Children's ability to play affected after mothers drinking while pregnant - new findings

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Fox News, the Huffington Post, the Daily Mail and Australia's Daily Telegraph are among media to publish stories about the globally significant study that has uncovered new types of damage to children after mothers drink while pregnant.The study, a global review of other studies, found children's ability to play is affected.

Lead author Barbara Lucas, of The George Institute, The University of Sydney and Sydney Medical School, funded by the Poche Centre, takes part in a Q and A about the paper: Gross Motor Deficits in Children Prenatally Exposed to Alcohol: a Meta-Analysis. Authors also included Jane Latimer, Rafael Z Pinto, Manuela L Ferreira, Robyn Doney, Mandy Lau, Taryn Jones, Danielle Dries, Elizabeth J Elliott.

• Why did you decide to do this large review of the literature?

I am a physiotherapist/ researcher who has been involved in Australia’s first population based prevalence study for Fetal Alcohol Spectrum Disorder – the Lililiwan Project. This was conducted in partnership with Australian Aborginal communities in a remote area of north Western Australia. I was responsible for assessing the children’s gross motor skills (ie basic play skills such as running, jumping, ball skills, co-ordination etc). We conducted this Systematic Review to determine how gross motor abilities may be affected by prenatal alcohol exposure or a FASD diagnosis. Reviews of the literature exist don’t exist specifically for gross motor skills and this is an area I was interested in.

• Could you briefly describe what you found regarding the likelihood that child diagnosed with FASD or PAE would have impairment?

Children with a FASD diagnosis are three times more likely to have gross motor impairment. This is biologically plausible as alcohol is a teratogen which causes damage to the developing brain. Areas of the brain that may be damaged include those which are important for motor control.

• Why do you believe you found impairment specifically in balance, coordination and ball skills? What is the mechanism behind the impairment?

Prenatal alcohol exposure causes damage to both central (brain) and peripheral nerves (structures innervating muscles) and to neurotransmitters. MRI studies have shown the cerebellum which control balance may be damaged by alcohol. More complex skills such as co-ordination and balls skills are likely to be affected due to damage to the motor cortex, basal ganglia and cerebellum, and damage to peripheral nerve structures and visual mechanisms which help control motor skills. Balance and complex motor skills have been found to be consistently affected in many studies.

• Why was there no impairment for some of the categories of alcohol exposure?

We were surprised that the “moderate” to “high” and “binge drinking” levels of alcohol were not associated with gross motor impairment (compared to the FASD category or a mixed category of children with FASD and “moderate” to “high” prenatal alcohol exposure). This is likely due to the small number of studies available (only three) and the small number of participants in this category. Also one of these studies did not use outcome measures which we found to be affected by alcohol.

• Do you think there needs to be better research on impairment after FASD diagnosis or PAE?

Yes - if the harms to motor function with FASD diagnosis or PAE were more widely known, then this may assist health professionals with their assessment and management of these children. In children gross motor skills are an integral part of their physical repertoire enabling exploration of the environment, social interaction and play. If these skills are impaired then child’s ability to participate is greatly diminished; for example in physical activities at school, with friends and in sport.

• What should parents know about your findings?

Gross motor skills are one of the functions which may be may be impaired following prenatal exposure to alcohol. Children who are exposed to alcohol prenatally would benefit from assessment of their gross motor skills. If problems are identified physiotherapists can assist children to improve their gross motor skills.

• What should doctors and policymakers know about your findings?

Our results validate policy which aims to prevent the harms of prenatal alcohol exposure by recommending that women who are pregnant or planning pregnancy avoid alcohol. Doctors have an important role in conveying this message and assisting women who drink alcohol to cease drinking during pregnancy.

• Is there anything else that you think is particularly important for people to know about your results or this topic?

While we found an association between gross motor function and “moderate” to “high” levels of exposure ie 10 drinks per week, or children with a FASD diagnosis, no safe level of alcohol intake in pregnancy has been established and the safest option is to avoid alcohol.