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. 2025 Jun:281:114327.
doi: 10.1016/j.jpeds.2024.114327. Epub 2024 Sep 30.

Clinical Features of Typically Developing Children with and without Prenatal Alcohol Exposure

Philip A May  1 , Barbara Tabachnick  2 , Julie M Hasken  3 , Anna-Susan Marais  4 , Marlene M de Vries  4 , Wendy O Kalberg  5 , David Buckley  5 , Melanie Manning  6 , Luther K Robinson  7 , Charles D H Parry  8 , Soraya Seedat  4 , H Eugene Hoyme  9
Affiliations

Clinical Features of Typically Developing Children with and without Prenatal Alcohol Exposure

Philip A May et al. J Pediatr. 2025 Jun.

Abstract

Objective: To determine if prenatal alcohol exposure (PAE) affected physical and cognitive/behavioral outcomes in apparently typically developing, first-grade children.

Study design: Three groups were compared: children with fetal alcohol spectrum disorders (FASD), children with PAE without FASD, and children without PAE.

Results: The 3 groups were significantly different on most physical traits and fewer neurodevelopmental traits. Two-group comparisons of exposed and unexposed, non-FASD groups were statistically different on: height, weight, body mass index (BMI), and palpebral fissure length. Neurobehavioral outcomes were significant in three-group, but not 2-group comparisons. Few sex differences were observed; however, sex ratios indicated fewer male offspring in first grade among women who consumed 6+ drinks per occasion during pregnancy. For weight, head circumference (OFC), BMI, rural residence, and drinking measures, mothers of exposed children without FASD were intermediaries between, and significantly different from, the other maternal groups. Adjusted for socioeconomic covariates, multivariate ANCOVA, three-group comparisons of the children were significantly different for cognitive/behavioral variables (P < .001); however, 2-group neurobehavior comparisons for children without FASD were not significant (P ≥ .05). Physical trait multivariate ANCOVA comparisons of the non-FASD groups were significant only for weight (P < .004) when tested univariately and through stepdown analysis. Socioeconomic-adjusted trend plots were in the expected direction for nonverbal IQ, attention, height, weight, OFC, palpebral fissure length, and total dysmorphology score.

Conclusions: Even when meeting developmental norms, children with PAE exhibited trends of poorer growth and cognitive/behavioral traits than children without PAE. These findings support the notion that abstinence during pregnancy is best.

Keywords: South Africa; child growth and development; fetal alcohol spectrum disorders; prenatal alcohol exposure.

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Conflict of interest statement

Declaration of Competing Interest Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number RO1/UO1 AA11685. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH). The NIH had no role in the design and conduct of the study. The authors declare no conflicts of interest.

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