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Popova S, Dozet D, Faulkner MR, Howie L, Temple V. Prenatal Exposures, Diagnostic Outcomes, and Life Experiences of Children and Youths with Fetal Alcohol Spectrum Disorder. Nutrients 2024; 16:1655. [PMID: 38892588 PMCID: PMC11174948 DOI: 10.3390/nu16111655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Children and youths diagnosed with FASD may experience a range of adverse health and social outcomes. This cross-sectional study investigated the characteristics and outcomes of children and youths diagnosed with FASD between 2015 and 2018 at the Sunny Hill Centre in British Columbia, Canada and examined the relationships between prenatal substance exposures, FASD diagnostic categories, and adverse health and social outcomes. Patient chart data were obtained for 1187 children and youths diagnosed with FASD and analyzed. The patients (mean age: 9.7 years; range: 2-19) had up to 6 physical and 11 mental health disorders. Prenatal exposure to other substances (in addition to alcohol) significantly increased the severity of FASD diagnosis (OR: 1.18): the odds of FASD with sentinel facial features (SFF) were 41% higher with prenatal cigarette/nicotine/tobacco exposure; 75% higher with exposure to cocaine/crack; and two times higher with exposure to opioids. Maternal mental health issues and poor nutrition also increase the severity of FASD diagnosis (60% and 6%, respectively). Prenatal exposure to other substances in addition to alcohol significantly predicts involvement in the child welfare system (OR: 1.52) and current substance use when adjusted for age (aOR: 1.51). Diagnosis of FASD with SFF is associated with an increased number of physical (R2 = 0.071, F (3,1183) = 30.51, p = 0.000) and mental health comorbidities (R2 = 0.023, F (3,1185) = 9.51, p = 0.000) as compared to FASD without SFF adjusted for age and the number of prenatal substances. Screening of pregnant women for alcohol and other substance use, mental health status, and nutrition is extremely important.
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Affiliation(s)
- Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (D.D.); (M.-R.F.)
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON M5S 1V4, Canada
| | - Danijela Dozet
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (D.D.); (M.-R.F.)
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Mary-Rose Faulkner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (D.D.); (M.-R.F.)
| | - Lesley Howie
- North Island Hospital Comox Valley, 101 Lerwick Rd, Courtenay, BC V9N 0B9, Canada;
| | - Valerie Temple
- Surrey Place, 2 Surrey Place, Toronto, ON M5S 2C2, Canada;
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Louw JG, Broodryk M, White L, Acker D, Viljoen DL, Olivier L. A multi-year, multi-site study of the prevalence of fetal alcohol syndrome in South Africa. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:867-879. [PMID: 38548386 DOI: 10.1111/acer.15306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD prevalence of 310 per 1000 in a community in the Western Cape Province. Because there is as yet no reliable estimate of the national burden of FASD in South Africa, further epidemiological studies are needed in diverse settings. This paper reports on a multiyear, multisite FASD epidemiological study that took place from 2015 to 2022 at eight study sites in four provinces. METHODS The cross-sectional epidemiological study used an active case-ascertainment method, specifically in primary schools. All children were recruited when they were enrolled in Grade 1 at a participating school. All consented participants progressed through a tiered-screening recruitment and diagnostic process. RESULTS Overall, 3033 children were included in the study. A total of 3001 children were screened for FASD in the first tier, with 1086 progressing to the second and 495 to the third tier. Of the 495 children referred, 475 were discussed during the final case conference. A total of 309 participants were diagnosed with FAS across the eight study sites. The highest reported prevalence was in the Northern Cape Province, with a rate of 199.3/1000 (95% CI, 147.6-251) using all eligible participants as the denominator. The lowest prevalence was in the Eastern Cape Province, with a rate of 57.4/1000 (95% CI, 36.5-78.3). The pooled FAS prevalence for the eight study sites was 80.2/1000 (95% CI, 70.4-89.9). CONCLUSIONS As with previous studies, we found a concerningly high prevalence of FASD in South Africa. Given the scope of the problem it should be a high priority for health and welfare services to address.
