CNS Impairment a Better Gauge of Fetal Alcohol Exposure?

Fran Lowry

July 27, 2012

July 27, 2012 — Contrary to current belief, functional neurologic impairment may be the only sign that a child has been exposed to alcohol in utero.

"One of the big take-home messages for us from this study is that there is, in general, a low prevalence of growth restriction and classical facial features of fetal alcohol syndrome," lead author Devon Kuehn, MD, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, told Medscape Medical News.

Dr. Devon Kuehn

"Instead, we found that the most common abnormality in our children was functional neurologic impairments in learning, behavior, language, and mental function," Dr. Kuehn said.

The finding highlights the importance of thinking about fetal alcohol exposure in utero in children who might present just with neurologic abnormalities, she noted.

The study was published online July 23 in Alcoholism: Clinical and Experimental Research.

Growth Restriction

The investigators initially screened 9628 women at their first prenatal visit in an attempt to find the women who were consuming large amounts of alcohol during the pregnancy.

The cutoff for large amounts of alcohol was determined to be 4 or more drinks per day.

The screening identified 101 women who were consuming that amount from the time of conception all the way through the pregnancy. These women were then matched with a cohort of 101 women who reported no consumption of any alcohol from conception until birth.

The women and children were followed for up to 8.5 years and were evaluated by clinicians who were blinded as to the participants' alcohol exposure status.

The researchers found that 1 or more functional central nervous system abnormalities were present in 44.0% (22/50) of the children who were exposed to alcohol compared with 13.6% (6/44) of the unexposed children (P = .002).

Growth restriction was present in 27.2% (25/92) of the exposed children and 12.5% (12/96) of the unexposed children (P = .02).

Strongest Predictor

The proportion of children exposed to alcohol who had abnormal facial features was unexpectedly low, Dr. Kuehn said, with 17.3% (14/81) of the exposed children showing abnormal facial features, compared with 1.1% (1/89) of the unexposed children (P = .0002).

The study also showed that 12 (20.3%) of the 59 children who were exposed to alcohol had no abnormalities.

Binge drinking (5 or more drinks at a time), especially after the pregnancy was recognized, was the strongest predictor of adverse child outcomes.

"We hope our study will add to the literature on fetal alcohol syndrome spectrum disorders, as we are one of the few studies that actually has this type of unselected population of women who drink large amounts of alcohol and who are then followed over time.

"We also hope we can heighten clinicians' awareness so that they can take into account functional neurologic deficits and not count only on the physical features of these children," Dr. Kuehn said.

The study was sponsored by the National Institutes of Health. Dr. Kuehn has disclosed no relevant financial relationships.

Alcohol Clin Exp Res. Published online July 23, 2012. Abstract

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