{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:13:45Z","timestamp":1792649625829,"version":"4.5.0"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Prenatal alcohol exposure (PAE) associated with fetal alcohol spectrum disorders (FASD) often remain underdiagnosed. They globally cause a wide range of health and social problems leading to high costs. To outline cumulative health and social care costs in children related with PAE with and without diagnosed FASD, we followed 427 children with PAE until the age of 20 years, and 1795 controls born 1992\u20132001 until the year 2016. All hospital care and out-of-home care episodes, including placements in foster or residential care, were analyzed, and their costs estimated. Age-dependent patterns of diagnoses and costs of those with PAE with and without diagnosed FASD were compared to controls. Children with PAE had significantly higher risks and hospital costs for both somatic and psychiatric conditions compared with controls. Mean cumulative hospital costs were 55500\u20ac (IQR, interquartile range, 56800\u20ac) for PAE with FASD, 30100\u20ac (IQR 25100\u20ac) for PAE without FASD and 15600\u20ac (IQR 12000\u20ac) for controls. Between 0\u201310 years, FASD was associated with higher somatic costs, whereas psychiatric costs dominated in the PAE without FASD group. FASD diagnosis was associated with lower risks of traumatic injuries, substance use disorders, and teenage pregnancies, independent of early out-of-home care, which was associated with FASD. Out-of-home care was common in PAE groups, and its costs far exceeded hospital costs: mean cumulative costs were 30-fold in FASD (610000\u20ac, IQR 375800\u20ac) and 17-fold in others with PAE (344300\u20ac, IQR 621900\u20ac) compared to controls (20500\u20ac, IQR 0\u20ac). Health and particularly social care costs associated with PAE are significant. High out-of-home care costs reflect substantial need for support for families at risk. Early diagnosis of FASD may mitigate secondary complications and associated costs emerging in adolescence. Prevention policies are urgently needed at primary, secondary and tertiary level.<\/jats:p>","DOI":"10.1371\/journal.pone.0332113","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T17:24:51Z","timestamp":1773249891000},"page":"e0332113","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["A register-based study of long-term health and social care costs among children with prenatal alcohol exposure"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6760-0495","authenticated-orcid":true,"given":"Mirjami","family":"Jolma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"Koivu-Jolma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taisto","family":"Sarkola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niina-Maria","family":"Nissinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Kahila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Sarajuuri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulus","family":"Torkki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilona","family":"Autti-R\u00e4m\u00f6","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Koponen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"issue":"3","key":"pone.0332113.ref001","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(17)30021-9","article-title":"Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis","volume":"5","author":"S Popova","year":"2017","journal-title":"Lancet Glob Health"},{"key":"pone.0332113.ref002","volume-title":"World Population Prospects 2022","author":"Economic UND of SAPD","year":"2022"},{"issue":"10","key":"pone.0332113.ref003","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1001\/jamapediatrics.2017.1919","article-title":"Global prevalence of fetal alcohol spectrum disorder among children and youth","volume":"171","author":"S Lange","year":"2017","journal-title":"JAMA Pediatr"},{"issue":"10","key":"pone.0332113.ref004","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1111\/acer.14922","article-title":"The prevalence of fetal alcohol spectrum disorders in rural communities in South Africa: A third