Effect of paternal alcohol consumption before conception on infant birth weight. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

Previous studies of paternal drinking and fetal growth in both animals and human have produced conflicting results. We evaluated the association between paternal drinking before conception and infant birth weight in a cohort of 9,845 liveborn singleton infant born to couples who participated in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC), ALSPAC is a population-based cohort study in which women and their partners completed several self-administered questionnaires over the course of pregnancy. Of participating male partners, 20% were reportedly daily drinkers before conception, and 8% were considered moderately heavy or very heavy drinkers. Because maternal drinking is highly correlated with paternal, the analyses were stratified by maternal drinking in early pregnancy. We also adjusted for confounders and known predictors of birth weight. For all three maternal drinking strata, all adjusted mean differences in birth weight across levels of paternal drinking were similar, and all had confidence intervals that included zero. These findings persisted even after adjustment for other covariates and after stratification by parental smoking, race, and education. The size of the ALSPAC cohort, the large number of heavy drinkers, and the availability of data from the fathers themselves support the conclusion that paternal drinking before conception is not an important predictor of infant birth weight in humans.

Postterm delivery: a challenge for epidemiologic research

About 5% of babies are born postterm (that is, delivered after 42 completed weeks of gestation). Postterm infants experience more morbidity and mortality than term infants, prompting routine (and expensive) antenatal testing and active management of postterm pregnancies. This article reviews the epidemiology of postterm delivery. A few congenital conditions associated with disruption of the fetal-pituitary-adrenal axis as well as a rare maternal enzyme deficiency have long been identified with postterm delivery. In recent literature, environmental pollution, diet, and pharmaceutical agents have been associated with postterm birth. Very little systematic research has focused on identifying risk factors for this poorly understood birth outcome.

Birthweight of term infants and maternal occupation in a prospective cohort of pregnant women. The ALSPAC Study Team

OBJECTIVE

To study the relation between birthweight of term infants and maternal occupation.

METHODS

Information on job titles since the age of 16, and sociodemographic and other lifestyle factors were obtained by means of questionnaires as part of the Avon longitudinal study of pregnancy and childhood (ALSPAC), from a cohort of 14,000 pregnant women. The British 1990 standard occupational classification was used to code jobs within nine major job groups.

RESULTS

For 9282 women who delivered term infants and reported a job for the relevant period, there was a significant difference in mean birthweight among the nine major job groups. A 148 g difference was found between the mean birthweight of infants born to women with professional occupations and those with plant and machine operative jobs. Multiple regression analysis adjusted for sex of infant, parity, maternal height, smoking, caffeine consumption, and race. After adjustment the maternal job was no longer significantly associated with birthweight.

CONCLUSION

Despite the absence of a significant association between birthweight and job after adjustment, there were several findings which agreed with publications on maternal occupation and pregnancy outcome. The major job groups with the lowest birthweights included the following jobs; metal forming or welding, electric or electronic work, jobs in the textile trade, and assembling and working with equipment (mobile and stationary). The lack of an association may indicate that the study was of insufficient power to detect a small difference; it may indicate the presence of confounding variables that were not adjusted for or it may indicate that no association exists.

Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder

We critique published incidences for fetal alcohol syndrome (FAS) and present new estimates of the incidence of FAS and the prevalence of alcohol-related neurodevelopmental disorder (ARND). We first review criteria necessary for valid estimation of FAS incidence. Estimates for three population-based studies that best meet these criteria are reported with adjustment for underascertainment of highly exposed cases. As a result, in 1975 in Seattle, the incidence of FAS can be estimated as at least 2.8/1000 live births, and for 1979-81 in Cleveland, approximately 4.6/1,000. In Roubaix, France (for data covering periods from 1977-1990), the rate is between 1.3 and 4.8/1,000, depending on the severity of effects used as diagnostic criteria. Utilizing the longitudinal neurobehavioral database of the Seattle study, we propose an operationalization of the Institute of Medicine's recent definition of ARND and estimate its prevalence in Seattle for the period 1975-1981. The combined rate of FAS and ARND is thus estimated to be at least 9.1/1,000. This conservative rate--nearly one in every 100 live births--confirms the perception of many health professionals that fetal alcohol exposure is a serious problem.

