Patterns of Prenatal Alcohol Use That Predict Infant Growth and Development

Abstract

Background: Previous studies have had inconsistent findings regarding the quantity and frequency of prenatal alcohol exposure (PAE) that lead to deficits in growth and neurodevelopment. This may be due to imprecise methods of exposure classification. Our objective in this study was to employ longitudinal trajectory modeling of maternal drinking patterns associated with infant growth or neurodevelopmental deficits to a homogenous sample of mothers and infants.

Methods: From a sample of 471 pregnant women prospectively enrolled in a longitudinal study in the Ukraine, we performed a longitudinal cluster analysis of drinking patterns across gestation. We employed multivariable regression analyses to determine if each trajectory group was associated with infant weight, length, or head circumference at birth or psychomotor or mental deficits in infancy.

Results: We identified 5 distinct PAE trajectory groups: minimal or no PAE throughout gestation, low-to-moderate PAE with discontinuation early in gestation, low-to-moderate PAE sustained across gestation, moderate-to-high PAE with reduction early in gestation, and high PAE sustained across gestation. The highest-trajectory group was associated with deficits in infant weight and length at birth and deficits in psychomotor and mental performance at 6 to 12 months of age. Although confidence intervals overlapped, low-to-moderate sustained use was more strongly associated with most negative infant outcomes than moderate-to-high PAE with early reduction.

Conclusions: With these findings, we confirm that high, sustained PAE confers the highest risk for adverse infant outcomes but demonstrate that even low-to-moderate PAE continued across gestation is associated with certain deficits. This approach may be used to help clinicians identify high-risk infants for targeted early intervention.

FIGURE 1

Trajectory groups based on ozAA per day across 40 weeks’ gestation (n = 471).

FIGURE 2

Multivariable linear regression of prenatal alcohol consumption by trajectory group and infant growth outcomes. Models were adjusted for vitamin use in pregnancy, Hollingshead SES, maternal age at enrollment, maternal smoking status, and gestational age at enrollment.

FIGURE 3

Multivariable linear regression of prenatal alcohol consumption by trajectory group and neurodevelopmental outcomes. Models were adjusted for vitamin use in pregnancy, Hollingshead SES, maternal age at enrollment, maternal smoking status, and gestational age at enrollment. Stabilized IPCWs were applied to account for loss to follow-up.