Development and validation of a postnatal risk score that identifies children with prenatal alcohol exposure

Alcohol Clin Exp Res. 2022 Jan;46(1):52-65. doi: 10.1111/acer.14749. Epub 2021 Dec 2.


Background: This study aimed to develop an efficient and easily calculable risk score that can be used to identify an individual's risk of having been exposed to alcohol prenatally.

Methods: Data for this study were collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, Phases 2 and 3. Two cohorts (ages 5 to 17 years) completed a comprehensive neurobehavioral battery and a standard dysmorphology exam: a development cohort (DC; n = 325) and a comparative cohort (CC; n = 523). Both cohorts included two groups: those with histories of heavy prenatal alcohol exposure (AE-DC, n = 121; AE-CC, n = 177) and a control group that included subjects with minimal or no prenatal alcohol exposure (CON-DC, n = 204; CON-CC, n = 346). Behavioral assessments and physical exam data were combined using regression techniques to derive a risk score indicating the likelihood of prenatal alcohol exposure. Subjects were then divided into two subgroups: (1) low risk and (2) high risk. Chi-square (χ2 ) determined classification accuracy and ROC curves were produced to assess the predictive accuracy. Correlations between risk scores and intelligence quotient and executive function scores were calculated.

Results: Subjects were accurately classified in the DC (χ2 = 78.61, p < 0.001) and CC (χ2 = 86.63, p < 0.001). The classification model also performed well in the DC (ROC = 0.835 [SE = 0.024, p < 0.001]) and CC (ROC = 0.786 [SE = 0.021, p < 0.001]). In the AE-CC and CON-CC, there were modest but significant associations between the risk score and executive function (AE-CC: r = -0.20, p = 0.034; CON-CC: r = -0.28, p < 0.001) and intelligence quotient (AE-CC: r = -0.20, p = 0.034; CON-CC: r = -0.28, p < 0.001).

Conclusion(s): The risk score significantly distinguished alcohol-exposed from control subjects and correlated with important cognitive outcomes. It has significant clinical potential and could be easily deployed in clinical settings.

Keywords: behavior; diagnosis; fetal alcohol spectrum disorders; identification; prenatal alcohol exposure; risk score.

Publication types

  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Adaptation, Psychological
  • Adolescent
  • Child
  • Cohort Studies
  • Craniofacial Abnormalities / epidemiology
  • Ethanol / adverse effects*
  • Executive Function
  • Female
  • Fetal Alcohol Spectrum Disorders / diagnosis*
  • Fetal Alcohol Spectrum Disorders / epidemiology
  • Fetal Alcohol Spectrum Disorders / psychology
  • Humans
  • Intelligence Tests
  • Male
  • Mental Disorders / epidemiology
  • Neuropsychological Tests
  • Pregnancy
  • Prenatal Exposure Delayed Effects*
  • Risk Factors*


  • Ethanol