Polydactyly and polysyndactyly induced by prenatal exposure to ethanol

A and B preaxial polydactyly with syndactyly of feet and hands in the same person--a case report

Preaxial polydactyly of the hand is more common than postaxial polydactyly and postaxial polydactyly of the foot is more common than preaxial in white patients. Syndactyly is commonly regarded as next in frequency among the congenital hand deformities. Preaxial polydactyly of the feet and hands and polydactyly type A and B with syndactyly in the same individual is a rare condition. In this work we present this rare disorder in male infant. The physical and X-ray examinations showed preaxial polydactyly type A of both hands and A and B polydactyly with syndactyly of feet.

Maternal cigarette smoking during pregnancy increases the risk of having a child with a congenital digital anomaly

BACKGROUND

The U.S. Natality database from 2001 and 2002 was used to investigate the relationship between maternal cigarette smoking during pregnancy and the risk of having a child with polydactyly, syndactyly, or adactyly.

METHODS

The records of 6,839,854 live births were examined to identify 5171 newborns with isolated polydactyly, syndactyly, or adactyly and 10,342 controls with no congenital anomalies.

RESULTS

Maternal cigarette use during pregnancy was associated with a significantly elevated risk of having a child with a congenital digital anomaly (unadjusted odds ratio, 1.33; 95 percent confidence interval, 1.21 to 1.47; p < 0.0001). Univariate analysis indicated that maternal marital status and medical risk factors (anemia, cardiac disease, lung disease, diabetes, hydramnios/oligohydramnios, pregnancy-associated hypertension, incompetent cervix, previous preterm or small-for-gestational-age infant, and rhesus factor sensitization) were potential confounding factors. After adjustment for these variables, the odds ratio remained significant (adjusted odds ratio, 1.31; 95 percent confidence interval, 1.18 to 1.45; p < 0.0001). Cigarette consumption per day was divided into four groups: no smoking, 1 to 10 cigarettes per day, 11 to 20 cigarettes per day, and 21 or more cigarettes per day. A statistically significant dose-response relationship was found when comparing each smoking category with the no-smoking reference group: 1.29 (95 percent confidence interval, 1.15 to 1.46), 1.38 (95 percent confidence interval, 1.12 to 1.71), and 1.78 (95 percent confidence interval, 0.97 to 3.26), respectively. Increased cigarette smoking during pregnancy resulted in an elevated risk of having a child with polydactyly, syndactyly, or adactyly.

CONCLUSIONS

This is the largest study to date to investigate specifically the association between maternal cigarette smoking and the risk of having a newborn with a congenital digital anomaly. The elevated odds ratio for tobacco use and the significant trend in the dose-response relationship suggests smoking during pregnancy may be an important preventable risk factor for these common congenital differences.

Prenatal alcohol exposure (PAE) reduces the size of the forepaw representation in forepaw barrel subfield (FBS) cortex in neonatal rats: relationship between periphery and central representation

Prenatal alcohol exposure (PAE) alters limb development that may lead to structural and functional abnormalities of the limb reported in children diagnosed with Fetal Alcohol Spectrum Disorder. To determine whether PAE alters the central representation of the forelimb we used the rodent barrel cortex as our model system where it was possible to visualize and quantitatively measure the size of the forepaw representation in the forepaw barrel subfield (FBS) in first somatosensory cortex. In the present study, we examined the effects of PAE on pattern and size of the forepaw and forepaw representation in FBS in neonatal rats at gestational day 32 that corresponds to postnatal day 9. Pregnant Sprague-Dawley rats were chronically intubated with binge doses of ethanol (6 g/kg) from gestational day 1 through gestational day 20. The offspring of the ethanol treated dams comprised the ethanol (EtOH) group. The effect of PAE on the EtOH group was compared with a nutritional-controlled pairfed (PF) group and a normal chowfed (CF) group. The ventral (glabrous) surface area of the forepaw digits, length of digit 2 through digit 5, and the corresponding glabrous forepaw digit representations in the FBS were measured and compared between treatment groups. In rats exposed to in utero alcohol, the sizes of the overall glabrous forepaw and forepaw digits were significantly reduced in EtOH pups compared to CF and PF pups; overall glabrous forepaw area was 11% smaller than CF controls. Glabrous digit lengths were also smaller in EtOH rats compared to CF controls and significantly smaller in digit 2 through digit 4. The glabrous digit representation in FBS was 18% smaller in the EtOH group when compared to the CF treatment. However, PAE did not produce malformations in the forepaw or alter the pattern of the forepaw representation in FBS; instead, PAE significantly reduced both body and brain weights compared to controls. Unexpectedly, little or no correlation was observed between the size of the glabrous forepaw compared to the size of the glabrous forepaw representation in the FBS for any of the treatment groups. The present findings of PAE-related alterations in sensory periphery and the central cortical representation may underlie deficits in sensorimotor integration reported among children with Fetal Alcohol Spectrum Disorder.

