European Child & Adolescent Psychiatry

, Volume 23, Issue 12, pp 1175–1180 | Cite as

Is alcohol binge drinking in early and late pregnancy associated with behavioural and emotional development at age 7 years?

  • Janni Niclasen
  • Anne-Marie Nybo Andersen
  • Katrine Strandberg-Larsen
  • Thomas William Teasdale
Original Contribution


The purpose of this study was to investigate associations of maternal binge drinking in early and late pregnancy with child behavioural and emotional development at age seven. It was hypothesised that late exposure is associated with more negative outcomes than early exposure. Differences were expected on the continuous outcome measures, but not on above cutoff scale scores. Data were derived from the Danish National Birth Cohort. Three exposure groups were defined according to binge drinking from three interviews regarding binge episodes in early, middle and late pregnancy. A ‘no binge’ group included women with no binge episodes reported in any of the interviews, the ‘early bingers’ reported episodes in the first interview only, and the ‘late bingers’ in the last part of pregnancy only. The outcome measure was the Strengths and Difficulties Questionnaire (SDQ) used as continuous externalising/internalising scores and above cutoff hyperactivity/inattention, conduct, emotional and peer problems scores. Only women with full information concerning binge drinking from the three interviews, together with full-scale SDQ information on their children at age seven and being term-born, were included in the study (N = 37,315). After adjustment for maternal education, psychiatric diagnoses, age and smoking, children exposed to binge drinking in early and late pregnancy had significantly higher mean externalizing scores at age seven than unexposed children, an effect albeit much less for early binge drinking (relative change in mean 1.02, CI 1.00–1.05) than for late binge drinking (relative change in mean 1.21, CI 1.04–1.42). No associations were observed for any of the above cutoff outcomes. Exposure to binge drinking in early and late pregnancy is associated with elevated externalising scores, particularly so in late pregnancy. No increased risk for any of the above cutoff scale scores was observed.


Prenatal alcohol exposure SDQ Binge drinking Danish National Birth Cohort Timing of exposure Strengths and difficulties questionnaire 



The study was supported financially by the Department of Psychology, University of Copenhagen; Ludvig og Sara Elsass Foundation; Aase og Ejnar Danielsens Foundation; Carl J. Becker’s Foundation; the Lundbeck Foundation; Børne- og Ungdomspsykiatrisk Selskab i Danmark; Dagmar Marshalls Foundation; The A.P. Møller Foundation for the Advancement of Medical Science; and Direktør Jakob Madsens Legat.

Conflict of interest

There are no declared conflict of interests for any of the authors.


