Who is most affected by prenatal alcohol exposure: Boys or girls?

•Prenatal maternal alcohol use affects both sexes similarly on most variables.•Girls had significantly more overall dysmorphology and worse cognitive outcomes.•Prenatal bingeing of 6+ drinks is associated with fewer males alive at age seven.•Controlling for 13 covariates, girls have a higher probability for fetal alcohol spectrum disorders (FASD).

ObjectiveTo examine outcomes among boys and girls that are associated with prenatal alcohol exposure.MethodsBoys and girls with fetal alcohol spectrum disorders (FASD) and randomly-selected controls were compared on a variety of physical and neurobehavioral traits.ResultsSex ratios indicated that heavy maternal binge drinking may have significantly diminished viability to birth and survival of boys postpartum more than girls by age seven. Case control comparisons of a variety of physical and neurobehavioral traits at age seven indicate that both sexes were affected similarly for a majority of variables. However, alcohol-exposed girls had significantly more dysmorphology overall than boys and performed significantly worse on non-verbal IQ tests than males. A three-step sequential regression analysis, controlling for multiple covariates, further indicated that dysmorphology among girls was significantly more associated with five maternal drinking variables and three distal maternal risk factors. However, the overall model, which included five associated neurobehavioral measures at step three, was not significant (p = 0.09, two-tailed test). A separate sequential logistic regression analysis of predictors of a FASD diagnosis, however, indicated significantly more negative outcomes overall for girls than boys (Nagelkerke R2 = 0.42 for boys and 0.54 for girls, z = −2.9, p = 0.004).ConclusionBoys and girls had mostly similar outcomes when prenatal alcohol exposure was linked to poor physical and neurocognitive development. Nevertheless, sex ratios implicate lower viability and survival of males by first grade, and girls have more dysmorphology and neurocognitive impairment than boys resulting in a higher probability of a FASD diagnosis.