Maternal and paternal risk factors associated with diagnoses within the continuum of fetal alcohol spectrum disorders in the USA: Proximal and distal influences

Philip A May; Julie M Hasken; Julie M Stegall; Heather A Mastro; Amy Baete; Jaymi Russo; Rosemary Bozeman; Mary Kay Burns; Jo-Viviane Jones; Wendy O Kalberg; David Buckley; Omar Abdul-Rahman; Margaret P Adam; Tamison Jewett; Luther K Robinson; Melanie A Manning; H Eugene Hoyme

doi:10.1111/acer.15501

Maternal and paternal risk factors associated with diagnoses within the continuum of fetal alcohol spectrum disorders in the USA: Proximal and distal influences

Alcohol Clin Exp Res (Hoboken). 2024 Dec 12. doi: 10.1111/acer.15501. Online ahead of print.

Authors

Philip A May^{1

2}, Julie M Hasken¹, Julie M Stegall¹, Heather A Mastro¹, Amy Baete³, Jaymi Russo³, Rosemary Bozeman⁴, Mary Kay Burns⁴, Jo-Viviane Jones⁴, Wendy O Kalberg², David Buckley², Omar Abdul-Rahman⁵, Margaret P Adam⁶, Tamison Jewett⁷, Luther K Robinson⁸, Melanie A Manning^{9

10}, H Eugene Hoyme³

Affiliations

¹ Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA.
² Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, USA.
³ Sanford Health, Sioux Falls, SD, USA.
⁴ City/County Health Department, USA.
⁵ School of Medicine, Department of Pediatrics, Cornell University, New York, NY, USA.
⁶ School of Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.
⁷ School of Medicine, Department of Pediatrics, Wake Forest University, Winston-Salem, NC, USA.
⁸ School of Medicine, Department of Pediatrics, State University of New York at Buffalo, Buffalo, NY, USA.
⁹ Department of Pathology, School of Medicine, Stanford University, Palo Alto, CA, USA.
¹⁰ Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA, USA.

PMID: 39667847
DOI: 10.1111/acer.15501

Abstract

Background: We sought to determine risk factors for fetal alcohol spectrum disorders (FASD) in the United States.

Method: Mothers of first-grade children participating in the Collaboration on FASD Prevalence (CoFASP) in three regional sites were interviewed. Maternal and paternal data were reported by mothers of children with an FASD diagnosis and controls.

Results: Interviews were conducted with mothers of children with an FASD (n = 114) and controls (n = 753). Fifty-seven percent of control mothers usually drank 2.7 drinks per drinking day (DDD) once per month prior to pregnancy, and 79% of mothers of children with FASD reported drinking 4.2 drinks 1-2 times per week. Mothers of children with alcohol-related neurodevelopmental disorder reported the most alcohol consumption overall: bingeing, drinking frequency, drinking in each trimester, and other drug use. Mothers of children with fetal alcohol syndrome (FAS) and partial FAS (PFAS) underreported consumption. Distal maternal risk factors were liver problems, depression, later pregnancy recognition and first prenatal visit, lower frequency of marriage, and lower spirituality. Postnatal risk indicators were low birthweight and gestational age. Regression analysis indicated that maternal reports of three DDD before pregnancy were associated with a diagnosis within the FASD continuum (p < 0.001, OR = 9.92). First-trimester exposure (p < 0.001, OR = 7.64) and all three trimesters (p < 0.001, OR = 7.77) were associated with a child's FASD diagnosis. An independent association was found between paternal DDD during pregnancy and FASD diagnoses (p = 0.002, OR = 1.08); but, once maternal drinking was a covariate, paternal influence was not significant. Stepwise models indicated that combined maternal alcohol use measures (p < 0.001, χ² = 61.09), later pregnancy recognition (p = 0.032, χ² = 4.58), later prenatal visits (p = 0.036, χ² = 4.38), and depression in lifetime (p = 0.002, χ² = 9.47) were significant FASD predictors. The final 10-step model explained 27.4% of the variance in FASD risk.

Conclusion: While multiple, significant maternal risk factors for FASD were identified, paternal drinking was not a statistically significant, independent risk factor.

Keywords: United States; fetal alcohol Spectrum disorders; maternal risk.

Grants and funding

AA019894/AA/NIAAA NIH HHS/United States