The Neurodevelopmental Consequences of Prenatal Alcohol Exposure

Elizabeth Welch-Carre, RN, MSN, NNP


Adv Neonatal Care. 2005;5(4):217-229. 

In This Article

Assessing for Signs and Symptoms of Alcohol Exposure

Some infants may be asymptomatic and display no signs of exposure. Others may present with irritability, hypertonia or hypotonia, opisthotonus, tremors, poor feeding, poor state regulation, poor habituation, and electroencephalographic (EEG) changes.[1] There may be differences in the threshold, latency, and pitch in the cry of infants with PAE.[66,67] Infants withdrawing from alcohol may have seizures.[1]

A number of laboratory tests currently under investigation may prove to be helpful in identifying exposed infants. Fatty-acid ethyl esters, a byproduct of ethanol metabolism, can be found in the meconium of ethanol-exposed infants during the second trimester. This test is not helpful in cases in which exposure occurred only during the first trimester of pregnancy.[68] Maternal blood can also be tested for 4 markers that have a high correlation with maternal alcohol abuse. These markers include whole-blood–associated acetaldehyde, carbohydrate-deficient transferrin, gamma-glutamyl transpeptidase, and mean red blood cell volume.[68] Women with 2 or more positive markers for alcohol use had infants with smaller head circumferences, shorter lengths, and lower weights. These blood markers are better predictors of infant outcome than self-reports of alcohol use.[68]

Obtaining a history of alcohol intake is an important, albeit sensitive, task. The accuracy of self-reports are often in question. Table 4 describes 2 screening tools that have been developed for use with pregnant women.[64,69] The T-ACE is a 4-question tool that more readily identifies women with alcohol risk than staff assessment alone; its specificity is 69%.69,[70] The TWEAK is a 5-item tool with a 79% specificity.[70] The key component of both of these tools is the reference to "tolerance." In pregnant women, questions about tolerance seem to elicit the most honest responses; there is less stigma attached to how much alcohol a person can drink before feeling drunk.[70] If maternal alcohol use is revealed, it is important to document the frequency and the amount of maternal alcohol consumption in both the mother's and the infant's charts.[12]


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