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Pregnancies involving alcohol exposure sufficient to affect the fetus may involve women with genetic risk for <jats:styled-content style=\"fixed-case\">alcohol dependence<\/jats:styled-content>. We hypothesized that known <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> will increase the odds of having an externalizing disorder compared to <jats:styled-content style=\"fixed-case\">COA<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The odds ratios of 3 externalizing disorders (attention\u2010deficit hyperactivity disorder [<jats:styled-content style=\"fixed-case\">ADHD<\/jats:styled-content>], conduct disorder [<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>], and oppositional defiant disorder [<jats:styled-content style=\"fixed-case\">ODD<\/jats:styled-content>]) were obtained for 2 domains: (i) <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> and (ii) <jats:styled-content style=\"fixed-case\">COA<\/jats:styled-content>, by estimating the logged odds ratio (<jats:styled-content style=\"fixed-case\">LOR<\/jats:styled-content>) for each study. Permutation tests were implemented to compare <jats:styled-content style=\"fixed-case\">LOR<\/jats:styled-content>s for <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> versus <jats:styled-content style=\"fixed-case\">COA<\/jats:styled-content> studies within each disorder, including <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> versus an alcohol dependent (AD) mother and <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> versus an <jats:styled-content style=\"fixed-case\">AD<\/jats:styled-content> father.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> studies, the odds of <jats:styled-content style=\"fixed-case\">ADHD<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> were elevated. Rates of all 3 disorders were elevated in <jats:styled-content style=\"fixed-case\">COA<\/jats:styled-content> studies. Permutation tests revealed that the mean <jats:styled-content style=\"fixed-case\">LOR<\/jats:styled-content> for <jats:styled-content style=\"fixed-case\">ADHD<\/jats:styled-content> was significantly higher in <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> studies compared to: <jats:styled-content style=\"fixed-case\">COA<\/jats:styled-content> (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.01), <jats:styled-content style=\"fixed-case\">AD<\/jats:styled-content> mother (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05), and <jats:styled-content style=\"fixed-case\">AD<\/jats:styled-content> father (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.03). No differences were found for <jats:styled-content style=\"fixed-case\">ODD<\/jats:styled-content> (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.09) or <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.21).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These results provide compelling evidence of an increased risk of <jats:styled-content style=\"fixed-case\">ADHD<\/jats:styled-content> in those with <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> beyond that due to parental alcohol dependence or a genetic liability, consistent with a unique etiology most likely due to direct alcohol exposure during prenatal 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