Forty Years of Assessing Neurodevelopmental and Behavioral Effects of Prenatal Alcohol Exposure in Infants: What Have We Learned?

Abstract

It has been known for over 4 decades that prenatal alcohol exposure (PAE) can adversely affect neurodevelopment and behavior (NDB). Yet, early detection of altered NDB due to PAE continues to present a major clinical challenge. Identification of altered NDB in the first 2 years of life, before higherorder cognitive processes develop, invites early interventions for affected children to improve long-term outcomes. Studies published in English from January of 1980 to July of 2018 were identified in PubMed/MEDLINE. The review focused on prospective birth cohort studies which used standardized NDB assessments in children up to 2 years of age, wherein PAE was the main exposure and NDB was the main outcome. NDB was categorized into the domains of neurocognitive, adaptive, and self-regulation based on the 2016 Updated Clinical Guidelines for Diagnosing fetal alcohol spectrum disorder. An initial search resulted in 1,867 articles for which we reviewed abstracts; 114 were selected for full-text review; and 3 additional abstracts were identified through review of references in eligible publications. Thirty-one publications met criteria and were included: of these, 24 reported neurocognitive outcomes, 24 reported adaptive behavior outcomes, and 12 reported outcomes in the domain of self-regulation. Although self-regulation was assessed in the fewest number of studies, 8/12 (75%) reported PAE-associated deficits. In contrast, results were mixed for the other 2 domains: 13/24 (54%) of the selected studies that included neurocognitive outcomes showed poorer performance following PAE, and 8/24 (33%) studies that assessed adaptive functioning found significant differences between PAE and comparison infants. There is considerable evidence to support the value of early-life assessments of infant NDB when PAE is known or suspected. More studies focusing on infant self-regulation, in particular, are needed to determine the utility of early evaluation of this critical developmental domain in infants with PAE.

Structural and functional brain network alterations in prenatal alcohol exposed neonates

“…Other functional MRI studies investigating the early effects of prenatal substance exposure in 2 to 6 week old infants, including alcohol, found hyper-connectivity of the amygdala with frontal regions ( Grewen et al 2015 ; Salzwedel et al 2015 ). Amygdala-frontal circuitry has been implicated in regulation of arousal, while self-regulation has been shown to be affected in infants with PAE ( Garrison et al 2019 ). Higher structural connectivity in the middle frontal gyrus in this cohort following PAE may indicate higher arousal as networks mature.…”

“…Few studies, however, have addressed the effects that PAE may have on early brain network organization. Such work is crucial given that PAE may lead to impairments in self-regulation, adaptive behavior, and cognition in young children ( Garrison et al 2019 ).…”

Balancing the story of fetal alcohol spectrum disorder: A narrative review of the literature on strengths

“…Individuals with FASD are diverse, with differing patterns of physical, cognitive, behavioral, and social‐emotional functioning between individuals (Mattson et al, 2019 ). Great strides have been made over the last several decades to identify the negative neurodevelopmental impacts of PAE and the high rates of adversity experienced by individuals with FASD across their lifespan (Garrison et al, 2019 ; McLachlan et al, 2020 ; Price et al, 2017 ; Streissguth et al, 2004 ). Important research has also been conducted to explore the experiences and needs of individuals with FASD and their families, but there remains a significant gap in research on strengths (Domeij et al, 2018 ; Skorka et al, 2020 ).…”

Concerns and Strengths: Caregiver Perceptions of Their Infant/Toddler with Prenatal Alcohol Exposure

“…Caregivers reported a broad array of concerns, reflecting the diversity of neurodevelopmental and behavioral outcomes known to be associated with PAE during early childhood [ 46 , 47 ]. Aggressive behaviors such as kicking and screaming, head banging, and prolonged temper tantrums raised the most concerns across both age groups and were relatively consistent across caregiver groups.…”