Academic journal article Alcohol Research

The Quest for a Neurobehavioral Profile of Heavy Prenatal Alcohol Exposure

Academic journal article Alcohol Research

The Quest for a Neurobehavioral Profile of Heavy Prenatal Alcohol Exposure

Article excerpt

The devastating consequences of fetal alcohol syndrome (FAS) are well established, and, as a leading cause of intellectual disabilities (Pulsifer 1996), FAS has significant societal and public health implications. Importantly, FAS is associated with a broad range of neurobehavioral deficits (for more information, see the article by Coles, pp. 42-50 in this issue). However, FAS is only the most serious possible consequence of heavy prenatal alcohol exposure, and many individuals who do not meet diagnostic criteria for FAS also are severely impacted by gestational alcohol exposure. The term fetal alcohol spectrum disorders (FASD) is used to encompass a spectrum of effects that includes FAS towards the extreme end as well as conditions such as alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). The term ARND (Hoyme et al. 2005) refers to individuals who, after heavy prenatal alcohol exposure, exhibit neurobehavioral effects without meeting the physical criteria for FAS (for a review, see Vaurio et al. 2010). Clinical identification of this group of individuals is hampered precisely because they do not exhibit the external physical features of FAS, and the existing physiological biomarkers for gestational alcohol exposure have several limitations. Determination of a profile based on the neurobehavioral effects of heavy prenatal alcohol exposure would allow more accurate identification of affected individuals. To be clear, development of such a profile is aimed at identifying and characterizing those who are affected by prenatal alcohol exposure, not simply those who have been exposed to alcohol prenatally.

Challenges of Establishing a Neurobehavioral Profile of Heavy Prenatal Alcohol Exposure

Although the main goal of the quest for a neurobehavioral profile of heavy prenatal alcohol exposure is improved identification of alcohol-affected individuals, additional benefits include enhanced intervention and treatment opportunities for these individuals as well as improved accuracy of incidence estimates. Thus far, accurate identification of individuals who are affected by alcohol exposure has proven difficult for several reasons. First, clinicians cannot rely only on external markers because the majority of alcohol-affected people do not meet the physical criteria for FAS. Second, the full range of effects of prenatal alcohol exposure is not currently known; therefore, individuals with less striking or atypical manifestations may be misdiagnosed or fail to get a diagnosis altogether. Third, individual neurobehavioral features, including decreases in an individual's intelligence quotient (IQ), also may result from clinical conditions or disorders other than FASD, further decreasing the ability to accurately identify individuals as alcohol affected. Finally, individual differences in factors that influence the consequences of prenatal alcohol exposure, such as the dose or timing of exposure, genetic variability, nutritional status, or postnatal factors, might interfere with developing a unifying neurobehavioral profile.

There currently are two main avenues for identifying individuals with prenatal alcohol exposure: maternal reports of drinking in pregnancy and dysmorphology exams. Maternal reports of exposure, if accurate, are ideal for identifying people who have been exposed to alcohol prenatally. Such data can be collected during pregnancy (i.e., prospectively) or afterwards (i.e., retrospectively). Recent research suggests that compared with prospective reports, retrospective maternal reports of gestational alcohol use indicate higher levels of exposure and are better predictors of behavioral outcomes in teenagers with histories of prenatal alcohol exposure (Hannigan et al. 2010). However, accurate maternal reports are notoriously difficult to obtain retrospectively because a large proportion of individuals with heavy prenatal alcohol exposure who participate in research studies are in foster or adoptive care (Streissguth et al. …

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