Second trimester prenatal alcohol exposure alters development of rat corpus callosum

Prenatal alcohol exposure produces many developmental defects of the central nervous system (CNS), such as in the corpus callosum (CC). This study was designed to observe the effect of prenatal alcohol exposure during the second trimester equivalent on the development of dendritic arbors of CC projection neurons (CCpn) in rat visual cortex. In addition, the effect of second trimester equivalent prenatal alcohol exposure on brain weight was determined. Pregnant dams received 1.2-6.0 g/kg ethanol (EtOH) during gestational day (G) 11-20. Controls consisted of normal and nutritionally matched pairfed (PF) dams. Pups were sacrificed on the day of birth, G26, G29 and G33. DiI crystals were placed in the midsagittal CC bundle to retrogradely label CCpn. Images of visual cortex were obtained from tissue slices using a confocal laser scanning microscope. The number and length of apical and basilar dendrite branches were determined. The results show that prenatal alcohol exposure restricted to the second trimester equivalent alters the development of the CCpn dendritic arbor and the brain weight in a blood alcohol concentration (BAC)-dependent manner. The alteration in the EtOH CCpn is manifested as an increase in the number and length of CCpn apical and basilar dendrite branches, while brain weight is reduced compared with Controls.

Teratogenic actions of ethanol in the mouse: a minireview

The deleterious effects of prenatal ethanol exposure have been extensively documented in clinical and experimental studies. This paper provides an overview of work conducted with mice to examine the myriad of adverse consequences that result from embryonic/fetal exposure to ethanol. All of the hallmark features of the clinical fetal alcohol syndrome have been demonstrated in mice, including prenatal and postnatal growth retardation, structural malformations and behavioral abnormalities associated with central nervous system dysfunction. As expected, the severity and profile of effects is related to both dosage level and timing of exposure. In addition, these effects have been demonstrated following acute and chronic exposure, with a variety of routes of administration employed. Furthermore, a number of strains have been used in these studies and the variant response (susceptibility) to the teratogenic actions of ethanol exhibited among different mouse strains support the notion that genetic factors govern, at least in part, vulnerability to these effects of ethanol. More recent studies using mouse models have focused on examining potential mechanisms underlying the full spectrum of ethanol's teratogenic actions.

Changes in blood alcohol levels as a function of alcohol concentration and repeated alcohol exposure in adult female rats: potential risk factors for alcohol-induced fetal brain injury

Fetal alcohol syndrome and alcohol-related birth defects are the result of heavy maternal alcohol consumption during gestation. The magnitude of deficit manifested by the offspring is invariably a consequence of several risk factors that may result in high peak blood alcohol concentrations (BACs), such as the duration, timing, or pattern of alcohol consumption. In addition, the alcohol content of the consumed beverage may play a role in determining offspring developmental consequences. Because higher BACs are positively correlated with risk and severity of brain injury early in postnatal life, initially it was important to determine how BAC is influenced by alcohol concentration and whether that influence is constant over repeated alcohol treatments. Groups of female Sprague-Dawley rats received daily intragastric intubations of 5 g/kg alcohol in one of several concentrations: 45% (v/v), 30% (v/v), 22.5% (v/v), or 15% (v/v) for a duration of 18 consecutive days. Blood samples were taken at various times postintubation on days 3, 8, 13, and 18 of treatment, and analyzed by headspace gas chromatography. Multivariate analyses of peak BAC, average BAC, and time to reach peak BAC revealed some noteworthy results. First, peak BAC and average BAC were significantly lower in the 45% group, compared with the other concentration groups, whereas this group also took a longer time to reach peak BAC than the other three groups. Second, peak BAC and average BAC were higher on the last day of treatment than any of the other treatment days. These results suggest that alcohol concentration and repeated alcohol exposure can influence BAC and, as such, are important risk factors to be considered in the appraisal of alcohol-induced fetal brain injuries.

