International Commission for Protection against Environmental Mutagens and Carcinogens. ICPEMC Working Paper No. 15/7. Reproductive consequences of alcohol abuse: males and females compared and contrasted

Coffee and Smoking as Risk Factors of Twin Pregnancies: The Danish National Birth Cohort

Twinning rates have changed substantially over time for reasons that are only partly known. In this study we studied smoking, coffee and alcohol intake, and their possible interaction with obesity as potential determinants of twinning rates using data from the Danish National Birth Cohort between 1996 and 2002. We identified 82,985 pregnancies: 81,954 singleton and 1031 twins. For the twins we had data to classify 121 as monozygotic, 189 dizygotic (same sex), 313 dizygotic (opposite sex) but, 408 were of the same sex but with unknown zygosity. All mothers were interviewed about their prepregnancy weight and height, coffee and alcohol intake, smoking habits, and potential confounding factors at early stages of pregnancy. We identified smoking (> 10 cigarettes/day) as a possible determinant of twinning, particularly for dizygotic twinning rates (same sex) and furthermore corroborated that obesity and the mother's age are strong correlates of twinning. Others have found coffee intake to increase twinning rates but that is not seen in these data.

Metabolism of ethanol to acetaldehyde and increased susceptibility to oxidative stress could play a role in the ovarian tissue cell injury promoted by alcohol drinking

It is known that drinking alcohol can lead to reproductive problems in women. In this study, we analyzed the possibility that part of those effects were mediated through alterations of ovarian function related to ethanol oxidation to acetaldehyde occurring in situ. Biotransformation in the rat ovary cytosolic fraction was partially inhibited by allopurinol, suggesting the participation of xanthine oxidoreductase in the process. Microsomal pathway was of enzymatic nature, requiring nicotinamide adenine dinucleotide phosphate-oxidase (NADPH), sensitive to oxygen and significantly inhibited by sodium diethyldithiocarbamate, 4-methylpyrazole and diphenyleneiodonium. Aldehyde dehydrogenase activity was detected by histochemistry in the ovarian tissue, in the strome surrounding the follicle while no alcohol dehydrogenase was detected. However, biochemical determination of alcohol dehydrogenase and aldehyde dehydrogenase activities in rat ovarian tissue revealed the presence of some activity of both enzymes but significantly lower than those found in the liver. By repetitive exposure of animals to ethanol, the microsomal metabolism to acetaldehyde was increased but not in the case of the cytosolic fraction. In these animals, t-butylhydroperoxyde-promoted chemiluminiscence was increased in comparison to control, revealing an increased susceptibility to oxidative stress due to alcohol drinking. Ultrastructure of ovarian tissue from rats exposed chronically to alcohol revealed alterations at the level of the granulosa; theca interna and pellucida zones. In the secondary follicle, alterations consisted of marked condensation of chromatin attached to the nuclear inner membrane. Intense dilatation of the outer perinuclear space could be observed. There was a marked dilatation of the rough endoplasmic reticulum accompanied of significant detachment of ribosomes from their membranes. Mitochondria appeared swollen. In the zona pellucida, most of the cell processes from oocyte and corona radiata cells were absent or broken totally or in part. Results suggest that in the rat ovary, metabolism of ethanol to acetaldehyde may play a role in alcohol effects on female reproductive function.

Medical risks for women who drink alcohol

OBJECTIVE

To summarize for clinicians recent epidemiologic evidence regarding medical risks of alcohol use for women.

METHODS

MEDLINE and PsychINFO, 1990 through 1996, were searched using key words "women" or "woman," and "alcohol." MEDLINE was also searched for other specific topics and authors from 1980 through 1996. Data were extracted and reviewed regarding levels of alcohol consumption associated with mortality, cardiovascular disease, alcohol-related liver disease, injury, osteoporosis, neurologic symptoms, psychiatric comorbidity, fetal alcohol syndrome, spontaneous abortion, infertility, menstrual symptoms, breast cancer, and gynecologic malignancies. Gender-specific data from cohort studies of general population or large clinical samples are primarily reviewed.

