# A prospective cohort study to assess if alcohol intake measured by routine pregnancy self-report predicts developmental concerns uncovered by routine health visitor screening of children at 30 months of age

## TL;DR

This study examines if self-reported alcohol use during pregnancy predicts child developmental issues at 30 months, finding some unexpected inverse associations.

## Contribution

The study links self-reported alcohol use with child developmental outcomes using a large cohort and routine health data.

## Key findings

- Self-reported alcohol use during pregnancy was associated with children being looked after by the local authority at 30 months.
- Developmental concerns in social and communication skills were inversely linked to self-reported alcohol use.
- The inverse relationship may reflect underreporting or effective interventions for those who self-report alcohol use.

## Abstract

Stigmatized behaviours are often underreported, especially in pregnancy, making them challenging to address. The Alcohol and Child Development Study (ACDS) seeks to inform prevention of foetal alcohol harm, linking self-report as well as a maternal blood alcohol biomarker with child developmental outcomes.

Maternity records from all pregnant women in the study city who presented for maternity care during the 12-month period June 2017 – June 2018 were transferred to the safe data facility creating the baseline cohort. Health Visitor routinely recorded child developmental screening data collected when the offspring were 30 months of age were transferred and linkage analysis performed on the cohort with a final linked sample of 10,876 records. Anonymous analysis was performed to assess associations between self-reported alcohol intake collected at maternity presentation with child development concerns and looked after by the local authority status of offspring at 30 months of age. Chi2 tests of association were used with limited multivariate regression to control for confounding variables.

14919 maternity records were transferred and 10,876 could be linked to developmental screening data collected at 30 months of age. As expected self-reported current alcohol use after conception measured at presentation to maternity care was associated with offspring being looked after by the local authority (chi2 = 7.85, p = 0.005) at age 30 months. 6.6% of children in care were attributable to self-report of current alcohol use during pregnancy. Developmental outcomes were generally inversely associated with self-report of current alcohol use notably concern regarding Social Development (chi2 = 4.08, p = 0.043) and Speech, Language or Communication Development (chi2 = 4.37, p = 0.037).

This unexpected inverse relationship could be due to underreporting of alcohol use (the risk) and inaccurate developmental and behavioural problems reported (the outcome) or effective intervention for women who self-report current alcohol intake at maternity presentation.

The online version contains supplementary material available at 10.1186/s13690-025-01766-2.