Fetal alcohol syndrome: diagnosis, epidemiology, and developmental outcomes

Prenatal alcohol exposure alters GABA(A)alpha5 expression: a mechanism of alcohol-induced learning dysfunction

OBJECTIVE

In a model for fetal alcohol syndrome (FAS), we have previously found an alteration in NMDA receptors suggesting mediation, at least in part, of alcohol-related learning deficit. NMDA and GABA receptors interact in a multisynaptic circuit for the regulation of the inhibitory tone through the CNS. The GABA receptor subunit GABA(A)alpha5 is involved in learning and is developmentally regulated, as it is excitatory in the perinatal brain and inhibitory in the adult. We were interested to evaluate alcohol's effect on GABA(A)alpha5 expression to further understand alcohol-induced learning dysfunction.

STUDY DESIGN

Timed, pregnant C57B16/J mice were treated on gestational day 8 with alcohol (25% alcohol, 0.03 mL/kg i.p.) or control (saline). Embryos and brains were harvested 10 days after treatment, and brains from adult offspring were collected after evaluation in the Morris Water Maze, a well-established test for spatial learning. Gene expression included samples from at least 3 litters per timepoint, and calibrator-normalized relative real-time polymerase chain reaction (PCR) was performed to quantify GABA(A)alpha5 with GAPDH standardization. Statistical analysis included analysis of variance (ANOVA).

RESULTS

Prenatal alcohol exposure significantly decreased GABA(A)alpha5 expression in the embryo (P < .02) and fetal brains (P < .01) 10 days after therapy. However, in adult brains GABA(A)alpha5 expression was increased versus controls (P < .01). As previously demonstrated, prenatal alcohol exposure resulted in deficits in adults learning the Morris Water Maze with controls learning faster (P < .05).

CONCLUSION

Prenatal alcohol exposure alters developmental GABA(A)alpha5 expression. This may further explain the long-lasting damage of alcohol on learning skills. Both the alcohol-induced reduction in the GABA(A)alpha5 subunit during development and up-regulation in adult brain may be related to learning deficits resulting in decreased learning potential caused by the developmental defect and an increased inhibition of learning resulting from increased expression as an adult. In combination with our previous findings, these suggest that alcohol-induced learning impairment is likely the result of alterations of both NMDA and GABA expression and function.

N-methyl-D-aspartate subunit expression during mouse development altered by in utero alcohol exposure

OBJECTIVE

Alcohol-related neurodevelopmental disorders are contributors to long-term learning disabilities. By using a model for fetal alcohol syndrome, we have shown that prenatal alcohol exposure results in adult learning deficits of unknown mechanisms. In the developing hippocampus, the N-methyl-D-aspartate (NMDA) receptor subunit NR2B triggers long-term potentiation, fundamental to learning and memory; this is supplemented by the less plastic NR2A subunit in the adult. To understand the mechanism of learning deficits in FAS, we evaluated NR2B and NR2A expression in embryonic and adult mice.

STUDY DESIGN

Pregnant C57Bl6/J mice were treated on gestational day 8 with alcohol or control (saline solution). Embryos were harvested at 6 hours, 24 hours, and 10 days, and brains from adult offspring were collected at 3 months (after evaluation for learning deficit). Calibrator-normalized relative real-time polymerase chain reaction was performed for NR2B and NR2A with glyceraldehyde-3-phosphate dehydrogenase standardization. Statistical analysis included analysis of variance.

RESULTS

At 6 hours, NR2B expression in the alcohol-exposed embryos was higher than in controls (P < .01). NR2A was not expressed in either group. By 24 hours there was no difference in NR2B (P = .3). However, at 10 days NR2B was lower in alcohol-exposed animals (P = .02). In the adult brains there was a relative decrease in NR2B (P = .03) and an increase in NR2A (P < .01).

CONCLUSION

Prenatal alcohol exposure during development induces NR2B expression deregulation in the embryos that persists until adulthood, when a relative increase in the less modifiable subunit NR2A occurs. This alteration in NMDA receptor subunits may underlie the learning abnormalities in fetal alcohol syndrome.

Prenatal alcohol and cocaine exposure: influences on cognition, speech, language, and hearing

This paper reviews research on the consequences of prenatal exposure to alcohol and cocaine on children's speech, language, hearing, and cognitive development. The review shows that cognitive impairment, learning disabilities, and behavioral disorders are the central nervous system manifestations of fetal alcohol syndrome (FAS), and cranio-facial abnormalities are also present. Delays in language acquisition, as well as receptive and expressive language deficits, are commonly reported. The cranio-facial abnormalities of FAS, which sometimes include cleft palate, make the child prone to otitis media with effusion and conductive hearing loss. The family environment in which one or both parents is a heavy alcohol user presents challenges to a child with normal intelligence, but may be especially deleterious to the child with mental retardation. Prenatal exposure to cocaine results in subtle cognitive disabilities when measured at 4 years of age. The cognitive effects may be ameliorated by a stimulating and sensitive care-giving environment. A small, deleterious "cocaine-effect" is also seen in speech and language development. The child with prenatal exposure to cocaine may be considered at increased risk for language delay or disorder. There is no evidence that prenatal cocaine exposure by itself is a risk factor for sensorineural hearing impairment, although auditory evoked potentials from the brainstem and cortex suggest some abnormalities in central auditory processing, at least during the newborn period. The strong effect of the home environment for ameliorating the effects of prenatal cocaine-exposure suggests that a family-focused approach for cognitive, language, and social-emotional habilitation would be beneficial to all.

LEARNING OUTCOMES

The learner will be able to describe the major features of fetal alcohol syndrome and how they relate to speech, language, hearing, and cognitive disorders. The learner will review the literature and determine research needs with respect to language, speech, and hearing among infants and children with fetal alcohol syndrome. Similarly, the learner will distinguish the outcomes of prenatal alcohol-exposure from those of prenatal cocaine-exposure. The learner will summarize the controversy regarding the possible stigmatization of cocaine-exposed infants. The learner will summarize the speech, language, and hearing effects of prenatal cocaine-exposure.

Alcohol consumption and serum hormone levels during pregnancy

Factors that change sex hormone levels during pregnancy may have long-term health consequences for the offspring, including changes in breast cancer risk. A cross-sectional analysis of alcohol consumption and hormone levels in 339 pregnant women sampled from the Child Health and Development Study cohort was undertaken. Alcohol intake was queried from 1959 to 1966, long before any hazards of drinking during pregnancy were publicized. Third trimester serum hormone levels including estradiol and testosterone were analyzed. Among 339 pregnant women, 196 reported some alcohol consumption during pregnancy. The drinkers were divided into three groups with intake levels of 0.2-0.5, 0.6-2.0, and 2.1-12.5 ounces of ethanol per week. The second group corresponds to a median intake of approximately 2 drinks per week, and the last group corresponds to a median intake of approximately 1 drink per day, which is considered "light" to "moderate" drinking. Maternal estradiol levels were not associated with alcohol intake during pregnancy. However, serum testosterone was significantly lower, by 12.2%, in the latter two groups of drinking pregnant women, [confidence interval (CI)=-3.0 to 25.2] and 25.6% (CI=9.2-39.5), respectively. The alcohol intakes reported are far below those shown to cause fetal alcohol syndrome, or any of the fetal alcohol effects so far studied. Light alcohol intake during pregnancy is associated with lower maternal testosterone. The health implications are uncertain, but may include an increased breast density in the daughters of drinking mothers.