  1. 1.
    Irner TB (2012) Substance exposure in utero and developmental consequences in adolescence: a systematic review. Child Neuropsychol 18(6):521–549PubMedCrossRefGoogle Scholar
  2. 2.
    Gray R, Henderson J (2007) Review of the fetal effects of prenatal alcohol exposure. University of Oxford, National Perinatal Epidemiology UnitGoogle Scholar
  3. 3.
    O’Leary CM, Zubrick SR, Taylor CL, Dixon G, Bower C (2009) Prenatal alcohol exposure and language delay in 2-year-old children: the importance of dose and timing on risk. Pediatrics 123(2):547–554PubMedCrossRefGoogle Scholar
  4. 4.
    Willford J, Leech S, Day N (2006) Moderate prenatal alcohol exposure and cognitive status of children at age 10. Alcohol Clin Exp Res 30(6):1051–1059PubMedCrossRefGoogle Scholar
  5. 5.
    Alvik A, Aalen OO, Lindemann R (2013) Early fetal binge alcohol exposure predicts high behavioral symptom scores in 5.5-year-old children. Alcohol Clin Exp Res 37(11):1954–1962PubMedCrossRefGoogle Scholar
  6. 6.
    Andersen SL (2003) Trajectories of brain development: point of vulnerability or window of opportunity? Neurosci Biobehav Rev 27(1–2):3–18PubMedCrossRefGoogle Scholar
  7. 7.
    Rice D, Barone S Jr (2000) Critical periods of vulnerability for the developing nervous system: evidence from humans and animal models. Environ Health Perspect 108(Suppl 3):511–533PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Schlotz W, Phillips DI (2009) Fetal origins of mental health: evidence and mechanisms. Brain Behav Immun 23(7):905–916PubMedCrossRefGoogle Scholar
  9. 9.
    Kesmodel U (2001) Binge drinking in pregnancy—frequency and methodology. Am J Epidemiol 154(8):777–782PubMedCrossRefGoogle Scholar
  10. 10.
    Abel EL (1998) Neurodevelopmental abnormalities. Behavioural and cognitive. Fetal alcohol abuse syndrome. Plenum, New York, pp 111–138Google Scholar
  11. 11.
    Schneider ML, Moore CF, Becker EF (2001) Timing of moderate alcohol exposure during pregnancy and neonatal outcome in rhesus monkeys (Macaca mulatta). Alcohol Clin Exp Res 25(8):1238–1245PubMedCrossRefGoogle Scholar
  12. 12.
    Maier SE, Miller JA, Blackwell JM, West JR (1999) Fetal alcohol exposure and temporal vulnerability: regional differences in cell loss as a function of the timing of binge-like alcohol exposure during brain development. Alcohol Clin Exp Res 23(4):726–734PubMedCrossRefGoogle Scholar
  13. 13.
    Mooney SM, Varlinskaya EI (2011) Acute prenatal exposure to ethanol and social behavior: effects of age, sex, and timing of exposure. Behav Brain Res 216(1):358–364PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Olsen J, Melbye M, Olsen SF, Sorensen TI, Aaby P, Andersen AM et al (2001) The Danish National Birth Cohort—its background, structure and aim. Scand J Public Health 29(4):300–307PubMedCrossRefGoogle Scholar
  15. 15.
    (2013) Danish National Birth Cohorts: the interviews. Statens Serum Institut.
  16. 16.
    Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38(5):581–586PubMedCrossRefGoogle Scholar
  17. 17.
    Goodman R, Scott S (1999) Comparing the strengths and difficulties questionnaire and the child behavior checklist: is small beautiful? J Abnorm Child Psychol 27(1):17–24PubMedCrossRefGoogle Scholar
  18. 18.
    Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345PubMedCrossRefGoogle Scholar
  19. 19.
    Niclasen J, Skovgaard AM, Andersen AM, Somhovd MJ, Obel C (2013) A confirmatory approach to examining the factor structure of the Strengths and Difficulties Questionnaire (SDQ): a large scale cohort study. J Abnorm Child Psychol 41(3):355–365PubMedCrossRefGoogle Scholar
  20. 20.
    Niclasen J (2012) SDQ Danish cut off scores: 5-7-year-olds.
  21. 21.
    Niclasen J, Teasdale TW, Andersen AM, Skovgaard AM, Elberling H, Obel C (2012) Psychometric properties of the Danish Strength and Difficulties Questionnaire: the SDQ assessed for more than 70,000 raters in four different cohorts. PLoS ONE 7(2):e32025PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Niclasen J, Andersen AM, Teasdale TW, Strandberg-Larsen K (2013) Binge drinking and cumulated alcohol exposure in pregnancy: behavioural and emotional development at age seven. J Epidemiol Community Health (2013). Published Online First. doi: 10.1136/jech-2013-202956
  23. 23.
    Henderson J, Kesmodel U, Gray R (2007) Systematic review of the fetal effects of prenatal binge drinking. J Epidemiol Community Health 61:1069–1073PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Kesmodel US, Eriksen HL, Underbjerg M, Kilburn TR, Stovring H, Wimberley T et al (2012) The effect of alcohol binge drinking in early pregnancy on general intelligence in children. BJOG 119(10):1222–1231PubMedCrossRefGoogle Scholar
  25. 25.
    Sayal K, Heron J, Golding J, Alati R, Smith GD, Gray R et al (2009) Binge pattern of alcohol consumption during pregnancy and childhood mental health outcomes: longitudinal population-based study. Pediatrics 123(2):e289–e296PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Janni Niclasen
    • 1
  • Anne-Marie Nybo Andersen
    • 2
  • Katrine Strandberg-Larsen
    • 2
  • Thomas William Teasdale
    • 1
  1. 1.Department of PsychologyUniversity of CopenhagenCopenhagen KDenmark
  2. 2.Department of Public HealthSection of Social MedicineCopenhagen KDenmark

Personalised recommendations