J Epidemiol Community Health doi:10.1136/jech.2009.091785
  • Theory and Methods

A new method of prenatal alcohol classification accounting for dose, pattern, and timing of exposure: Improving our ability to examine fetal effects from low to moderate exposure.

  1. Colleen M O'Leary1,*,
  2. Carol Bower1,
  3. Stephen R Zubrick2,
  4. Elizabeth Geelhoed3,
  5. Jennifer J Kurinczuk4,
  6. Natasha Nassar1
  1. 1 Telethon Institute for Child Health Research, Centre for Child Health Research, University of WA, Australia;
  2. 2 Centre for Developmental Health, Curtin University of Technology, Australia;
  3. 3 School of Population Health, University of Western Australia, Australia;
  4. 4 National Perinatal Epidemiology Unit, University of Oxford, Australia
  1. Correspondence to: Colleen M O'Leary, Division of Epidemiology, Telethon Institute for Child Health Research, PO Box 855, 100 Roberts Rd, Subiaco 6008, West Perth, 6857, Australia; colleeno{at}
  • Received 22 April 2009
  • Accepted 7 September 2009
  • Published Online First 19 October 2009


Background: When examining the association between prenatal alcohol exposure and fetal effects, epidemiological studies have ignored the timing and intensity of the exposure. This study investigates the effect of using dose, pattern and timing of consumption (‘composite’ method) for examining the association between prenatal alcohol exposure and fetal effects.

Methods: The ‘composite’ method resulted in six categories of exposure (abstinent, low, moderate, binge <weekly, binge 1-2x/week and heavy). The odds of language delay and child behaviour problems were calculated for the ‘composite’ method and then compared with an analysis using averaged estimates of <1 and 1+ drinks per day and with stratification by quantity ignoring dose per occasion. Data used for the analyses are from a 10% random sample of non-Indigenous women delivering a live infant in Western Australia (1995-1996) were invited to participate in an 8-year longitudinal survey (78% response rate n=2,224; 85% were followed-up at two-years, 73% (five-years), 61% (eight-years)).

Results: The effect of moderate and binge levels of exposure was only evident with the ‘composite’ method; anxious/depressed problems following first trimester moderate exposure OR 2.05 (95% CI 1.09;3.87) and following late pregnancy moderate (aggressive behaviour OR 1.90 (0.90-3.98)) and binge (language delay OR 3.00 (0.90;9.93)) exposure. Results for heavy levels of exposure were similar with each method. The estimates for late pregnancy were imprecise due to small numbers.

Conclusion: The ‘composite’ method of classification more closely reflects real life drinking patterns and better discriminates maternal drinking than the other methods, particularly low, moderate and binge levels.


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