Maternal risk factors for fetal alcohol spectrum disorders: Distal variables

Philip A. May, Julie M. Hasken, Marlene M. de Vries, Anna Susan Marais, Omar Abdul-Rahman, Luther K. Robinson, Margaret P. Adam, Melanie A. Manning, Wendy O. Kalberg, David Buckley, Cudore L. Snell, Soraya Seedat, Charles D.H. Parry, H. Eugene Hoyme

Research output: Contribution to journalArticlepeer-review


Background: A variety of maternal risk factors for fetal alcohol spectrum disorders (FASD) have been described in the literature. Here, we conducted a multivariate analysis of a large array of potential distal influences on FASD risk. Methods: Interviews were conducted with 2515 mothers of first-grade students whose children were evaluated to assess risk for FASD. Topics included: physical/medical status, childbearing history, demographics, mental health, domestic violence, and trauma. Regression modeling utilized usual level of alcohol consumption by trimester and six selected distal variables (maternal head circumference, body mass index, age at pregnancy, gravidity, marital status, and formal years of education) to differentiate children with FASD from control children. Results: Despite individual variation in distal maternal risk factors among and within the mothers of children with each of the common diagnoses of FASD, patterns emerged that differentiated risk among mothers of children with FASD from mothers whose children were developing typically. Case-control comparisons indicate that mothers of children with FASD were significantly smaller physically, had higher gravidity and parity, and experienced more miscarriages and stillbirths, were less likely to be married, reported later pregnancy recognition, more depression, and lower formal educational achievement. They were also less engaged with a formal religion, were less happy, suffered more childhood trauma and interpersonal violence, were more likely to drink alone or with her partner, and drank to deal with anxiety, tension, and to be part of a group. Regression analysis showed that the predictor variables explain 57.5% of the variance in fetal alcohol syndrome (FAS) diagnoses, 30.1% of partial FAS (PFAS) diagnoses, and 46.4% of alcohol-related neurodevelopmental disorder (ARND) diagnoses in children with FASD compared to controls. While the proximal variables explained most of the diagnostic variance, six distal variables explained 16.7% (1/6) of the variance in FAS diagnoses, 13.9% (1/7) of PFAS, and 12.1% (1/8) of ARND. Conclusions: Differences in distal FASD risks were identified. Complex models to quantify risk for FASD hold promise for guiding prevention/intervention.

Original languageEnglish (US)
Pages (from-to)319-344
Number of pages26
JournalAlcohol: Clinical and Experimental Research
Issue number2
StatePublished - Feb 2024


  • South Africa
  • fetal alcohol spectrum disorders
  • maternal risk for FASD
  • prenatal alcohol use

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health
  • Toxicology


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