Prenatal alcohol exposure and attention, learning and intellectual ability at 14 years: a prospective longitudinal study

Relationship between childhood short stature and academic achievement in adolescents and young adults--a longitudinal study

AIM

To determine if short stature at 14 or 21 years and patterns of 'catch-up' growth from 5 to 14 or 21 years are related to academic achievement in adolescents.

METHODS

The Mater University of Queensland Study of Pregnancy is a longitudinal study of 7223 singleton infants born between 1981 and 1984. Data were available for cross-sectional analyses of 3785 adolescents of whom 2149 were seen as young adults. Longitudinal patterns of growth were examined for 2936 subjects from 5 to 14 years and 1753 subjects from 5 to 21 years.

RESULTS

Adolescents or young adults with height <10th centile had a lower mean Wide Range Achievement Test (WRAT) score in adolescence and at 21 years than those of normal height (2.7 and 3.0 points, respectively) and increased odds of a WRAT score <85 (1.57 and 1.87, respectively) and learning difficulties (1.61 and 1.78, respectively). For growth patterns from 5 to 14 years, adolescents short at 5 years, irrespective of height at 14 years, had a lower mean WRAT score and increased odds of WRAT score <85 and learning difficulties. However, for growth patterns from 5 to 21 years, only the group short at both ages had increased learning difficulties.

CONCLUSIONS

Youth short at 14 years or at 21 years and those persistently short have an increased prevalence of academic difficulties. Catch-up growth by 21, although not 14 years, was associated with improved outcomes.

Validity of the T-ACE in pregnancy in predicting child outcome and risk drinking

Preventing fetal alcohol spectrum disorders (FASDs) requires detection of in-pregnancy maternal risk drinking. The widely used T-ACE screen has been applied in various ways, although the impact of those different uses on effectiveness is uncertain. We examined relations among different T-ACE scoring criteria, maternal drinking, and child outcome. Self-reported across-pregnancy maternal drinking was assessed in 75 African-American women. The different T-ACE criteria used varied the level of drinking that defined tolerance (two or three drinks) and the total T-ACE score cut-points (two or three). Receiver operator curves and regression analysis assessed the significance of relations. Increasing the total T-ACE score cut-point to 3 almost doubled specificity in detecting risk drinking whereas maintaining adequate sensitivity, equivalent to that in the original report, and identified substantially more neurobehavioral deficits in children. Redefining tolerance at three drinks did not improve T-ACE effectiveness in predicting outcomes. This study is among the first to show the ability of an in-pregnancy T-ACE assessment to predict child neurodevelopmental outcome. In addition, increasing the total T-ACE score criterion (from 2 to 3) improved identification of non-drinking mothers and unaffected children with little loss in detection of drinkers and affected children. Efficient in-pregnancy screens for risk drinking afford greater opportunities for intervention that could prevent/limit FASDs.

Midwives and pregnant women talk about alcohol: what advice do we give and what do they receive?

BACKGROUND

the Australian National Health and Medical Research Council (NHMRC) recently revised its guidelines for alcohol consumption during pregnancy and breast feeding, moving from a recommendation of minimising intake to one of abstinence. Women are potentially exposed to a variety of messages about alcohol and pregnancy, including from the media and social contacts, and are likely to see midwives as the source of expert advice in understanding these contradictory messages.

OBJECTIVE

to explore the advice that midwives believe they give to pregnant women about alcohol consumption, and the advice that pregnant women believe they receive; the knowledge and attitudes of both groups regarding alcohol consumption and the consistency with the NHMRC guidelines; and the receptivity and comfort of both groups in discussing alcohol consumption in the context of antenatal appointments.

DESIGN

individual semi-structured interviews with midwives and pregnant women.

SETTING

face-to-face interviews with midwives and telephone interviews with pregnant women were conducted in two regional areas of New South Wales in 2008-2009.

PARTICIPANTS

12 midwives and 12 pregnant women.

FINDINGS

midwives and pregnant women consistently agreed that conversations about alcohol are generally limited to brief screening questions at the first visit, and the risks are not discussed or explained (except for high-risk women).

