Twelve‐year follow‐up of children exposed to alcohol in utero

Abstract

Eighty-two women who were consuming alcohol while pregnant attended a special clinic at the University Central Hospital, Helsinki with the aim of reducing heavy drinking during pregnancy. The children born to these women were followed up regularly. During their preschool years the children were assessed to have fetal alcohol syndrome, fetal alcohol effects, alcohol-related neurodevelopmental disorder, pre-and/or postnatal growth retardation, or they were assessed to have normal cognitive and somatic growth. Of the original children, 70 of 82 could be traced at the age of 12 years. Through semistructured interview and contact with the health and social care authorities, information was gathered about schooling, family structure, whether help had been sought for behavioural difficulties and major adverse events in the family. The longer the intrauterine alcohol exposure and the more severe the diagnosis related to prenatal alcohol exposure, the more often the children required special education, were temporarily or permanently taken into care, and had behavioural problems. There is a considerable need for prolonged multidisciplinary follow-up and support of all children whose mothers have not been able to reduce drinking in early pregnancy, whether or not cognitive disturbances are evident in early childhood.

Foetal alcohol syndrome — a multifaceted condition

“…In addition, it is clear that there is no such thing as a child with typical FAS, typical FAE, or typical ARND, but all children show their individual deficits and need individually planned support. 8 Attention problems, with or without hyperactivity, are often considered as clinical hallmarks of children with FAS. Studies on children and adults with FAS/FAE and ARND have shown difficulties in focusing, maintaining, and shifting attention but the results have not been consistent.…”

“…However, it has been shown to be critical to the quality of life of children affected by the disorder. 8,22,23 Mattson and Riley, 24 using a parent-rated Child Behaviour Checklist, 25 showed that there were significant differences in externalizing scales, indicating particular difficulties in social, attention, and aggressive domains, between children with prenatal alcohol exposure and control participants matched by age, sex, socio-economic status, ethnicity, and Verbal IQ score. Clinical experience 8 suggests that many children who have been exposed in utero to heavy maternal alcohol consumption (regardless of whether the criteria for a diagnosis of FAS were met and of whether they lived with their biological parent or foster parents) need the help of psychological services to cope with their lives.…”

“…The birth of a child with FAE or partial FAS is likely if there has been fairly regular consumption of more than 10 drinks per week until at least midway through the pregnancy. 4,8,32 One drink (33 cL strong beer [mean concentration of alcohol 5%], 12 cL light wine, [<15% alcohol], 8 cL strong wine [15 to 21% alcohol], or 4 cL spirits [>30% alcohol]) contains approximately 14 g of absolute alcohol. Some children with ARND have been found to have been born to mothers who did not drink continually throughout pregnancy but every so often, especially those who engaged in binge drinking.…”

“…In published studies there is, however, confusion about classifying conditions in which all three FAS criteria are not met. Children have been classified as exhibiting foetal alcohol effects (FAE) [5][6][7][8] or experiencing partial FAS 4 when only one or two of the three FAS criteria are met. Children diagnosed as exhibiting FAE or with partial FAS are usually found to be affected by a neurobehavioural disorder together with particular physical characteristics but not the typical craniofacial appearance.…”

“…The term alcohol-related neurobehavioural disorder (ARND) has been used when children have exhibited CNS manifestations but none of the characteristic facial features or impaired growth characteristics of FAS. 4,8 It is recommended that children exhibiting major organ malformation caused by prenatal alcohol exposure are diagnosed with alcohol-related birth defect (ARBD). 4 ARBD is an additional diagnosis to FAS, FAE, or ARND.…”