Pathogenesis of ethanol-induced limb reduction defects in mice

Acute administration of dosages of 2.5, 2.8, or 2.9 g/kg of ethanol to pregnant C57BL/6J mice on gestational day 9 1/4 resulted in major malformations of the forelimb including postaxial ectrodactyly, preaxial syndactyly, and reduction defects involving intermediate digits. The incidence and severity of these defects was positively correlated with dosage. Sidedness of the defects was also dose-dependent. In affected embryos, excessive amounts of cell death were notable within 5-9 hr of treatment initiation in selected cell populations. Cell death was primarily distributed in two regions of the developing limb bud--a ventrodistal ectodermal cell population (apical ectodermal ridge) and a proximal mesenchymal cell population. The patterns of cell death observed appear to be pathogenically related to the limb defects noted at later stages. In particular, it would appear that the deficiencies in the apical ectodermal ridge resulting from ethanol-induced cell death can account for virtually all the subsequent limb defects.

Review of drug-induced limb defects in mammals

The objective of this paper was to illustrate the spectrum of possible limb malformations in mammals resulting from drug exposure. A bibliography of 171 papers from 20 journals was generated from which pertinent data (drug used, limb defects reported, predominant defect location) were tabulated. These data should provide a basis for predictions about types of defects that might be expected in further studies and for judging postulated drug-induced human limb defects. However, direct extrapolation to humans is inappropriate. The following trends were observed: 1) Distal limb defects (autopod) are almost twice as common as proximal limb defects (stylopod and zygopod). 2) Ectrodactyly is the single most common type of limb defect, accounting for over half of the autopod defects. 3) Ectrodactyly is almost twice as common in the hindlimb as in the forelimb. 4) Postaxial ectrodactyly is over twice as common as preaxial ectrodactyly in the forelimb, but preaxial ectrodactyly is four times more common in the hindlimbs. 5) Polydactyly occurs with approximately equal frequency in forelimbs and hindlimbs, and preaxial polydactyly is most common in both fore and hindlimbs. 6) Polymelia (supernumerary limbs) occurred in one case, and may have been a spurious result. 7) Either transverse hemimelia is greatly underreported in teratology studies or it essentially does not occur. We have concluded that, at least in some cases, acetazolamide, adenine, 1,7-dimethylxanthine, and xanthine derivative aminophylline, retinoic acid, acetoxy-methyl-methylnitrosamine, aspirin, and cadmium can all cause unilateral defects.

Pharmacological concepts and developmental toxicology

This communication provides evidence to support the concept that developmental toxicants (teratogens) produce their effect by either interfering with or enhancing the time-dependent signal-response mechanisms within the embryo. Essential to this hypothesis is the need to show that an observed effect is a function of the administered dose, that there is a positive correlation between the observed effect and pharmacokinetic parameters and that there is evidence for the existence of a specific receptor for the toxicant. While extensive effort is required for ultimate validation of this concept, it serves to emphasize the value of applying known pharmacological principles in defining a mechanistic framework for the biological activity of developmental toxicants.