Maternal exposure to exogenous nitrogen compounds and complications of pregnancy

Increased lipid peroxidation and reduced antioxidant activity have been reported with pregnancy complications. Given that exogenous oxidants stimulate formation of lipid peroxides, the authors investigated the relationship between exposure to nitrogen-oxidizing species and pregnancy complications and took into account markers of antioxidant and oxidant status. The study sample included pregnant women who were from an area polluted by oxidized nitrogen compounds. Methemoglobin, a biomarker of individual exposure, was determined, as were measures of oxidant/antioxidant status, including glutathione balance and lipid peroxide levels. Only 10 women experienced normal pregnancies. The most common complications were anemia (67%), threatened abortion/premature labor (33%), and signs of preeclampsia (23%). Methemoglobin was elevated significantly in all three conditions, compared with normal pregnancies. Reduced:total glutathione decreased, whereas lipid peroxide levels increased. These results suggest that maternal exposure to environmental oxidants can increase the risk of pregnancy complications through stimulation of the formation of cell-damaging lipid peroxides and from a decrease in maternal antioxidant reserves.

Agreement between self and partner reports of paternal drinking and smoking. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

BACKGROUND

We examined agreement between self and proxy reports of paternal drinking and smoking behaviour using data collected as part of the prospective, population-based Avon (England) Longitudinal Study of Pregnancy and Childhood.

METHODS

Information on the smoking and drinking habits of pregnant women's male partners was obtained through self-administered questionnaires completed by pregnant participants and by their partners. For dichotomous indicators (e.g. smoker versus non-smoker), we evaluated self/proxy agreement by calculating Kappa coefficients and per cent agreement. For ordinal measures of smoking and drinking amounts, we calculated per cent perfect agreement, per cent agreement within one category, and Spearman correlation coefficients. Data from 8414 respondent pairs were included in the analyses.

RESULTS

Men's and women's reports of paternal smoking and drinking status were in nearly complete agreement (95% and 98%, respectively). For analyses of smoking and drinking amounts, agreement within one category remained high (90% and 98% for smoking and drinking, respectively), but perfect agreement on amount was somewhat lower (81% and 71%, respectively). Per cent perfect agreement on smoking amount was especially low (50%) when non-smokers were excluded. When couples' reports were not in perfect agreement, women tended to report lower amounts of smoking and drinking for their partners compared to the men's self reports.

CONCLUSIONS

Our results suggest that women's proxy reports of their partners' drinking and smoking status can be used with considerable confidence in reproductive epidemiological studies when the enrollment of both women and men as participants is infeasible for financial or logistical reasons. Caution is warranted, however, when proxy reports are used for more detailed information on smoking and drinking amounts.

Is there an association between preconception paternal x-ray exposure and birth outcome? The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

Diagnostic x-rays are performed commonly on men of reproductive age, yet little is known about the potential effects of these x-rays on the future unborn children of such men. This study examines the possibility that preconception diagnostic x-ray studies of fathers may adversely effect their newborns. The authors used prospectively collected data from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) for 7,678 birth records for women who gave birth in the County of Avon, England, in 1991-1992. Birth weight, gestational age, and fetal growth of infants whose fathers received diagnostic x-ray examinations likely to deliver significant gonadal doses within one year prior to conception were compared with infants whose fathers did not receive such x-rays. The mean birth weight of babies of exposed fathers was 3,358 g compared with a mean of 3,437 g in the unexposed group (p = 0.055). A similar difference was noted for intrauterine growth, 3,374 g exposed versus 3,437 g unexposed (p = 0.078). The downward trend in birth weight and fetal growth (birth weight adjusted for gestational age) persisted despite control for infants' sex and important parental variables such as age, height, race, education, occupational exposure, parity, and maternal smoking. Because medical x-rays are the largest controllable source of man-made ionizing radiation, more detailed study of the potential effect of paternal x-irradiation on progeny seems justified.

The effect of maternal drinking before conception and in early pregnancy on infant birthweight. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

We examined the association of maternal drinking before and during early pregnancy on infant birthweight, using data collected from a population-based cohort in Avon Country, England. Participants completed several self-administered questionnaires during their index pregnancy. Our analysis included 10,539 women who provided drinking data and delivered a liveborn singleton child. Infants born to women who reported drinking one to two drinks daily with at least one binge, or three or more drinks daily with or without binges, had an adjusted mean birthweight approximately 150 gm less than that of infants whose mothers reported abstaining during (but not before) pregnancy. Mean birthweights were similar for infants of prepregnancy drinkers who drank weekly in early pregnancy, less than weekly, or not at all.

