News — People with prenatal alcohol exposure (PAE) are at raised risk of postnatal adversity (PA), according to an evaluation of current research. The review in Alcohol: Clinical & Experimental Research highlights substantial vulnerabilities for affected people and major gaps in mental health interventions and other supports. PAE is related to fetal alcohol spectrum disorders (FASD), neurodevelopmental disabilities affecting at least 1–5% of school-age children in the USA. People with PAE are more likely than others to experience PA, such as neglect or abuse in childhood. This additional risk, along with genetic and environmental factors, contributes to wide variation in developmental trajectories and life experiences. The new assessment of the scientific literature on the intersection of PAE and PA identifies possible routes to improving outcomes.
Investigators affiliated with the University of Rochester, New York, were guided by a Developmental Psychopathology framework, new to this field, that acknowledges complex interactions between multiple factors. They used established review criteria to identify 29 published studies exploring PAE, PA, biological, cognitive, and emotional functioning, the role of external systems such as mental health care, and family and cultural contexts.
Their systematic review highlights the complex interaction of PAE, PA, systems, and cultural factors, as well as the varied effects on multiple areas of development and functioning in affected people. Essentially, PAE raises the risk of PA, with PA, in turn exacerbating the effects of PAE. People with PAE experience an average of 4.4 adverse childhood experiences (ACEs); those with FASD experience 3.7 more ACEs than those without FASD. Adversity is associated with atypical neurological and hormonal development. It compounds the risks for physical and mental health issues, including psychological trauma and cognitive, academic, and behavioral challenges. The co-occurrence of PAE and PA has substantive impacts on families and systems. Outcomes experienced by people with both conditions are highly variable. The research acknowledges the strengths of people with PAE, including social motivation and determination and the protective value of caregiver stability.
The review commends researchers for exploring the complexities of the issue. In addition, it highlights substantial gaps in resources—most notably, no mental health interventions that meet the needs of people with PAE and trauma have been developed for or tested in this population. The reviewers recommend building on the strengths of people with PAE to cultivate resilience. They also advise certain system changes. For example, while the data point to the need for routine PAE and PA screening in some clinical care settings, the overlap in symptom presentation calls for incorporating the possibility of PA into the FASD diagnostic procedure and PAE into the diagnosis of trauma-related conditions.
The mix of methods and tools and limited sample sizes in studies to date prevented fuller synthesis of the findings. The reviewers call for further research with large, diverse samples, community-based participatory approaches, and tracking people over time to illuminate the dual developmental impact of PAE and PA. This could help identify, for example, how the timing of adversity affects outcomes and additional factors that have a role in resilience. Research should account for socioeconomic status, cultural context (such as intergenerational colonial trauma affecting Indigenous communities), and life experiences outside the school-age and teen years, informing interventions accordingly.
Understanding the intersection of prenatal alcohol exposure and postnatal adversity: A systematic review from a developmental psychopathology lens. M. Rockhold, E. Handley, & C. Petrenko.
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