KEY CONCLUSIONS

both groups expressed comfort with the idea of discussing alcohol consumption, but lacked knowledge of the risk and recommendation, and it appears that this opportunity to provide women with information is under-utilised.

IMPLICATIONS FOR PRACTICE

there is a need to provide midwives with accurate information about the risks of alcohol consumption during pregnancy and effective communication tools to encourage them to discuss the risks and recommendations with their patients.

Ethanol and cognition: indirect effects, neurotoxicity and neuroprotection: a review

Ethanol affects cognition in a number of ways. Indirect effects include intoxication, withdrawal, brain trauma, central nervous system infection, hypoglycemia, hepatic failure, and Marchiafava-Bignami disease. Nutritional deficiency can cause pellagra and Wernicke-Korsakoff disorder. Additionally, ethanol is a direct neurotoxin and in sufficient dosage can cause lasting dementia. However, ethanol also has neuroprotectant properties and in low-to-moderate dosage reduces the risk of dementia, including Alzheimer type. In fetuses ethanol is teratogenic, and whether there exists a safe dose during pregnancy is uncertain and controversial.

The antecedents of non-affective psychosis in a birth-cohort, with a focus on measures related to cognitive ability, attentional dysfunction and speech problems

OBJECTIVE

Adults with non-affective psychosis show subtle deviations in a range of developmental trajectories as children and adolescents.

METHOD

Based on a birth-cohort (n = 3801), we examined the Peabody Picture Vocabulary Test (PPTV) at age 5, and Raven's Standard Progressive Matrices (RSPM) and Wide Range Achievement Test reading scale (WRAT-R) at age 14. Items related to speech problems and attentional dysfunction were available from maternal- or self-report. At age 21, we identified 60 cohort members who were screen-positive for non-affective psychosis (SP-NAP).

RESULTS

Impaired performance on the PPVT and RSPM (but not WRAT-R) predicted SP-NAP for males only. Male cohort members in the highest quartile for attentional dysfunction at ages 5 and 14 were about 5-8 times more likely to develop SP-NAP. SP-NAP in males was significantly associated with speech problems at age 14.

CONCLUSION

Males who develop non-affective psychoses have subtle impairments in cognitive capacity prior to the development of their psychotic disorder.

Alcohol abuse in pregnant women: effects on the fetus and newborn, mode of action and maternal treatment

Offspring of mothers using ethanol during pregnancy are known to suffer from developmental delays and/or a variety of behavioral changes. Ethanol, may affect the developing fetus in a dose dependent manner. With very high repetitive doses there is a 6-10% chance of the fetus developing the fetal alcoholic syndrome manifested by prenatal and postnatal growth deficiency, specific craniofacial dysmorphic features, mental retardation, behavioral changes and a variety of major anomalies. With lower repetitive doses there is a risk of "alcoholic effects" mainly manifested by slight intellectual impairment, growth disturbances and behavioral changes. Binge drinking may impose some danger of slight intellectual deficiency. It is advised to offer maternal abstinence programs prior to pregnancy, but they may also be initiated during pregnancy with accompanying close medical care. The long term intellectual outcome of children born to ethanol dependent mothers is influenced to a large extent by the environment in which the exposed child is raised.

Evidence of a complex association between dose, pattern and timing of prenatal alcohol exposure and child behaviour problems

BACKGROUND

There is a lack of evidence regarding the effect of dose, pattern and timing of prenatal alcohol exposure and behaviour problems in children aged 2 years and older.

METHODS

A 10% random sample of women delivering a live infant in Western Australia (1995-96) were invited to participate in an 8-year longitudinal survey (78% response rate n = 2224); 85% were followed-up at 2 years, 73% at 5 years and 61% at 8 years. Alcohol consumption was classified by combining the overall dose, dose per occasion and frequency to reflect realistic drinking patterns. Longitudinal analysis was conducted using generalized estimating equations (GEE) to investigate the association between child behaviour as measured by the Child Behaviour Checklist at 2, 5 and 8 years of age and prenatal alcohol exposure collected 3 months postpartum for each trimester separately, adjusting for a wide range of confounding factors.

