Helen M. Barr

Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects.

ABSTRACT. Clinical descriptions of patients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) suggest major problems with adaptive behavior. Five operationally defined adverse outcomes and 18 associated risk/protective factors were examined using a Life History Interview with knowledgeable informants of 415 patients with FAS or FAE (median age 14 years, range 6-51; median IQ 86, range 29-126). Eighty percent of these patients were not raised by their biological mothers. For adolescents and adults, the life span prevalence was 61% for Disrupted School Experiences, 60% for Trouble with the Law, 50% for Confinement (in detention, jail, prison, or a psychiatric or alcohol/drug inpatient setting), 49% for Inappropriate Sexual Behaviors on repeated occasions, and 35% for Alcohol/Drug Problems. The odds of escaping these adverse life outcomes are increased 2- to 4-fold by receiving the diagnosis of FAS or FAE at an earlier age and by being reared in good stable environments.

Direct and indirect effects of prenatal alcohol damage on executive function.

Patients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) often have difficulty functioning appropriately in everyday life and seem to employ poor problem-solving strategies. Tests of executive function are relevant for quantifying the functional deficits and underlying real-life problems associated with prenatal alcohol exposure. This study considers two pathways for the effects of prenatal alcohol on executive function: a direct effect and an indirect effect through prenatal alcohols effect on IQ. We compared 30 men who had been diagnosed with FAS or FAE with young adults participating in a longitudinal prospective study (n = 419) and 15 control participants that comprised a comparison group. This study is unique in its analysis of the same battery of assessments of executive function in both a large low dose longitudinal study sample and a clinically diagnosed group. Participants were evaluated on 9 tests (including 58 scores) of executive function. For some but not all of the tests in this executive function battery, the decrement in the alcohol exposure group is greater than would be predicted from their IQ scores. We found that 3 of 6 Stroop scores, 2 of 4 Trails scores, 9 of 16 Wisconsin Card Sorting scores, 1 of 2 Ruffs Figural Fluency scores, and 2 of 4 Consonant Trigrams scores appear to be particularly sensitive to the direct effects of prenatal alcohol damage for patients with FAS and FAE. The findings suggest that these executive function tests would be particularly useful in clinical evaluations of persons suspected of fetal alcohol damage because they would not simply reflect deficits in IQ or facial stigmata.

Corpus callosum shape and neuropsychological deficits in adult males with heavy fetal alcohol exposure.

Persons with brain damage consequent to prenatal alcohol exposure have typically been diagnosed with either fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE), depending on facial features. There is great variability of behavioral deficits within these groups. We sought to combine neuroanatomical measures with neurocognitive and neuromotor measures in criteria of greater sensitivity over the variety of consequences of alcohol exposure. To this end, midline curves of the corpus callosum were carefully digitized in three dimensions from T1-weighted MR scans of 15 adult males diagnosed with FAS, 15 with FAE, and 15 who were unexposed and clinically normal. From 5 h of neuropsychological testing we extracted 260 scores and ratings pertaining to attention, memory, executive function, fine and gross motor performance, and intelligence. Callosal midline shape was analyzed by new morphometric methods, and the relation of shape to behavior by partial least squares. The FAS and FAE subgroups have strikingly more variability of callosal shape than our normal subjects. With the excess shape variation are associated two different profiles of behavioral deficit unrelated to full-scale IQ or to the FAS/FAE distinction within the exposed subgroup. A relatively thick callosum is associated with a pattern of deficit in executive function; one that is relatively thin, with a deficit in motor function. The two combine in a very promising bipolar discrimination of the exposed from the unexposed in this sample. Thus there is considerable information in callosal form for prognosis of neuropsychological deficits in this frequently encountered birth defect.

Prenatal alcohol and offspring development: the first fourteen years.

This report summarizes findings from a prospective longitudinal study of the effects of prenatal alcohol exposure on a birth cohort of 500 offspring selected from 1,529 consecutive pregnant women in prenatal care by mid-pregnancy at two representative community hospitals. Effects of prenatal alcohol observable on size measures at birth were insignificant after 8 months. Morphometric analysis of facial features identified effects only at the very highest alcohol exposure levels. By contrast, dose-dependent effects on neurobehavioral function from birth to 14 years have been established using partial least squares (PLS) methods jointly analysing multiple measures of both alcohol dose and outcome. Particularly salient effects included problems with attention, speed of information processing, and learning problems, especially arithmetic.

Neurobehavioral Effects of Prenatal Alcohol: Part I. Research Strategy

This paper, Part I of a three-part series, reviews the literature on the neurobehavioral effects of prenatal alcohol exposure and describes a large group of tests assembled to assess neurobehavioral outcomes of alcohol teratogenesis in 7-year-old children. This paper presents the distribution of these test scores for our sample and discusses their relationships with an alcohol binge score and with full-scale IQ. This group of tests is suitable for children with a wide range of abilities and provides a broad assessment of neurobehavioral deficits. Part II of this series describes a new method of statistical analysis, Partial Least Squares (PLS), which is particularly well suited to complex multivariate data sets such as these, and with its aid, examines the effects of prenatal alcohol exposure on IQ, achievement, vigilance and classroom behavior, a total of 43 outcome scores. Part III examines prenatal alcohol effects on outcomes from the broad group of 164 scores deriving from 17 neuropsychologic tests, using the Partial Least Squares methodology, and summarizes the implications of our findings for the behavioral teratology of alcohol.

Prenatal alcohol exposure, birthweight, and measures of child size from birth to age 14 years.

