0145-6008/94/1801-0202$3.00/0 zyxwvutsrqpon ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH zyxwvutsrqpo Vol. 18, No. zy 1 January/February 1994 Maternal Drinking During Pregnancy: Attention and Short-Term Memory in 14-Year-Old Offspring- A Longitudinal Prospective Study Ann P. Streissguth, Paul D. Sarnpson, Heather Carrnichael Olson, Fred L. Bookstein, Helen M. Barr, Mike Scott, Julie Feldrnan, and Allan F. Mirsky A large and compelling experimental literature has documented the adverse impact of prenatal alcohol exposure on the developing brain of the offspring. This is the first report of adolescent attention/ memory performance and its relationship with prenatal alcohol ex- posure in a population-based, longitudinal, prospective study (n = 462) involving substantial covariate control and "blind" examiners. Prenatal alcohol exposure was significantly related to attention/ memory deficits in a dose-dependent fashion. A latent variable reflecting 13 measures of maternal drinking was correlated 0.26 with a latent variable representing 52 scores from 6 tests measuring various components of attention and short-term memory perform- ance. The number of drinks/occasion was the strongest alcohol predictor. Fluctuating attentional states, problems with response inhibition, and spatial learning showed the strongest associationwith prenatal alcohol exposure. A latent variable reflecting the pattern of attention/memory deficits observed at 14 years correlated 0.67 with a composite pattern of deficits previously detected on neurobehav- ioral tests administered during the first 7 years of life. The 14-year attention/memory deficits observed in the present study appear to be the adolescent sequelae of deficits observed earlier in develop- ment. As is usual in such studies, not all exposed offspring showed deficits. Key Words: Fetal Alcohol Effects, BehavioralTeratology, Alcohol, Adolescent Development, Attention. RENATAL ALCOHOL EXPOSURE has been shown P to relate to a wide variety of offspring effects in several fields of study. Its effects have been documented in exper- imental animal studies where dose and environment are well controlled, and in clinical studies of patients with fetal alcohol syndrome (FAS). Prenatal alcohol effects have also been found in epidemiologic studies where de- sign features and statistical procedures are used to adjust for potentially confounding influences. Until now, the population-based studies have been confined to the pe- zyxwvu From the Departments zyxwvutsrq of Psychiatry and Behavioral Sciences (A.P.S., H.C.O.. H.M.B.), Statistics (P.D.S.). and Psychology (M.S., J.F.), Uni- versity zyxwvutsrqpon of Washington, Seattle Washington; Center for Human Growth and Developmenr, University of Michigan (F. L. B,), Ann Arbor, Michigan; and the Laboratory of Psychology and Psychopathology, National Insti- tute of Mental Health (A.F. M.), Bethesda. Maryland. Received for publication November 28, 1992; accepted July 28. 1993 This research was supportedprirnarily by Grant AA01455-0I-18from the National Institute on Alcohol Abuse and Alcoholism, U.S. Public Health Service. Reprint requests: Ann P. Streissguth, Ph.D., Fetal Alcohol and Drug Unit, Department of Psychiatry and Behavioral Sciences, GG-20, Univer- sity of Washington Medical School, Seattle, WA 98195. Copyright zyxwvutsrq 0 I994 by The Research Society on Alcoholism. 202 nods of infancy and childhood. This study extends the epidemiologic research on prenatal alcohol effects into the adolescent years and compares the findings to those from recent experimental and clinical studies. We present the first report on the 14-year wave of data collection from the Seattle Longitudinal Study on Alcohol and Pregnancy, ongoing since 1974, involving a birth cohort of close to 500 children whose alcohol exposure histories were doc- umented prenatally. The long-term behavioral consequences of prenatal al- cohol exposure have already been demonstrated in exper- imental studies of laboratory animals,' and the compara- bility of these findings to those from earlier human studies has been described.2 Several recent reviews of the expen- mental animal literature have now documented the sub- stantial impact of prenatal ethanol on the developing central nervous system (CNS).3-8 A causal link of prenatal alcohol with hippocampal damage and memory deficits in adult animals6-'@ is in accordance with this study's focus on memory and attentional deficits in humans exposed to varying alcohol doses prenatally. The possibility that attentional and memory problems in young adolescents could be related to subtle forms of prenatal brain damage from alcohol has not previously been investigated. To date, studies have shown prenatal alcohol effects on habituation and information processing in infants,",'2 on attentional problems in preschool chil- dren,l3.l4 and on school-age children assessed in the labo- ratory or classr~om.'~-'~ Although not all studies have reported positive findings ( e g , refs. 18 and 19), alcohol teratogenesis in these persistent developmental domains- attention, memory, and information processing-remains of interest across the lifespan. The objective of the present study is to examine the relationship of prenatal alcohol exposure to objective measures of attention and short- term memory performance assessed in 14-year-old off- spring, taking into consideration the potential influences of appropriate covarying conditions that might also predict these outcomes. Neurobehavioral outcomes are of great interest in the study of "low-dose" teratogenic effects, because they are often produced at lower exposure levels than growth and morphologic effects.*' METHODS The Seattle Longitudinal ProspectiveStudy on Alcohol and Pregnancy began in 1974 with interviews of a population-based group of 1529 zy Alcohol Clin Exp Res, Vol 18, No 1, 1994: pp 202-218