Inconsistent data on the association between prenatal alcohol exposure and a range of pregnancy outcomes, such as preterm birth (PTB) and small for gestational age (SGA) raise new questions. This study aimed to assess whether the association between low-moderate prenatal alcohol exposure and PTB and SGA differs according to maternal education, maternal mental distress or maternal smoking.

Aims: The study aimed to investigate (a) the association between low to moderate prenatal alcohol exposure (PAE) and the use of alcohol, tobacco and illicit drugs in adolescence and (b) whether the associations are modified by gender and ethnicity. Methods: The subjects of the study were 5922 children and adolescents, aged from 11 to 17 years, enrolled in the cross-sectional German Health Interview and Examination Survey for Children and Adolescents (the KiGGS study). Information on PAE is based on parental self-report questionnaires. Use of alcohol, tobacco and illicit drugs was assessed through self-report questionnaires for adolescents. Results: Low to moderate PAE was associated with an increased risk of drinking alcohol (adjusted odds ratio (OR) 1.73, 95% confidence interval (CI) 1.34, 2.18) and also of illicit drug use (adjusted OR 1.62, 95% CI 1.23, 2.14). The associations between PAE and the use of alcohol, tobacco and illicit drugs differed according to gender and ethnicity. Gender-stratified analyses resulted in adverse effects of PAE on drinking alcohol, smoking and illicit drug use in females; however, in German males, the associations disappeared. Stronger associations between PAE and the outcome measures were found in non-Germans. Conclusions: Our findings indicate that low to moderate levels of maternal alcohol intake during pregnancy are a risk factor for use of alcohol, tobacco and illicit drugs by the offspring, with stronger associations in females and non-Germans.

Aims: This study aimed 1. to examine the prevalence of German children born with prenatal alcohol exposure (PAE) from 1985 to 2005, and asked 2. whether it differed on levels of socioeconomic status (SES) and 3. whether there are differences between abstainers and drinkers during pregnancy in regard to physical, behavioural and sociodemographic features. Methods: 16 978 German mothers, enrolled in the German Health Interview and Examination Survey (KiGGS) were studied. Results: Between 1985 and 2005 13.5 percent of the children were born with PAE. No stable decrease was found over time. Over 20 years, the prevalence of children born with PAE was highest in the upper class. Drinkers differed from abstainers in regard to physical, behavioural and sociodemographic characteristics. High SES women were on a higher risk of alcohol intake during pregnancy. Conclusions: The prevalence of children born with PAE over time indicates that alcohol intake during pregnancy needs further interventions and prevention as no long-lasting decrease was found in the years from 1985 to 2005. Alcohol intake during pregnancy was and still is an issue in women from the upper class. Future research should therefore aim to explain the social gradient.

There is evidence for social inequalities in the health status of children with prenatal alcohol exposure (PAE). This study aimed to describe social inequalities in low birth weight (LBW) in children/adolescents with PAE and to examine the contribution of anthropometric and health-related behavioral factors to the explanation of social inequalities. A total of 2,159 participants with parental self-reported moderate to regular PAE (enrolled in the cross-sectional German Health Interview and Examination Survey for Children and Adolescents) were examined. At similar levels of PAE, the risk of LBW was significantly increased in subjects with a low socioeconomic status (SES) (adjusted odds ratio (OR) 2.78, 95% confidence interval (CI) 1.59, 4.86) and middle SES (adjusted OR 2.04, 95% CI 1.28, 3.24). Maternal height, maternal body mass index (BMI) and smoking during pregnancy mediated the association. The mediating effect of maternal height was 12.5% to 33.7%. Maternal BMI explained 7.9% of the socioeconomic difference in LBW between the high and low SES groups in children with PAE. The mediating effect of smoking during pregnancy was 17.3% to 31.5%. Maternal height, maternal BMI and smoking during pregnancy together explained 24.4% to 60.1% of the socioeconomic differences in LBW in children with PAE. A large proportion of the socioeconomic differences in LBW in children with PAE can be attributed to anthropometric and health-related behavioral factors.