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. 2021 Aug;45(8):1624-1638.
doi: 10.1111/acer.14656. Epub 2021 Aug 2.

Gestational age and birth growth parameters as early predictors of fetal alcohol spectrum disorders

Julie M Hasken  1 , Anna-Susan Marais  2 , Marlene de Vries  2 , Belinda Joubert  2 , Marise Cloete  2 , Isobel Botha  2 , Sumien Roux Symington  2 , Wendy O Kalberg  3 , David Buckley  3 , Luther K Robinson  4 , Melanie A Manning  5   6 , Charles D H Parry  2   7 , Soraya Seedat  2 , H Eugene Hoyme  8   9 , Philip A May  1   2   3
Affiliations

Gestational age and birth growth parameters as early predictors of fetal alcohol spectrum disorders

Julie M Hasken et al. Alcohol Clin Exp Res. 2021 Aug.

Abstract

Objective: To investigate gestational age and growth at birth as predictors of fetal alcohol spectrum disorders (FASD).

Methods: The sample analyzed here comprises 737 randomly selected children who were assessed for growth, dysmorphology, and neurobehavior at 7 years of age. Maternal interviews were conducted to ascertain prenatal alcohol exposure and other maternal risk factors. Birth data originated from clinic records and the data at 7 years of age originated from population-based, in-school studies. Binary linear regression assessed the relationship between preterm birth, small for gestational age (SGA), and their combination on the odds of a specific FASD diagnosis or any FASD.

Results: Among children diagnosed with FASD at 7 years of age (n = 255), a review of birth records indicated that 18.4% were born preterm, 51.4% were SGA, and 5.9% were both preterm and SGA. When compared to non-FASD controls (n = 482), the birth percentages born preterm, SGA, and both preterm and SGA were respectively 12.0%, 27.7%, and 0.5%. Mothers of children with FASD reported more drinking during all trimesters, higher gravidity, lower educational attainment, and older age at pregnancy. After controlling for usual drinks per drinking day in the first trimester, number of trimesters of drinking, maternal education, tobacco use, and maternal age, the odds ratio of an FASD diagnosis by age 7 was significantly associated with SGA (OR = 2.16, 95% CI: 1.35 to 3.45). SGA was also significantly associated with each of the 3 most common specific diagnoses within the FASD continuum: fetal alcohol syndrome (FAS; OR = 3.1), partial FAS (OR = 2.1), and alcohol-related neurodevelopmental disorder (OR = 2.0).

Conclusion: SGA is a robust early indicator for FASD in this random sample of children assessed at 7 years of age.

Keywords: Preterm; fetal alcohol spectrum disorders; prenatal alcohol exposure; small for gestational age.

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Conflict of interest statement

Conflict of Interest: The authors of have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Institute of Medicine Diagnostic Guidelines for Specific Fetal Alcohol Spectrum Disorders (FASD) as clarified by Hoyme (2016). Reproduced with permission from Pediatrics, Vol. 138, Pages 3–4, Copyright © 2016 by the AAP
Figure 1.
Figure 1.
Institute of Medicine Diagnostic Guidelines for Specific Fetal Alcohol Spectrum Disorders (FASD) as clarified by Hoyme (2016). Reproduced with permission from Pediatrics, Vol. 138, Pages 3–4, Copyright © 2016 by the AAP
Figure 2.
Figure 2.
FASD Diagnosis: Growth Trajectory Note: All birth centiles were adjusted for gestational age at birth
See this image and copyright information in PMC

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