Maternal Drinking during Pregnancy Is Associated with the Substance Use and Related Problems of Adolescent Offspring

Background & Purpose: Adolescent substance use is a persistent public health concern. Although multiple psychosocial factors have been examined, relatively little attention has been given to the role of intrauterine substance exposure.  Fetal exposure to alcohol is associated with attention problems, impulsivity, and deficits in executive cognitive functioning, all of which may affect early substance use initiation.  The purpose of this study is to examine the association between fetal exposure to alcohol and adolescent substance use and its related problems.  Given that no reliable clinical tools are available for assessing levels of drinking in pregnant women, fatty acid ethyl esters (FAEE), the nonoxidative metabolites of ethanol in meconium, are potential biomarkers to quantify the level of fetal alcohol exposure.

Methods: This is a secondary analysis of a prospective cohort of adolescents, primarily African-American and of low socioeconomic status, recruited at birth.  Meconium was analyzed for FAEEs in 216 newborns.  At age 15, 183 adolescents (81 boys, 102 girls), 85% retention, were assessed for alcohol, tobacco, and marijuana use via self-report and biologic assays (urine, hair, and blood spots).  Substance use problems (e.g., experiencing mood swings, forgetfulness, accidents) were assessed via the 17-item Substance Use/Abuse scale from the Problem Oriented Screening Instrument for Teenagers.  Respondents reporting ≥ 1 problem associated with substance use were coded 1 (yes).  Adolescent gender, other drug exposure (cocaine, tobacco, marijuana), maternal psychological distress (α= .95) assessed at birth via the Brief Symptom Inventory, quality of the caregiving environment assessed at age 9 via The Home Observation for Measurement of the Environment, and violence exposure (α= .75) assessed at age 12, were used as covariates.  

Results: About one-third of the offspring reported tobacco (34%), alcohol (39%), and marijuana (31%) use by age 15, and 22% reported experiencing substance use problems.  Findings from multiple logistic regression analyses indicated that higher levels of FAEE were related to a greater likelihood of marijuana use (OR= 1.50, 95% CI= 1.05 - 2.14, p= .02) and experiencing substance use problems (OR = 2.29, 95% CI= 1.05 - 5.0, p= .04), controlling for other prenatal drug exposure and covariates.  No relationship was found between FAEE and adolescent tobacco or alcohol use.  Boys were more likely to report substance use problems (OR= 3.70, 95% CI= 1.61 - 8.50, p = .0003), despite no gender difference in alcohol, tobacco, or marijuana use. As we have reported previously, prenatal cocaine exposure was also independently related to a higher likelihood of marijuana use (OR= 2.33, 95% CI= 1.19 - 4.55, p= .01) and substance use problems (OR= 3.76, 95% CI= 1.63 - 8.65, p= .0003).       

Conclusions & Implications: Prenatal alcohol exposure is a risk factor for developing substance use problems.  Elevated levels of FAEEs are potential markers for identifying newborns at risk for early substance use and developing substance use problems. Continued follow-up with this sample will elucidate whether and how prenatal alcohol exposure may affect the chronicity or severity of substance use problems over time.