Prenatal Alcohol Exposure and the Development of Multiple Risk Behaviors in Adolescence: A Birth Cohort Study

The United Kingdom has the fourth highest estimated prevalence globally of maternal alcohol consumption during pregnancy (41%). It is therefore important to understand the long-term impacts of prenatal alcohol exposure (PAE) by examining its impact on the development of adolescent multiple risk behaviors (MRBs) that may increase morbidity and premature mortality across the life-course.

Using Avon Longitudinal Study of Parents and Children (ALSPAC) cohort data with multiple imputation (n = 6752), we examined the impacts of "infrequent," "frequent," and "binge" PAE groups on the development of seven MRBs at 16 years old, encompassing substance misuse, risky sexual behavior, and antisocial behavior. Data were analyzed using multiple regression, using q-statistics to adjust for multiple comparisons.

Adolescents with "infrequent" and "frequent" PAE were more likely to develop hazardous alcohol use at 16 years old compared to those without PAE, with the strongest association being for the "frequent" group (adjusted odds ratio [aOR] 1.45 [1.19-1.76], p < 0.001, q value = 0.005). Adolescents exposed to binge drinking prenatally had an increased risk of engaging in underage sexual intercourse (aOR 1.34 [1.09-1.64], p = 0.005, q value = 0.044). Binge drinking predicted a higher total MRB score (Coefficient = +0.21 [+0.08 to +0.33], p = 0.001, q value = 0.017).

This study supports the UK Chief Medical Officer's Low Risk Drinking Guidelines that the safest approach if pregnant, or if there is a possibility of becoming pregnant, is to avoid drinking alcohol, with the more alcohol consumed during pregnancy the greater the risks of long-term harm to the baby. Given the findings that PAE may increase the risk of adolescent hazardous alcohol use and risky sexual behavior, this study highlights the need for further research to understand the intergenerational effects of PAE.