Identification of Children With Prenatal Alcohol Exposure

The term “fetal alcohol spectrum disorders” (FASD) denotes the broad spectrum of morphological changes and functional deficits seen in children exposed to alcohol prenatally. While some children on the spectrum show the characteristic pattern of malformations called “fetal alcohol syndrome” (FAS), a significant proportion of alcohol-exposed children do not evidence clinically identifiable morphological alterations. The term “alcohol-related neurodevelopmental disorder” (ARND) is used to label the latter group. The identification of children with ARND has proven to be challenging because of the lack of clinically discernable physical signs. Therefore, some investigators have used the strategy of assessing maternal drinking during pregnancy and then tracking developmental outcomes in offspring longitudinally. Other methods that investigators have utilized to identify children with prenatal alcohol exposure in population-based studies include multi-source surveillance and active case ascertainment. In the current review, we discuss the merits and demerits of these methodologies and then present novel methods of identifying prenatal alcohol exposure (e.g., biomarkers) and subtle effects of morphological alterations and neural effects (e.g., neuroimaging).