Microencephaly and hyperactivity in adult rats can be induced by neonatal exposure to high blood alcohol concentrations

To investigate whether or not blood alcohol concentration during the brain growth spurt has an influence on the permanency of alcohol-induced central nervous system damage, an artificial rearing technique was used to administer a daily dose of alcohol (6.6 g/kg/day) to neonatal rats during postnatal days 4 to 10. The alcohol was administered either in a condensed pattern over 8 h resulting in cyclic blood alcohol concentrations with high peaks, or uniformly over each 24-h period resulting in stable, but low peaks. The condensed alcohol exposure resulted in considerable microencephaly (20% to 25%), with significant growth deficits in the cerebrum, cerebellum, and brain stem of rats of either sex at day 10; there still was significant microencephaly (16% to 19%) in adult rats that received the condensed alcohol exposure as neonates. Furthermore, activity at day 90 in rats of either sex that had condensed alcohol exposure was elevated compared with that of the gastrostomy control group. In contrast, the rats having uniform alcohol exposure had only nonsignificant changes in brain weight both on day 10 and day 90 and did not exhibit hyperactivity at day 90. Thus, neonatal alcohol exposure producing high blood alcohol concentrations caused permanent deficits in brain growth and significant changes in activity, whereas the same daily dose of alcohol administered in a pattern that resulted in consistently low blood alcohol concentrations failed to produce either permanent microencephaly or increased activity. These data support the hypothesis that patterns of alcohol exposure that produce high concentrations in the blood, such as "binge-drinking," increase the risk of permanent damage to the developing brain.

Major limb malformations following intrauterine exposure to ethanol: two additional cases and literature review

Two children are reported in whom major limb malformations were identified and whose mothers had consumed large quantities of alcohol in the first trimester of pregnancy. In one there was complete amelia of the upper limbs, while the other had preaxial polydactyly of both hands. These cases, taken together with previously reported instances of major limb anomalies following intrauterine ethanol exposure, as well as animal investigations that have demonstrated virtually identical limb malformations following ethanol administration, suggest that maternal ethanol abuse may be casually related to these limb malformations. We suggest that interruption of blood supply to the developing limb may be caused by ethanol exposure and may result in all of the various limb malformations described.

Perforant pathway lamination in the dentate gyrus is unaffected by prenatal ethanol exposure

The entorhinal (perforant path) projection to the dentate gyrus was labeled with an anterograde horseradish peroxidase method to test whether prenatal exposure to ethanol affected the normal development of afferent lamination. Mean ethanol consumption of the ethanol-consuming dams was 12.7 g/kg +/- 0.3 g per day during days 1-21 of gestation. Adult offspring of normal and pair-fed controls as well as ethanol-exposed rats were analyzed. Computer-assisted image analysis of the entorhinal terminal field organization revealed no permanent changes in the development of the afferent lamination pattern in the dentate gyrus molecular layer in spite of the heavy in utero ethanol exposure.

Potentiation of chemically induced cleft palate by ethanol ingestion during gestation in the mouse

The influence of ethanol consumption on cleft palate induction by methylmercury, cortisone, and retinyl acetate was investigated in Swiss white mice. Consumption of 20% ethanol throughout gestation significantly increased the incidence of cleft palate compared to water-fed mice, when methylmercury was given on four consecutive days (days 9-12, 5 mg/kg of body weight). Ethanol also increased the incidence of cleft palate in mice given retinyl acetate (3,400 or 5,100 IU) on day 12, compared to retinol acetate-treated mice given water, but did not affect cleft palate induction by cortisone (2.5 mg/d, days 8-11). Ethanol significantly reduced fetal weight in the presence or absence of the three teratogens, but the results do not support a hypothesis that growth retardation is directly responsible for the potentiating action of ethanol. It may be that ethanol acts to increase cleft palate induction by some teratogens by retarding fetal developmental processes.

[Modification of maneb toxicity by chronic ethanol intake--prenatal toxicologic studies on a high-risk group]

Rats, dose-dependent on maneb during pregnancy and lactation (20, 110, 200 or 290 ppm maneb in their food) obtained water or 20 percent alcohol to drink. The animals given pure water indicated no effect. Alcohol in combination with the same concentrations of maneb in the food raised embryotoxicity and produced retardation of the skeletons and postnatal growths in the F1-generation. There was dose-dependent coergistic effect in the breeding results from the alcoholic mothers. The practical significance of this over 15-fold higher susceptibility of alcoholic animals is discussed.

