Prenatal alcohol exposure has been linked to adverse neurodevelopmental outcomes. However, its effects on developmental outcomes in children with autism spectrum disorder (ASD) remain unclear. We examined associations between prenatal alcohol exposure during the first trimester (PAE-FT) and early learning ability, behavioral problems, and severity of autistic traits in preschool-aged children in a large multi-site case-control study, the Study to Explore Early Development. Children were classified as ASD (n = 1237) or population comparison without ASD (POP, n = 1334) after an in-person assessment covering cognitive abilities and detailed autistic traits. Mothers completed questionnaires on their child's behavior and autism-related traits, as well as their alcohol use during pregnancy. Of children in the ASD and POP groups, 18.5% and 20.2%, respectively, were exposed to PAE-FT. Exposure to 3 or more alcoholic drinks per week was associated with increased externalizing behaviors (i.e., attention deficits and aggressive behaviors) in children in both the ASD and POP groups, and with exacerbated social communication and interaction deficits in children with ASD only. First trimester exposure to 1-2 alcoholic drinks per week was associated with early learning delays for children in the ASD group, but not the POP group. As expected, our findings suggest that PAE-FT is associated with adverse behavioral development of children regardless of ASD status. However, PAE-FT may exacerbate autism-specific developmental problems and learning difficulties in children with ASD. Gathering a prenatal alcohol exposure history for children with and without ASD could contribute to a better understanding of developmental trajectories, aiding informed decisions for interventions and support.

The first three SARS-CoV-2 phylogenetic lineages classified as variants of concern (VOCs) in the United States (U.S.) from December 15, 2020 to February 28, 2021, Alpha (B.1.1.7), Beta (B.1.351), and Gamma (P.1) lineages, were initially detected internationally. This investigation examined available travel history of coronavirus disease 2019 (COVID-19) cases reported in the U.S. in whom laboratory testing showed one of these initial VOCs. Travel history, demographics, and health outcomes for a convenience sample of persons infected with a SARS-CoV-2 VOC from December 15, 2020 through February 28, 2021 were provided by 35 state and city health departments, and proportion reporting travel was calculated. Of 1,761 confirmed VOC cases analyzed, 1,368 had available data on travel history. Of those with data on travel history, 1,168 (85%) reported no travel preceding laboratory confirmation of SARS-CoV-2 and only 105 (8%) reported international travel during the 30 days preceding a positive SARS-CoV-2 test or symptom onset. International travel was reported by 92/1,304 (7%) of persons infected with the Alpha variant, 7/55 (22%) with Beta, and 5/9 (56%) with Gamma. Of the first three SARS-CoV-2 lineages designated as VOCs in the U.S., international travel was common only among the few Gamma cases. Most persons infected with Alpha and Beta variant reported no travel history, therefore, community transmission of these VOCs was likely common in the U.S. by March 2021. These findings underscore the importance of global surveillance using whole genome sequencing to detect and inform mitigation strategies for emerging SARS-CoV-2 VOCs.