BACKGROUND: Maternal alcohol consumption can adversely affect children's development, but the impact of paternal drinking is less understood. We aimed to investigate whether maternal or paternal alcohol consumption during pregnancy affected children's mental health and behavior. METHODS: A total of 2,013 parent-child triads from the European Longitudinal Study of Pregnancy and Childhood cohort were used. Data on alcohol consumption was obtained from questionnaires during pregnancy and after the child's birth. Mental health and behavior of children were assessed with Strength and Difficulties Questionnaire (SDQ). The associations were tested using linear regression, adjusting for socio-demographic and psychosocial covariates. RESULTS: Increased maternal alcohol consumption was associated with higher total SDQ scores at ages 7, 11, and 18 years old when the outcomes were reported by mothers, but only at 11 years when reported by children. We did not observe any dose-response relationship, and the effect size did not change during the follow-up. The effects were observed across various domains of SDQ: in the emotional symptoms subscale at age 11, in the conduct problems subscale at ages 7 and 11, and in the hyperactivity/inattention subscale at age 18. Paternal alcohol consumption was not associated with SDQ. CONCLUSIONS: Maternal alcohol consumption during pregnancy is associated with long-term effects on children's mental health and behavior, particularly when reported by mothers. No association was found between paternal alcohol consumption, suggesting that the results may stem from biological effects of alcohol or other factors beyond the direct exposure, potentially encompassing broader maternal psychosocial or behavioral characteristics.

Department of Epidemiology 2nd Faculty of Medicine https ror org 024d6js02Charles University Prague Czech Republic

Faculty of Humanities https ror org 024d6js02Charles University Prague Czech Republic

RECETOX Faculty of Science https ror org 02j46qs45Masaryk University Brno Czech Republic

See more in PubMed

Easey KE, Dyer ML, Timpson NJ, Munafò MR. Prenatal alcohol exposure and offspring mental health: a systematic review. Drug Alcohol Depend. 2019;197:344–53. 10.1016/j.drugalcdep.2019.01.007. PubMed DOI PMC

Popova S, Lange S, Probst C, Gmel G, Rehm J. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. The Lancet Global Health. 2017;5:e290–9. 10.1016/S2214-109X(17)30021-9. PubMed DOI

Popova S, Charness ME, Burd L, Crawford A, Hoyme HE, Mukherjee RAS, et al. Fetal alcohol spectrum disorders. Nat Rev Dis Primers. 2023;9:11. 10.1038/s41572-023-00420-x. PubMed DOI

Kruithof P, Ban S. A brief overview of fetal alcohol syndrome for health professionals. Br J Nurs. 2021;30:890–3. 10.12968/bjon.2021.30.15.890. PubMed DOI

Popova S, Dozet D, Shield K, Rehm J, Burd L. Alcohol’s Impact on the fetus. Nutrients. 2021;13:3452. 10.3390/nu13103452. PubMed DOI PMC

Luan M, Zhang X, Fang G, Liang H, Yang F, Song X, et al. Preconceptional paternal alcohol consumption and the risk of child behavioral problems: a prospective cohort study. Sci Rep. 2022;12:1508. 10.1038/s41598-022-05611-2. PubMed DOI PMC

Sayal K, Draper ES, Fraser R, Barrow M, Davey Smith G, Gray R. Light drinking in pregnancy and mid-childhood mental health and learning outcomes. Arch Dis Child. 2013;98:107–11. 10.1136/archdischild-2012-302436. PubMed DOI PMC

Alvik A, Aalen OO, Lindemann R. Early fetal binge alcohol exposure predicts high behavioral symptom scores in 5.5-year-old children. Alcohol Clin Exp Res. 2013;37:1954–62. 10.1111/acer.12182. PubMed DOI

Niclasen J, Nybo Andersen AM, Teasdale TW, Strandberg-Larsen K. Prenatal exposure to alcohol, and gender differences on child mental health at age seven years. J Epidemiol Community Health. 2014;68:224–32. 10.1136/jech-2013-202956. PubMed DOI

Niclasen J, Andersen A-MN, Strandberg-Larsen K, Teasdale TW. Is alcohol binge drinking in early and late pregnancy associated with behavioural and emotional development at age 7 years? Eur Child Adolesc Psychiatry. 2014;23:1175–80. 10.1007/s00787-013-0511-x. PubMed DOI

Kelly Y, Sacker A, Gray R, Kelly J, Wolke D, Quigley MA. Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age? Int J Epidemiol. 2009;38:129–40. 10.1093/ije/dyn230. PubMed DOI

