title: Gross motor deficits in children prenatally exposed to alcohol: a meta-analysis.
abstract: OBJECTIVE
  Gross motor (GM) deficits are often reported in children with prenatal alcohol exposure (PAE), but their prevalence and the domains affected are not clear. The objective of this review was to characterize GM impairment in children with a diagnosis of fetal alcohol spectrum disorder (FASD) or "moderate" to "heavy" maternal alcohol intake.
  
  
  METHODS
  A systematic review with meta-analysis was conducted. Medline, Embase, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PEDro, and Google Scholar databases were searched. Published observational studies including children aged 0 to ≤18 years with (1) an FASD diagnosis or moderate to heavy PAE, or a mother with confirmed alcohol dependency or binge drinking during pregnancy, and (2) GM outcomes obtained by using a standardized assessment tool. Data were extracted regarding participants, exposure, diagnosis, and outcomes by using a standardized protocol. Methodological quality was evaluated by using Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
  
  
  RESULTS
  The search recovered 2881 articles of which 14 met the systematic review inclusion criteria. The subjects' mean age ranged from 3 days to 13 years. Study limitations included failure to report cutoffs for impairment, nonstandardized reporting of PAE, and small sample sizes. The meta-analysis pooled results (n = 10) revealed a significant association between a diagnosis of FASD or moderate to heavy PAE and GM impairment (odds ratio: 2.9; 95% confidence interval: 2.1-4.0). GM deficits were found in balance, coordination, and ball skills. There was insufficient data to determine prevalence.
  
  
  CONCLUSIONS
  The significant results suggest evaluation of GM proficiency should be a standard component of multidisciplinary FASD diagnostic services.
authors.affiliation: Discipline of Paediatrics and Child Health, The University of Sydney, The Children's Hospital at Westmead, Westmead, Australia;The George Institute for Global Health, Sydney Medical School, andPoche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, Australia;Physiotherapy Department, and blucas@georgeinstitute.org.au.
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Lucas
authors.affiliation: The George Institute for Global Health, Sydney Medical School, and.
authors.forename: Jane
authors.initials: J
authors.lastname: Latimer
authors.affiliation: Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia;Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, UNESP - Univ Estadual Paulista, Presidente Prudente, Brazil;
authors.forename: Rafael Z
authors.initials: RZ
authors.lastname: Pinto
authors.affiliation: The George Institute for Global Health, Sydney Medical School, and.
authors.forename: Manuela L
authors.initials: ML
authors.lastname: Ferreira
authors.affiliation: School of Public Health, Curtin University, Western Australia, Australia;
authors.forename: Robyn
authors.initials: R
authors.lastname: Doney
authors.affiliation: The George Institute for Global Health, Sydney Medical School, and.
authors.forename: Mandy
authors.initials: M
authors.lastname: Lau
authors.affiliation: Department of Health Professions, Faculty of Human Sciences, Macquarie University, Sydney, Australia; and.
authors.forename: Taryn
authors.initials: T
authors.lastname: Jones
authors.affiliation: Physiotherapy Department, and.
authors.forename: Danielle
authors.initials: D
authors.lastname: Dries
authors.affiliation: Discipline of Paediatrics and Child Health, The University of Sydney, The Children's Hospital at Westmead, Westmead, Australia;The George Institute for Global Health, Sydney Medical School, andThe Sydney Children's Hospital Networks (Westmead), Westmead, Australia.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking; D002648:Child; D002675:Child, Preschool; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders; D006801:Humans; D007223:Infant; D019957:Motor Skills Disorders / Q000453:epidemiology* / Q000209:etiology*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects
keywords: alcohol drinking; alcohol related neurodevelopmental disorder; child development; fetal alcohol spectrum disorders; motor skills