Fetal growth retardation in sudden infant death syndrome (SIDS) babies and their siblings

To evaluate the intrauterine growth potential of infants that die from sudden infant death syndrome (SIDS), the authors compared SIDS infants with their surviving siblings. The SIDS sibships themselves were also compared with sibships where all infants survived. Data from the population-based Medical Birth Registry of Norway, with 1.3 million births during 1967-1988, were used. From the birth cohorts, 1,984 SIDS cases were identified. All births were linked into sibships. The mean birth weight and gestational age were calculated across sibships of different sizes for first to fourth birth order. In a further analysis, birth weights were standardized to adjust for gestational age. Mothers of SIDS infants give birth to smaller babies in general. SIDS infants weighed, on average, 85 g less at birth than their siblings and 164 g less compared with babies in nonaffected sibships. When birth weights were standardized for gestational age, most of the weight difference between SIDS infants and siblings was due to a shorter gestational age of SIDS infants, while the difference between surviving siblings of SIDS infants and births from nonaffected sibships remained. All births in sibships with a SIDS infant were intrauterine growth retarded. This may reflect factors that contribute to SIDS risk (such as maternal smoking). The factors that contribute to shorter gestational age and further slowing of growth in the SIDS infants may specifically influence the SIDS infant and not its siblings.

Maternal smoking during lactation: relation to infant size at one year of age

This study was conducted to test the hypothesis that breast-fed infants of smokers are smaller in size at 1 year of age than breast-fed infants of nonsmokers. Three groups of infants were selected from all singletons born to women who were seen for prenatal care in their 6th month of pregnancy at a health maintenance organization in Seattle, Washington, between January 1982 and April 1983. Breast-fed infants of smokers (n = 74) were compared with breast-fed infants of nonsmokers (n = 195) and with bottle-fed infants of smokers (n = 64). Mothers were interviewed at 1 and 3 months after delivery; both the mother and the infant were seen at 1 year. Among breast feeders, smokers' infants were twice as likely as nonsmokers' infants to have body mass more than 1 standard deviation above the mean (relative risk = 2.04, 95% confidence interval 1.15-3.61). This relation persisted after control for gestational age and weight at birth, length of lactation, mother's size and diet, exposure to other drugs in breast milk, and all other variables measured in this study. Every 10 cigarettes smoked while breast feeding predicted an additional 3% infant body mass at 1 year. In summary, breast-fed infants of smokers in this study gained more weight after birth than the other two groups; at 1 year of age, they were heavier and had significantly higher body mass. Reasons for this paradoxical finding are explored.

Complications of pregnancy in relation to maternal lipid peroxides, glutathione, and exposure to metals

Lipid peroxides, glutathione, and metals (lead, cadmium, and arsenic) were measured in pregnant women residing in the vicinity of a copper smelter. A diagnosis of pregnancy complications experienced by each woman was made on the basis of interview and clinical record. Patients were assigned to groups of normal or pathologic pregnancies (threatened spontaneous abortion, toxemia, and anemia) according to this diagnosis. Biochemical changes suggestive of increased lipid peroxidation and decreased antioxidant protection (involving the reduced: oxidized glutathione balance) were found in the diagnostic groups of pregnancy complications. These changes were independent of measured maternal variables. Maternal exposure to metals (as indicated by blood lead and cadmium) was associated with a decrease in reduced glutathione in blood. Since increased lipid peroxidation has been implicated in other studies as a pathogenetic factor for maternal toxemia, it is suggested that exposure to metals during gestation could enhance the development of pregnancy complications by increasing lipid peroxidation via depletion of reduced glutathione reserves.

Host and environmental effects on plasma apolipoprotein B

In this study, levels of apo B in an unselected sample of 487 middle-aged Caucasian spouses of patients and spouses of the patients' relatives are described. In males, apo B levels increased with age until the 7th decade, then declined; apo B levels in females, which were lower than in males, increased linearly with age across the entire life-span. Height and weight, smoking, and presence of noninsulin-dependent diabetes mellitus significantly influenced age- and gender-adjusted apo B levels in this sample, whereas use of alcohol, diuretics, beta-blockers, or insulin did not. Age, gender, height, weight, smoking, and noninsulin-dependent diabetes mellitus account for 21% of the total variation in apo B levels in this sample.

Occasional binges by moderate drinkers: implications for birth outcomes

We investigated the effects of occasional alcohol binges on birth outcomes in a cohort of live singletons born to 709 moderate drinkers recruited from a Seattle, WA, health maintenance organization before their sixth month of pregnancy. We compared infants of women with one or more binges in the month before pregnancy or in the first two trimesters with those whose mothers reported no binges in either period. Mean values of birthweight, length, head circumference, gestational age, intrauterine growth, and Apgar scores did not differ notably between the two groups. The risk of having an adverse neonatal discharge diagnosis initially appeared lower in infants of binging mothers, but this difference vanished after recategorization of the variable and control for confounding. Our results indicate that occasional binges, during a broad window of exposure and among otherwise moderate drinkers, do not adversely affect the birth outcomes examined here.

