Early diagnosis and evidence-based care needed for prenatal alcohol exposure

In a recent discussion with Contemporary OB/GYN, Jun Wang, PhD, and Rajesh Miranda, PhD, professors at Texas A&M University College of Medicine, outlined current challenges and recommended approaches for managing children with prenatal alcohol exposure (PAE), emphasizing the limitations of prevention messaging, the need for early diagnosis, and the importance of developing evidence-based interventions.

Wang noted that PAE is strongly associated with later cognitive deficits, underscoring the established recommendation that pregnant individuals abstain from alcohol across prenatal and perinatal periods. For children already affected by PAE or for pregnant patients with known alcohol exposure, he stressed the importance of vigilant developmental surveillance with early evaluation for cognitive impairment.

Although choline supplementation is currently of interest, Wang emphasized that choline alone—despite its known role in supporting cholinergic activity—may not sufficiently counteract the complex disruptions in neuronal signaling thought to underlie Fetal Alcohol Spectrum Disorder (FASD). He called for further investigation into additional nutritional and therapeutic approaches.

Miranda highlighted that relying solely on prevention is unrealistic. Despite longstanding public health messaging, including federal warnings introduced in the 1970s, unplanned pregnancies and the addictive nature of alcohol significantly limit behavioral change. Many pregnancies are recognized only in the second trimester, well after critical windows of fetal vulnerability.

Moreover, individuals with alcohol dependence frequently experience withdrawal symptoms that make cessation difficult even after pregnancy recognition. Data from Texas illustrate the extent of the issue: approximately 8% of births assessed were alcohol-positive in the final month of pregnancy, and an estimated 5 percent of the US population may meet criteria for FASD.

Miranda stressed that poor diagnostic capacity remains a critical barrier. Without timely, accurate diagnosis, clinicians cannot anticipate developmental needs or deploy appropriate supports.

He advised that clinicians assume a baseline prevalence of approximately 5 in 100 pediatric patients and screen early. Effective management will require coordinated behavioral interventions, individualized education plans, nutritional strategies beyond choline alone, and sufficient clinical resources to implement these supports.

Both experts emphasized the need for rigorous research to guide treatment. Wang noted parallels between cognitive deficits observed in FASD and those seen in Alzheimer’s disease, suggesting opportunities to explore drug repurposing.

Miranda added that although some clinicians are already prescribing Alzheimer’s medications off-label for children and young adults with FASD, these practices lack controlled evidence. Anecdotal improvement reports highlight the urgency for properly designed clinical trials.

Overall, Wang and Miranda stressed that comprehensive management of PAE requires early identification, evidence-based intervention development, and substantial investment in diagnostic and therapeutic research.

This video is part 2 of a 2-part series. Click here for part 1.

Reference

Purvines W, Gangal H, Xie X, et al. Perinatal and prenatal alcohol exposure impairs striatal cholinergic function and cognitive flexibility in adult offspring. Neuropharmacology. 2025;279:110627. doi:10.1016/j.neuropharm.2025.11062