Journal Articles

Who is most affected by prenatal alcohol exposure: Boys or girls?

June 15, 2017

Philip A. May, Barbara Tabachnick, Julie M. Hasken, Anna-Susan Marais, Marlene M. de Vries, Ronel Barnard, Belinda Joubert, Marise Cloete, Isobel Botha, Wendy O. Kalberg, David Buckley, Zachary R. Burroughs, Heidre Bezuidenhout, Luther K. Robinson, Melanie A. Manning, Colleen M. Adnams, Soraya Seedat, Charles D.H. Parry, H. Eugene Hoyme (2017). Who is most affected by prenatal alcohol exposure: Boys or girls? Drug and Alcohol Dependence.

Author Affiliatons

The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States
Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States


To examine outcomes among boys and girls that are associated with prenatal alcohol exposure.

Boys and girls with fetal alcohol spectrum disorders (FASD) and randomly-selected controls were compared on a variety of physical and neurobehavioral traits.

Sex ratios indicated that heavy maternal binge drinking may have significantly diminished viability to birth and survival of boys postpartum more than girls by age seven. Case control comparisons of a variety of physical and neurobehavioral traits at age seven indicate that both sexes were affected similarly for a majority of variables. However, alcohol-exposed girls had significantly more dysmorphology overall than boys and performed significantly worse on non-verbal IQ tests than males. A three-step sequential regression analysis, controlling for multiple covariates, further indicated that dysmorphology among girls was significantly more associated with five maternal drinking variables and three distal maternal risk factors. However, the overall model, which included five associated neurobehavioral measures at step three, was not significant (p = .09, two-tailed test). A separate sequential logistic regression analysis of predictors of a FASD diagnosis, however, indicated significantly more negative outcomes overall for girls than boys (Nagelkerke R2 = .42 for boys and .54 for girls, z = −2.9, p = .004).

Boys and girls had mostly similar outcomes when prenatal alcohol exposure was linked to poor physical and neurocognitive development. Nevertheless, sex ratios implicate lower viability and survival of males by first grade, and girls have more dysmorphology and neurocognitive impairment than boys resulting in a higher probability of a FASD diagnosis.

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