The Association of Prenatal Alcohol Exposure With Brain Development During the First 1000 Days of Life: A Systematic Review

ABSTRACT Prenatal exposure to alcohol (PAE) can impact short‐ and long‐term offspring health. However, knowledge on PAE and brain development in early life is limited. This systematic review investigated associations between PAE and brain development during the first 1000 days of life, and was registered in PROSPERO at CRD42022355144. The literature search was performed from inception until February 2024 in EMBASE, MEDLINE, Web of Science, PsycINFO, and the Cochrane Library. Studies investigating PAE and brain development during the first 1000 days using ultrasound, magnetic resonance imaging (MRI) or diffusion tensor imaging (DTI) were included. Our search initially identified 3618 articles, of which 16 were included. The findings suggest inconsistent associations between PAE and early brain development. Ultrasound studies on PAE and brain size report no clear relationship. Some postnatal MRI studies reported smaller thalami, amygdalae and hippocampi in alcohol exposed neonates. Postnatal DTI studies (n = 5) examining network integrity and connectivity reported bidirectional results in multiple brain networks. Our results highlight the need for further research on first trimester brain development, timing and quantity of alcohol exposure using a core set of validated instruments. Longitudinal assessments and standardized procedures for neuroimaging are crucial to understand the impact of PAE on early brain development.