Risk factors for antepartum and intrapartum stillbirth

Data from married women who participated in the 1980 National Natality Survey and the National Fetal Mortality Survey were used for a case-control study of antepartum and intrapartum stillbirth. Risk factors were identified by comparing antepartum deaths and intrapartum deaths to livebirths in separate logistic regression analyses. Risk of antepartum death was increased among black mothers, those having their first delivery, those aged 35 years or more, and those with less education. Smoking cigarettes was associated with increased risk. For intrapartum deaths, total abstention from alcohol during pregnancy was associated with increased risk in the best-fitting logistic model, as was first delivery. Body mass index was logit-linear in both models, with lower body mass index associated with lower risk. While some of these factors have already been associated with stillbirth, others have not; the new associations may reflect the continuum of loss over the gestational period, bias in the study, or clues to mechanisms by which the risk of death, before or during parturition, is increased.

Analysis of facial shape in children gestationally exposed to marijuana, alcohol, and/or cocaine

The association between fetal marijuana and/or alcohol exposure and facial features resembling fetal alcohol syndrome was investigated in a sample of 80 children. Standardized lateral and frontal facial photographs were taken of 40 children, 5 to 7 years of age, whose mothers reported frequent use of marijuana during the first trimester of pregnancy and 40 children whose mothers reported no use of marijuana during pregnancy. The marijuana-exposed and unexposed children were group-matched on alcohol exposure prior to and during pregnancy, sex, race, and age at the time of assessment. The photographs were assessed clinically by a study staff dysmorphologist and morphometrically by computerized landmark analysis. Fetal alcohol syndrome-like facial features were not associated with prenatal marijuana exposure in this study sample. No consistent patterns of facial features were identified among the marijuana-exposed group. Maternal consumption of two or more ounces of alcohol per day, on average, in early gestation was found to be associated with fetal alcohol syndrome-like facial features identified both clinically and morphometrically. Cocaine use reported by 13 of the 80 women was independently associated with mild facial dysmorphic features of hypertelorism and midfacial flattening. The results demonstrate the usefulness of this diagnostic technique for quantifying anomalies apparently unique to fetal alcohol syndrome and for targeting clusters of anomalies in new conditions for future evaluation.

Gestational duration and birthweight in white, black and mixed-race babies

Using the 1983 United States population of single live births, birthweight and gestational duration were compared for babies of these different parental racial groups: both parents White, mother White-father Black, mother Black-father White, both parents Black. The four groups differed significantly with respect to the usual sociodemographic variables. Mean birthweight and mean gestational duration decreased in that order from the White-White reference group, and conversely there were increasing trends for low birthweight and preterm delivery. Adjustment for the usual sociodemographic variables did not alter these trends appreciably. Group differences were more strongly related to the mother's race than to the father's, and the trends were related to the mother's race. Because the father's race was significant, genetic factors are probably of some importance. The evidence from this study, together with the often-demonstrated relationships between low birthweight and preterm delivery with sociodemographic variables, and the short-term downward secular trends in low birthweight, support the concept that non-genetic maternal factors are more important for these abnormal outcomes. But because neither the usually utilised sociodemographic variables nor genetic factors seem to explain much of the group differences, new approaches are necessary to understand why, irrespective of ethnic group, some women are at excess risk for suboptimal birth outcome.

The effects of maternal drinking in the reproductive period: an epidemiologic review

The major effects of maternal alcohol use during pregnancy are decreased fetal growth, morphologic abnormalities, and CNS impairment. If all three of these are present, with a characteristic facies in the infant, fetal alcohol syndrome (FAS) is diagnosed. FAS occurs only with heavy or alcoholic drinking. The individual components of the syndrome exhibit a dose-response association with ethanol intake in many, but not all studies. Discrepancies in maternal drinking and pregnancy outcome reflect the myriad difficulties of these investigations. Drinking "before" pregnancy also has been linked to decrements in fetal development, possibly because before pregnancy may include the periconceptional period. However, women who are usually abstainers before pregnancy appear to have infants at higher risk of some adverse pregnancy outcomes than women who are light drinkers. Future studies need to construct careful drinking histories to address this and other questions that deal with parents' ethanol use and reproductive health.

