Exposure to alcohol in the womb is known to increase the risk of abnormal brain development and a range of cognitive and behavioral problems known as fetal alcohol spectrum disorders (FASD) in offspring. A study appearing in JAMA Network Open that compared the brains of a group of middle-aged people with and without FASD suggests that those with FASD are no more likely to experience accelerated brain aging in their 40s than those without FASD. 

While the study participants with FASD continued to exhibit alcohol-induced structural deficits in the brain and had observable behavioral symptoms as they did as young adults, “our findings do not suggest that FASD is a progressive disorder by middle age but one for which continued habilitative efforts are warranted,” wrote Adolf Pfefferbaum, M.D., of Stanford University School of Medicine and colleagues.

Pfefferbaum and colleagues recruited adults who had participated in a University of Washington FASD study as young adults. As part of the original study, participants received a thorough clinical assessment for FASD as well as an MRI brain scan. For the current study, Pfefferbaum and colleagues repeated MRI scans in 66 middle-aged adults representing three groups:

• 22 adults (average age, 41 years) with fetal alcohol syndrome—defined as the presence of central nervous system dysfunction, growth deficits, and sentinel facial features of prenatal alcohol exposure.
• 18 adults (average age, 43 years) with fetal alcohol effects—defined as the presence of some, but not all characteristics of fetal alcohol syndrome.
• 26 adults (average age, 42 years) who had no history of prenatal alcohol exposure—the control group.

The follow-up MRI scans were taken about 20 years after the first ones. The researchers found the same pattern of brain volume differences between the three groups as they had previously identified: Average total intracranial brain volume as well as the volume of specific regions such as the cerebellum were much larger in the control group than the group with fetal alcohol syndrome; the brain volumes of those with fetal alcohol effects were lower than the control group but larger than the group with fetal alcohol syndrome.

All three groups showed normal changes in brain volume over time; that is, there was no evidence of any accelerated brain aging or reversal of brain volume deficits in the group with fetal alcohol syndrome and fetal alcohol effects compared with the control group.

Pfefferbaum and colleagues emphasized the importance of continuing to track the brain health of adults with FASD as they age. “There is a critical need to extend the longitudinal assessment of this cohort into older ages when clearer signs of accelerated aging might manifest morphologically to track whether the FASD population is at heightened risk for premature or exacerbated dementia or other disorders of aging,” they wrote.

To read more about this topic, see the Psychiatric News article “Patients With Prenatal Alcohol Exposure Frequently Misdiagnosed, Face Multiple Challenges.”