People Exposed to Alcohol in Utero Have Increased Likelihood of Physical Health Problems in Midlife, Implicating a Complex Pattern of Risk Factors

People exposed to alcohol in utero report a greater range and frequency of physical health problems in midlife than those who were not exposed, according to a new study. Prenatal stressors and difficult early life experiences are known to increase the risk of the early onset of disease in adulthood. A theory on the developmental origins of health and disease implies that risky exposures occurring during pregnancy may increase the offspring’s vulnerability to the effects of subsequent adverse influences. Prenatal alcohol exposure (PAE) may be one such exposure. Improved understanding of the long-term effects of PAE could lead to improved clinical care for affected people. Identifying areas of concern may also inform early interventions to reduce the long-term impact of PAE. In the study in Alcohol: Clinical & Experimental Research, investigators considered the possible implications of PAE for a wide range of health problems that typically occur as people grow older.

Researchers recruited 357 midlife adults, with and without PAE, from long-term studies in Atlanta and Seattle. The participants had been identified initially via maternal self-reports during pregnancy or were diagnosed with fetal alcohol syndrome (FAS) or fetal alcohol exposure (FAE) in childhood. They were divided into three groups: no PAE, PAE without FAS or the associated facial dysmorphic symptoms, and PAE with FAS or dysmorphia. The participants took a comprehensive health survey that included questions about cancer, problems with vision, hearing, immune function, dentistry, skin, or sleep, and issues affecting cardiovascular, urinary, gastrointestinal, or endocrine function. The investigators compared the reported prevalence of health issues among the three groups while using statistical analyses to account for demographic characteristics and other influences on health, including adverse childhood experiences.

Health problems were reported across all groups; however, people with PAE reported a higher frequency of most health issues. In addition, PAE was linked to an increased risk of hearing, urinary, and gastrointestinal problems, which appear to be directly affected by alcohol exposure after statistical control of other factors. The increased frequency of other health issues suggests that PAE leads to greater vulnerability across many bodily systems, intensifying the negative effects of other social determinants, such as socioeconomic struggles and poor diet. It’s also possible that disability associated with PAE renders people less able to maintain healthy behaviors and that the stressors associated with disability further amplify negative health influences. Health status was also related to age, race, gender, and adverse childhood experiences: older white women with more early life adversity reported more health problems. Facial dysmorphia was not associated with a greater risk of physical health problems in midlife.

The findings of this study—one of the first to examine the midlife health of people with PAE—point to a long-term health impact of early alcohol exposure. It is likely that PAE is associated with a complex pattern of risk factors with cumulative health implications. This new insight has the potential to improve the clinical care of—and broader support for—people affected by PAE by promoting comprehensive health evaluations of patients at elevated risk. More research to validate patient self-report through clinical investigation with objective health measures in larger samples is the next step in understanding the impact of early alcohol exposure.

Prenatal alcohol exposure and health at midlife: Self-reported health outcomes in two cohorts. C. Coles, Z. Shapiro, J. Kable, S. Stoner, G. Ritfeld, T. Grant.

ACER-24-6030.R1