title: A prospective cohort study of the prevalence of growth, facial, and central nervous system abnormalities in children with heavy prenatal alcohol exposure.
abstract: BACKGROUND
  Most children who are exposed to large quantities of alcohol in utero do not develop fetal alcohol syndrome (FAS). Population-based prospective data on the risk of developing components of fetal alcohol spectrum disorders (FASD), however, are limited.
  
  
  METHODS
  This was a prospective cohort study of 9,628 women screened during their first prenatal appointment in Chile, which identified 101 who consumed at least 4 drinks/d (exposed) matched with 101 women with no reported alcohol consumption during pregnancy (unexposed). Detailed alcohol consumption data were collected during the pregnancy. Children were evaluated up to 8.5 years of age by clinicians masked to exposure status.
  
  
  RESULTS
  One or more functional central nervous system abnormalities were present in 44.0% (22/50) of the exposed children compared to 13.6% (6/44) of the unexposed (p = 0.002). Growth restriction was present in 27.2% (25/92) of the exposed and 12.5% (12/96) of the unexposed (p = 0.02). Abnormal facial features were present in 17.3% (14/81) of the exposed children compared to 1.1% (1/89) of the unexposed children (p = 0.0002) by direct examination. Of the 59 exposed children with data available to detect at least 1 abnormality, 12 (20.3%) had no abnormalities. Binge drinking from conception to recognition of pregnancy (OR = 1.48 per day, 95% CI: 1.15 to 1.91, p = 0.002) and after recognition of pregnancy (OR= 1.41 per day, 95% CI: 1.01 to 1.95, p = 0.04) and total number of drinks consumed per week from conception to recognition of pregnancy (OR = 1.02 per drink, 95% CI: 1.01 to 1.04, p = 0.0009) were significantly associated with abnormal child outcome.
  
  
  CONCLUSIONS
  After exposure to heavy alcohol consumption during pregnancy, 80% of children had 1 or more abnormalities associated with alcohol exposure. Patterns of alcohol use that posed the greatest risk of adverse outcomes were binge drinking and high total weekly intake. Functional neurologic impairment occurred most frequently and may be the only sign to alert physicians to prenatal alcohol exposure.
authors: Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
authors: Devon
authors: D
authors: Kuehn
authors: Sofía
authors: S
authors: Aros
authors: Fernando
authors: F
authors: Cassorla
authors: Maria
authors: M
authors: Avaria
authors: Nancy
authors: N
authors: Unanue
authors: Cecilia
authors: C
authors: Henriquez
authors: Karin
authors: K
authors: Kleinsteuber
authors: Barbara
authors: B
authors: Conca
authors: Alejandra
authors: A
authors: Avila
authors: Tonia C
authors: TC
authors: Carter
authors: Mary R
authors: MR
authors: Conley
authors: James
authors: J
authors: Troendle
authors: James L
authors: JL
authors: Mills
mesh_terms: D000015:Abnormalities, Multiple / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D000293:Adolescent; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology*; D001724:Birth Weight / Q000187:drug effects* / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019465:Craniofacial Abnormalities; D019066:Facies; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis / Q000453:epidemiology; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000002:abnormalities* / Q000187:drug effects* / Q000254:growth & development; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009133:Muscular Atrophy / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D009421:Nervous System Malformations / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult