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Maternal Factors Predicting Cognitive and Behavioral Characteristics of Children with Fetal Alcohol Spectrum Disorders

May, Philip A. PhD*,†; Tabachnick, Barbara G. PhD; Gossage, J. Phillip PhD; Kalberg, Wendy O. MA, CED; Marais, Anna-Susan BSRN§; Robinson, Luther K. MD; Manning, Melanie A. MD; Blankenship, Jason PhD; Buckley, David MA; Hoyme, H. Eugene MD**; Adnams, Colleen M. MD††

Journal of Developmental & Behavioral Pediatrics: June 2013 - Volume 34 - Issue 5 - p 314–325
doi: 10.1097/DBP.0b013e3182905587
Original Articles

Objective: To provide an analysis of multiple predictors of cognitive and behavioral traits for children with fetal alcohol spectrum disorders (FASDs).

Method: Multivariate correlation techniques were used with maternal and child data from epidemiologic studies in a community in South Africa. Data on 561 first-grade children with fetal alcohol syndrome (FAS), partial FAS (PFAS), and not FASD and their mothers were analyzed by grouping 19 maternal variables into categories (physical, demographic, childbearing, and drinking) and used in structural equation models (SEMs) to assess correlates of child intelligence (verbal and nonverbal) and behavior.

Results: A first SEM using only 7 maternal alcohol use variables to predict cognitive/behavioral traits was statistically significant (B = 3.10, p < .05) but explained only 17.3% of the variance. The second model incorporated multiple maternal variables and was statistically significant explaining 55.3% of the variance. Significantly correlated with low intelligence and problem behavior were demographic (B = 3.83, p < .05) (low maternal education, low socioeconomic status [SES], and rural residence) and maternal physical characteristics (B = 2.70, p < .05) (short stature, small head circumference, and low weight). Childbearing history and alcohol use composites were not statistically significant in the final complex model and were overpowered by SES and maternal physical traits.

Conclusions: Although other analytic techniques have amply demonstrated the negative effects of maternal drinking on intelligence and behavior, this highly controlled analysis of multiple maternal influences reveals that maternal demographics and physical traits make a significant enabling or disabling contribution to child functioning in FASD.

*Nutrition Research Institute, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC;

Center on Alcoholism, Substance Abuse, and Addictions (CASAA), The University of New Mexico, Albuquerque, NM;

Department of Psychology, California State University, Northridge, CA;

§Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa;

Department of Pediatrics, School of Medicine, State University of New York, Buffalo, NY;

Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA;

**Department of Pediatrics, Sanford School of Medicine, The University of South Dakota, Vermillion, SD;

††Department of Psychiatry, University of Cape Town, Cape Town, South Africa.

Address for reprints: Philip A. May, PhD, Nutrition Research Institute, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081; e-mail: O. Kalberg, MA, LED, CASAA, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106; e-mail:

This research was funded in part by Grants RO1AA09440, RO1/UO1AA11685, and RO1 AA15134 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the NIH National Center on Minority Health and Health Disparities (NCMHD).

Disclosure: The authors have no conflicts of interests to declare.

Received May , 2012

Accepted March , 2013

© 2013 by Lippincott Williams & Wilkins