MAIN RESULTS

Women develop many alcohol-related medical problems at lower levels of consumption than men, probably reflecting women's lower total body water, gender differences in alcohol metabolism, and effects of alcohol on postmenopausal estrogen levels. Mortality and breast cancer are increased in women who report drinking more than two drinks daily. Higher levels of alcohol consumption by women are associated with increased menstrual symptoms, hypertension, and stroke. Women who drink heavily also appear to have increased infertility and spontaneous abortion. Adverse fetal effects occur after variable amounts of alcohol consumption, making any alcohol use during pregnancy potentially harmful.

CONCLUSIONS

In general, advising nonpregnant women who drink alcohol to have fewer than two drinks daily is strongly supported by the epidemiologic literature, although specific recommendations for a particular woman should depend on her medical history and risk factors.

Alcohol and cancer: a review for psycho-oncologists

Researchers have documented a link between alcohol consumption and the development of certain types of cancers. In addition, the prevalence of alcoholism and comorbid psychiatric disorders has been well-documented both the general population and medical settings. The role of the psycho-oncologist in the assessment and management of alcoholism and comorbid psychiatric disorders is crucial to improving both treatment adherence and the quality of life of the patient. This paper will provide psycho-oncologists with a review of: (1) the relationship of alcoholism to cancer; (2) psychiatric comorbidity frequently encountered in alcoholics, as a key to assessment and management; and (3) the goals and strategies of management of alcoholic cancer patient.

Effects of acetaldehyde on cell regeneration and differentiation of the upper gastrointestinal tract mucosa

BACKGROUND

The tumor-promoting effect of ethanol on cancer of the upper respiratory-digestive tract is not well understood. Although ethanol itself is not carcinogenic, the first product of ethanol metabolism-acetaldehyde is. Acetaldehyde can be produced from ethanol by oral bacteria, and high concentrations have been observed in human saliva after ethanol consumption. The purpose of this study was to investigate whether acetaldehyde administered orally to rats induces altered differentiation and proliferation in the animals' upper gastrointestinal tracts.

METHODS

Twenty Wistar rats were given either water containing acetaldehyde at a concentration of 120 mM or tap water to drink for 8 months. Tissue specimens were then taken from the tongue, epiglottis, and forestomach of each animal and immunohistochemically stained for markers of cellular proliferation (Ki67 nuclear antigen) or differentiation (cytokeratins 1, 4, 10, 11, 14, and 19). The mean epithelial thickness of each sample was measured via light microscopy, using an eyepiece containing grid lines. Differences between the control and acetaldehyde-treated groups were analyzed by use of the unpaired Student's t test. All reported P values are two-sided.

RESULTS

Although no tumors were observed, staining for cytokeratins 4 and 14 revealed an enlarged basal layer of squamous epithelia in the rats receiving acetaldehyde. In these animals, cell proliferation was significantly greater than that observed in the control animals for samples from the tongue (P<.0001), epiglottis (P<.001), and forestomach (P<.0001). In addition, the epithelia from acetaldehyde-treated rats were significantly thicker than in epithelia from control animals (P<.05 for all three sites).

CONCLUSIONS

Acetaldehyde, administered orally to rats, can cause hyperplastic and hyperproliferative changes in epithelia of the upper gastrointestinal tract. This finding suggests that microbially produced acetaldehyde in saliva may explain the tumor-promoting effect of ethanol on these epithelia.

Paternal exposures: impact on reproductive and developmental outcome. An overview

Experimental and epidemiologic investigations document the adverse consequences of an array of paternal exposures on the development of subsequent offspring. Male-mediated abnormalities have been reported after exposure to therapeutic and recreational drugs, to chemicals in the workplace and environment and to ionizing radiation. The impact on progeny outcome includes: an increase in congenital malformations, spontaneous abortions, fetal resorptions; low birth weight; increase in childhood cancers; developmental, neurobehavioral, neuroendocrine, neurochemical abnormalities; effects in F2 generation progeny. Fertility is often unaffected. The comparative influence of genetic, epigenetic and nongenetic mechanisms in the etiology of paternally-mediated adverse outcomes is unknown. There is no a priori reason to assume that male-mediated effects are limited to the agents studied to date. The broad spectrum of alterations recorded after exposure to a variety of unrelated agents suggests the need for a more focused effort and multidisciplinary exploration of the potential impact of the male parent on reproductive outcome.