regional sample of child characteristics and maternal risk factors","volume":"46","author":"PA May","year":"2022","journal-title":"Alcohol Clin Exp Res"},{"issue":"2","key":"pone.0332113.ref005","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-4256","article-title":"Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders","volume":"138","author":"HE Hoyme","year":"2016","journal-title":"Pediatrics"},{"issue":"1","key":"pone.0332113.ref006","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41572-023-00420-x","article-title":"Fetal alcohol spectrum disorders","volume":"9","author":"S Popova","year":"2023","journal-title":"Nat Rev Dis Primers"},{"issue":"10022","key":"pone.0332113.ref007","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/S0140-6736(15)01345-8","article-title":"Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis","volume":"387","author":"S Popova","year":"2016","journal-title":"Lancet"},{"issue":"8","key":"pone.0332113.ref008","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/S1474-4422(19)30150-4","article-title":"Clinical presentation, diagnosis, and management of fetal alcohol spectrum disorder","volume":"18","author":"JR Wozniak","year":"2019","journal-title":"Lancet Neurol"},{"issue":"1","key":"pone.0332113.ref009","article-title":"Heavy prenatal alcohol exposure and overall morbidities: a Danish nationwide cohort study from 1996 to 2018","volume":"8","author":"M Broccia","year":"2023","journal-title":"Lancet Public Health"},{"issue":"5","key":"pone.0332113.ref010","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1001\/jama.2017.21896","article-title":"Prevalence of fetal alcohol spectrum disorders in 4 US Communities","volume":"319","author":"PA May","year":"2018","journal-title":"JAMA"},{"issue":"6","key":"pone.0332113.ref011","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1097\/ADM.0000000000000438","article-title":"A Multicountry updated assessment of the economic impact of fetal alcohol spectrum disorder: costs for children and adults","volume":"12","author":"JR Greenmyer","year":"2018","journal-title":"J Addict Med"},{"issue":"5","key":"pone.0332113.ref012","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s10198-016-0811-4","article-title":"Societal costs of fetal alcohol syndrome in Sweden","volume":"18","author":"L Ericson","year":"2017","journal-title":"Eur J Health Econ"},{"issue":"7","key":"pone.0332113.ref013","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/pai.12772","article-title":"Cost of asthma in children: A nationwide, population-based, cost-of-illness study","volume":"28","author":"M Ferreira de Magalh\u00e3es","year":"2017","journal-title":"Pediatr Allergy Immunol"},{"issue":"5","key":"pone.0332113.ref014","first-page":"788","article-title":"Children with FASD-Evolving Patterns of developmental problems and intervention costs in ages 0 through 16 in finland","volume":"10","author":"LM Jolma","year":"2023","journal-title":"Children (Basel)"},{"key":"pone.0332113.ref015","first-page":"1443","article-title":"Prevalence of fetal alcohol spectrum disorder in foster care: A scoping review. Alcohol","volume":"48","author":"B Engesether","year":"2024","journal-title":"Clinical and Experimental Research"},{"issue":"11","key":"pone.0332113.ref016","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1111\/j.1651-2227.2007.00474.x","article-title":"Risk factors for out-of-home custody child care among families with alcohol and substance abuse problems","volume":"96","author":"T Sarkola","year":"2007","journal-title":"Acta Paediatr"},{"issue":"10","key":"pone.0332113.ref017","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1111\/j.1651-2227.2011.02317.x","article-title":"Early healthcare utilization and welfare interventions among children of mothers with alcohol and substance abuse: a retrospective cohort study","volume":"100","author":"T Sarkola","year":"2011","journal-title":"Acta Paediatr"},{"issue":"7","key":"pone.0332113.ref018","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1111\/j.1651-2227.2012.02670.x","article-title":"Alcohol and substance abuse identified during pregnancy: maternal morbidity, child