Fetal Alcohol Exposure Ups Motor Deficit Risk in Kids

Tinker Ready

June 10, 2014

Babies born to women who engage in moderate to heavy alcohol consumption during pregnancy are nearly 3 times more likely to develop gross motor (GM) deficits than those born to mothers who abstained or drank little, according to a review published online June 9 in Pediatrics.

A review of data from 14 studies finds "significant' evidence of GM impairment in children born to women diagnosed with fetal alcohol spectrum disorder (FASD) and those who reported moderate to heavy drinking during pregnancy.

"On the basis of our findings, we recommend that the evaluation of GM proficiency and strategies to ameliorate impairment should be a standard component of FASD diagnostic and management services," the authors write. The team of researchers from Australia and Brazil was led by Barbara R. Lucas, MPH, from the University of Sydney and the Children's Hospital at Westmead, Australia.

However, the author note several factors that limit their findings, including the size of the studies (8 had fewer than 100 subjects). Another limitation is that 4 studies "did not adjust for confounders, which means there is the potential to wrongly attribute GM deficits to [prenatal alcohol exposure (PAE)] when other factors may be contributing."

"Currently there is no high quality evidence to describe the effects of an FASD diagnosis or significant levels of PAE on GM proficiency," they write. For the study, they defined GM skills as those requiring "the use of large muscle groups to coordinate movement, such as walking, running, throwing, and maintaining balance." Understanding the link between drinking and GM impairment will aid in the assessment of exposed children. In addition, clinicians, teachers, and policymakers will benefit from "the best available evidence" when devising treatment strategies, according to the authors.

Meta-Analysis Shows 2.9-fold Increased Risk

The researchers searched Medline, Embase, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PEDro, and Google Scholar. They looked at studies of children from birth to 18 years of age that included a FASD diagnosis or moderate to heavy PAE or a mother with confirmed alcohol dependency or binge drinking during pregnancy. In addition, the studies included GM outcomes, obtained using a standardized assessment tool. The researchers extracted data on participants, exposure, diagnosis, and outcomes by using a standardized protocol and evaluated quality using Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

Of the 2881 articles identified, 14 met the review criteria, with 10 being included in the meta analysis. The mean age of the participants ranged from 3 days to 13.1 years. In addition to small sample sizes, the limitations of the studies included failure to report cutoffs for impairment and nonstandardized reporting of PAE.

In an overall analysis, with data pooled from all 10 studies that met the criteria for the meta-analysis, the researchers found a 2.9-fold increase in risk of GM impairment with a diagnosis of FASD or moderate to heavy PAE (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.1 - 4.0). GM deficits were found in balance, coordination, and ball skills. There were insufficient data to determine prevalence.

When the team restricted their analysis to 3 studies of moderate to heavy prenatal drinking or binge drinking, they saw no significant association with GM impairment (OR, 1.1; 95% CI, 0.4 - 2.7; random effects meta-analysis, I 2, 5%).

The researchers call that finding "unexpected" but note that "[c]lose inspection of the studies suggests the small numbers of studies (n = 3), sensitivity of tasks to detect GM impairment, young age (3 days) and other factors affecting the degree of expression of alcohol-related birth disorders, such as dose, pattern, and timing of PAE, may have contributed to this outcome."

In contrast, when they restricted their analysis to 5 studies in which the children had a diagnosis of FASD, there was a significant association with GM deficits (OR, 3.0; 95% CI, 2.0 - 4.4).

The researchers conclude, "Further work is required to develop a standardized approach for assessing GM proficiency in children with maternal alcohol exposure or an FASD."

Lucas received a scholarship from the Poche Centre for Indigenous Health, Sydney Medical School, and the University of Sydney. Three coauthors received funding from an Australian Research Council Future Fellowship. Another coauthor received funding from the Australian Federal Government. Another coauthor received funding from a Career Development Fellowship from the George Institute for Global Health. Another coauthor received funding from National Health and Medical Research Council of Australia Practitioner Fellowships The other authors have disclosed no relevant financial relationships.

Pediatrics. Published online June 9, 2014. Abstract

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