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Affiliation(s)
- Jacobus Gidion Louw
- Foundation for Alcohol Related Research, Cape Town, South Africa
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mandi Broodryk
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Liska White
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Debbie Acker
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | | | - Leana Olivier
- Foundation for Alcohol Related Research, Cape Town, South Africa
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3
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Sundermann B, Feldmann R, Mathys C, Rau JMH, Garde S, Braje A, Weglage J, Pfleiderer B. Functional connectivity of cognition-related brain networks in adults with fetal alcohol syndrome. BMC Med 2023; 21:496. [PMID: 38093292 PMCID: PMC10720228 DOI: 10.1186/s12916-023-03208-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Fetal alcohol syndrome (FAS) can result in cognitive dysfunction. Cognitive functions affected are subserved by few functional brain networks. Functional connectivity (FC) in these networks can be assessed with resting-state functional MRI (rs-fMRI). Alterations of FC have been reported in children and adolescents prenatally exposed to alcohol. Previous reports varied substantially regarding the exact nature of findings. The purpose of this study was to assess FC of cognition-related networks in young adults with FAS. METHODS Cross-sectional rs-fMRI study in participants with FAS (n = 39, age: 20.9 ± 3.4 years) and healthy participants without prenatal alcohol exposure (n = 44, age: 22.2 ± 3.4 years). FC was calculated as correlation between cortical regions in ten cognition-related sub-networks. Subsequent modelling of overall FC was based on linear models comparing FC between FAS and controls. Results were subjected to a hierarchical statistical testing approach, first determining whether there is any alteration of FC in FAS in the full cognitive connectome, subsequently resolving these findings to the level of either FC within each network or between networks based on the Higher Criticism (HC) approach for detecting rare and weak effects in high-dimensional data. Finally, group differences in single connections were assessed using conventional multiple-comparison correction. In an additional exploratory analysis, dynamic FC states were assessed. RESULTS Comparing FAS participants with controls, we observed altered FC of cognition-related brain regions globally, within 7 out of 10 networks, and between networks employing the HC statistic. This was most obvious in attention-related network components. Findings also spanned across subcomponents of the fronto-parietal control and default mode networks. None of the single FC alterations within these networks yielded statistical significance in the conventional high-resolution analysis. The exploratory time-resolved FC analysis did not show significant group differences of dynamic FC states. CONCLUSIONS FC in cognition-related networks was altered in adults with FAS. Effects were widely distributed across networks, potentially reflecting the diversity of cognitive deficits in FAS. However, no altered single connections could be determined in the most detailed analysis level. Findings were pronounced in networks in line with attentional deficits previously reported.
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Affiliation(s)
- Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus Oldenburg, Universitätsmedizin Oldenburg, Oldenburg, Germany
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
- Research Center Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Reinhold Feldmann
- Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Christian Mathys
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus Oldenburg, Universitätsmedizin Oldenburg, Oldenburg, Germany
- Research Center Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Johanna M H Rau
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Stefan Garde
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Anna Braje
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Josef Weglage
- Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Bettina Pfleiderer
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
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Tousley AR, Yeh PWL, Yeh HH. Precocious emergence of cognitive and synaptic dysfunction in 3xTg-AD mice exposed prenatally to ethanol. Alcohol 2023; 107:56-72. [PMID: 36038084 PMCID: PMC10183974 DOI: 10.1016/j.alcohol.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 12/27/2022]
Abstract
Alzheimer's disease (AD) is the most common cause of dementia, affecting approximately 50 million people worldwide. Early life risk factors for AD, including prenatal exposures, remain underexplored. Exposure of the fetus to alcohol (ethanol) is not uncommon during pregnancy, and may result in physical, behavioral, and cognitive changes that are first detected during childhood but result in lifelong challenges. Whether or not prenatal ethanol exposure may contribute to Alzheimer's disease risk is not yet known. Here we exposed a mouse model of Alzheimer's disease (3xTg-AD), bearing three dementia-associated transgenes, presenilin1 (PS1M146V), human amyloid precursor protein (APPSwe), and human tau (TauP301S), to ethanol on gestational days 13.5-16.5 using an established binge-type maternal ethanol exposure paradigm. We sought to investigate whether prenatal ethanol exposure resulted in a precocious onset or increased severity of AD progression, or both. We found that a brief binge-type gestational exposure to ethanol during a period of peak neuronal migration to the developing cortex resulted in an earlier onset of spatial memory deficits and behavioral inflexibility in the progeny, as assessed by performance on the modified Barnes maze task. The observed cognitive changes coincided with alterations to both GABAergic and glutamatergic synaptic transmission in layer V/VI neurons, diminished GABAergic interneurons, and increased β-amyloid accumulation in the medial prefrontal cortex. These findings provide the first preclinical evidence for prenatal ethanol exposure as a potential factor for modifying the onset of AD-like behavioral dysfunction and set the groundwork for more comprehensive investigations into the underpinnings of AD-like cognitive changes in individuals with fetal alcohol spectrum disorders.
