{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:32:22Z","timestamp":1785526342697,"version":"3.56.0"},"reference-count":59,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T00:00:00Z","timestamp":1772928000000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alcohol, Clinical and Experimental Research"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prenatal alcohol exposure (PAE) is a risk factor for early\u2010onset psychopathology. Low birthweight (LBW), one potential consequence of PAE, increases the vulnerability of children for externalizing disorders. This study investigates potential sex\u2010specific indirect pathways linking PAE to behavioral symptoms in offspring, focusing on LBW as a mediating and moderating factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants were 9\u201310\u2010year\u2010old singleton children whose biological parents reported on pregnancy experiences in the Adolescent Brain Cognitive Development (ABCD) study. PAE was a binary variable, indicating any use during pregnancy. Externalizing behavioral problems were assessed with the Child Behavior Checklist and modeled continuously. LBW (&lt;2500\u2009g) was calculated based on parental reports. We applied a four\u2010way decomposition analysis with stratification by sex. This causal framework allows to dissect the total effect into controlled direct effect (CDE), reference interaction (INTref), mediated interaction (INTmed), and pure indirect effect (PIE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The analytic sample (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20097502) was evenly split by sex, and nearly 50% were non\u2010Hispanic White children. A total of 2083 children were exposed to PAE. The adjusted total effect of PAE on externalizing behavioral problems was identified (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.91; 95%CI: 0.38, 1.44), with slightly weaker effects observed in males (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.88; 95%CI: 0.12, 1.64) than in females (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.98; 95%CI: 0.25, 1.71). Decomposition analysis indicated potential interaction with a major difference in CDE in the presence of LBW and in its absence, specifically for males (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20094.30, 95% CI: 1.97, 8.40 and\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.70, 95%CI:\u20100.17, 1.57, respectively). This indicates higher externalizing behavioral problems in males with a joint exposure to PAE and LBW, also confirmed with the INTref parameter (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.18, 95%CI: 0.08, 0.4). We found no evidence for mediation (PIE) or mediated interaction (INTmed) via LBW.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early identification and intervention for children with PAE have been shown to mitigate the risk of more severe secondary impacts. Our findings highlight the potential importance of birthweight as a factor that may exacerbate behavioral problems among PAE\u2010exposed offspring, particularly males.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acer.70266","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:28:08Z","timestamp":1773012488000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prenatal alcohol exposure, birthweight, and externalizing behavior in children: Insights from sex\u2010stratified four\u2010way decomposition"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0277-5745","authenticated-orcid":false,"given":"Anna","family":"Shchetinina","sequence":"first","affiliation":[{"name":"Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastien","family":"Haneuse","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4675-7722","authenticated-orcid":false,"given":"Christina","family":"Chambers","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Herbert Wertheim School of Public Health and Human Longevity Science University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Tiemeier","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Slopen","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2010.100"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13034-019-0291-2"},{"key":"e_1_2_10_4_1","volume-title":"Manual for the ASEBA school\u2010age forms & profiles","author":"Achenback T.","year":"2001"},{"key":"e_1_2_10_5_1","article-title":"The essential role of growth deficiency in the diagnosis of fetal alcohol spectrum disorder","volume":"3","author":"Astley S.J.","year":"2016","journal-title":"Advances in Pediatric Research"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9280.2009.02279.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1136\/bmj.297.6641.134-b","article-title":"Low birth weight and hypertension","volume":"297","author":"Barker D.","year":"1988","journal-title":"BMJ: British Medical Journal"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2004.00336.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.1997.tb01612.x"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13210"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0892-0362(91)90085-B"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-008-0704-x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10802-015-0032-9"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3345\/kjp.2016.59.1.1"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agae029"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1994.10476871"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10519-021-10062-y"},{"key":"e_1_2_10_18_1","volume-title":"Med4way: a Stata command to investigate mediating and interactive mechanisms using the four\u2010way effect decomposition","author":"Discacciati A.","year":"2019"},{"key":"e_1_2_10_19_1","volume-title":"Computer age statistical inference","author":"Efron B.","year":"2022"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dcn.2018.04.004"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.2493"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1101\/2020.02.10.942011"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3940(94)90632-7"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.14686"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2007.04.001"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.12331"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-018-3977-2"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/155.4.305"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/CHI.0b013e31819a1cbc"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.13805"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0954579419001755"},{"key":"e_1_2_10_32_1","first-page":"663","article-title":"Determinants of low birth weight: methodological assessment and meta\u2010analysis","volume":"65","author":"Kramer M.S.","year":"1987","journal-title":"Bulletin of the World Health Organization"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-127"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2010.12.004"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avb.2010.12.003"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-7795.2009.00583.x"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.5972"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1047-2797(97)00081-1"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0032247"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.99.6.869"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/CHI.0b013e31819996f1"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1037\/abn0000238"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-017-4341-9"},{"key":"e_1_2_10_44_1","unstructured":"National Institute on Alcohol Abuse and Alcoholism (NIAAA). 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Available from:https:\/\/www.who.int\/data\/nutrition\/nlis\/info\/low\u2010birth\u2010weight#:~:text=How%20is%20it%20defined%3F 2500%20grams%20(5.5%20pounds)[Accessed 11th February 2024]."},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-022-02241-x"}],"container-title":["Alcohol, Clinical and Experimental Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acer.70266","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acer.70266","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acer.70266","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:58:21Z","timestamp":1785520701000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acer.70266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":59,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/acer.70266"],"URL":"https:\/\/doi.org\/10.1111\/acer.70266","archive":["Portico"],"relation":{},"ISSN":["2993-7175","2993-7175"],"issn-type":[{"value":"2993-7175","type":"print"},{"value":"2993-7175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-11-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70266"}}