morbidity and welfare interventions","volume":"101","author":"T Sarkola","year":"2012","journal-title":"Acta Paediatr"},{"key":"pone.0332113.ref019","doi-asserted-by":"crossref","first-page":"106683","DOI":"10.1016\/j.childyouth.2022.106683","article-title":"Out-of-home care and diagnosed mental and behavioral disorders among youth with and without prenatal substance exposure \u2013 A longitudinal register-based cohort study","volume":"143","author":"AM Koponen","year":"2022","journal-title":"Children and Youth Services Review"},{"key":"pone.0332113.ref020","first-page":"476","article-title":"Les enfants de parents alcooliques. Anomalies observ\u00e9es. A propos de 127 cas","author":"P Lemoine","year":"1968","journal-title":"Ouest-M\u00e9dical"},{"issue":"7815","key":"pone.0332113.ref021","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/S0140-6736(73)91291-9","article-title":"Pattern of malformation in offspring of chronic alcoholic mothers","volume":"1","author":"KL Jones","year":"1973","journal-title":"Lancet"},{"issue":"4454","key":"pone.0332113.ref022","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1126\/science.6992275","article-title":"Teratogenic effects of alcohol in humans and laboratory animals","volume":"209","author":"AP Streissguth","year":"1980","journal-title":"Science"},{"issue":"5","key":"pone.0332113.ref023","doi-asserted-by":"crossref","first-page":"319","DOI":"10.3109\/07853899009147914","article-title":"Teratogenic effects of alcohol on brain development","volume":"22","author":"JR West","year":"1990","journal-title":"Ann Med"},{"issue":"3","key":"pone.0332113.ref024","first-page":"185","article-title":"Teratogenic effects of alcohol on brain and behavior","volume":"25","author":"SN Mattson","year":"2001","journal-title":"Alcohol Res Health"},{"issue":"4","key":"pone.0332113.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0176440","article-title":"Ethanol itself is a holoprosencephaly-inducing teratogen","volume":"12","author":"M Hong","year":"2017","journal-title":"PLoS One"},{"issue":"16","key":"pone.0332113.ref026","doi-asserted-by":"crossref","first-page":"8785","DOI":"10.3390\/ijms22168785","article-title":"Toxic and Teratogenic Effects of Prenatal Alcohol Exposure on Fetal Development, Adolescence, and Adulthood","volume":"22","author":"DD Chung","year":"2021","journal-title":"Int J Mol Sci"},{"issue":"5","key":"pone.0332113.ref027","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1080\/09297049.2011.553591","article-title":"Prenatal exposure to methadone and buprenorphine: a review of the potential effects on cognitive development","volume":"17","author":"C Konijnenberg","year":"2011","journal-title":"Child Neuropsychol"},{"issue":"6","key":"pone.0332113.ref028","article-title":"Maternal Use of Opioids During Pregnancy and Congenital Malformations: A Systematic Review","volume":"139","author":"JN Lind","year":"2017","journal-title":"Pediatrics"},{"issue":"5","key":"pone.0332113.ref029","doi-asserted-by":"crossref","first-page":"585","DOI":"10.2174\/1871527316666170413101257","article-title":"Is there a Teratogenicity Risk Associated with Cannabis and Synthetic Cannabimimetics\u2019 ('Spice\u2019) Intake?","volume":"16","author":"L Orsolini","year":"2017","journal-title":"CNS Neurol Disord Drug Targets"},{"issue":"4","key":"pone.0332113.ref030","doi-asserted-by":"crossref","DOI":"10.4088\/JCP.18r12412","article-title":"Benzodiazepine Use During Pregnancy Alone or in Combination With an Antidepressant and Congenital Malformations: Systematic Review and Meta-Analysis","volume":"80","author":"S Grigoriadis","year":"2019","journal-title":"J Clin Psychiatry"},{"issue":"15","key":"pone.0332113.ref031","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1002\/bdr2.1766","article-title":"Update on the developmental consequences of cannabis use during pregnancy and lactation","volume":"112","author":"KS Grant","year":"2020","journal-title":"Birth Defects Res"},{"issue":"3","key":"pone.0332113.ref032","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.drugalcdep.2010.04.014","article-title":"Maternal welfare, morbidity and mortality 6-15 