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Affiliation(s)
- Adelaide R Tousley
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States; MD-PhD Program, Geisel School of Medicine at Dartmouth; Integrative Neuroscience at Dartmouth Graduate Program, Hanover, NH, United States
| | - Pamela W L Yeh
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Hermes H Yeh
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
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Martinez-Cengotitabengoa M, Jackson CL, Pugh EJ, Long-Martinez D, Sanchez-Martinez A, Sanchez-Martinez M, Bermudez-Ampudia C, Martinez-Cengotitabengoa MT. Global intellectual ability and adaptive functioning in children with FASD with and without sentinel facial features. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:123-128. [PMID: 36745739 DOI: 10.1080/00952990.2022.2164503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disorder characterized by cognitive and adaptive impairment. FASF can be presented or not with sentinel facial features (SFF). The presence of such SFF have been positively correlated with cognitive impairment in children with FASD.Objectives: The current study explores difference in global intellectual functioning and how cognition affects adaptive behavior in children with and without SFF.Methods: A total of 88 children and adolescents (55 males, 33 females) with confirmed FASD diagnosis were included in the study, of which 16 had sentinel facial features. Childrens' neuropsychological functioning was assessed using the Wechsler Intelligence Scale for Children (WISC-V) and The Behavioral Assessment of the Dysexecutive Syndromes for Children (BADS-C). Adaptive behavior was explored through the Adaptive Behavior Assessment System (ABAS-3).Results: Children with SFF performed more poorly in tasks assessing processing speed (t = 2.495, t = .020) and executive functioning (t = 4.147, t = .001). Those children also had lower IQ scores than children without SFF (t = 2.658, t = .016). BADS-C overall scaled score was related to three of the four domains of the ABAS scale (conceptual, social, and practical) but only in the group of FASD children without SFF (B = 0.547, t = .020; B = 0.544,t = .049; B = 0.431,t = .040, respectively).Conclusions: The present study founds poorer cognitive outcomes in children who have FASD with sentinel facial features. In children without SFF, stronger executive functioning is also related to significantly stronger reported conceptual, social, and practical adaptive behaviors. Better understanding of cognitive and adaptive functioning in children with FASD may help in the design of tailored evidenced-based interventions.
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Affiliation(s)
- Monica Martinez-Cengotitabengoa
- School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.,Psychology Clinic of East Anglia, Norwich, UK.,Osakidetza Basque Health Service, Barakaldo, Spain
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6
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Little B, Sud N, Nobile Z, Bhattacharya D. Teratogenic effects of maternal drug abuse on developing brain and underlying neurotransmitter mechanisms. Neurotoxicology 2021; 86:172-179. [PMID: 34391795 DOI: 10.1016/j.neuro.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022]
Abstract
The aim of this review is to highlight our knowledge of the various drugs of abuse that can prove potential teratogens affecting the brain and cognitive development in an individual exposed to maternal consumption of such agents. Among several drugs of abuse in women, we specifically highlighted the commonly used alcohol, nicotine, opioids, cannabis, cocaine and marijuana. These drugs can affect the fetal development and slow the cognitive maturation apart from physical disabilities. However, no known therapy exists to counter the toxic potential of these drugs. Several researchers used animal models of drug abuse to understand the underlying mechanisms affecting brain development and the relevant neurotransmitter system. Identifying such targets can potentially help in drug discovery research. We reported in depth analysis of such mechanisms and discussed the potential targets for drug development research.
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Affiliation(s)
- Brianna Little
- Lake Erie College of Osteopathic Medicine, 1858 Grandview Blvd., Erie, PA, 16509, United States
| | - Neilesh Sud
- Lake Erie College of Osteopathic Medicine, 1858 Grandview Blvd., Erie, PA, 16509, United States
| | - Zachary Nobile
- Lake Erie College of Osteopathic Medicine, 1858 Grandview Blvd., Erie, PA, 16509, United States
| | - Dwipayan Bhattacharya
- Lake Erie College of Osteopathic Medicine, 1858 Grandview Blvd., Erie, PA, 16509, United States.
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7
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Teacher-Reported Prevalence of FASD in Kindergarten in Canada: Association with Child Development and Problems at Home. J Autism Dev Disord 2021; 51:433-443. [PMID: 32472249 PMCID: PMC7835185 DOI: 10.1007/s10803-020-04545-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The prevalence of Fetal Alcohol Spectrum Disorder (FASD) may be underestimated as it can be difficult to diagnose in early childhood possibly reflecting unique developmental trajectories relative to other Neurodevelopmental Disabilities (NDDs). Using data collected via the Early Development Instrument (EDI) between 2010 and 2015, we examined the prevalence of kindergarten children with FASD and their concurrent developmental outcomes. We found that the prevalence of FASD ranged from 0.01 to 0.31%. A greater percentage of children with FASD had teacher-reported home problems that interfered with their classroom functioning. Overall children with FASD had higher mean scores on the developmental domains compared to children with NDDs. Results of the current study can inform strategies and policies for early identification and intervention.
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8
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Crawford A, Te Nahu Rongomaiwahine Rāua Ko Kahungunu LTH, Peterson ER, McGinn V, Robertshaw K, Tippett L. [Formula: see text] Cognitive and social/emotional influences on adaptive functioning in children with FASD: Clinical and cultural considerations. Child Neuropsychol 2020; 26:1112-1144. [PMID: 32519571 DOI: 10.1080/09297049.2020.1771296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Fetal Alcohol Spectrum Disorder (FASD) is one of the leading causes of intellectual disability and learning difficulties around the world. Children with FASD often have extremely low adaptive behavior due to the severity of brain impairment, however there is limited understanding as to the important predictors of adaptive behavior. In a study of 39 children with FASD and 29 comparison children, we found that social cognition (specifically recognizing emotions) was the only significant independent predictor of teacher-rated adaptive functioning even after including IQ, executive functioning, and adverse childhood experiences into the model. In this current study, Māori (Indigenous people of Aotearoa New Zealand) were overrepresented; therefore, the research was supported by a strong partnership with Te Wāhanga Hauora Māori (Māori Health Service). Aotearoa New Zealand's colonized history is recognized and findings are discussed with regard to both the psychological literature and a Te Ao Māori worldview.
