PEDIATRICS Vol. 81 No. 6 June 1988, pp. 772-778
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Independent Dysmorphology Evaluations at Birth and 4 Years of Age for Children Exposed to Varying Amounts of Alcohol in Utero

John M. Graham Jr MD, ScD1, James W. Hanson MD1, Betty L. Darby PhD1, Helen M. Barr MS1, and Ann P. Streissguth PhD1

1 From the Dysmorphology and Clinical Genetics Program, Department of Maternal and Child Health, Dartmouth Hitchcock Medical Center, Hanover, New Hampshire; Division of Medical Genetics, Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City; and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle

Two groups of 4-year-old children were examined by a dysmorphologist without knowledge of previous examination results or prenatal exposure and categorized as to whether or not they showed fetal alcohol effects. A priori classification of children into the two groups was on the basis of their mothers' self-report of drinking when interviewed during pregnancy. Children born to 108 mothers in a "heavier" drinking group (absolute alcohol concentration ge30 mL/d [1.0 oz/d]) were compared with a matched group of children born to 97 mothers whose average absolute alcohol concentration was <0.3 mL/d (0.01 oz/d). The percentage of children with fetal alcohol effects in the heavier drinking ngr the comparison group was 20.4% ngr 9.3%. When fetal alcohol effects were studied in relation to only the absolute alcohol concentration scores, there was a significantly greater chance of a child being classified as having fetal alcohol effects with increasing levels of alcohol exposure prior to recognition of pregnancy (P = .013). A logistic regression, run on the absolute alcohol concentration scores and other primary exposures, indicated that fetal alcohol effects classification was not significantly related to nicotine, caffeine, or marijuana but was significantly related to absolute alcohol concentration scores even after statistically adjusting for these other exposures (P = .002). Classification of fetal alcohol effects at 4 years of age was compared to a fetal alcohol effects classification obtained at birth by an independent dysmorphologist in a sample of 75 subjects examined at both ages, and 80% of the infants classified as having fetal alcohol effects at birth were classified as having fetal alcohol effects at 4 years of age. These findings have important implications in terms of evaluations of alcohol-exposed infants at various ages.

Key Words: dysmorphology • alcohol • fetus

Submitted on April 1, 1987
Accepted on July 9, 1987




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