Unravelling complexity: Embracing the exposome in prenatal alcohol exposure and FASD research

Prenatal alcohol exposure (PAE) has the potential to adversely impact development of the embryo and fetus and may result in fetal alcohol spectrum disorder (FASD). Traditionally, research into the effects of PAE has predominately taken a single-exposure approach to examining adverse outcomes, rarely capturing cumulative or interacting exposures. However, adopting the exposome concept could transform this approach by considering lifetime environmental exposures as an interconnected and dynamic system. This is particularly relevant in global settings with heterogeneous environmental and social risk profiles. The exposome framework provides a holistic view of quantifiable environmental exposures on health and development across an individuals’ lifespan, including both beneficial and adverse exposures and external and internal factors. By examining the complex interplay between PAE and other environmental factors through the exposome lens, we can uncover new insights into both risk and resilience. Moreover, given the increased risk of child protection involvement and out-of-home care placement amongst children with FASD, this has the potential to inform prevention, assessment and support within child welfare systems, and shift statutory responses from individualised blame to structural and environmental understanding. Thus, this discussion paper provides a comprehensive overview of the exposome approach, how it has historically been used in PAE research, and how it can evolve, including in the field of child welfare.