years after a pregnancy complicated by alcohol and substance abuse: a register-based case-control follow-up study of 524 women","volume":"111","author":"H Kahila","year":"2010","journal-title":"Drug Alcohol Depend"},{"key":"pone.0332113.ref033","doi-asserted-by":"crossref","first-page":"100625","DOI":"10.1016\/j.ssmph.2020.100625","article-title":"Prenatal substance exposure, adverse childhood experiences and diagnosed mental and behavioral disorders - A longitudinal register-based matched cohort study in Finland","volume":"11","author":"AM Koponen","year":"2020","journal-title":"SSM Popul Health"},{"issue":"2","key":"pone.0332113.ref034","first-page":"176","article-title":"Adverse childhood experiences and neurodevelopmental disorders among youth with and without prenatal substance exposure: A longitudinal matched register-based cohort study","volume":"40","author":"AM Koponen","year":"2023","journal-title":"Nordisk Alkohol Nark"},{"key":"pone.0332113.ref035","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.jad.2022.04.039","article-title":"Mood and neurotic disorders among youth with prenatal substance exposure: A longitudinal register-based cohort study","volume":"308","author":"N-M Nissinen","year":"2022","journal-title":"J Affect Disord"},{"issue":"3","key":"pone.0332113.ref036","first-page":"348","article-title":"Financial difficulties among youth prenatally exposed to substances: a longitudinal register-based cohort study","volume":"31","author":"N-M Nissinen","year":"2023","journal-title":"Drugs: Education, Prevention and Policy"},{"issue":"1","key":"pone.0332113.ref037","first-page":"32","article-title":"Cohort profile: ADEF Helsinki - a longitudinal register-based study on exposure to alcohol and drugs during foetal life","volume":"37","author":"AM Koponen","year":"2020","journal-title":"Nordisk Alkohol Nark"},{"key":"pone.0332113.ref038","volume-title":"Terveydenhuollon yksikk\u00f6kustannukset Suomessa vuonna 2001. 1","author":"T Hujanen","year":"2001"},{"key":"pone.0332113.ref039","volume-title":"Terveydenhuollon yksikk\u00f6kustannukset Suomessa vuonna 2006","author":"T Hujanen","year":"2008"},{"key":"pone.0332113.ref040","volume-title":"Terveyden- ja sosiaalihuollon yksikk\u00f6kustannukset Suomessa vuonna 2011. 3","author":"S Kapiainen","year":"2014"},{"key":"pone.0332113.ref041","volume-title":"Terveyden- ja sosiaalihuollon yksikk\u00f6kustannukset Suomessa vuonna 2017. 21","year":"2020"},{"key":"pone.0332113.ref042","volume-title":"Kuuden suurimman kaupungin lasten sijaishuollon palvelujen ja kustannusten vertailu 2005","author":"A Kumpulainen","year":"2006"},{"key":"pone.0332113.ref043","volume-title":"Sosiaalihuollon yksikk\u00f6kustannukset Suomessa vuonna 2007. 1","author":"A V\u00e4is\u00e4nen","year":"2010"},{"key":"pone.0332113.ref044","volume-title":"R: A Language and Environment for Statistical Computing","author":"Team R Core","year":"2022"},{"key":"pone.0332113.ref045","volume-title":"Epitools: Epidemiology Tools. CRAN: Contributed Packages","author":"TJ Aragon","year":"2004"},{"issue":"2","key":"pone.0332113.ref046","doi-asserted-by":"crossref","DOI":"10.1177\/2515245921999602","article-title":"Psychologists should use brunner-munzel\u2019s instead of Mann-Whitney\u2019s U Test as the default nonparametric procedure","volume":"4","author":"JD Karch","year":"2021","journal-title":"Advances in Methods and Practices in Psychological Science"},{"issue":"1","key":"pone.0332113.ref047","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/(SICI)1521-4036(200001)42:1<17::AID-BIMJ17>3.0.CO;2-U","article-title":"The nonparametric behrens-fisher problem: asymptotic theory and a small-sample approximation","volume":"42","author":"E Brunner","year":"2000","journal-title":"Biom J"},{"issue":"10","key":"pone.0332113.ref048","doi-asserted-by":"crossref","first-page":"5192","DOI":"10.1016\/j.csda.2006.05.024","article-title":"A studentized permutation test for the non-parametric Behrens\u2013Fisher problem","volume":"51","author":"K Neubert","year":"2007","journal-title":"Computational Statistics & Data Analysis"},{"issue":"3","key":"pone.0332113.ref049","article-title":"lawstat: