Prenatal alcohol exposure and health at midlife: Self-reported health outcomes in two cohorts.

Background: The Developmental Origins of Health and Disease Hypothesis (DOHaD) suggests prenatal alcohol exposure (PAE) should have implications for adult physical and mental health. Since the health profile of older adults with PAE and diagnoses of fetal alcohol spectrum disorder (FASD) is unknown, the current study evaluates self-reported health problems of midlife adults with and without a history of PAE to describe these outcomes.

Methods: Participants (N = 357) recruited from longitudinal cohorts in Atlanta, GA and Seattle, WA completed a health survey assessing a range of physical conditions. Initial analysis compared the frequency of conditions between alcohol-exposed and nonexposed groups. To identify patterns within groups, 10 problem areas were subjected to latent class analysis (LCA). Finally, the direct effect of PAE on health outcomes was evaluated using multilevel modeling, controlling for effects of other factors.

Results: Compared with unexposed controls, individuals with PAE reported significantly higher frequencies of problems with hearing, dentition, heart, cancer, gastritis, kidney stones, bladder, diabetes, thyroid, skin, and seizures. LCA found that controls yielded two classes, with 45% reporting sleep and vision problems and 55% reporting sleep, vision, cardiovascular, endocrine, immune, and dental problems. The PAE group yielded three classes, with 13% endorsing few health problems, 43% reporting sleep, vision, immune, and dental problems, and 43% reporting sleep, vision, cardiovascular, urinary, endocrine, skin, immune, dental, and gastrointestinal problems. With multivariate analysis, controlling for other influences, PAE was associated directly with hearing, urinary, dental, and gastrointestinal problems. A similar pattern was found for alcohol-exposed individuals who did and did not meet criteria for fetal alcohol syndrome (FAS).

Discussion: Patients affected by alcohol may report greater frequency and range of health adversity. That PAE was only uniquely associated with a limited set of problems suggests that many health outcomes in midlife result from an initial vulnerability potentiated by postnatal stress resulting from other associated factors.