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Updated: May 20, 2025
Moderate Prenatal Alcohol Exposure and Quantification of Social Behavior in Adult Rats
Published on: December 14, 2014
Abnormal neurobehavior profiles observed in the newborn period following low-to-moderate prenatal alcohol exposure
Jessie R Maxwell1,2, Melissa H Roberts3, Jean Lowe1
1Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, USA.
Insights
Prenatal alcohol exposure (PAE) in infants can be identified using the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale, First Edition (NNNS-I). This tool aids in early risk stratification for better intervention outcomes.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Public Health
Background:
- Prenatal alcohol exposure (PAE) leads to lifelong physical, neurodevelopmental, and behavioral issues.
- Early identification of at-risk infants is crucial for timely intervention but currently lacks effective methods.
- The Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale, First Edition (NNNS-I) shows promise for assessing substance-exposed infants.
Purpose of the Study:
- To evaluate the utility of the NNNS-I for identifying infants with low-to-moderate prenatal alcohol exposure (PAE).
Main Methods:
- The Ethanol, Neurodevelopment, Infant, and Child Health (ENRICH-2) cohort involved maternal and infant assessments.
- Prenatal alcohol exposure (PAE) was confirmed using Timeline Follow Back interviews and ethanol biomarkers.
- Infant neurobehavioral organization was assessed using the NNNS-I, with data analyzed via latent profile analysis (LPA).
Main Results:
- The study included 130 dyads (71 with PAE, 59 without).
- Prenatal alcohol exposure (PAE) was linked to lower attention and higher lethargy scores on the NNNS-I.
- Latent profile analysis (LPA) revealed a high-risk neurobehavioral profile characterized by poor self-regulation and attention deficits.
Conclusions:
- Low-to-moderate prenatal alcohol exposure (PAE) is associated with detectable neurobehavioral differences using the NNNS-I.
- The NNNS-I demonstrates potential as a screening and risk stratification tool for infants exposed to alcohol prenatally.
- Early identification via NNNS-I can facilitate prompt diagnosis and access to necessary therapeutic interventions.
Background:
Prenatal alcohol exposure (PAE) has lifelong consequences on affected individuals, with a range of physical, neurodevelopmental, learning, and behavioral adverse outcomes. There is no method to identify children at risk of these outcomes shortly after birth, resulting in delayed diagnosis and access to therapeutic modalities. The Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale, First Edition (NNNS-I), has demonstrated utility in the risk stratification of substance-exposed infants but has not been previously used to assess infants with PAE. The purpose of this study was to assess the utility of NNNS-I in the identification of infants with low-to-moderate PAE.
Methods:
The Ethanol, Neurodevelopment, Infant, and Child Health (ENRICH-2) prospective cohort included maternal assessments in the second and third trimesters of pregnancy and infant assessments at birth. PAE was evaluated by prospective, repeated Timeline Follow Back interviews and a comprehensive panel of ethanol biomarkers. During the birth hospitalization, certified examiners completed the NNNS-I assessment, which included infant neurobehavioral organization summarized into 12 summary scores. Summary scores and profiles, generated by latent profile analysis (LPA), were compared between PAE and no-PAE groups.
Results:
This analysis included 130 caregiver-infant dyads (71 with PAE and 59 with no-PAE). The absolute alcohol ounces per day in the PAE group were 0.08 ± 0.11, on average, or ~1.1 standard drinks per week. In multivariable analysis, PAE was associated with lower attention (β = -0.79) and higher lethargy (β = -0.86) scores (p's < 0.05) on NNNS-I after controlling for maternal mental health, marijuana use during pregnancy, and family income. LPA identified three profiles of neurobehavior, with a high-risk profile demonstrating poor infant self-regulation and decreased attention.
Conclusion:
Low-to-moderate PAE was associated with neurobehavioral findings identifiable on the NNNS-I assessment, highlighting its potential utility for screening and risk stratification of infants with PAE shortly after birth.