Alcohol and endometrial cancer risk: findings from an Italian case-control study

Using data from a case-control study conducted in Northern Italy, we analyzed the relation between alcohol drinking and risk of endometrial cancer. Cases were 726 patients, < 75 years of age, admitted to the Ospedale Maggiore (including the 4 largest teaching and general hospitals in the Greater Milan area), the University Obstetrics and Gynecology Clinics, and the National Cancer Institute of Milan with histologically confirmed endometrial cancer. Controls were 2,123 nonhysterectomized patients, < 75 years of age, admitted for acute nongynecological non-hormone-related nonneoplastic conditions to the same network of hospitals where cases had been identified. When total consumption of all alcoholic beverages was considered, 68.2% of cases and 63.9% of controls were drinkers and 12% of cases and 9.3% of controls reported > or = 2 drinks/day. Considering total alcohol drinking, the relative risk for alcohol drinkers vs. nondrinkers was 1.3 (95% confidence interval 1.1-1.5), and the RR estimates for subsequent levels of intake were 1.1, 1.4, and 1.6 for women drinking > 0 < or = 1, > 1 < or = 2 drinks/day (chi 2(1) trend 11.33, p < 0.001). The estimates were similar when wine only (which represents the large majority of all alcohol intake in Italy) was considered, whereas data were less informative for beer and spirits intake only. No relation emerged between duration of alcohol consumption and risk of endometrial cancer. These findings suggest a potential link between alcohol drinking and endometrial cancer risk and are, in any case, inconsistent with a protective role of alcohol in endometrial carcinogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Toxicological effects of ethanol on human health

Moderate ethanol consumption reduces stress and increases feelings of happiness and well-being, and may reduce the risk of coronary heart disease. Heavy consumption of alcohol, however, may cause addiction and increases all types of injury and trauma. Environmental and genetic factors are involved in susceptibility to alcoholism. Ethanol can lead to malnutrition, and can exert a direct toxicological effect due to its interference with hepatic metabolism and immunological functions. A causal effect has been observed between alcohol and various cancers. Cessation of alcohol consumption and balanced nutrition are recommended primary nonspecific therapeutic measures for alcoholics. Drug therapies for alcoholics suffering from liver injury has resulted in mixed results. In end-stage liver disease, liver transplantation may be considered.

Infertility in women and moderate alcohol use

OBJECTIVE

The purpose of this study was to investigate the relationship between moderate alcohol intake and fertility.

METHODS

Interviews were conducted with 3833 women who recently gave birth and 1050 women from seven infertility clinics. The case subjects were categorized based on the infertility specialist's assignment of the most likely cause of infertility: ovulatory factor, tubal disease, cervical factor, endometriosis, or idiopathy. Separate logistic regression models were used to assess the relationship between alcohol use and each type of infertility, adjusted for age, infertility center, cigarette smoking, caffeine use, number of sexual partners, use of an intrauterine device (for tubal disease), and body mass index and exercise (for ovulatory factor).

RESULTS

We found an increase in infertility, due to ovulatory factor or endometriosis, with alcohol use. The odds ratio for ovulatory factor was 1.3 (95% confidence interval [CI] = 1.0, 1.7) for moderate drinkers and 1.6 (95% CI = 1.1, 2.3) for heavier drinkers, compared with nondrinkers. The risk of endometriosis was roughly 50% higher in case subjects with any alcohol intake than in control subjects (OR = 1.6, 95% CI = 1.1, 2.3, at moderate levels; OR = 1.5, 95% CI = 0.8, 2.7, at heavier levels).

CONCLUSIONS

Moderate alcohol use may contribute to the risk of specific types of infertility.