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Affiliation(s)
- Andi Crawford
- School of Psychology, University of Auckland, Science Centre , Auckland, New Zealand.,Child Development Service, Hawke's Bay District Health Board , Hawke's Bay, New Zealand
| | | | - Elizabeth R Peterson
- School of Psychology, University of Auckland, Science Centre , Auckland, New Zealand
| | - Valerie McGinn
- Honorary Senior Research Fellow, School of Population Health, The University of Auckland , Auckland, New Zealand
| | - Kate Robertshaw
- Child Development Service, Hawke's Bay District Health Board , Hawke's Bay, New Zealand
| | - Lynette Tippett
- School of Psychology, University of Auckland, Science Centre , Auckland, New Zealand.,The Center of Brain Research, University of Auckland , New Zealand
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9
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Temple VK, Cook JL, Unsworth K, Rajani H, Mela M. Mental Health and Affect Regulation Impairment in Fetal Alcohol Spectrum Disorder (FASD): Results from the Canadian National FASD Database. Alcohol Alcohol 2020; 54:545-550. [PMID: 31216355 DOI: 10.1093/alcalc/agz049] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/10/2019] [Accepted: 05/26/2019] [Indexed: 01/23/2023] Open
Abstract
AIMS Individuals with fetal alcohol spectrum disorder (FASD) frequently have challenges with regulating emotional arousal, or affect regulation (AR), and experience high rates of mental health disorders. This study examined children and adults with FASD to investigate the relationship between AR impairment and several mental health problems and diagnoses. METHODS Data from the Canadian national FASD database was used for analysis. Seven mental health diagnoses, including attention-deficit/hyperactivity disorder, post-traumatic stress disorder, conduct disorder, attachment disorder, intellectual disability, and language disorder were examined. A history of suicidality was also examined. The prevalence of these mental health problems in individuals with and without AR impairment was compared. RESULTS Individuals with FASD and AR impairment were significantly more likely to be diagnosed with conduct disorder (OR 4.8), attachment disorder (OR 6.1), or post-traumatic stress disorder (OR 8.1) when compared to those without AR impairment. They were also more likely to have a history of suicidality (OR 8.6). AR impairment was most commonly found in those with greater overall neurodevelopmental impairment. Having AR impairment was associated with receiving a diagnosis of FASD at a later age, but was not related to gender, intellectual disability, or language disorder. CONCLUSION AR impairment is strongly related to several mental health diagnoses in those with FASD and presents some promising possibilities for targeted early intervention.
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Affiliation(s)
- Valerie K Temple
- Clinical Psychologist, Surrey Place, 2 Surrey Place, Toronto, Ontario
| | - Jocelynn L Cook
- Scientific Director, The Society of Obstetricians and Gynaecologists of Canada, 2781 Lancaster Road, Ottawa, Ontario K1B 1A7 and Adjunct Professor, Department of Obstetrics and Gynaecology, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario
| | - Kathy Unsworth
- Managing Director, The Canada FASD Research Network, PO Box 11364 Wessex PO, Vancouver, British Columbia
| | - Hasu Rajani
- Professor Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Mansfield Mela
- Professor Department of Psychiatry, University of Saskatchewan, 103 Hospital Dr., Saskatoon, Saskatchewan
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10
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Louw JG, Olivier L, Skeen S, van Heerden A, Tomlinson M. Evaluation of a Custom-Developed Computer Game to Improve Executive Functioning in 4- to 6-Year-Old Children Exposed to Alcohol in Utero: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14489. [PMID: 31596247 PMCID: PMC6806122 DOI: 10.2196/14489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 11/28/2022] Open
Abstract
Background Fetal alcohol spectrum disorder (FASD) is one of the most common causes of preventable intellectual disability, and the key associated deficits are in executive function (EF). Aspects of EF can be improved using cognitive training interventions. The highest prevalence of FASD globally (at a rate of 135.1 per 1000) has been found in a South African population in the Western Cape province. There is a shortage of specialized health service personnel, and there are limited remedial services. Computer-based cognitive training, if age and culturally appropriate, could be an effective way to provide the interventions with minimal need for skilled personnel and other resources. The Foundation for Alcohol Related Research has developed such a program for the South African context. Objective This protocol aimed to evaluate whether it is feasible to use computerized cognitive training in a resource-poor context to improve cognitive function in children exposed to alcohol in utero. Methods We are conducting a randomized controlled trial in the Saldanha Bay Municipal area, evaluating a custom-developed cognitive training program to improve the cognitive function of children aged between 4 and 6 years who were exposed to alcohol in the prenatal stage. Participants will be recruited from local Early Childhood Development centers. Community workers will interview biological mothers to identify alcohol-exposed pregnancies. Alcohol-exposed children will be randomized into an intervention or a control group of 40 participants each using block