Prenatal alcohol use as a risk for attention-deficit/hyperactivity disorder

  • Daniel PagninEmail author
  • Maria Luiza Zamboni Grecco
  • Erikson Felipe Furtado
Original Paper


The objective of the study was to investigate the association between alcohol use during pregnancy and mental disorders in childhood, controlling for confounding risk factors by a longitudinal study of pregnant women and their offspring. The initial cohort comprised pregnant women attending an obstetric service. From the initial sample of 449 pregnant women, 81 mother–child pairs agreed to participate. After 12 years, mother–child pairs were assessed through self-administered questionnaires and semi-structured interviews. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (K-SADS-PL) was used to assess the presence of any mental disorders in the children. The mothers were assessed by the Self-Reporting Questionnaire (SRQ) and the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, data on the mother’s alcohol use collected during pregnancy were analysed. A logistic regression tested the influence of alcohol consumption in all trimesters and binge drinking on the occurrence of attention-deficit/hyperactivity disorder (ADHD), controlling for covariates. Binge drinking at any time during pregnancy or low–moderate alcohol consumption in all trimesters of pregnancy was associated with a fivefold increased odds of child ADHD. The combination of both patterns of alcohol use added an increase of 19% in the variance of ADHD’s occurrence. The episodic use of at least four drinks or the regular use of low–moderate alcohol doses during pregnancy was associated with significantly increased odds of subsequent child ADHD. Reducing binge drinking and regular alcohol use of pregnant women may lead to a significant decrease in their children developing ADHD.