Alcoholic beverage consumption and risk of breast cancer in Spain

The relation between alcoholic beverage consumption and risk of breast cancer was examined. We used data from a population-based, case-control study that included almost all incident cases occurring in five Spanish regions from February 1990 to July 1991. A total of 762 women between 18 and 75 years of age, with a histologically confirmed, first diagnosis of breast cancer, were compared with 988 control women. Alcoholic beverage intake was measured by an interviewer-administered, semiquantitative food-frequency questionnaire. We used 'nondrinkers' as the reference category and divided the remainder into four categories according to alcohol intake. The multiple logistic analyses included not only alcohol intake but also possible confounding factors such as total caloric intake, age, socioeconomic status, and reproductive and medical histories. Even at moderate levels of alcohol intake (less than 8 g/day), a 50 percent increase in risk of breast cancer was found. The trend across categories of intake was statistically significant for wine and distilled drinks, as well as total alcohol intake. Consumption of 20 g or more of alcohol per day was associated with a 70 percent elevation in breast cancer risk compared with that of nondrinkers (adjusted relative risk (RR) = 1.7, 95 percent confidence interval = 1.3-2.3). Although the magnitude of the RR observed in our study was modest, our findings provide further support for a positive association between alcohol consumption and risk of breast cancer.

Alcohol consumption and postmenopausal endometrial cancer: results from the Iowa Women's Health Study

At least three case-control studies have examined the association between alcohol consumption and endometrial cancer; two studies showed inverse associations, and a third a positive association. To our knowledge, no prospective studies of this association have been reported. The association between alcohol and endometrial cancer was examined in the Iowa Women's Health Study (United States), a prospective study of postmenopausal women. Information on alcohol consumption and other variables was obtained through a mailed questionnaire in January 1986. Through December 1990, 167 incident endometrial cancer cases occurred in the at-risk cohort of 25,170 women. Multivariate-adjusted relative risks (RR) and 95 percent confidence intervals (CI) were computed using Cox proportional hazards regression controlling for age, body mass index (BMI), parity, age at menopause, and noncontraceptive estrogen use, and to determine multiplicative interactions. The RRs of endometrial cancer associated with < 4.0 and > or = 4.0 g of alcohol per day compared with abstainers were 0.7 (CI = 0.5-1.1) and 1.0 (CI = 0.7-1.6), respectively. No statistically significant association between endometrial cancer and consumption of either beer, wine, or liquor was observed. There was no interaction between alcohol and any other endometrial cancer risk factors, including BMI or noncontraceptive estrogen use. These data do not support an association between alcohol and endometrial cancer among postmenopausal women.

Ultrastructural study of the ventral lobe of the prostate of rats submitted to experimental chronic alcoholism

The effects of chronic alcohol ingestion on the ventral lobe of the prostate were studied in rats (Rattus norvegicus). Ultrastructural observations on the epithelial cells of the ventral lobe of the prostate showed irregularly shaped nuclei with deep infoldings, dilated RER cisternae, and a small number of microvilli covering the cell surface. After 90 and 135 days of alcohol treatment, the epithelial cells showed signs of degeneration.

The effect of tequila in the synaptonemal complex structure of mouse spermatocytes

The effect of tequila in the synaptonemal complex (SC) of mouse spermatocytes was determined. We tested 3 dosages (2.1, 4.2 and 8.4 g/kg) administered in a single intraperitoneal inoculation. The frequency of SC alterations was established in pachytenic nuclei 5 days after the administration using a silver impregnation technique. Three types of alterations were observed (desynapses, breaks and multiaxials) and the rate of each alteration was compared with that obtained with appropriate controls, including cyclophosphamide (CP) (150 mg/kg). The results showed a significant increase induced by tequila only in the frequency of desynapses. This damage began at the second highest dose (4.2 g/kg). The other SC alterations were in the control range. CP, however, induced a significant increase in all 3 types of SC alterations.

