TABLE 4

Systematic Review: Association of Alcohol Exposure With GM Performance Outcomes (n = 14)

StudyAlcohol ExposureReference GroupStandardized Assessment ToolGM OutcomesAssociationsConfounders and BCs
FASD diagnosis (n = 3)
 Age range, 0 – <2 y
  Davies et al 201136a(1) n = 45; FASDb; (2) n = 35; FASDb(1) n = 347; No FASD, but some PAEb; (2) n = 48; No FASD, but some PAEbGMDScLocomotor subscaleMean (SD); (1) 7–12 mo; FASD: 89.8 (17.9); Reference group: 100 (13.4); P < .001; GM outcome: impaired; (2) 17–21 mo: FASD: 78.3 (17.6); Reference group: 90.1 (15.4); P < .001; GM outcome: impairedNone reported. Not matched for BCs.
 Age range, 5 – <10 y
  Adnams et al 200128,an = 34; FAS; Mean (SD); 84.41 drinks/wk (13.25); Drinks/wkn = 34; No FAS, but some PAE exposure: Mean (SD); 3.03 drinks/wk (5.19); Drinks/wkGMDScLocomotor subscaleMean (SE); PAE group: 102.13 (1.45); Reference group: 104.93 (1.30); P > 0.05; GM outcome: no impairmentMaternal education. BCs matched on child’s age, gender, first language, family income and school.
  Kooistra et al 200932,an = 77; FASDb (n = 30); ADHD (n = 47); Groups: ADHD–C (combined ADHD group; n = 31), ADHD–PI (predominantly inattentive; n = 16)n = 39; No ADHD or FASDbM-ABCdStatic and dynamic balance subscale; Ball skills subscaleMean (SD); Static and dynamic balance: FASD: 2.3 (2.6), ADHD–C: 2.9 (2.9), ADHD–PI: 1.9 (1.6); Reference group: 0.5 (0.9), F(4110) = 6.09, P < .001. GM outcome: impaired, FASD: 3.0 (2.5), ADHD–C: 3.1 (2.9), ADHD–PI: 1.6 (1.4); Reference group: 1.9 (1.5); F (4110) = 3.58; P = .009; GM outcome: impairedNone reported. BCs matched for gender and SES.
  Jirikowic et al 201338,an = 10; FASDn = 10; Typically developing (< 3 drinks throughout pregnancy)(1)M-ABC2e; (2) p-CTSIB-2f; (3) DGIgBalance total; Static balance; Dynamic balanceMean (SD); PAE group: 8.5 (2.7), Reference group: 11.3 (3.1), P = .08; GM outcome: no impairment; Balance; total ordinal score: PAE group: 27.6 (2.3), Reference group: 29.1 (1.1), P = .07; GM outcome: no impairment; Balance: vestibular sensory system score: PAE group: 8.2 (1.4), Reference group: 9.3 (1.1), P = .06; GM outcome: no impairment, PAE group: 21.4 (1.4), Reference group: 23.2 (1.1), P = .02, GM outcome: impairedNot performed because of small sample size. BCs matched for age and gender.
Moderate to heavy alcohol exposure or binge drinking (n = 4)
 Age range, 0 – <2 y
  Smith et al 198635; PAE level: moderate to heavyn = 149; “Stopped” group 28–56 g (2–4 drinks) in first and second trimesters; “Continued” group: 56–142 g (4–10 drinks) in 3 trimesters; Continued group: 170–368 g (12–26 drinks) in 3 trimesters; Continued group: >396 g (28 drinks) in 3 trimesters; g AA/wk h,j,knh; “Never” group: 0 g; g AA/wkBNBASiMotor performance cluster scoreMean (SD); “Never” group: 4.97 (0.99), Stopped group: 4.53 (1.01), Continued groups combined: 4.69 (1.05), P > .05; GM outcome: no impairmentSmoking for growth parameters only. Not matched for BCs.
  Coles et al 198731,a; PAE level: “high risk”n = 48; Stopped group: 345 g (12 drinks) in first and second trimesters (n = 22); Continued group: 345 g (12 drinks) in first through third trimesters (n = 26); g AA/wkj,kn = 55; Never group: 0 g; g AA/wkjBNBASiMotor Performance cluster scoreMean (SD); Never group: 4.96 (0.98); Stopped group: 4.66 (1.13); Continued group: 4.40 (1.06); F (1,99) = 3.07; P < .05. GM outcome: Continued group differed significantly to Never group in motor performance (ie, general tonus, maturity, pull-to-sit, defensive movements, activity).None reported. Not matched for BCs.
 Age range, 2 – <5 y
