Prenatal alcohol exposure and mental health at midlife: A preliminary report on two longitudinal cohorts

Alcohol Clin Exp Res. 2022 Feb;46(2):232-242. doi: 10.1111/acer.14761. Epub 2022 Feb 14.


Background: Although the effects of prenatal alcohol exposure (PAE) have been studied extensively, there is relatively little information available on adult mental health functioning among exposed individuals. The current study compares the self-reported midlife mental health status of individuals who were prenatally exposed to alcohol and diagnosed in childhood with the effects of this exposure with that of unexposed individuals.

Methods: Participants (N = 292) were recruited from two longitudinal cohorts in Atlanta and Seattle and asked to complete an Adult Health Questionnaire that surveyed their current health and mental health status. The questionnaire was completed either in-person or remotely and included questions about current symptoms of depression and anxiety and mental health disorder diagnoses. The analysis compared a Nonexposed Contrast group to those in two exposure groups: (1) Alcohol Exposed with Fetal Alcohol Effect but not meeting criteria for Fetal Alcohol Syndrome (FAS) and (2) Alcohol Affected and meeting criteria for FAS.

Results: Both alcohol-exposed groups reported higher levels of current depressive symptoms and a higher prevalence of diagnoses of depression, anxiety, bipolar disorder, and/or attention deficit/hyperactivity disorder. No differences were noted for psychotic disorders. PAE was also associated with greater environmental stressors, including higher levels of adverse childhood events and lower current socioeconomic status. Path analyses suggested that PAE was indirectly related to mood disorders with its effects being mediated by other environmental factors.

Conclusions: PAE is associated with greater rates of mental health disorders in middle adulthood. These outcomes appear to result from multiple stressors that affect individuals made vulnerable by their early alcohol exposure. Clinical outcomes could be improved by prevention efforts directed at preventing prenatal alcohol use and reducing environmental stressors later in life, and by the early identification of PAE and its effects.

Keywords: adverse childhood experiences; fetal alcohol spectrum disorders; mental health; prenatal alcohol exposure.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Adverse Childhood Experiences / psychology
  • Adverse Childhood Experiences / statistics & numerical data
  • Anxiety Disorders / epidemiology*
  • Attention Deficit Disorder with Hyperactivity / epidemiology*
  • Bipolar Disorder / epidemiology*
  • Case-Control Studies
  • Causality
  • Depression / epidemiology*
  • Female
  • Fetal Alcohol Spectrum Disorders / epidemiology*
  • Fetal Alcohol Spectrum Disorders / psychology
  • Humans
  • Longitudinal Studies
  • Male
  • Surveys and Questionnaires