OBJECTIVES The purpose of the study was to examine the effect of prenatal alcohol exposure on offsprings weight, height, and head circumference from birth through 14 years of age. METHODS This longitudinal prospective study examined a cohort of approximately 500 offspring (oversampled for heavier drinkers and stratified for smoking from a population of 1529 women in prenatal care at the 5th gestational month) at birth; 8 and 18 months; and 4, 7, and 14 years of age. Covariates were examined by means of multiple regression. Birth size measures were also examined as predictors of 7-year neurodevelopmental outcomes. RESULTS Effects of alcohol were observed on weight, length, and head circumference at birth; these effects were not altered by adjustment for covariates including smoking. However, the birthweight effect is clearly transient: although alcohol effects remained observable at 8 months, they were not measurable thereafter through age 14 years. CONCLUSIONS In this population-based sample, neither birthweight nor any later size measure was as useful an indicator of the enduring effects of prenatal alcohol exposure as were certain neurodevelopmental outcomes.

Attention: Prenatal alcohol and continuities of vigilance and attentional problems from 4 through 14 years.

This study examined the longitudinal components of vigilance performance and attentional behaviors across the ages of 4, 7, and 14 years of life as they relate to prenatal alcohol exposure assessed by maternal self-report in midpregnancy for a cohort of 512 children. The vigilance score most salient for prenatal alcohol across this 10-year developmental period was Standard Deviation of Reaction Time (SDRT). Also salient were False Alarms (FA) on the AX task, impulsive errors reflecting difficulty in withholding a response. All 19 of the children with poorest scores on a Vigilance Latent Variable (LV) at 14 years had scored low on a similarly-defined Vigilance LV at age 7 years. Cross-lagged correlations revealed that the 7-year Vigilance LV not only predicted second-grade teacher ratings of attention a year later ( r = – .38), but also predicted fourth-fifth-grade teacher ratings of attention ( r = – .36). These data reveal considerable consistency across time in the impact of prenatal alcohol on child/adolescent vigilance performance and attention between 4 and 14 years of age.

Prenatal exposure to alcohol and school problems in late childhood: A longitudinal prospective study

The population-based Seattle Longitudinal Prospective Study on Alcohol and Pregnancy unites the fields of developmental psychopathology and behavioral teratology. Examining prenatal biological influences on childhood learning problems, this report is the first to extend earlier findings of alcohol-related deficits into late childhood. This follow-up study of 458 singletons assesses the degree to which childrens classroom behavior and achievement difficulties at age 11 are predicted by prenatal alcohol exposure across the full spectrum of maternal use. Partial least squares statistical techniques are used to summarize complex multiple measures of exposure and outcome as latent variables. Accounting for many factors potentially important in development, analyses reveal a significant and subtle dose-response relationship between prenatal alcohol exposure and childrens school performance a decade later. Maternal binge drinking (five or more drinks per occasion) and drinking during very early pregnancy are particularly salient for childrens poorer school performance. A wide variety of problematic classroom behaviors, including attentional, activity, information-processing, and academic difficulties, are salient for prenatal alcohol exposure. Considered within the body of data on alcohol teratogenesis, these findings suggest that prenatal alcohol exposure has an enduring and predictable relationship with developmental difficulties through late childhood. Clinical, research, and public health implications are discussed.

Cocaine and the use of alcohol and other drugs during pregnancy

Recent reports of adverse pregnancy outcomes associated with prenatal cocaine exposure have raised questions about the actual numbers of infants who are exposed to cocaine in utero. Whereas toxicologic urine screens obtained at delivery can detect cocaine use in the preceding few days, they fail to yield a comprehensive picture of use during and immediately before pregnancy. According to postpartum self-report, 15% of a teaching hospital sample and 3% of a private hospital sample of mothers had used cocaine during pregnancy or in the previous month (total = 876). Rates at the teaching hospital reflect a fifteenfold increase over the past 12-year period, when compared with previously obtained data. Cocaine users were significantly more likely to report that they drank alcohol, smoked cigarettes, and took other illicit drugs during pregnancy than women who denied using cocaine. Mothers at highest risk for cocaine use were those who were black (20%), were single-separated-divorced (24% to 33%), and had less than a high school education (21%).

Effects of prenatal alcohol exposure on fine motor coordination and balance: A study of two adult samples.

Motor coordination was assessed in two samples of adult subjects: one sample (n = 90) included adults previously diagnosed with one of a number of Fetal Alcohol Spectrum Disorders (FASD) and comparison peers, the second was a prospective longitudinal study of adults who were exposed to varying levels of alcohol as fetuses (n = 402). This comparative analysis sought to determine whether motor effects seen in both clinical and nonclinical children persist into adulthood, whether any individual motor tasks show significant effects of prenatal alcohol exposure across the age range, and whether motor assessments of adults have any role in diagnostic strategies for adults suspected of FASD. Motor tests included balance and unilateral, bilateral, finger, hand and foot coordination. Three-quarters of the subjects with FASD demonstrated deficits in motor function outside the range of comparison subjects. Adults with FASD performed more poorly, on average, on all individual tests including balance and fine motor control. In the prospective longitudinal sample, only subjects who had been previously identified in childhood as having a possible diagnosis on the Fetal Alcohol Spectrum were still in deficit as adults on motor tasks, relative to comparison subjects. Thus, the dose-dependent motor coordination effects of alcohol previously found in children do not appear to persist into adulthood, except in those most highly exposed children who also have other accompanying neuropsychological effects in childhood.