  Barr et al 199027; PAE level: moderate to high; 1.0 oz AA = 2 standard drinksn = 449; At least 0.5–1.5 ozb (at least 7 to ≤21 drinks/wk)h; oz AA/wknh; Abstainersb,h,j; oz AA/wk“Battery of gross motor tasks”l based on: (1) GMTOT, (2) The Gessell, (3) BSID – PDI; Items tested were balance, coordination, and distanceBalance, coordination, and distance subscalesMean (SD); Balance: 76 (8); Coordination: 55 (15); Distance: 47 (18); R = 0.27, F = 5.00; P = .026; GM outcome: Increasing alcohol exposure in early pregnancy was related to increasing poor balanceCaffeine, nicotine, aspirin, gender, birth order, maternal race age, and prenatal nutrition, maternal and paternal education, examiner, and age of child. Not matched for BCs.
 Age range, 5 – <10 y
  Bay et al 201212; PAE level: only moderate PAE included for this reviewn = 93; (1) 5–8 drinks/wk (n = 82); (2) ≥9 drinks /wk (n = 11); Drinks/wkn = 325; 0 drinks/wk; Drinks/wkM-ABCdGM subarea: catching beanbag, rolling ball; Balance subarea: One-leg balance, jumping over cord, walking heels raised.Mean difference (95% CI); (1) PAE group: −0.41 (−1.31 to 0.48), P = .79; GM outcome: no impairment; (2) PAE group: −0.40 (−2.18 to 1.39), P = .79; GM outcome: no impairment; (1) PAE group: −0.66 (−1.74 to 0.42), P = .47; GM outcome: no impairment; (2) PAE group: 1.06 (−1.76 to 3.88), P = .47; GM outcome: no impairmentParental education, maternal IQ, prenatal maternal smoking, maternal age, parity, maternal binge drinking episodes during pregnancy, prenatal and postnatal marital status, postnatal parental smoking, maternal prepregnancy BMI, child gender, age at testing, health status, hearing and vision on the day of testing, family/home environment, and physical activity (organized sport). Not matched for BCs.
  Kesmodel et al 201339,a; PAE level: Binge drinking defined as an intake >5 standard drinks on a single occasion; 1 standard drink = 12 g AAn = 160; 3+ binges; Binge drinking episodes over the first 8 wk first trimestern = 46; 0 binges; Binge drinking episodes over the first 8 wk in first trimesterM-ABCdGM subarea: catching beanbag, rolling ball. Balance subarea: one-leg balance, jumping over cord, walking heels raised.Mean difference (95% CI); PAE group: −0.32 (−1.09 to 0.45), P = .79; GM outcome: no impairment; PAE group: 0.42 (−0.85 to 1.68), P = .92; GM outcome: no impairmentParental education, maternal IQ, prenatal maternal smoking, prenatal maternal average alcohol intake, maternal age, parity, prenatal and postnatal marital status, postnatal parental smoking, maternal prepregnancy BMI, child gender, age at testing, health status, hearing and vision on the day of testing, family/home environment, and physical activity (organized sport). Not matched for BCs.
Mixed: FASD and moderate to heavy alcohol exposure (n = 5)
Age range, 0 – <2 y
  Autti-Rämö and Granström 199130,a; PAE level: moderate to heavyn = 53; (1) >28–140 g (2–10 drinks) in first trimester (n = 21); (2) >140 g (10–45 drinks) in first and second trimesters (n = 19; inclusive of 1 FAS child), g AA/day; (3) > 140 g (10–45 drinks) (n = 19), AA/wk in first – third trimesters, (n = 13; inclusive of 5 FAS children); g AA/weekkn = 56; 0 g (0 drinks); g AA/dayGMTOTmAge of independent walking (months)Mean (P value, pairwise analysis with no PAE); No PAE 11.97, Group 1: 12.48, P > .05; Group 2: 13.45, P < .05n; Group 3: 14.23, P < .01o; F = 5.93 (3), P = .0009 (difference between all groups); GM outcome: Significantly delayed independent walking in groups 2 and 3None reported. Not matched for BCs. (Higher level of 2-parent families in controls, and higher foster families/children’s homes in groups 2 and 3).
 Age range, 5 – <10 y
  Aronson et al 198529n = 21; Children of alcoholb dependent mothers