Drinking and smoking at 3 months postpartum by lactation history

A spontaneous decrease in maternal drinking and smoking often occurs during pregnancy. The present study was conducted to determine if these lower levels of maternal drinking and smoking during pregnancy persist into the postpartum period, and if so, to determine if they are related to breastfeeding. Drinking and smoking were estimated in three cohorts of postpartum women who had been followed since pregnancy. The first group never breastfed their infants; the second group breastfed for less than 1 month; the third group breastfed for more than three months. (Women who weaned between one and three months were not studied). Drinking and smoking in all three groups decreased sharply during pregnancy but rose again in the 3 months after delivery, though not to levels that were reported before conception. Usual drinking in the third month postpartum did not differ significantly among the three lactation groups. However, women who were still nursing were less likely to report occasional episodes of heavy drinking (binges) in this month than women who had weaned early or never breastfed. Women nursing in the third month postpartum were also significantly less likely to smoke during the month; if smoking, they were less likely to smoke heavily. These differences in postpartum drinking and smoking were not due entirely to habits before conception or to the influence of other potentially confounding variables.

Maternal marijuana use during lactation and infant development at one year

Prenatal marijuana exposure is associated with adverse perinatal effects. Very little is known about the effect of postnatal marijuana exposure on infant development. Postnatal exposure can result from maternal use of marijuana during lactation. Delta-9-tetrahydrocannabinol (THC) transfers and concentrates in the mother's milk and is absorbed and metabolized by the nursing infant. The present study investigated the relationship between infant exposure to marijuana via the mother's milk and infant motor and mental development at one year of age. One hundred and thirty-six breast-fed infants were assessed at one year of age for motor and mental development. Sixty-eight infants were exposed to marijuana via the mother's milk. An additional 68 infants were matched to the marijuana-exposed infants on pre- and postpartum maternal alcohol and tobacco use. Marijuana exposure via the mother's milk during the first month postpartum appeared to be associated with a decrease in infant motor development at one year of age.

Torsade de pointes and T-U wave alternans associated with arsenic poisoning

Arsenic intoxication is a common form of heavy metal poisoning. Although arsenic-induced circulatory collapse, seizures, and syncope are well known, the potential for serious ventricular arrhythmias is less well recognized. Reported in this study are two cases of arsenic poisoning causing torsade de pointes. Furthermore, marked prolongation of the QT-U interval and the rarely observed phenomenon of T-U wave alternans are demonstrated. Thus, arsenic intoxication may be complicated by prolongation of the QT-U interval and torsade de pointes. T-U wave alternans occurs in the presence of a long QT-U interval and may be an electrocardiographic warning sign of torsade de pointes.

Erythrocyte acid phosphatase phenotype and gestational length: no relationship in a sample of 3001 births

Erythrocyte acid phosphatase (ACP1) phenotype was examined in 3001 Caucasian infants born at the University of Michigan Women's Hospital. Contrary to reports from other studies, there was no relationship between the ACP1 phenotype and risk of preterm birth in either the total sample or when the sample was subdivided by sex of infant.

Arrhythmias after orthotopic cardiac transplantation. Prevalence and determinants during initial hospitalization and late follow-up

The prevalence of arrhythmias after orthotopic cardiac transplantation in the era of cyclosporine immunosuppression is unknown. Accordingly, we analyzed telemetry data from the initial hospitalization period for 33 cardiac transplant procedures and from 100 hospital readmissions in 23 long-term survivors. Prevalence of arrhythmias was analyzed in relation to immunosuppressive regimen, occurrence of acute rejection, and other clinical and hemodynamic variables. Atrial and ventricular arrhythmias were recorded in 55% and 79% of patients during initial hospitalization and in 39% and 43% of long-term survivors, respectively. Compared with cyclosporine-treated patients, atrial (24% vs. 88%, p less than 0.001) and ventricular (65% vs. 94%, p = 0.085) arrhythmias during the initial hospitalization were more prevalent in patients receiving azathioprine. There was no difference in the prevalence of arrhythmias during initial hospitalization between patients experiencing acute rejection and those who did not. Potential associations between arrhythmia occurrence and a prolonged donor heart ischemic time (p = 0.022), elevated pulmonary arterial pressure (p = 0.01), and a lower ejection fraction (p = 0.009) were noted. These data suggest that arrhythmias occur in the majority of patients during the initial hospitalization for transplantation, even in those who never experience acute rejection. Ventricular arrhythmias are common in patients treated with either immunosuppressive regimen; however, atrial arrhythmias are less prevalent in patients receiving cyclosporine. Arrhythmias tend to occur in the setting of altered hemodynamics.