AnRPackage for law, public policy and biostatistics","volume":"28","author":"W Hui","year":"2008","journal-title":"J Stat Soft"},{"key":"pone.0332113.ref050","volume-title":"Lawstat: Tools for Biostatistics, Public Policy, and Law","author":"JL Gastwirth","year":"2023"},{"key":"pone.0332113.ref051","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jad.2024.05.035","article-title":"Prevalence of co-occurring diagnoses in people exposed to alcohol prenatally: Findings from a meta-analysis","volume":"358","author":"CA Clark","year":"2024","journal-title":"J Affect Disord"},{"issue":"4","key":"pone.0332113.ref052","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/00004703-200408000-00002","article-title":"Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects","volume":"25","author":"AP Streissguth","year":"2004","journal-title":"J Dev Behav Pediatr"},{"issue":"7","key":"pone.0332113.ref053","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1111\/epi.13015","article-title":"The health, education, and social care costs of school-aged children with active epilepsy: A population-based study","volume":"56","author":"RM Hunter","year":"2015","journal-title":"Epilepsia"},{"issue":"1","key":"pone.0332113.ref054","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s12978-017-0385-3","article-title":"Prevalence of prenatal exposure to substances of abuse: questionnaire versus biomarkers","volume":"14","author":"A Chiandetti","year":"2017","journal-title":"Reprod Health"},{"issue":"11","key":"pone.0332113.ref055","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1080\/00016340600589958","article-title":"Alcohol use before and during pregnancy: a population-based study","volume":"85","author":"A Alvik","year":"2006","journal-title":"Acta Obstet Gynecol Scand"},{"key":"pone.0332113.ref056","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.addbeh.2015.06.018","article-title":"Alcohol use, smoking and their co-occurrence during pregnancy among Canadian women, 2003 to 2011\/12","volume":"50","author":"S Lange","year":"2015","journal-title":"Addict Behav"},{"key":"pone.0332113.ref057","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1186\/s12889-016-3354-9","article-title":"\u201cDid you ever drink more?\u201d A detailed description of pregnant women\u2019s drinking patterns","volume":"16","author":"E Muggli","year":"2016","journal-title":"BMC Public Health"},{"issue":"3","key":"pone.0332113.ref058","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1080\/07315724.2020.1737984","article-title":"Altered maternal plasma fatty acid composition by alcohol consumption and smoking during pregnancy and associations with fetal alcohol spectrum disorders","volume":"39","author":"KD Sowell","year":"2020","journal-title":"J Am Coll Nutr"},{"issue":"1","key":"pone.0332113.ref059","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000150597","article-title":"Combined effects of cigarette smoking and alcohol consumption on perinatal outcome","volume":"67","author":"HJ Odendaal","year":"2009","journal-title":"Gynecol Obstet Invest"},{"issue":"1","key":"pone.0332113.ref060","first-page":"45","article-title":"The combined effects of alcohol and tobacco use during pregnancy on birth outcomes","volume":"69","author":"J Hamu\u0142ka","year":"2018","journal-title":"Rocz Panstw Zakl Hig"},{"issue":"1","key":"pone.0332113.ref061","doi-asserted-by":"crossref","first-page":"10252","DOI":"10.1590\/1414-431x202010252","article-title":"Association between tobacco and\/or alcohol consumption during pregnancy and infant development: BRISA Cohort","volume":"54","author":"MEA Negr\u00e3o","year":"2020","journal-title":"Braz J Med Biol Res"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0332113","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T17:25:04Z","timestamp":1773249904000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0332113"}},"subtitle":[],"editor":[{"given":"Nafisa M.","family":"Jadavji","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":61,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0332113","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]}}}