Heavy prenatal alcohol exposure and healthcare use during childhood and adolescence: a Danish nationwide cohort study 1997-2022

Children with heavy prenatal alcohol exposure may experience increased healthcare needs and access barriers. We aimed to quantify their healthcare utilisation patterns compared to all other Danish children in this nationwide cohort study of children born 1997-2020, followed until Dec 31, 2022. Data was derived from eight national registers. Heavy prenatal alcohol exposure was defined by hospital contacts with 100% alcohol-attributable diagnoses given to mother or child, redeemed prescriptions for drugs to treat alcohol dependence, or enrollment into treatment clinics, one year before or during pregnancy. We estimated age- and sex-specific rates and incidence rate ratios (IRRs) for use of somatic and psychiatric hospitals, and use of general practice (GP), and risk ratio (RR) for participation in the GP-based preventive child health programme. Of 1,457,962 children followed for 17,778,705 person-years, 5898 (0.4%) were heavily prenatal alcohol exposed. Exposed children had higher use of GP and hospitals compared to reference children, particularly notable for psychiatric hospital contacts with IRR for respectively ages 0-5, 6-11 and 12-18 years of 3.55 (2.98-4.24), 2.68 (2.41-2.98), and 2.19 (1.95-2.46); and for planned outpatient contacts 2.01 (1.92-2.10), 1.29 (1.21-1.37), and 1.20 (1.12-1.28). Despite higher healthcare use, participation in the preventive child health programme had a RR of 0.69 (95% CI 0.67-0.72) for exposed compared to reference children. The higher use of hospitals and GP, but lower participation in the child health programme underscores the long-term consequences and societal burden of heavy prenatal alcohol exposure, and leaves a need for awareness and adequate support to ensure health equity.