Children with prenatal alcohol exposure (PAE) are more likely than the general population to experience adverse exposures such as abuse, neglect, or poverty, which can affect brain development and behavior. Although PAE and adverse experiences often happen together, it is unclear whether postnatal exposures change the effects of PAE on brain structure and mental health. Our study looked at the brain and mental health in 66 children aged 7-16 years. We looked at 3 groups: children with PAE and no adverse experiences after birth, children with PAE and at least one adverse experience, and children with neither PAE nor adversity after birth. Children with PAE, regardless of whether they had adverse experiences, had worse mental health symptoms than children without PAE. The brains of children with PAE and no adverse experiences looked different than the brains of children with PAE and adverse experiences. This suggests that prenatal exposures and adverse experiences after birth have different impacts on the brain, and both are important to consider.