Prenatal Alcohol Exposure Predicts Academic Outcomes from Childhood to Adolescence: A Prospective Longitudinal Study Based on Meconium Ethyl Glucuronide

Background: Prenatal alcohol exposure (PAE) is a major preventable cause of neurodevelopmental impairment. Little is known about its impact on real-life child/adolescent academic outcomes, which are key functional indicators of long-term social participation. Methods: PAE was assessed in a sample of 156 participants via (1) meconium ethyl glucuronide (EtG) concentration (≥10 ng/g; EtG-positive, n = 36) and (2) third-trimester maternal self-report (SR-positive, n = 40). At primary school (6–10 years, t1) and secondary school ages (12–14 years, t2), exposed and non-exposed children were compared regarding primary school grades (t1) and secondary track placement (t2). Results: At t1, EtG-positive children exhibited lower school report grades by trend (n = 15, p = 0.068–0.085) with a moderate effect size (r = 0.36–0.39). SR-positive children demonstrated significantly lower school report grades (n = 15, p = 0.016) with strong effect (r = 0.56). At t2, both exposure groups had increased trend-significant odds of attending lower educational tracks (EtG-positive/-negative: n = 153, OR = 1.84, p = 0.059; SR-positive/-negative: n = 153, OR = 1.78, p = 0.066). Conclusions: PAE is associated with reduced real-life academic outcomes across development. School performance represents a sensitive functional outcome of neurodevelopmental vulnerability following PAE. Meconium EtG may contribute to postnatal identification of affected children.