randomization. A group of 40 children not exposed to alcohol will be included in a normative group using individual randomization. The intervention group will play the game for 6 months (40 sessions). Normative and control groups will receive no intervention. Neurodevelopmental assessments will be done at baseline and upon completion of the study with all participants. Results The intervention has started, and all baseline assessments have been done at the time of submission. Conclusions This study will provide insight into whether computerized cognitive training is viable and effective in the South African context. It has the potential to provide a means of intervention globally and in other resource-poor context and expand the knowledge base regarding executive functioning and FASD. This paper presents the research protocol and intervention design of the study. Trial Registration ISRCTN Registry ISRCTN17244156; http://www.isrctn.com/ISRCTN17244156. International Registered Report Identifier (IRRID) DERR1-10.2196/14489
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Affiliation(s)
- Jacobus Gidion Louw
- Foundation for Alcohol Related Research, Cape Town, South Africa.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.,Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leana Olivier
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alastair van Heerden
- Human and Social Development, Human Sciences Research Council, Pietermaritzburg, South Africa.,MRC/WITS Developmental Pathways for Health Research Unit Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
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11
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Reid N, Harnett P, O'Callaghan F, Shelton D, Wyllie M, Dawe S. Physiological self-regulation and mindfulness in children with a diagnosis of fetal alcohol spectrum disorder. Dev Neurorehabil 2019; 22:228-233. [PMID: 29634386 DOI: 10.1080/17518423.2018.1461948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To explore the differences in baseline respiratory sinus arrhythmia (RSA) between children with fetal alcohol spectrum disorder (FASD) and typically developing children (TDC) and to investigate whether children with FASD have the capacity to engage in a brief mindfulness exercise. METHODS Participants were 14 children with FASD and 20 TDC. RSA was measured at baseline, during, and following a mindfulness exercise. A mindfulness compliance checklist was completed to ascertain if children could follow the task instructions. RESULTS Both groups obtained high scores on the mindfulness compliance checklist. There was a trend for children with FASD to have lower baseline RSA compared to TDC. Children in both groups demonstrated an increase in RSA during the mindfulness task. CONCLUSIONS Children with FASD could engage in a mindfulness task, and both groups showed an increase in RSA. Further research is needed to establish whether prolonged mindfulness practice could be beneficial.
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Affiliation(s)
- Natasha Reid
- a School of Applied Psychology, Menzies Health Institute Queensland , Griffith University , Mt Gravatt , Queensland , Australia
| | - Paul Harnett
- b School of Psychology , University of Queensland , St Lucia , Queensland , Australia
| | - Frances O'Callaghan
- c School of Applied Psychology, Menzies Health Institute Queensland , Griffith University , Gold Coast , Queensland , Australia
| | - Doug Shelton
- d Director of Community Child Health, Child Development Service , Gold Coast Hospital & Health Service , Queensland , Gold Coast , Australia
| | - Melissa Wyllie
- a School of Applied Psychology, Menzies Health Institute Queensland , Griffith University , Mt Gravatt , Queensland , Australia
| | - Sharon Dawe
- a School of Applied Psychology, Menzies Health Institute Queensland , Griffith University , Mt Gravatt , Queensland , Australia
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12
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Mendoza R, Morales-Marente E, Palacios MS, Rodríguez-Reinado C, Corrales-Gutiérrez I, García-Algar Ó. Health advice on alcohol consumption in pregnant women in Seville (Spain). GACETA SANITARIA 2019; 34:449-458. [PMID: 30733046 DOI: 10.1016/j.gaceta.2018.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To analyse to what extent pregnant women remembered having received health advice regarding alcohol consumption during pregnancy, what the message they perceived was and whether there is social inequality in this regard. METHOD A cross-sectional descriptive study was performed with a sample of 426 pregnant women (in their 20th week of pregnancy) receiving care in the outpatient clinics of a university hospital in a southern Spanish city (Seville). The data were collected through face-to-face structured interviews carried out by trained health professionals. RESULTS 43% of the interviewed women stated that they had not received any health advice in this regard. Only 43.5% of the sample remembered having received the correct message (not to consume any alcohol at all during pregnancy) from their midwife, 25% from their obstetrician and 20.3% from their general practitioner. The women with a low educational level were those who least declared having received health advice on the issue. CONCLUSION The recommended health advice to avoid alcohol consumption during pregnancy does not effectively reach a large proportion of pregnant women. Developing institutional programmes which help healthcare professionals to carry out effective preventive activities of foetal alcohol spectrum disorder is needed.