Fetal alcohol spectrum disorders Attention-deficit/hyperactivity disorder Disruptive behaviour disorders 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    World Health Organisation (2014) Global status report on alcohol and health 2014. In: Global status report on alcohol and health, pp 1–392Google Scholar
  2. 2.
    Hutchinson D, Moore EA, Breen C et al (2013) Alcohol use in pregnancy: prevalence and predictors in the longitudinal study of Australian children. Drug Alcohol Rev 32:475–482PubMedGoogle Scholar
  3. 3.
    Lanting CI, van Dommelen P, van der Pal-de Bruin KM et al (2015) Prevalence and pattern of alcohol consumption during pregnancy in the Netherlands. BMC Public Health 15:723CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Cannon MJ, Guo J, Denny CH et al (2015) Prevalence and characteristics of women at risk for an alcohol-exposed pregnancy (AEP) in the United States: estimates from the National Survey of Family Growth. Matern Child Health J 19:776–782CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Tan CH, Denny CH, Cheal NE et al (2015) Alcohol use and binge drinking among women of childbearing age—United States, 2011–2013. Morb Mortal Wkly Rep 64:1042–1046CrossRefGoogle Scholar
  6. 6.
    Fabbri CE, Furtado EF, Laprega MR (2007) Alcohol consumption in pregnancy: performance of the Brazilian version of the questionnaire T-ACE. Medicina (B Aires) 41:979–984Google Scholar
  7. 7.
    Dorrie N, Focker M, Freunscht I, Hebebrand J (2014) Fetal alcohol spectrum disorders. Eur Child Adolesc Psychiatry 23:863–875CrossRefPubMedGoogle Scholar
  8. 8.
    Nash K, Rovet J, Greenbaum R et al (2006) Identifying the behavioural phenotype in fetal alcohol spectrum disorder: sensitivity, specificity and screening potential. Arch Womens Mental Health 9:181–186CrossRefGoogle Scholar
  9. 9.
    Roozen S, Peters G-JY, Kok G et al (2016) Worldwide prevalence of fetal alcohol spectrum disorders: a systematic literature review including meta-analysis. Alcohol Clin Exp Res 40:18–32CrossRefPubMedGoogle Scholar
  10. 10.
    Streissguth AP, Barr HM, Kogan J, Bookstein FL (1996) Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). In: Final report to the Centers for Disease Control and Prevention (CDC), SeattleGoogle Scholar
  11. 11.
    Popova S, Lange S, Shield K et al (2016) Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis. Lancet 387:978–987CrossRefPubMedGoogle Scholar
  12. 12.
    Essex MJ, Kraemer HC, Armstrong JM et al (2006) Exploring risk factors for the emergence of children’s mental health problems. Arch Gen Psychiatry 63:1246–1256CrossRefPubMedGoogle Scholar
  13. 13.
    Ramsay M (2010) Genetic and epigenetic insights into fetal alcohol spectrum disorders. Genome Med 2:27CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Keen CL, Uriu-Adams JY, Skalny A et al (2010) The plausibility of maternal nutritional status being a contributing factor to the risk for fetal alcohol spectrum disorders: the potential influence of zinc status as an example. Biofactors 36:125–135PubMedPubMedCentralGoogle Scholar
  15. 15.
    Thapar A, Rutter M (2009) Do prenatal risk factors cause psychiatric disorder? Be wary of causal claims. Br J Psychiatry 195:100–101CrossRefPubMedGoogle Scholar
  16. 16.
    O’Connor MJ, Paley B (2006) The relationship of prenatal alcohol exposure and the postnatal environment to child depressive symptoms. J Pediatr Psychol 31:50–64CrossRefPubMedGoogle Scholar
  17. 17.
    Pinheiro SN, Laprega MR, Erikson E, Furtado F (2005) Revista de Saúde Pública. Psychiatric morbidity and alcohol use by pregnant women in a public obstetric service. Rev Saúde Pública 39:593–598CrossRefPubMedGoogle Scholar
  18. 18.
    Kaufman J, Birmaher B, Brent D et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988CrossRefGoogle Scholar
  19. 19.
    Brasil HHA (2003) Development of the brazilian version of K-SADS-PL (schedule for affective disorders and schizophrenia for school aged children present and lifetime version) and study of psychometric properties. Dissertation, Universidade Federal de São Paulo (UNIFESP)Google Scholar
  20. 20.
    Gonçalves DM, Stein AT, Kapczinski F (2008) Performance of the self-reporting questionnaire as a psychiatric screening questionnaire: a comparative study with structured clinical interview for DSM-IV-TR. Cad Saude Publica 24:380–390CrossRefPubMedGoogle Scholar
  21. 21.
    Méndez EB (1999) A Brazilian version of AUDIT (alcohol use disorders identification test). Dissertation, Federal University of PelotasGoogle Scholar
  22. 22.
    Saunders JB, Aasland OG, Babor TF et al (1993) Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction 88:791–804CrossRefPubMedGoogle Scholar
  23. 23.
    Andreoli SB, Mari JJ, Blay SL et al (1994) The factor structure of the adult psychiatry morbidity questionnaire (QMPA) in a community sample of Brazilian cities. Rev Saude Publica 28:249–260CrossRefPubMedGoogle Scholar
  24. 24.
    Chiodo LM, Sokol RJ, Delaney-Black V et al (2010) Validity of the T-ACE in pregnancy in predicting child outcome and risk drinking. Alcohol 44:595–603CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    National Institute on Alcohol Abuse and Alcoholism (2004) NIAAA council approves definition of binge drinking. NIAAA Newsl 3:3Google Scholar
  26. 26.
    Dufour MC (1999) What is moderate drinking ? Alcohol Res Health 23:5–14PubMedGoogle Scholar
  27. 27.
    Thomas R, Sanders S, Doust J et al (2015) Prevalence of attention-deficit/ hyperactivity disorder: a systematic review and meta-analysis. Pediatrics 135:e994CrossRefGoogle Scholar
  28. 28.
    Fryer SL, McGee CL, Matt GE et al (2007) Evaluation of psychopathological conditions in children with heavy prenatal alcohol exposure. Pediatrics 119:e733–e741CrossRefPubMedGoogle Scholar
  29. 29.
    Kelly Y, Sacker A, Gray R et al (2009) Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age? Int J Epidemiol 38:129–140CrossRefPubMedGoogle Scholar
  30. 30.
    Rodriguez A, Olsen J, Kotimaa AJ et al (2009) Is prenatal alcohol exposure related to inattention and hyperactivity symptoms in children? Disentangling the effects of social adversity. J Child Psychol Psychiatry Allied Discip 50:1073–1083CrossRefGoogle Scholar
  31. 31.
    Tsang TW, Lucas BR, Carmichael H (2016) Prenatal alcohol exposure, FASD, and child behavior: a meta-analysis. Pediatrics 137:e2015–e2542CrossRefGoogle Scholar
  32. 32.
    Sayal K (2009) Commentary: light drinking in pregnancy: can a glass or two hurt? Int J Epidemiol 38:140–142CrossRefPubMedGoogle Scholar
  33. 33.
    Sood B, Delaney-Black V, Covington C et al (2001) Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. Dose-response effect. Pediatrics 108:E34CrossRefPubMedGoogle Scholar
  34. 34.
    Jacobson SW, Jacobson JL, Sokol RJ et al (2004) Maternal age, alcohol abuse history, and quality of parenting as moderators of the effects of prenatal alcohol exposure on 7.5-year intellectual function. Alcohol Clin Exp Res 28:1732–1745CrossRefPubMedGoogle Scholar
  35. 35.
    Willcutt EG (2012) The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 9:490–499CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Thanh NX, Jonsson E, Salmon A, Sebastianski M (2014) Incidence and prevalence of fetal alcohol spectrum disorder by sex and age group in Alberta, Canada. J Popul Ther Clin Pharmacol 21:e395–e404PubMedGoogle Scholar
  37. 37.
    Mattejat F, Remschmidt H (2008) The children of mentally ill parents. Dtsch Arztebl Int 105:413–418PubMedPubMedCentralGoogle Scholar
  38. 38.
    Feldman HM, Reiff MI (2014) Attention deficit–hyperactivity disorder in children and adolescents. N Engl J Med 370:838–846CrossRefGoogle Scholar
  39. 39.
    Thapar A, Cooper M (2016) Attention deficit hyperactivity disorder. Lancet 387:1240–1250CrossRefPubMedGoogle Scholar
  40. 40.
    Yolton K, Cornelius M, Ornoy A et al (2014) Exposure to neurotoxicants and the development of attention deficit hyperactivity disorder and its related behaviors in childhood. Neurotoxicol Teratol 44:30–45CrossRefPubMedGoogle Scholar
  41. 41.
    Dos M, Mesquita A, Aparecida C, Segre M (2009) Frequency of alcohol effects in fetus and pattern of alcohol consumption by pregnant women at a public maternity. Bras Crescimento Desenvolv Hum 19:63–77Google Scholar
  42. 42.
    Esper LH, Furtado EF (2014) Identifying maternal risk factors associated with fetal alcohol spectrum disorders: a systematic review. Eur Child Adolesc Psychiatry 877–889Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosciences and BehaviorUniversity of São PauloRibeirão PretoBrazil
  2. 2.Department of Psychiatry and Mental HealthFluminense Federal UniversityNiteróiBrazil

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