Low–moderate prenatal alcohol exposure and risk to child behavioural development: a prospective cohort study M Robinson, a,b WH Oddy, a NJ McLean, b P Jacoby, a CE Pennell, c NH de Klerk, a SR Zubrick, d FJ Stanley, a JP Newnham c a Telethon Institute for Child Health Research, Centre for Child Health Research, Perth, Australia b School of Psychology, The University of Western Australia, Perth, Australia c School of Women’s and Infants’ Health, The University of Western Australia at King Edward Memorial Hospital, Perth, Australia d Telethon Institute for Child Health Research, Curtin Health Innovation Research Institute, Centre for Developmental Health, Curtin University of Technology, Perth, Australia Correspondence: Dr M Robinson, Telethon Institute for Child Health Research, PO Box 855, West Perth, WA 6872, Australia. Email moniquer@ichr.uwa.edu.au Accepted 15 February 2010. Published Online 28 May 2010. Objective To examine the association of fetal alcohol exposure during pregnancy with child and adolescent behavioural development. Design The Western Australian Pregnancy Cohort (Raine) Study recruited 2900 pregnancies (1989–91) and the 14-year follow up was conducted between 2003 and 2006. Setting Tertiary obstetric hospital in Perth, Western Australia. Population The women in the study provided data at 18 and 34 weeks of gestation on weekly alcohol intake: no drinking, occasional drinking (up to one standard drink per week), light drinking (2–6 standard drinks per week), moderate drinking (7–10 standard drinks per week), and heavy drinking (11 or more standard drinks per week). Methods Longitudinal regression models were used to analyse the effect of prenatal alcohol exposure on Child Behaviour Checklist (CBCL) scores over 14 years, assessed by continuous z-scores and clinical cutoff points, after adjusting for confounders. Main outcome measure Their children were followed up at ages 2, 5, 8, 10 and 14 years. The CBCL was used to measure child behaviour. Results Light drinking and moderate drinking in the first 3 months of pregnancy were associated with child CBCL z-scores indicative of positive behaviour over 14 years after adjusting for maternal and sociodemographic characteristics. These changes in z-score indicated a clinically meaningful reduction in total, internalising and externalising behavioural problems across the 14 years of follow up. Conclusions Our findings do not implicate light–moderate consumption of alcohol in pregnancy as a risk factor in the epidemiology of child behavioural problems. Keywords Alcohol, behaviour, child behaviour checklist, prenatal exposures, Raine Study. Please cite this paper as: Robinson M, Oddy W, McLean N, Jacoby P, Pennell C, de Klerk N, Zubrick S, Stanley F, Newnham J. Low–moderate prenatal alcohol exposure and risk to child behavioural development: a prospective cohort study. BJOG 2010; DOI:10.1111/j.1471-0528.2010.02596.x. Introduction High levels of alcohol consumption during pregnancy have a teratogenic influence on fetal development, resulting in physical, cognitive and behavioural deficits. 1 The devastat- ing impact of extreme levels of exposure to ethanol in pregnancy is evidenced in conditions such as fetal alcohol spectrum disorder and fetal alcohol syndrome. 1 Some stud- ies claim that prenatal exposure to alcohol has a dose– response mechanism, where light drinking shows an effect mainly on behavioural and adaptive function and high lev- els are associated with more serious developmental impact and problems. 2 These data suggest that alcohol exposure at levels common in nonaddicted individuals, and so-called ‘social drinking’, may still be associated with long-term risk. 3 Many researchers have noted that most empirical enquiry into the effects of alcohol exposure during preg- nancy has focused on and emphasised the devastating effects of high levels of alcohol exposure, often neglecting the influence of light–moderate drinking. 4 ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology 1 DOI: 10.1111/j.1471-0528.2010.02596.x www.bjog.org