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Affiliation(s)
- Ramón Mendoza
- Department of Social, Developmental and Educational Psychology, University of Huelva, Huelva, Spain; Research Group on Health Promotion and Development of Lifestyle across the Life Span, University of Huelva, Huelva, Spain
| | - Elena Morales-Marente
- Department of Social, Developmental and Educational Psychology, University of Huelva, Huelva, Spain; Center for Research in Contemporary Thought and Innovation for Social Development (COIDESO)
| | - M Soledad Palacios
- Department of Social, Developmental and Educational Psychology, University of Huelva, Huelva, Spain; Center for Research in Contemporary Thought and Innovation for Social Development (COIDESO)
| | - Carmen Rodríguez-Reinado
- Research group in Social Studies and Social Intervention, Center for Research in Contemporary Thought and Innovation for Social Development (COIDESO), University of Huelva, Huelva, Spain
| | | | - Óscar García-Algar
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clínic-Maternitat, BCNatal, Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Reid N, Petrenko CLM. Applying a Developmental Framework to the Self-Regulatory Difficulties of Young Children with Prenatal Alcohol Exposure: A Review. Alcohol Clin Exp Res 2018; 42:987-1005. [PMID: 29672859 DOI: 10.1111/acer.13756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/08/2018] [Indexed: 12/31/2022]
Abstract
Prenatal alcohol exposure (PAE) can be associated with significant difficulties in self-regulatory abilities. As such, interventions have been developed that focus on improving varying aspects of self-regulation for this population. The application of a multilevel theoretical framework that describes the development of self-regulation during early childhood could further advance the field. First, this framework could assist in elucidating mechanisms in the trajectories of early adjustment problems in this population and, second, informing the development of more precise assessment and interventions for those affected by PAE. The aims of the current review were to provide an overview of the self-regulatory framework proposed by Calkins and colleagues (e.g., Calkins, 2007; Calkins and Fox, 2002); examine the self-regulatory difficulties that are commonly experienced during infancy (i.e., 0 to 2 years) and early childhood (i.e., 3 to 8 years) in children with PAE in the context of the developmental framework; and describe how the framework can inform the development of future assessment and intervention provision for young children with PAE. The application of a developmental framework, such as proposed by Calkins and colleagues, allows for a systematic and theoretically driven approach to assessment and intervention programs for young children with PAE.
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Affiliation(s)
- Natasha Reid
- Centre for Child Health Research, University of Queensland, Brisbane, Queensland
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14
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Reid N, Gamble J, Creedy DK, Finlay-Jones A. Benefits of caseload midwifery to prevent fetal alcohol spectrum disorder: A discussion paper. Women Birth 2018; 32:3-5. [PMID: 29602689 DOI: 10.1016/j.wombi.2018.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/02/2018] [Accepted: 03/14/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Exposure to alcohol prenatally can result in a child being diagnosed with fetal alcohol spectrum disorder. Affected infants experience lifelong impairments that can involve, physical, cognitive, behavioural and emotional difficulties that impact on their functional capacity. Effective prevention of fetal alcohol spectrum disorder is critically needed in Australia. Reduction in the prevalence of this disorder will only be possible if we prevent alcohol consumption during pregnancy. AIM This paper provides an overview of fetal alcohol spectrum disorder and discusses the role of caseload midwifery as part of a multi-level prevention approach. FINDINGS Drawing on previous research, caseload midwifery has potential to support the prevention of fetal alcohol spectrum disorder through continuity of care. CONCLUSION Prevention of fetal alcohol spectrum disorder will be more likely if women experience a supportive relationship with a known midwife, who has received appropriate training and can enable women to feel comfortable in discussing and addressing alcohol use.
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Affiliation(s)
- Natasha Reid
- The University of Queensland, Child Health Research Centre, 62 Graham Street, South Brisbane, Queensland 4101, Australia.
| | - Jenny Gamble
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, Australia.
| | - Debra K Creedy
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, Australia.
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15
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Unrealistic optimism with regard to drinking during pregnancy among women of childbearing age in a South African community. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246317717105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drinking alcohol during pregnancy is a risk factor in a range of adverse birth outcomes, including fetal alcohol spectrum disorders, and is a major health concern. For this behaviour to change one of the necessary conditions is for women to have an accurate perception of the risks drinking during pregnancy poses. A major obstacle to this is the presence of unrealistic optimism which leads to women believing they are less at risk than others. This study examined a sample of women ( N = 129) from a community in the Northern Cape Province in South Africa with a high prevalence of fetal alcohol spectrum disorder for signs of unrealistic optimism. A questionnaire about the perception of personal and general risk was administered during a one-on-one interview and responses compared. Neither a Student’s t-test ( t(115) = −1.720, p = .088, 95% confidence interval [−0.180, 0.013]) nor a Wilcoxon matched-pairs signed-rank test ( z = −1.72, p = .285) showed a significant difference. The perception of risk posed by drinking during pregnancy to others, knowledge of fetal alcohol spectrum disorder, and the perception of how easy it would be for the participant to quit drinking were significant predictors of the perception of personal risk. Only the perception of personal risk predicted the perception of general risk. There was no evidence that participants believed themselves to be less at risk than their peers when it came to the risks of drinking during pregnancy. Future directions for research into unrealistic optimism and drinking during pregnancy are discussed.
