Prenatal alcohol exposure and child cognition: semi-continuous exposures, causal inference and evidence synthesis

Xiaoya Wang; Richard J. Cook; Yeying Zhu; Tugba Akkaya-Hocagil; R. Colin Carter; Sandra W. Jacobson; Joseph L. Jacobson; Louise M. Ryan

arXiv · 2512.09237

Prenatal alcohol exposure and child cognition: semi-continuous exposures, causal inference and evidence synthesis

Xiaoya Wang·Richard J. Cook·Yeying Zhu·Tugba Akkaya-Hocagil·R. Colin Carter·Sandra W. Jacobson·Joseph L. Jacobson·Louise M. Ryan

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Abstract

We address the challenge of causal inference status and the dose-response effects with a semi-continuous exposure. A two-stage approach is proposed using estimating equation for multiple outcomes with large sample properties derived for the resulting estimators. Homogeneity tests are developed to assess whether causal effects of exposure status and the dose-response effects are the same across multiple outcomes. A global homogeneity test is also developed to assess whether the effect of exposure status (exposed/not exposed) and the dose-response effect of the continuous exposure level are each equal across all outcomes. The methods of estimation and testing are rigorously evaluated in simulation studies and applied to a motivating study on the effects of prenatal alcohol exposure on childhood cognition defined by executive function (EF), academic achievement in math, and learning and memory (LM).

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Xiaoya Wang, Richard J. Cook, Yeying Zhu, Tugba Akkaya-Hocagil, R. Colin Carter, Sandra W. Jacobson, Joseph L. Jacobson, Louise M. Ryan. 2025-12-10. Prenatal alcohol exposure and child cognition: semi-continuous exposures, causal inference and evidence synthesis. https://arxiv.org/abs/2512.09237

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