General movement assessment and early motor abnormalities in infants with prenatal toxin and isolated alcohol exposure: A prospective cohort study.

BACKGROUND

Prenatal substance use, particularly alcohol, adversely affects fetal neurodevelopment. General Movement Assessment (GMA) is a non-invasive method evaluating spontaneous infant motor activity that reflects the integrity of the developing nervous system.

AIMS: To examine whether prenatal toxin exposure, and isolated alcohol exposure specifically, is associated with abnormal early general movements.

STUDY

DESIGN

Prospective cohort study.

SUBJECTS: We enrolled 625 infants from February 2022 to December 2024 at neonatal units and a neuropaediatric outpatient clinic at the LMU University Hospital, Munich; 131 had documented prenatal toxin exposure, including 78 exposed to alcohol only.

OUTCOME MEASURES: Quality of general movements was assessed using the Hadders-Algra classification by blinded raters at a mean corrected age of 3.6 weeks (SD 5.9) and, where available, 13.1 weeks (SD 3.9). Odds ratios (ORs) with 95% confidence intervals (CIs) were used to compare the proportions of definitely abnormal recordings between groups.

RESULTS

At the first assessment (mean corrected age 3.6 weeks, SD 5.9), infants with isolated alcohol exposure showed significantly more definitely abnormal general movements than controls (9.0% vs 3.6%; OR 2.57, 95% CI 1.04-6.37; p = 0.04). In the broader toxin-exposed group, the difference did not reach significance (7.6% vs 3.6%; OR 2.19, 95% CI 0.98-4.86; p = 0.055).

CONCLUSIONS

Isolated prenatal alcohol exposure was associated with abnormal early general movements, supporting GMA as a potential early screening tool. The borderline overall effect and high attrition warrant cautious interpretation and replication.