TABLE 2

Definition of Documented Prenatal Alcohol Exposure (as Applied to the Diagnostic Categories Set Forth in Table 1)

One or more of the following conditions must be met to constitute documented prenatal alcohol exposure during pregnancy (including drinking levels reported by the mother 3 mo before her report of pregnancy recognition or a positive pregnancy test documented in the medical record). The information must be obtained from the biological mother or a reliable collateral source (eg, family member, social service agency, or medical record):
− ≥6 drinks/wk for ≥2 wk during pregnancya
− ≥3 drinks per occasion on ≥2 occasions during pregnancya
− Documentation of alcohol-related social or legal problems in proximity to (before or during) the index pregnancy (eg, history of citation[s] for driving while intoxicated or history of treatment of an alcohol-related condition)
− Documentation of intoxication during pregnancy by blood, breath, or urine alcohol content testing
− Positive testing with established alcohol-exposure biomarker(s) during pregnancy or at birth (eg, analysis of fatty acid ethyl esters, phosphatidylethanol, and/or ethyl glucuronide in maternal hair, fingernails, urine, or blood, or placenta, or meconium)5055
− Increased prenatal risk associated with drinking during pregnancy as assessed by a validated screening tool of, for example, T-ACE (tolerance, annoyance, cut down, eye-opener) or AUDIT (alcohol use disorders identification test)56
  • Assignment of documented prenatal alcohol exposure to any individual case requires the sound judgment of an experienced clinician.

  • a These criteria for maternal drinking are based on large epidemiologic studies that demonstrate adverse fetal effects from ≥3 drinks per occasion26,57 and others that indicate 1 drink/day as a threshold measure for FASD.5860