The impact of prenatal alcohol exposure on sleep outcomes in 10,336 young adolescents: An Adolescent Brain Cognitive Development (ABCD) Study.

Study Objectives: This study investigated the associations between prenatal alcohol exposure (PAE), including low and moderate levels of exposure, and sleep outcomes in adolescence. This is an area that remains understudied despite evidence linking PAE to poor sleep in younger children and the growing recognition of harms associated with low levels of PAE. Methods: Participants were 10,336 adolescents (aged 12-13) from the fourth assessment wave of the Adolescent Brain Cognitive Development Study. Cross-sectional generalised linear mixed models and generalised additive mixed models were used to assess the impact of prenatal alcohol exposure, conceptualised as the presence and absence of PAE, total drinks consumed during pregnancy (i.e. dose), and patterns of PAE (i.e., abstainers, light reducing, light stable, heavy reducing), on adolescent sleep outcomes. Results: Adolescents with any PAE experienced worse sleep outcomes compared to those without, with the sleep-wake transitions and excessive somnolence being the domains most impacted. A non-linear dose effect was observed, whereby worse sleep-wake transitions occurred predominantly with low levels of exposure. In addition, those in the group with a light reducing pattern of PAE, compared to abstainers, experienced greater problems with sleep-wake transitions. Conclusion: These findings contribute to the growing evidence that there are no safe levels of alcohol consumption during pregnancy, as even low to moderate PAE negatively impacts adolescent sleep. Identifying sleep-wake transitions and excessive somnolence as the most affected domains provides targets for both screening and intervention.