Jm M, Fj J, Gm M, As K, Fp M. Prenatal alcohol exposure and risk of attention deficit hyperactivity disorder in offspring: a retrospective analysis of the millennium cohort study. J Affective Disord. 2020;269:94–100. 10.1016/j.jad.2020.03.027. PubMed DOI

Kelly YJ, Sacker A, Gray R, Kelly J, Wolke D, Head J, et al. Light drinking during pregnancy: still no increased risk for socioemotional difficulties or cognitive deficits at 5 years of age? J Epidemiol Community Health. 2012;66:41–8. 10.1136/jech.2009.103002. PubMed DOI

Skogerbø Å, Kesmodel U, Denny C, Kjaersgaard M, Wimberley T, Landrø N, et al. The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on behaviour in 5-year-old children: a prospective cohort study on 1628 children. BJOG. 2013;120:1042–50. 10.1111/1471-0528.12208. PubMed DOI PMC

NHS. Developmental and emotional milestones 0–18 years n.d.. https://inourplace.co.uk/developmental-and-emotional-milestones-0-18y-leaflet/.

Van Roy B, Groholt B, Heyerdahl S, Clench-Aas J. Understanding discrepancies in parent-child reporting of emotional and behavioural problems: Effects of relational and socio-demographic factors. BMC Psychiatry. 2010;10:56. 10.1186/1471-244X-10-56. PubMed DOI PMC

Global Drinking Demographics. AlcoholOrg 2024. https://alcohol.org/guides/global-drinking-demographics/.

European longitudinal study of pregnancy and childhood (ELSPAC). Paediatric Perinatal Epid. 1989;3:460–9. 10.1111/j.1365-3016.1989.tb00533.x. PubMed DOI

Piler P, Kandrnal V, Kukla L, Andrýsková L, Švancara J, Jarkovský J, et al. Cohort profile: The European Longitudinal Study of Pregnancy and Childhood (ELSPAC) in the Czech Republic. Int J Epidemiol. 2016:dyw091. 10.1093/ije/dyw091. PubMed DOI PMC

Goodman R. The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581–6. 10.1111/j.1469-7610.1997.tb01545.x. PubMed DOI

Goodman R, Ford T, Simmons H, Gatward R, Meltzer H. Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry. 2000;177:534–9. 10.1192/bjp.177.6.534. PubMed DOI

Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40:1337–45. 10.1097/00004583-200111000-00015. PubMed DOI

Stepanikova I, Acharya S, Colón-López A, Abdalla S, Klanova J, Darmstadt GL. Maternal gender discrimination and child emotional and behavioural problems: A population-based, longitudinal cohort study in the Czech Republic. EClinicalMedicine. 2022;53:101627. 10.1016/j.eclinm.2022.101627. PubMed DOI PMC

Kuruczova D, Klanova J, Jarkovsky J, Pikhart H, Bienertova-Vasku J. Socioeconomic characteristics, family structure and trajectories of children’s psychosocial problems in a period of social transition. PLoS One. 2020;15:e0234074. 10.1371/journal.pone.0234074. PubMed DOI PMC

Dachew BA, Heron JE, Alati R. Parental depressive symptoms across the first three years of a child’s life and emotional and behavioural problem trajectories in children and adolescents. J Psychiatr Res. 2023;159:135–44. 10.1016/j.jpsychires.2023.01.019. PubMed DOI

Mareckova K, Miles A, Liao Z, Andryskova L, Brazdil M, Paus T, et al. Prenatal stress and its association with amygdala-related structural covariance patterns in youth. Neuroimage Clin. 2022;34:102976. 10.1016/j.nicl.2022.102976. PubMed DOI PMC

Buuren SV, Groothuis-Oudshoorn K. Mice: multivariate imputation by chained equations in DOI

Azur MJ, Stuart EA, Frangakis C, Leaf PJ. Multiple imputation by chained equations: what is it and how does it work? Int J Methods Psych Res. 2011;20:40–9. 10.1002/mpr.329. PubMed DOI PMC

Casson RJ, Farmer LD. Understanding and checking the assumptions of linear regression: a primer for medical researchers. Clinical Exper Ophthalmol. 2014;42:590–6. 10.1111/ceo.12358. PubMed DOI

What is the SDQ? n.d.. https://www.sdqinfo.org/py/sdqinfo/c0.py.

Bandoli G. Low to moderate prenatal alcohol exposure and neurodevelopmental outcomes: a narrative review and methodological considerations. ARCR. 2023;43:01. 10.35946/arcr.v43.1.01. PubMed DOI PMC

Nattala P, Kishore MT, Murthy P, Christopher R, Veerabathini JS, Suresh S. Association between parent-reported executive functions and self-reported emotional problems among adolescent offspring of fathers with alcohol-dependence. JNRP. 2022;13:441–7. 10.1055/s-0042-1745820. PubMed DOI PMC

Raj, H, Kumar, K, Sinha, V.K., Dogra, R. A comparative study on behavioural problems in children of alcohol dependent parents. Dysphrenia. n.d.;2012.

