FETAL ALCOHOL EFFECTS IN ALCOHOLIC VETERAN PATIENTS

Fetal alcohol syndrome is often associated with severe physical and ne uropsychiatric maldevelopment. On the other hand, some offspring of wo men who drank during pregnancy appear to be effected in minimal ways a nd function relatively well within society. We questioned whether this effect of prenatal alcohol in the adult is generally minimal. To bear on this, we determined whether we could distinguish alcohol-exposed f rom nonexposed individuals in a population of male veterans, selected because of both their accepted level of function within society (e.g., honorable discharge from the military) end their admission to an alco hol treatment unit (thus, a greater likelihood of parental alcoholism, because of its familial aggregation). Consecutively admitted alcoholi cs (cases; n = 77) with likely maternal alcohol ingestion during their pregnancy or the first 10 years of life were matched with alcoholics with no maternal alcohol exposure during these periods (controls; n = 161). Each subject completed questionnaires regarding personal birthwe ight, alcohol, drug, educational and work histories, and family (inclu ding parental) alcohol and drug histories. We measured height, weight, and head circumference; checked for facial and hand anomalies; and to ok a frontal facial photograph, from which measurements of features we re made. Data were analyzed by univariate statistics and stepwise logi stic regression. No case had bona fide fetal alcohol syndrome. With un ivariate statistical analyses, the cases differed from the controls in 10 variables, including duration of drinking, width of alae nasae, be ing hyperactive or having a short attention span, and being small at b irth. By stepwise logistic regression, the variables marital status, s mall sire at birth, duration of drinking, and the presence of a smooth philtrum were marginally (the first two) or definitely (the last two) significant predictors of case status. Analysis of only the 37 cases in whom maternal prenatal drinking was the most likely yielded a margi nal association for small size at birth (odds ratio = 3.1, p = 0.08) a nd a significant association for the presence of a smooth philtrum (od ds ratio = 11.9, p = 0.005). Predictability was poor in all regression models. Based on the presence of this single physical finding (smooth philtrum), we estimate that the prevalence of manifestations of fetal alcohol exposure (fetal alcohol effects) is 6 to 13% in adult male ve teran children (not necessarily nonveteran offspring) of women who dra nk alcohol during pregnancy. Thus, in our study of adult veterans, mos t individuals who were born to women who drank during pregnancy could not be differentiated from normal individuals, and those who were affe cted were distinguished by a single, nonspecific physical finding.