(n = 20; inclusive of 10 FAS children)n = 21; PAEb (Only n = 13 case control pairs for GMDS for children <7 y of age).GMDScLocomotor subscaleMean (SD); PAE group: 95.7 (12); Reference group: 113.5 (9), P < .001; GM outcome: impairedNone reported. BCs matched for gender, age, BW, GA, and living area but not for smoking.
  Kyllerman et al 198533an = 21; Children of alcoholb dependent mothers
(n = 20; inclusive of 10 FAS children)n = 21; PAEbCTSp based on the Oseretsky Test of Motor ProficiencyCoordinationMean (SD); (2) CTS: PAE group: 2.2 (1.1), Reference group: 3.1 (1.2), P < .05; GM outcome: impairedNone reported. BCs matched for gender, age, BW, GA, and living area but not for smoking.
 Age range, 10 – ≤18 y
  Roebuck et al 199834,a; PAE level: heavyn = 11; FAS (n = 8); Heavyb PAE (n = 3)n = 11; Minimal exposurebSOTqEquilibrium composite scoreMean (SE); PAE group: 70.73 ± 2.84; Reference group: 79.64 ± 1.27, F(1,17) = 18.77, P < .01; GM outcome: balance impaired when somatosensory input was inaccurateNone reported. BCs matched on age and gender
  Simmons et al 201037,a; PAE level: heavyn = 28; FAS (n = 9), heavy PAE, (n = 19); Heavy = 3–4 glasses of wine/day, being drunk day and night, drinking a fifth of vodka or case of beer each dayn = 23; No PAEResponse box with multifunction timing device,r standardized proceduresReaction time alone (milliseconds); Reaction time and move (milliseconds); Movement time (milliseconds)Mean (SE); FAS: 437.9 ms (46.9), PAE: 378.2 ms (22.0); Control: 378.6 (8.6), F (2,49) = 2.87, P > .05; GM outcome: no impairment; FAS: 612.9 ms (70.4), PAE: 493.5 ms (19.9), Control: 467.2 (62.4), F (2,49) = 6.15, P < .05; GM outcome: FAS group slower reaction time. Target 1: FAS: 505.7 ms (43.1), PAE: 375.8 ms (29.8), Control: 364.4 ms (27.7), F (2,49) = 4.13, P < .05; GM outcome: Slower movement times to targets in FAS children. Significantly longer and more variable reaction times in FAS children. Significant results repeated for Target 2 and 3. Target 2: FAS: 857.4 ms (68.6), PAE: 595.5 ms (47.4), Control: 661.3 ms (44.1), F (2,49) = 4.99, P < .01. Target 3: FAS: 1171.2 ms (89.5), PAE: 862.8 ms (61.8), Control: 913.9 ms (57.5), F (2,49) = 4.22, P < .05.None reported. Not matched for BCs.
  • AA, absolute alcohol; ADHD, attention-deficit/hyperactivity disorder; BC, baseline characteristic; BNBAS, Brazelton Neonatal Behavioral Assessment Screen; BSID–PDI, Bayley Scales of Infant Development–Psychomotor Development Index; BW, birth weight; CTS, Coordination Test Score; DGI, Dynamic Gait Index; GA, gestational age; GMTOT, Gross Motor Total Score; M-ABC, Movement Assessment Battery for Children; M-ABC2, Movement Assessment Battery for Children, Second Edition; p-CTSIB-2, Pediatric Clinic Test of Sensory Integration for Balance, Second Edition; SES, socioeconomic status; SOT, Sensory Organization Test.

  • a Studies included in meta-analysis.

  • b PAE not quantified.

  • c Higher scores indicate better performance.

  • d Lower scores indicating better performance.

  • e Higher score indicates better performance.

  • f Higher scores indicate better performance.

  • g Higher scores indicate better performance.

  • h Subjects per group not provided.

  • i Higher scores indicate better performance.

  • j Ounces AA converted to grams AA for comparison purposes (1 ounce = 28.35 g).

  • k Grams AA converted to drinks for comparison purposes (1 standard drink = 14 g AA US definition).

  • l Battery of gross motor tasks: higher scores indicate better performance.

  • m Higher scores indicate better performance.

  • n Prevalence of GM impairment = 31.6%.

  • o Prevalence of GM impairment = 30.8%.

  • p Higher scores indicate better performance.

  • q Lower scores indicate better performance.

  • r Response box with multifunction timing device: lower scores indicate better performance.