Drug effects on afterdischarge and seizure threshold in lissencephalic ferrets: an epilepsy model for drug evaluation

In normal and lissencephalic ferrets with chronically implanted electrodes, two antiepileptic drugs, (E)-2-[(amino)phenylmethylen]-benzo [b] thiophen-3(2H)-on (AF-CX 921 XX) and carbamazepine (CBZ), were compared. The variables included afterdischarges (AD) and seizures induced by cortical electrical stimulations (ES). Both drugs were given orally, 100 mg/kg of pure substance. ES was applied before and 1, 2, 3, 4, 5, and 24 h after drug administration. Lissencephaly was produced by a single intraperitoneal injection of 15 mg methylazoxymethanol acetate to pregnant animals. The administration of both drugs resulted in increases of the AD threshold current to 240% in the normal and to 170% in the lissencephalic ferrets, in comparison with control stimulations (the difference significant at p less than 0.001). Moreover, duration of the AD was shorter (p less than 0.01) than before the drugs. Seizure threshold also increased 170% after AF-CX 921 XX and 175% after CBZ in normal and 153% and 138% in lissencephalic ferrets, respectively. The difference between the two drugs was significant. However, in contrast to the threshold, duration of seizures during AF-CX 921 XX administration was significantly shorter (p less than 0.05) than during CBZ. In general, lissencephalic ferrets responded less than normal ferrets to both drugs, but AF-CX 921 XX had a greater inhibitory effect on the duration of seizures. The lissencephalic ferret is proposed as an animal model of epilepsy with diffuse developmental defects.

Acute embryopathic effects of ethanol in the Long-Evans rat

Thirty-two pregnant Long-Evans rats were divided into 10 groups of 3 or 4 pregnant rats, and each rat was given a single dose of 4 ml ethanol/kg (20 ml/kg of a 20% solution) between d 6 and 15 of gestation. An 11th group of 50 pregnant rats received distilled water and served as controls. Offspring body weights were decreased in groups of rats given ethanol as compared to controls (3.0-3.6 g, versus 3.9 g for controls). Total litter weight was decreased in dams given ethanol on d 6. Skeletal variants were seen in 13-78% of the offspring given ethanol, compared to 0.6% of the controls. Variations may be considered as additional signs of embryotoxicity. Malformations such as hydronephrosis, pelvic kidney, microcephalus, cranioschisis, and microphthalmia occurred in 72-100% of the ethanol treated offspring, as compared to 12% of controls. Hydronephrosis was most frequent on d 9 or 14, pelvic kidney on d 8 and 11, and microphthalmia from d 10-12. Cranioschisis was maximal on d 7, 11, and 15, and microcephalic offspring were most frequently born to dams given ethanol on d 7 or 14. Skeletal defects were usually single entities, while soft-tissue anomalies occurred in a consistent pattern. These results suggest that ethanol is a stage-specific teratogen in the rat at comparable exposure levels attained by many humans.

Teratogenic effects of acetaldehyde in the rat

Acetaldehyde, the proximal metabolite of ethanol, was administered intraperitoneally in single and triple doses (50, 75, 100 mg/kg) to pregnant CF rats on days 10, 11 and 12 of gestation and fetuses were collected on day 21. Besides significant fetal resorptions, malformations were found which included edema, microcephaly, micrognathia, micromelia, hydrocephaly, exencephaly, hemorrhages etc. Somatometric measurements of fetuses (i.e. crown rump length, transumbilical distance and tail length) revealed significant growth retardation. Alizarin red-stained skeletal preparations showed considerable stunting. The placental weight and umbilical cord length were also significantly reduced. The close similarity of the pattern of acetaldehyde-induced fetal malformations with those resulting from maternal alcohol consumption during pregnancy is suggestive of the possible implication of acetaldehyde in the fetal alcohol syndrome.

Prenatal exposure to ethanol alters the organization of hippocampal mossy fibers in rats

Rats exposed to ethanol throughout their gestation were found to have abnormally distributed mossy fibers in temporal regions of the hippocampus. This demonstrates that prenatal exposure to ethanol causes alterations in neuronal circuitry that persist to maturity. Such defects may play a role in the mental retardation often observed in children with fetal alcohol syndrome.