Do the Effects of Prenatal Exposure to Alcohol Differ by Culture?

  • Fetal alcohol syndrome (FAS) is a preventable neurodevelopmental disorder
  • Most studies of FAS have been conducted in western countries and cultures
  • A first-of-its-kind study has examined FAS children in a South African community
  • "Cultural context" may have little influence on the damaging effects of prenatal exposure to alcohol

Fetal alcohol syndrome (FAS) comprises a number of birth defects that occur as a result of in utero exposure to alcohol. Researchers have established that the effects of prenatal alcohol exposure may vary according to the quantity and frequency of exposure, genetic factors, and postnatal environment. An important component of a child’s environment is its culture. In fact, cultural variances have been shown to influence a range of cognitive abilities, including memory, problem solving, language, and visual perception. Examining a group of children with FAS in a South African community, a study in the April issue of Alcoholism: Clinical & Experimental Research is the first to systematically investigate if the effects of prenatal alcohol exposure vary as a function of culture.

"After fetal alcohol syndrome became recognized as a preventable neurodevelopmental disorder," said Piyadasa W. Kodituwakku (Kodi), research assistant professor of psychology at the University of New Mexico and co-author of the study, "North American and European physicians were trained to diagnose it. Furthermore, many studies of prevalence, cognitive and behavioral characteristics, and biological mechanisms of this disorder have been funded, specifically in the United States. However, even though FAS has been highly prevalent in non-western countries such as Russia and South Africa, it was not recognized as a problem until recently, partly because of sociopolitical climates."

"Studies of other kinds of neurodevelopmental disabilities," added Daniel D. Savage II, Regent’s Professor and chair of the department of neurosciences at the University of New Mexico School of Medicine, "suggest that some measures of a child’s performance may be affected by cultural context. This question had not been systematically addressed with respect to the interaction between prenatal alcohol exposure, genetics and environment. The unique population in this study made it possible to address this question. The results suggest that cultural context may have little influence on the deleterious effects on prenatal alcohol exposure."

One of the characteristics of children with prenatal alcohol exposure is hyperactivity. Kodi and his colleagues were surprised to find that children with FAS in South Africa were not hyperactive, despite having difficulties in attention and concentration. The group hypothesized that the lack of hyperactivity in these children might reflect their upbringing in a society that emphasizes obeying authority.

The South African community chosen for the study is notable for several different reasons. One, the FAS children all lived with their biological mothers. Two, the mothers were available for interviews. These two factors made it possible to obtain detailed information on the children, their mothers, and other pertinent information. Three, the FAS children were not treated any differently than other children in the community. Four, the community was very cooperative. This meant the study results were less variable than perhaps in other studies.

The results showed that the FAS group performed significantly worse than the control group when assessed for several aspects of "higher order cognitive-motor skills:" language, practical reasoning, construction of designs (putting together puzzles), and fine motor skills (threading beads). The two groups did not, however, markedly differ in gross motor (running, jumping) and daily living skills. The difference between higher and lower order skills can be illustrated by a comparison between fine and gross motor skills. Fine motor (or higher order) skills, such as those involved in threading beads or drawing, develop later than gross motor activities (or lower order skills) such as running and jumping. Furthermore, higher order skills are more complex than lower order skills and constitute what is called "intellectual abilities."

"Having deficits in so-called ‘higher order cognitive-motor skills,’" said Savage, "means that - as they mature - these children will have an increasingly more difficult time succeeding in life. As adults, this will severely limit their prospects to advance, no matter how hard they work on more challenging and complex tasks."

"By and large," noted Kodi, "these findings are similar to what others have found in North America and Europe. Therefore, it appears that the adverse effects of alcohol on children resulting from their mothers drinking during pregnancy are comparable across cultures. In other words, irrespective of their color of the skin or culture, children prenatally exposed to alcohol show similar patterns of impairments."

Savage agreed that the study’s results provide compelling evidence that the effects of alcohol on the developing brain are quite similar in different cultural and socioeconomic settings. "The damage caused by prenatal ethanol exposure does not discriminate based on race, ethnicity, social, economic, geographic or education background." Yet, he added, "the potential influence of cultural context on offspring outcome cannot be excluded based on a single study."

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

Articles were written based on the following published research:

Adnams, C.M., Kodituwakku, P.W., Hay, A., Molteno, C.D., Viojoen, D., & May, P.A. (2001, April). Patterns of cognitive-motor development in children with fetal alcohol syndrome from a community in South Africa. Alcoholism: Clinical and Experimental Research, 25(4), 557-562.