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This study examines predictive factors relating to child outcomes from pregnancies characterized by PAE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data originated from seven cross\u2010sectional, population\u2010based, in\u2010school studies of fetal alcohol spectrum disorders (FASD) in South Africa. Data analysis was limited to mothers who reported consuming five or more drinks per drinking day (DDD) and three or more drinking days per week (DDW) during two or more trimesters of pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 225 mother\/child dyads, 53.3% of children had fetal alcohol syndrome (FAS); 16.9% partial FAS (PFAS); 17.3% alcohol\u2010related neurodevelopmental disorder (ARND); and 12.4% \u201cnot FASD.\u201d Child growth and dysmorphology measures varied significantly among diagnostic groups: height, weight, head circumference, body mass index (BMI), palpebral fissure length, smooth philtrum, narrow vermilion border of the upper lip, total dysmorphology, and nonverbal and verbal IQ. Predictors of child outcomes were explored for an FASD diagnosis, FAS only, and total dysmorphology score. Children with FAS and ARND generally performed most poorly. Mothers of children with FAS drank more DDD in second and third trimesters and more DDW in third trimester than other mothers. Significant, distal, negative influences were as follows: low maternal weight, older age at pregnancy, and fewer years of formal education. Regression models, with DDD and DDW in third trimester as predictors, indicated that all FASD diagnoses were associated with lower maternal BMI (OR\u2009=\u20090.896,\n                      <jats:italic>p<\/jats:italic>\n                      =\u20090.022) and higher DDW (OR\u2009=\u20091.807,\n                      <jats:italic>p<\/jats:italic>\n                      =\u20090.020), but not DDD. When DDW was excluded from the model, DDD in third trimester was associated with an FAS (the most severe) diagnosis (OR\u2009=\u20091.082,\n                      <jats:italic>p<\/jats:italic>\n                      =\u20090.047).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher maternal body weight and a BMI between 25 and 29 appear to be protective for the offspring. Long\u2010term adequate nutrition and less alcohol consumption in the third trimester may protect highly exposed children from the most severe and negative outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acer.70228","type":"journal-article","created":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T15:00:26Z","timestamp":1769958026000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An examination of child outcomes and predictors of severity when prenatal alcohol exposure is frequent and heavy"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1939-8701","authenticated-orcid":false,"given":"Philip A.","family":"May","sequence":"first","affiliation":[{"name":"Department of Nutrition, Gillings School of Global Public Health, Nutrition Research Institute University of North Carolina at Chapel Hill  Kannapolis North\u00a0Carolina USA"},{"name":"Center on Alcohol, Substance Use and Addictions (CASAA) The University of New Mexico  Albuquerque New Mexico USA"},{"name":"Department of Psychiatry, Faculty of Medicine and Health Sciences Stellenbosch University  Tygerberg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie M.","family":"Hasken","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Gillings School of Global Public Health, Nutrition Research Institute University of North Carolina at Chapel Hill  Kannapolis North\u00a0Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna\u2010Susan","family":"Marais","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine and Health Sciences Stellenbosch University  Tygerberg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlene M.","family":"De Vries","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine and Health Sciences Stellenbosch University  Tygerberg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy O.","family":"Kalberg","sequence":"additional","affiliation":[{"name":"Center on Alcohol, Substance Use and Addictions (CASAA) The University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Buckley","sequence":"additional","affiliation":[{"name":"Center on Alcohol, Substance Use and Addictions (CASAA) The University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Abdul\u2010Rahman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Weill Cornell Medical College  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret P.","family":"Adam","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luther K.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Dysmorphology and Clinical Genetics State University of New York at Buffalo  Buffalo New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie A.","family":"Manning","sequence":"additional","affiliation":[{"name":"Department of Pathology Stanford University School of Medicine  Palo Alto California USA"},{"name":"Department of Pediatrics Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9787-2785","authenticated-orcid":false,"given":"Charles D. 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