Drinking Moderately and Pregnancy (1999)

Children exposed to levels of alcohol during pregnancy show growth deficits and intellectual and behavioral problems similar to, although less severe than, those found in children with fetal alcohol syndrome. Research has begun to examine the extent to which these problems affect the child's ability to function on a day-to-day basis at school and with peers. Findings indicate that drinking has much more impact on child development when the mother consumes several drinks in a single day than when she drinks the same quantity in doses of one to two drinks per day over several days. KEY WORDS: AOD use; gestation; prenatal alcohol exposure; growth retardation; behavioral problem; neurodevelopmental anomaly; intelligence and ability; fetal alcohol syndrome; amount of AOD use; child; mother; literature review Moderate drinking1 during pregnancy is associated with developmental problems in childhood that resemble but are less severe than the growth deficiencies and intellectual and behavioral impairment found among children with fetal alcohol syndrome (FAS). Children with FAS grow more slowly than do other children both before and after birth, exhibit intellectual and social problems, and display a distinctive pattern of abnormal facial features (Jones and Smith 1973). Intellectual and behavioral impairment are the most disabling characteristics of FAS. About one-half of all FAS patients are mentally retarded (i.e., they have an IQ below 702), and virtually all FAS patients exhibit serious attention and behavioral problems (Streissguth et al. 1991). Several studies have found that children exposed to alcohol during pregnancy at lower levels than FAS children experience intellectual and behavioral deficits that resemble those of FAS children but on a less severe level (Streissguth et al. 1993; Coles et al. 1997; Goldschmidt et al. 1996; J.L. Jacobson et al.1996). Most of the mothers of children in these studies drank an average of 7 to 14 drinks per week (J.L. Jacobson and S.W Jacobson 1994), a range generally considered as moderate drinking. Although the deficits associated with full-blown FAS are devastating, the more subtle developmental problems associated with lower levels of prenatal alcohol exposure are far more prevalent among children than FAS. In response, researchers at the Institute of Medicine (IOM) have suggested a new medical term-alcohol-related neurodevelopmental disorder (ARND)-characterized by the intellectual and behavioral deficits experienced in alcohol-exposed, non-FAS children (Stratton et al. 1996). This article summarizes the effects of prenatal alcohol exposure on children's growth, intellectual competence, and behavior as well as discusses research findings regarding the impact of these effects on children's general ability to function. The article also investigates the doses and patterns of drinking during pregnancy that have been linked to developmental problems in offspring. EFFECTS ON GROWTH AS WELL AS INTELLECTUAL AND BEHAVIORAL FUNCTION Children whose mothers drink moderately during pregnancy exhibit growth deficits as well as intellectual and behavioral impairment. Growth Although growth deficits are not a hallmark of ARND, consistent evidence indicates modest growth retardation in alcohol-exposed non-FAS infants before birth (e.g., Day et al. 1989; J.L. Jacobson et al. 1994a), and several studies have reported an association between prenatal alcohol exposure and slower-than-normal growth during the first 6 to 8 months after birth (J.L. Jacobson et al. 1994b). Moreover, deficits in height and head circumference have been documented in alcohol-- exposed non-FAS children through age 6 (Day et al. 1994; also see Sampson et al. 1994). This slower growth pattern contrasts with the traditional finding that infants who weigh less at birth because of maternal smoking during pregnancy grow faster and tend to catch up during their first 5 to 6 months. …