RESULTS

Low levels of prenatal alcohol were not associated with child behaviour problems. There were increased odds of internalizing behaviour problems following heavy alcohol exposure in the first trimester; anxiety/depression [adjusted odds ratio (aOR) 2.82; 95% confidence interval (CI) 1.07-7.43] and somatic complaints (aOR 2.74; 95% CI 1.47-5.12) and moderate levels of alcohol exposure increased the odds of anxiety/depression (aOR 2.24; 95% CI 1.16-4.34).

CONCLUSIONS

Prenatal alcohol exposure at moderate and higher levels increased the odds of child behaviour problems with the dose, pattern and timing of exposure affecting the type of behaviour problems expressed. Larger studies with more power are needed to confirm these findings.

GSK3beta in ethanol neurotoxicity

Alcohol consumption during pregnancy is a significant public health problem and may result in a wide range of adverse outcomes for the child. The developing central nervous system (CNS) is particularly susceptible to ethanol toxicity. Children with fetal alcohol spectrum disorders (FASD) have a variety of cognitive, behavioral, and neurological impairments. FASD currently represents the leading cause of mental retardation in North America ahead of Down syndrome and cerebral palsy. Ethanol exposure during development causes multiple abnormalities in the brain such as permanent loss of neurons, ectopic neurons, and alterations in synaptogenesis and myelinogenesis. These alcohol-induced structural alterations in the developing brain underlie many of the behavioral deficits observed in FASD. The cellular and molecular mechanisms of ethanol neurotoxicity, however, remain unclear. Ethanol elicits cellular stresses, including oxidative stress and endoplasmic reticulum stress. Glycogen synthase kinase 3beta (GSK3beta), a multifunctional serine/threonine kinase, responds to various cellular stresses. GSK3beta is particularly abundant in the developing CNS, and regulates diverse developmental events in the immature brain, such as neurogenesis and neuronal differentiation, migration, and survival. Available evidence indicates that the activity of GSK3beta in the CNS is affected by ethanol. GSK3beta inhibition provides protection against ethanol neurotoxicity, whereas high GSK3beta activity/expression sensitizes neuronal cells to ethanol-induced damages. It appears that GSK3beta is a converging signaling point that mediates some of ethanol's neurotoxic effects.

Cyanidin-3-glucoside reverses ethanol-induced inhibition of neurite outgrowth: role of glycogen synthase kinase 3 Beta

Ethanol is a potent teratogen for the developing central nervous system (CNS), and fetal alcohol syndrome (FAS) is the most common nonhereditary cause of mental retardation. Ethanol disrupts neuronal differentiation and maturation. It is important to identify agents that provide neuroprotection against ethanol neurotoxicity. Using an in vitro neuronal model, mouse Neuro2a (N2a) neuroblastoma cells, we demonstrated that ethanol inhibited neurite outgrowth and the expression of neurofilament (NF) proteins. Glycogen synthase kinase 3beta (GSK3beta), a multifunctional serine/threonine kinase negatively regulated neurite outgrowth of N2a cells; inhibiting GSK3beta activity by retinoic acid (RA) and lithium induced neurite outgrowth, while over-expression of a constitutively active S9A GSK3beta mutant prevented neurite outgrowth. Ethanol inhibited neurite outgrowth by activating GSK3beta through the dephosphorylation of GSK3beta at serine 9. Cyanidin-3-glucoside (C3G), a member of the anthocyanin family rich in many edible berries and other pigmented fruits, enhanced neurite outgrowth by promoting p-GSK3beta(Ser9). More importantly, C3G reversed ethanol-mediated activation of GSK3beta and inhibition of neurite outgrowth as well as the expression of NF proteins. C3G also blocked ethanol-induced intracellular accumulation of reactive oxygen species (ROS). However, the antioxidant effect of C3G appeared minimally involved in its protection. Our study provides a potential avenue for preventing or ameliorating ethanol-induced damage to the developing CNS.

