Wayne State University research team designs new measure that better predicts resulting problems in children exposed to maternal drinking

February 5, 2009

DETROIT-There is increased awareness that drinking during pregnancy is harmful and can lead to a range of Fetal Alcohol Spectrum Disorders (FASDs), including the serious Fetal Alcohol Syndrome (FAS). However, linkages between maternal-drinking measures and child outcomes have been inconsistent. A team of researchers at Wayne State University designed a "metric" or combination of measures that appears better able than individual measures alone to predict prenatal neurobehavioral dysfunction and deficits in children.

Results from this collaborative study at Wayne State University will be published in the April issue of Alcoholism: Clinical & Experimental Research and are available at Early View. The WSU School of Medicine co-authors of the ACER paper, "A Metric of Maternal Prenatal Risk Drinking Predicts Neurobehavioral Outcomes in Preschool Children," included Lisa Chiodo, PhD, research associate of pediatrics; James Janisse, PhD, assistant professor of family medicine; Virginia Delaney-Black, MD, MPH, professor of pediatrics; Robert J. Sokol, MD, director of the C.S. Mott Center for Human Growth and Development, and distinguished professor of obstetrics and gynecology; and John H. Hannigan, PhD, professor of obstetrics and psychology and principal investigator on the study.

John H. Hannigan, PhD, and Lisa Chiodo, PhD

"The number of children being born with FAS remains unnecessarily high," said Lisa M. Chiodo, PhD, first author for the study. "In part this is because it is difficult to identify patterns of drinking during pregnancy that put women's children at risk for FAS and other FASDs."

Dr. Chiodo said that although there are several measures of maternal drinking during pregnancy, their ability to predict child outcomes - particularly cognitive and behavioral problems - has been inconsistent. "We thought that combining many of the clinical and research measures of alcohol drinking into a single metric might help us find every child in our study who had been exposed to levels of alcohol that put them at risk.

"It is imperative that health-care professionals ask pregnant women about their alcohol and drug use in order to provide appropriate care for the women, and to provide anticipatory guidance for their children," she said. "Knowing that a woman has a substance-abuse problem or is an alcoholic is likely to be highly related to later developmental problems in the children."

The research team examined a sample of 75 African-American mothers as well as their four- to five-year-old offspring. The mothers self-reported peri-conceptional and repeated in-pregnancy maternal drinking in response to a number of semi-structured interviews and standard screening instruments, which were then used to construct a metric of "maternal prenatal risk drinking." The children were tested for IQ, attention, memory, visual-motor integration, fine motor skills, and behavior. The metric was then assessed against these outcomes.

The metric identified more than 62 percent of the mothers as drinking at risk levels; 23 percent more than the individual selection criteria identified.

"We had good reason to think that risk drinking was more common than thought," said Chiodo, "so detecting more risk drinkers was not that surprising. The real surprise was how successful the metric was in predicting deficits and problems in the children. In fact, our metric predicted poor child cognition and behavior problems better than any of the individual measures of maternal alcohol consumption or screens for problem drinking alone."

The paper reinforces the idea that alcohol use during pregnancy, particularly at levels that would identify a woman as a potential alcohol abuser or problem drinker, has serious consequences for the developing baby. For clinicians, it reinforces the idea that pregnant women must be questioned about their drug and alcohol use, and that reliable and quick methods for identification of those at risk are available.

"Clinicians must be able to identify risk levels of drinking in their pregnant patients because that is a critical time for possible treatment and prevention," said Chiodo. "After the children are born, we also need to be able to identify which children were exposed to 'risky' alcohol levels during pregnancy to allow correct diagnosis of, and early intervention with, children with FASDs. We do not know how or if our current metric might be adapted in practice for clinicians. However, our results suggest that it might be useful for health-care providers to use more than one measure of drinking in a more thorough examination of risk patterns and problem drinking."

The study was funded by the National Institute of Drug Abuse, the Gerber Foundation, and the National Institute on Alcohol Abuse and Alcoholism.

Wayne State University is one of the nation's pre-eminent public research universities in an urban setting, ranking in the top 50 in R & D expenditures of all public universities by the National Science Foundation. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world.