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16
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du Plooy CP, Malcolm-Smith S, Adnams CM, Stein DJ, Donald KA. The Effects of Prenatal Alcohol Exposure on Episodic Memory Functioning: A Systematic Review: Table 1. Arch Clin Neuropsychol 2016; 31:710-726. [DOI: 10.1093/arclin/acw067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 01/04/2023] Open
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17
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Rai JK, Abecassis M, Casey JE, Flaro L, Erdodi LA, Roth RM. Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children. Child Neuropsychol 2016; 23:713-732. [DOI: 10.1080/09297049.2016.1191628] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jaspreet K. Rai
- Department of Psychology, University of Windsor, Ontario, Canada
| | - Maurissa Abecassis
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Joseph E. Casey
- Department of Psychology, University of Windsor, Ontario, Canada
| | | | - Laszlo A. Erdodi
- Department of Psychology, University of Windsor, Ontario, Canada
| | - Robert M. Roth
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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18
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Hellenbach M, Karatzias T, Brown M. Intellectual Disabilities Among Prisoners: Prevalence and Mental and Physical Health Comorbidities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:230-241. [PMID: 26775928 DOI: 10.1111/jar.12234] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Limited evidence suggests that people with ID (ID) are overrepresented in prisons although prevalence rates of ID among prisoners vary significantly across studies, making it difficult to identify prevalence and assess existing need. METHOD A systematic review of relevant literature was conducted, and results were organized and compared in relation to study aims, design, measures used to screen for ID, sample, limitations and key findings. RESULTS Existing international data suggest a prevalence of prisoners with ID between 7 and 10%. Most frequent coexisting health issues among this population are hearing and vision impairments, obesity, diabetes and a range of mental health disorders, notably anxiety and personality and conduct disorders. CONCLUSION More research is required on prevalence rates and associated comorbidities of ID within prison settings, taking into account the heterogeneity of the population with ID.
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Affiliation(s)
- Mike Hellenbach
- Faculty of Health, Life and Social Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Thanos Karatzias
- Faculty of Health, Life and Social Sciences, Edinburgh Napier University, Edinburgh, UK.,The Rivers Centre, Royal Edinburgh Hospital, NHS Lothian, Edinburgh, UK
| | - Michael Brown
- Faculty of Health, Life and Social Sciences, Edinburgh Napier University, Edinburgh, UK.,Learning Disability Service, NHS Lothian, Edinburgh, UK
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Morton RA, Valenzuela CF. Further characterization of the effect of ethanol on voltage-gated Ca(2+) channel function in developing CA3 hippocampal pyramidal neurons. Brain Res 2015; 1633:19-26. [PMID: 26711851 DOI: 10.1016/j.brainres.2015.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/16/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
Developmental ethanol exposure damages the hippocampus, a brain region involved in learning and memory. Alterations in synaptic transmission and plasticity may play a role in this effect of ethanol. We previously reported that acute and repeated exposure to ethanol during the third trimester-equivalent inhibits long-term potentiation of GABAA receptor-dependent synaptic currents in CA3 pyramidal neurons through a mechanism that depends on retrograde release of brain-derived neurotrophic factor driven by activation of voltage-gated Ca(2+) channels (Zucca and Valenzuela, 2010). We found evidence indicating that voltage-gated Ca(2+) channels are inhibited in the presence of ethanol, an effect that may play a role in its mechanism of action. Here, we further investigated the acute effect of ethanol on the function of voltage-gated Ca(2+) channels in CA3 pyramidal neurons using Ca(2+) imaging techniques. These experiments revealed that acute ethanol exposure inhibits voltage-gated Ca(2+) channels both in somatic and proximal dendritic compartments. To investigate the long-term consequences of ethanol on voltage-gated Ca(2+) channels, we used patch-clamp electrophysiological techniques to assess the function of L-type voltage-gated Ca(2+) channels during and following ten days of vapor ethanol exposure. During ethanol withdrawal periods, the function of these channels was not significantly affected by vapor chamber exposure. Taken together with our previous findings, our results suggest that 3(rd) trimester-equivalent ethanol exposure transiently inhibits L-type voltage-gated Ca(2+) channel function in CA3 pyramidal neurons and that compensatory mechanisms restore their function during ethanol withdrawal. Transient inhibition of these channels by ethanol may be, in part, responsible for the hippocampal abnormalities associated with developmental exposure to this agent.