Binge pattern of alcohol consumption during pregnancy and childhood mental health outcomes: longitudinal population-based study

OBJECTIVE

Patterns of alcohol consumption during pregnancy such as episodes of binge drinking may be as important as average levels of consumption in conferring risk for later childhood mental health and learning problems. However, it can be difficult to distinguish risk resulting from episodic or regular background levels of drinking. This large study investigates whether patterns of alcohol consumption are independently associated with child mental health and cognitive outcomes, whether there are gender differences in risk, and whether occasional episodes of higher levels of drinking carry any risk in the absence of regular daily drinking during pregnancy.

METHODS

This prospective, population-based study used data from the Avon Longitudinal Study of Parents and Children. We investigated the relationships between a binge pattern of alcohol use (consumption of > or =4 drinks in a day) in the second and third trimesters of pregnancy and childhood mental health problems at 47 and 81 months of age (n = 6355 and 5599, respectively). In a subgroup, we also investigated these relationships with child IQ at 49 months of age (n = 924).

RESULTS

fter controlling for a range of prenatal and postnatal factors, any episodes of consuming > or =4 drinks in a day were independently associated with higher risks for mental health problems (especially hyperactivity/inattention) in girls at the age of 47 months and in both genders at 81 months. There was no association with IQ scores at 49 months after adjustment for confounders. The consumption of > or =4 drinks in a day continued to carry risk for mental health problems (especially hyperactivity/inattention) in the absence of regular daily drinking.

CONCLUSIONS

The consumption of > or =4 drinks in a day on an occasional basis during pregnancy may increase risk for child mental health problems in the absence of moderate daily levels of drinking. The main risks seem to relate to hyperactivity and inattention problems.

Intrauterine exposure to alcohol and tobacco use and childhood IQ: findings from a parental-offspring comparison within the Avon Longitudinal Study of Parents and Children

This study aims to test the hypothesis that moderate maternal alcohol and tobacco use in pregnancy is associated with intelligent quotient (IQ) scores in childhood through intrauterine mechanisms. We conducted parental-offspring comparisons between the associations of tobacco and alcohol consumption with child's IQ in the Avon Longitudinal Study of Parents and Children. Analyses were conducted on 4332 participants with complete data on maternal and paternal use of alcohol and tobacco at 18 wk gestation, child's IQ and a range of confounders. IQ was measured at child age 8 with the Weschler Intelligence Scale for Children (WISC-III). We used multivariable linear and logistic regression to estimate mean differences and 95% confidence intervals in IQ scores across the exposure categories and computed f statistics to compare maternal and paternal associations. In fully adjusted models, there was no strong statistical evidence that maternal alcohol and tobacco consumption during pregnancy were associated with childhood IQ with any greater magnitude than paternal alcohol and tobacco consumption (also assessed during their partners' pregnancy). Our findings suggest that the relationship between maternal moderate alcohol and tobacco use in early pregnancy and childhood IQ may not be explained by intrauterine mechanisms.

Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age?

BACKGROUND

The objective of this study was to determine whether there was an association between mothers' light drinking during pregnancy and risk of behavioural problems, and cognitive deficits in their children at age 3 years.

METHODS

Data from the first two sweeps of the nationally representative prospective UK Millennium Cohort study were used. Drinking patterns during pregnancy and behavioural and cognitive outcomes were assessed during interviews and home visits. Behavioural problems were indicated by scores falling above defined clinically relevant cut-offs on the parent-report version of the Strengths and Difficulties Questionnaire (SDQ). Cognitive ability was assessed using the naming vocabulary subscale from the British Ability Scale (BAS) and the Bracken School Readiness Assessment (BSRA).

