The causal web of foetal alcohol spectrum disorders: a review and causal diagram

Cheryl McQuire, Rhian Daniel, Lisa Hurt, Alison Kemp, Shantini Paranjothy

Research output: Contribution to journalArticle (Academic Journal)peer-review

7 Citations (Scopus)
312 Downloads (Pure)


Foetal alcohol spectrum disorders (FASDs) are a leading cause of developmental disability. Prenatal alcohol use is the sole necessary cause of FASD, but it is not always sufficient. Multiple factors influence a child’s susceptibility to FASD following prenatal alcohol exposure. Much of the FASD risk factor literature has been limited to discussions of association, rather than causation. While knowledge of predictor variables is important for identifying who is most at risk of FASD and for targeting interventions, causal knowledge is important for identifying effective mechanisms for prevention and intervention programmes. We conducted a systematic search and narrative synthesis of the evidence and used this to create a causal diagram (directed acyclic graph; DAG) to describe the causal pathways to FASD. Our results show that the aetiology of FASD is multifaceted and complex. FASD risk is determined by a range of lifestyle, sociodemographic, maternal, social, gestational, and genetic factors. The causal diagram that we present in this review provides a comprehensive summary of causal risk factors for FASD and can be used as a tool to inform data collection and statistical modelling strategies to minimise bias in future studies of FASD.
Original languageEnglish
Number of pages20
JournalEuropean Child and Adolescent Psychiatry
Early online date16 Jan 2019
Publication statusE-pub ahead of print - 16 Jan 2019


  • Foetal alcohol spectrum disorders
  • Causal diagram
  • Directed acyclic graph
  • Causal inference
  • Review
  • Prenatal exposures

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