
Early identification of risk for effects of prenatal alcohol exposure
C D Coles1, J A Kable, C Drews-Botsch
1Department of Psychiatry and Behavioral Sciences & Marcus Institute, a Division of Kennedy-Krieger Institute at Emory University, Atlanta, Georgia, USA.
Insights
Early identification of infants at risk for alcohol-related developmental delays is possible using neonatal information. A cumulative risk index based on maternal characteristics proved most predictive for developmental outcomes.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Public Health
Background:
- Fetal alcohol syndrome (FAS) and related disorders are often diagnosed late in childhood.
- Early identification of prenatal alcohol exposure effects is crucial for timely intervention and preventing secondary disabilities.
- Diagnosing these effects in high-risk groups, such as low-birthweight infants, is particularly challenging.
Purpose of the Study:
- To develop and evaluate methods for the early identification of infants at risk for developmental consequences of prenatal alcohol exposure.
- To assess the utility of microcephaly, heavy episodic drinking during pregnancy, and a cumulative risk index in identifying at-risk neonates.
Main Methods:
- Three risk identification methods were applied to neonates.
- Infants identified as at-risk were compared to an unexposed group at 6 and 12 months.
- Developmental outcomes were measured using Bayley Scales of Infant Development and growth parameters, controlling for confounding factors like race, socioeconomic status, and birthweight.
Main Results:
- At 6 months, trends indicated lower language and behavioral regulation scores in exposed infants.
- At 12 months, alcohol-exposed infants showed significantly lower cognitive scores (p < .02).
- Alcohol-exposed infants were more likely to be classified as developmentally delayed at 12 months (p < .02).
Conclusions:
- Infants at risk for alcohol-related developmental delays can be identified neonatally.
- A cumulative risk index derived from maternal characteristics demonstrated the highest predictive value among the methods tested.
- Early identification facilitates crucial interventions during infancy.
Objective:
Fetal alcohol syndrome (FAS) and less severe outcomes are typically diagnosed later in childhood, although earlier diagnosis of the effects of exposure would allow intervention in infancy and prevention of associated secondary disabilities. Identification is particularly difficult in such high-risk groups as low-birthweight infants. The goal of this study was to develop methods for early identification of at-risk infants.
Method:
Three methods (microcephaly, heavy episodic drinking [> 5 drinks/occasion] in pregnancy and a cumulative risk index) identified neonates at risk for those developmental consequences of prenatal exposure that can be measured at 6 and 12 months (i.e., standard scores on Bayley Scales of Infant Development and growth measures). The usefulness of these methods was assessed by comparing those infants selected to an unexposed contrast group, while controlling for potentially confounding factors (e.g., race, socioeconomic status and birthweight).
Results:
At 6 months, when 70 infants were tested, trends were found for lower language facet scores and lower scores on the Behavioral Regulation Scale; at 12 months, when 134 were tested, alcohol-exposed infants had significantly lower cognitive facet scores (p < .02) and were more likely to be classified as either mildly or significantly developmentally delayed (p < .02).
Conclusions:
It is possible to identify infants at risk for alcohol-related developmental delays using information available in the neonatal period, although it is not usually done. Of the three methods tested, a cumulative risk index based on maternal characteristics was found to be most predictive.