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Affiliation(s)
- Russell A Morton
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - C Fernando Valenzuela
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
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20
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An animal model of fetal alcohol spectrum disorder: Trace conditioning as a window to inform memory deficits and intervention tactics. Physiol Behav 2014; 148:36-44. [PMID: 25477227 DOI: 10.1016/j.physbeh.2014.11.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/21/2014] [Accepted: 11/23/2014] [Indexed: 01/03/2023]
Abstract
Animal models of Fetal Alcohol Spectrum Disorders (FASD) afford the unique capacity to precisely control timing of alcohol exposure and alcohol exposure amounts in the developing animal. These models have powerfully informed neurophysiological alterations associated with fetal and perinatal alcohol. In two experiments presented here we expand use of the Pavlovian Trace Conditioning procedure to examine cognitive deficits and intervention strategies in a rat model of FASD. Rat pups were exposed to 5g/kg/day ethanol on postnatal days (PD) 4-9, simulating alcohol exposure in the third trimester in humans. During early adolescence, approximately PD 30, the rats were trained in the trace conditioning task in which a light conditioned stimulus (CS) and shock unconditioned stimulus (US) were paired but separated by a 10-s stimulus free trace interval. Learning was assessed in freezing behavior during shock-free tests. Experiment 1 revealed that neonatal ethanol exposure significantly impaired hippocampus-dependent trace conditioning relative to controls. In Experiment 2 a serial compound conditioning procedure known as 'gap filling' completely reversed the ethanol-induced deficit in trace conditioning. We also discuss prior data regarding the beneficial effects of supplemental choline and novel preliminary data regarding the pharmacological cognitive enhancer physostigmine, both of which mitigate the alcohol-induced cognitive deficit otherwise seen in trace conditioning controls. We suggest trace conditioning as a useful tool for characterizing some of the core cognitive deficits seen in FASD, and as a model for developing effective environmental as well as nutritional and pharmacological interventions.
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21
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Szturm T, Polyzoi E, Marotta J, Srikesavan CS. An In-School-Based Program of Combined Fine Motor Exercise and Educational Activities for Children with Neurodevelopmental Disorders. Games Health J 2014; 3:326-32. [PMID: 26192639 DOI: 10.1089/g4h.2014.0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article introduces a game-based rehabilitation platform designed to integrate training of fine motor skills and cognitive functions. A novel computer interface device was developed that can effectively replace a standard computer mouse when doing exercises to rehabilitate hand function. This smart device converts signals from miniature motion sensors to signals equivalent to that of a computer mouse. In this way, nearly any object or utensil can be changed to function exactly as a computer mouse, simply by attaching the motion sensor. Multiple objects with varied sizes, shapes, weights, and functional demands for precision can be used for exercise and to practice a variety of gross or fine motor skills, and, importantly, while playing fun computer games. The platform was designed to work with modern and common computer games, which have a broad range of movement speeds and accuracy levels, cognitive activities (puzzles, choices, distractors), and educational content. The platform includes a designed assessment game with advanced data logging for electronic monitoring. Data analysis methods have been developed to quantify performance metrics that provide insights into the quality, efficiency, and skill of a child and thus mean to conduct trend analyses that indicate how the child is performing over time.
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Affiliation(s)
- Tony Szturm
- 1 Department of Physical Therapy, College of Rehabilitation Sciences, Faculty of Health Sciences, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Eleoussa Polyzoi
- 2 Faculty of Education (Developmental Studies & Special Needs Education), University of Winnipeg , Winnipeg, Manitoba, Canada
| | - Jonathan Marotta
- 3 Department of Psychology, University of Manitoba , Winnipeg, Manitoba, Canada
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Ulrich F, Petermann F. Zur Bedeutung von sozialer Unterstützung während der Schwangerschaft. PSYCHOLOGISCHE RUNDSCHAU 2014. [DOI: 10.1026/0033-3042/a000197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Eine wachsende Zahl an Studien dokumentiert die negativen Auswirkungen von mütterlichen psychosozialen Stressoren (z. B. mütterliche Depression) und gesundheitsrelevanten Verhaltensweisen (z. B. Nikotin- und Alkoholkonsum) während der Schwangerschaft auf den Geburtsausgang. Jedoch werden mütterliche Ressourcen in diesem Kontext noch unzureichend berücksichtigt. Das Ziel ist es daher, die Bedeutung sozialer Unterstützung als frühe Ressource im Schwangerschaftsverlauf und zum Zeitpunkt der Geburt im Hinblick auf das Gesundheitsverhalten der Schwangeren und im Hinblick auf Geburtsmaße zu untersuchen. Die Datenbanken Web of Science und PubMed wurden entsprechend nach deutsch- und englischsprachigen Beiträgen für den Zeitraum 2003 bis 2013 durchsucht. 23 Studien erfüllten die Auswahlkriterien. Die Ergebnisse verdeutlichen, dass die Befundlage sehr inkonsistent ist, was teilweise auf die unterschiedlichen Definitionen sozialer Unterstützung und die Nutzung verschiedener Erhebungsinstrumente zurückzuführen ist. Des Weiteren fehlt es an Studien zur Bedeutung sozialer Unterstützung im Kontext mütterlicher psychosozialer Stressoren und Geburtsmaßen. Es bedarf weiterer Studien an Risiko- und Allgemeinpopulationen, die auf der Basis eines fundierten Rahmenkonzeptes mögliche Effekte der sozialen Unterstützung differenziert analysieren können.
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