RESULTS

There was a J-shaped relationship between mothers drinking during pregnancy and the likelihood of high scores (above the cut-off) on the total difficulties scale of the SDQ and the conduct problems, hyperactivity and emotional symptom SDQ subscales. Children born to light drinkers were less likely to score above the cut-offs compared with children of abstinent mothers. Children born to heavy drinkers were more likely to score above the cut-offs compared with children of abstinent mothers. Boys born to mothers who had up to 1-2 drinks per week or per occasion were less likely to have conduct problems (OR 0.59, 95% CI 0.45-0.77) and hyperactivity (OR 0.71, 95% CI 0.54-0.94). These effects remained in fully adjusted models. Girls were less likely to have emotional symptoms (OR 0.72, 95% CI 0.51-1.01) and peer problems (OR 0.68, 95% CI 0.52-0.92) compared with those born to abstainers. These effects were attenuated in fully adjusted models. Boys born to light drinkers had higher cognitive ability test scores [standard deviations, (95% CI)] BAS 0.15 (0.08-0.23) BSRA 0.24 (0.16-0.32) compared with boys born to abstainers. The difference for BAS was attenuated on adjustment for socio-economic factors, whilst the difference for BSRA remained statistically significant.

CONCLUSIONS

Children born to mothers who drank up to 1-2 drinks per week or per occasion during pregnancy were not at increased risk of clinically relevant behavioural difficulties or cognitive deficits compared with children of abstinent mothers. Heavy drinking during pregnancy appears to be associated with behavioural problems and cognitive deficits in offspring at age 3 years whereas light drinking does not.

Effects of developmental exposure to ethanol on Caenorhabditis elegans

BACKGROUND

We investigated the effects of chronic ethanol exposure on physical development, reproduction, and life expectancy of Caenorhabditis elegans, a microscopic nematode worm. It has a small nervous system of 302 neurons and a short lifespan of 2 to 3 weeks.

METHODS

In this study, the worms were chronically exposed to varying concentrations of ethanol for different periods of their life: for their entire lifespan, during larval development only, and during adulthood only. In addition, the worms were exposed to ethanol acutely during different stages of embryonic development.

RESULTS

Chronic exposure to ethanol during larval development temporarily delayed physical growth, slowed development, delayed the onset of reproductive maturity, and decreased both reproductive fecundity and longevity. Chronic exposure to ethanol beginning when worms completed development and reached reproductive maturity resulted in reduced C. elegans body length, decreased reproductive fecundity, and life expectancy. Finally, acute embryonic exposure of C. elegans eggs to high concentrations of ethanol at different stages of development resulted in a lower probability of exposed eggs hatching into larval worms depending on when eggs were exposed during development. Furthermore, some of the worms that did hatch displayed distinct physical dysmorphologies as a consequence of acute ethanol exposure during embryonic development.

CONCLUSIONS

These data suggest that exposing C. elegans to ethanol during critical development periods results in characteristic phenotypic outcomes. Thus, C. elegans offers a novel model for exploring the mechanisms by which ethanol exposure affects development.

Patterns and average volume of alcohol use among women of childbearing age

OBJECTIVES

Maternal alcohol use is a leading preventable cause of neurobehavioral and developmental abnormalities in children. This study examines the patterns and average volume of alcohol use among U.S. women of childbearing age in order to identify subgroups of high-risk women for selective intervention.

METHODS

A sample of 188,290 women aged 18-44 years participated in the Centers for Disease Controls and Prevention (CDC)'s Behavioral Risk Factor Surveillance System (BRFSS) survey during the period of 2001-2003. Reported alcohol use patterns and average volume were examined for pregnant and nonpregnant women. Efforts were made to evaluate and characterize women who practiced various levels of binge drinking.

RESULTS

The results showed that approximately 2% of pregnant women and 13% of nonpregnant women in the United States engaged in binge drinking during the period of 2001-2003. Among the estimated average of 6.7 million women of childbearing age overall who engaged in binge drinking during the period, approximately 28.5% women also reported consuming an average of 5 drinks or more on typical drinking days, or about 21.4% women consumed at least 45 drinks on average in a month. Larger proportions of binge drinkers with high usual quantity of consumption were found among women of younger ages (18-24 years) or current smokers.

CONCLUSIONS

Future prevention efforts should include strategies that combine health messages and encourage women of childbearing age, with particular emphasis on women 18-24 years, to avoid alcohol and tobacco use, and take multivitamins and folic acid daily for better pregnancy outcomes. Other efforts must also include broad-based implementation of screening and brief intervention for alcohol misuse in primary and women's health care settings.