Mattson SN, Bernes GA, Doyle LR. Fetal alcohol spectrum disorders: a review of the neurobehavioral deficits associated with prenatal alcohol exposure. Alcoholism Clin Exp Res. 2019;43:1046–62. 10.1111/acer.14040. PubMed DOI PMC

Raitasalo K, Holmila M, Jääskeläinen M, Santalahti P. The effect of the severity of parental alcohol abuse on mental and behavioural disorders in children. Eur Child Adolesc Psychiatry.2019;28:913–22. 10.1007/s00787-018-1253-6. PubMed DOI PMC

Easey KE, Timpson NJ, Munafò MR. association of prenatal alcohol exposure and offspring depression: a negative control analysis of maternal and partner consumption. Alcoholism Clin Exp Res. 2020;44:1132–40. 10.1111/acer.14324. PubMed DOI PMC

Lees B, Mewton L, Jacobus J, Valadez EA, Stapinski LA, Teesson M, et al. Association of prenatal alcohol exposure with psychological, behavioral, and neurodevelopmental outcomes in children from the adolescent brain cognitive development study. AJP. 2020;177:1060–72. 10.1176/appi.ajp.2020.20010086. PubMed DOI PMC

Anda RF, Whitfield CL, Felitti VJ, Chapman D, Edwards VJ, Dube SR, et al. Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. PS. 2002;53:1001–9. 10.1176/appi.ps.53.8.1001. PubMed DOI

Zuccolo L, DeRoo LA, Wills AK, Davey Smith G, Suren P, Roth C, et al. Pre-conception and prenatal alcohol exposure from mothers and fathers drinking and head circumference: results from the Norwegian Mother-Child Study (MoBa). Sci Rep. 2016;6:39535. 10.1038/srep39535. PubMed DOI PMC

The effects of alcoholism on families: how alcoholism effects families. AmericanAddictionCentersOrg. 2025. https://americanaddictioncenters.org/alcohol/support-recovery/family.

Bakhireva LN, Solomon E, Roberts MH, Ma X, Rai R, Wiesel A, et al. Independent and combined effects of prenatal alcohol exposure and prenatal stress on fetal hpa axis development. IJMS. 2024;25:2690. 10.3390/ijms25052690. PubMed DOI PMC

Sandtorv LB, Hysing M, Rognlid M, Nilsen SA, Elgen IB. Mental health in school-aged children prenatally exposed to alcohol and other substances. Subst Abuse. 2017;11:117822181771816. 10.1177/1178221817718160. PubMed DOI PMC

Barbuscia A, Staff J, Ploubidis GB, Fitzsimons E, Maggs J. Light drinking during pregnancy: social advantages explain positive correlates with child and early adolescent adjustment. Addictive Behav. 2019;98:106003. 10.1016/j.addbeh.2019.05.027. PubMed DOI

Murray J, Burgess S, Zuccolo L, Hickman M, Gray R, Lewis SJ. Moderate alcohol drinking in pregnancy increases risk for children’s persistent conduct problems: causal effects in a Mendelian randomisation study. Child Psychol Psychiatry. 2016;57:575–84. 10.1111/jcpp.12486. PubMed DOI PMC

Pfinder M, Lhachimi S. Lifestyle-related risk factors during pregnancy: even low-to-moderate drinking during pregnancy increases the risk for adolescent behavioral problems. J Substance Use. 2020;25:135–40. 10.1080/14659891.2019.1664668. DOI

Haan E, Westmoreland KE, Schellhas L, Sallis HM, Taylor G, Zuccolo L, et al. Prenatal smoking, alcohol and caffeine exposure and offspring externalizing disorders: a systematic review and meta-analysis. Addiction. 2022;117:2602–13. 10.1111/add.15858. PubMed DOI PMC

San Martin Porter M, Maravilla JC, Betts KS, Alati R. Low–moderate prenatal alcohol exposure and offspring attention-deficit hyperactivity disorder (ADHD): systematic review and meta-analysis. Arch Gynecol Obstet. 2019;300:269–77. 10.1007/s00404-019-05204-x. PubMed DOI

Rønning JA, Mørch W-T, Handegaard BH, Sourander A. The Strengths and Difficulties Self-Report Questionnaire as a screening instrument in Norwegian community samples. Eur Child Adolescent Psychiatry. 2004;13:73–82. 10.1007/s00787-004-0356-4. PubMed DOI