Prenatal Alcohol exposure and mental health at midlife: A preliminary report on two longitudinal cohorts

M E TH O DS

Subjects: In the current study, we report on 292 individuals who responded to a health survey between January 2017 and May 2021. Of these, 283 had responses that included all data necessary to carry out causal modeling. Participants were recruited from two existing cohorts in Atlanta and Seattle. Individuals defined as alcohol exposed in these cohorts were known to have been diagnosed with an FASD or to have been exposed to alcohol prenatally according to maternal self-report during the prenatal period. Individuals in contrast groups were recruited either at the same time as those in the alcohol groups or at later time points… Measures: Two surveys were used. The first is a simple demographic form that obtains basic information about the participant (e.g., date of birth, gender identity, racial identification) and their family (e.g., marital status, number of children). As part of the form, the information necessary to calculate the Hollingshead social status index (Hollingshead, 2011) was collected (i.e., the educational achievement and occupation of participants and their spouses/partners, if relevant). The second instrument was a 190-item health survey based on the Behavioral Risk Factor Surveillance System (BRFSS) used by the Centres for Disease Control and Prevention (CDC; CDC—BRFSS— Questionnaires). Our goal was to survey the systemic health status of the participants. The number of questions completed depended on the participants’ responses as follow- up questions were not presented unless a health problem was acknowledged.

TRANSLATION

The method involved participants from two research groups in Atlanta and Seattle with some exposed to alcohol before birth or had been diagnosed with Fetal Alcohol Spectrum Disorder (FASD) while others had not. From what I understand in the methods section, the researchers used two surveys to collect data from the participants; the first being personal and family information such as age, race, marital status and number of children, the other was a 190-question health survey created by the Behavorial Risk Factor Surveillance System (BRFSS) of CDC

There is relatively little information available about the impact of PAE on emotional status in adulthood and, in the clinically referred groups who are often the subjects of study, it can be difficult to discriminate the effects of prenatal exposure against the backdrop of social and environmental stressors that often accompany PAE… Although mental health problems are found frequently in individuals with PAE, the contribution of other factors to these outcomes also should be considered, as O’Connor has pointed out in her review (O’Connor, 2014). In 2017, Price et al. (2017) reviewed the literature on the impact of adverse childhood experiences (ACEs; Felitti et al., 1998) in individuals with PAE, finding only five articles that had addressed this issue. They concluded that while the available research was suggestive of an additive impact of ACES and PAE compared to either ACES or PAE alone, it was limited in scope and that there were design issues limiting generalizability. These researchers noted that there was no research yet addressing the lifetime risk associated with the joint occurrence of these two risk factors

TRANSLATION

My understanding of the above is that there’s not enough research on how prenatal alcohol exposure (PAE) affects mental health in adulthood. It also states that previous research carried out found it challenging to determine an exclusively direct relationship between mental health conditions and PAE individuals because those individuals also experience social and environmental conditions, one of which is adverse childhood experiences (ACE) e.g abuse, neglect and other traumatic events during childhood. The researchers agreed with other studies that found only 5 articles addressing that issue, creating a gap yet to be fully explored.

R E S U LT S

Participants

Across sites, of the 342 individuals who could be located to date and who were approached for the study, 292 agreed to participate (85%) and 28 refused to participate. Other individuals were found but did not participate due to location, life circumstances, or incarceration and a total of 41 were identified as deceased. Of the 292 who provided data, 283 had all items available that were necessary to carry out the Path Analyses. Table 2 shows the characteristics of participants comparing those in the non-exposed contrast group with those who were alcohol exposed/ FAE (without physical features) and those who could be classified as alcohol affected/FAS (having dysmorphic physical features)… Path analysis was used to model the relationship between PAE and the mental health status outcomes while taking into account other factors that might contribute to outcomes, including age, gender, site of data collection, SES and ACEs, and dysmorphology. IBM SPSS Amos 28 was used to assess the proposed path model (for an example, see Figure 1). The goal of these analyses was to determine the direct and indirect relationships of PAE with mental health outcomes for which individuals with PAE reported significantly higher rates. Table 4 shows these relationships as well as other relationships that significantly affected mental health outcomes

TRANSLATION

Out of 342 people contacted by the researchers, 85% agreed to participate with about 8% who declined and approximately 7% who could not participate for other reasons. From the 85%, 283 participants provided complete information that the researchers used for the analysis. The participants were divided into three groups; those who had not been exposed to alcohol before birth, those who had PAE but no physical features of FAS, and those who had both PAE and physical features of FAS. The researchers used a statistical method (Path Analysis) to examine how PAE was related to mental health while considering other factors (such as age, adverse childhood experience – ACEs) that could influence the outcome. This was used to determine the correlation between PAE, mental health and external influences among the individuals.

D I S CUS S I O N: The results of the current study confirm that individuals with PAE are more likely to report both symptoms of depression and diagnosis of mental health problems and that these problems remain observable in middle adulthood. Similarly, we find in these samples that participants are more likely to report ACEs if they have been prenatally exposed to alcohol… Path analyses indicate that alcohol effects on mood disorders and anxiety are indirect, mediated by the postnatal environmental factors that include ACEs as well as social and economic status…We need to understand that when prenatal exposure has occurred, the child is more vulnerable to subsequent environmental insults. By taking preventive steps to reduce or eliminate environmental stressors early in development, we may be able to mitigate lifelong consequences of PAE.

TRANSLATION

My understanding is that the researchers found that individuals exposed to alcohol prior to their births had a higher possibility to experience depression and other mental health disorders which often continued to adulthood. They also found that individuals with PAE were more likely to have adverse childhood experiences. The statistical analysis showed that PAE was not exclusively the direct cause for mood disorders and anxiety as environmental factors such as ACE, and socioeconomic status had their roles to play in it. The researchers concluded that children exposed to alcohol before birth are more vulnerable to negative experiences in adulthood. They suggest that reducing stress and providing safe and supportive environment during childhood may help reduce the long- term mental health effects of PAE

PERSONAL ANSWER: Future research should examine how prenatal alcohol exposure and adverse childhood experiences work together over a person’s lifetime, I believe. Researchers should also investigate/explore other factors (such as early support, stable family environments and mental health services) and their long-term effects on prenatal alcohol exposure.

OBSERVATION FROM THE RESEARCH PAPER: According to the researchers from the introduction section of the article, they noted that although people with PAE were associated with mental health problems, there were other contributing factors that have been ignored or not fully researched on, creating a gap for biased results or interpretations. They also mentioned that limited spotlight has been thrown on the combined implications of ACE and PAE on individuals. Below is a direct quotation from the article.

Although mental health problems are found frequently in individuals with PAE, the contribution of other factors to these outcomes also should be considered, as O’Connor has pointed out in her review (O’Connor, 2014). In 2017, Price et al. (2017) reviewed the literature on the impact of adverse childhood experiences (ACEs; Felitti et al., 1998) in individuals with PAE, finding only five articles that had addressed this issue. They concluded that while the available research was suggestive of an additive impact of ACES and PAE compared to either ACES or PAE alone, it was limited in scope and that there were design issues limiting generalizability. These researchers noted that there was no research as yet addressing the lifetime risk associated with the joint occurrence of these two risk factors.

One part of this paper that was challenging was the interpretation of the tables in the result section. The terminology used in that section was quite confusing and daunting.