Does the highly prevalent East Asian ALDH2 null variant magnify adverse effects of prenatal alcohol exposure on child development? A commentary

That maternal alcohol consumption during pregnancy may lead to adverse consequences for the offspring is well known, but it is less widely recognised that this problem may be magnified substantially in East Asian countries, due to the high prevalence of ALDH2 null variation. The paper by Miyake et al. (2025) in this journal leveraged data from a large Japanese population-based cohort to investigate the joint associations of maternal alcohol use during pregnancy and maternal genotype on offspring development. We provide context for this study, highlight what we think is its critical finding and key questions that still need to be addressed, before considering the potentially serious public health implications of this work.