Evaluation of the co-mutagenicity of ethanol and Δ9-tetrahydrocannabinol with Trenimon

The mutagenic potential of chronic treatments of male CF-1 mice with ethanol and delta 9-tetrahydrocannibinol (THC), and their comutagenic potential with a known mutagenic agent, Trenimon, were examined. This was accomplished by measuring the frequency of dominant lethal mutations arising from mating of treated males with nontreated females. Adult male mice were treated with 5% (v/v) ethanol as part of a liquid diet (28% ethanol-derived calories) for five weeks; 10 mg/kg body weight (p.o.) THC every two days for five weeks; a single injection of Trenimon (0.125 mg/kg, i.p.) on day 28 of diet treatment; and all combinations of treatments. The control group was pair-fed a liquid diet in which isocaloric sucrose replaced ethanol; these males were also given sesame oil (vehicle for THC) and saline (vehicle for Trenimon) on the same schedule as that for the treated males. Neither body weights nor hematocrits were adversely affected by any treatment. Both ethanol and Trenimon treatments resulted in a small (8-9%; p less than 0.05) decrease in testicular weight. The effect of combined treatment with ethanol and Trenimon was roughly additive. Treatment with THC had no effect on testicular weight. Seminal vesicle weights were not affected by any treatment. Treatments were without significant effect on fertility, as measured by the frequency of males producing pregnancies. Ethanol and Trenimon treatments produced approximately 3- and 7-fold increases, respectively in the frequencies of preimplantational loss over that seen for the control group (7.3%), resulting in significant ethanol and Trenimon effects (p less than 0.001). No interactive effects of ethanol and Trenimon treatments were noted. Frequencies of dead fetuses per pregnancy in the ethanol- and Trenimon-treated groups were increased approximately 2.5- and 4-fold, respectively, over the control value of approximately 16%. However, the effect of combined treatments was not greater than that due to Trenimon alone, resulting in Trenimon and ethanol effects (p less than 0.001) and ethanol-Trenimon interaction (p less than 0.001). The calculated mutation index resulting from each treatment yielded significant (p less than 0.001) ethanol- and Trenimon-induced effects. In contrast to effects of ethanol and Trenimon treatments, THC, given alone, or in combination with ethanol and/or Trenimon, had no effect on either preimplantational loss, fetal mortality or the resulting mutation index. The data suggest that chronic ethanol treatment, at levels resulting in minimal fertility impairment, increases the frequency of dominant lethal mutations. In contrast, chronic treatment with THC, as administered in the present study, appears to be without effect.(ABSTRACT TRUNCATED AT 400 WORDS)

A comparative study on ethanol and acetaldehyde as inducers of chromosome malsegregation in Aspergillus nidulans

The activity of ethyl alcohol and acetaldehyde on mitotic chromosome segregation and conidial germination in Aspergillus nidulans was studied. Ethanol effectively induced malsegregation in a narrow range of concentrations (4.5-5.5%, v/v) and was inactive at doses which arrested conidial germination (above 6%). The same bell-shaped dose-response curve was shown by the spindle poison chloral hydrate, which was active in the range 6-10 mM. Acetaldehyde displayed a diphasic dose-response curve. Genetic analysis of induced segregants suggests that the disturbance of chromosome segregation is the primary genetic effect at low doses (0.025-0.037%), while at higher doses (above 0.1%), when growth was arrested, chromosome damage was primarily induced. The same pattern of segregants was produced by hydroquinone, a substance which indirectly affects chromosome segregation in A. nidulans. These differences in the genotoxic profiles of ethanol and acetaldehyde suggest that the effect exerted by ethanol on A. nidulans mitosis is not dependent on its conversion into acetaldehyde. In the absence of an effect of ethanol on in vitro polymerization of tubulin (actively inhibited by acetaldehyde at doses above 0.075%), a direct effect of ethanol on cell membranes is hypothesized. Comparison of the inhibition of growth and the effectiveness in aneuploidy induction displayed by ethanol, methanol, n-propanol and n-butanol demonstrates, in fact, a fair correlation with logP, a descriptor of lipophilicity related to the partitioning of compounds in biological membranes.

Biochemical and structural evidence for ethanol-induced impairment of testicular development: apparent lack of Leydig cell involvement

The present study was conducted to provide biochemical and morphological evidence for ethanol-induced impairment of testicular development. The specific activities of testicular postmeiotic enzyme markers--sorbitol dehydrogenase (SDH), lactate dehydrogenase (LDH), and alpha-glycerophosphate dehydrogenase (GDH)--increased with age in CFW mice from ages 23 to 60 days, providing a biochemical measure of testicular development during puberty. Chronic ethanol treatment via liquid diets from ages 20 to 55 days resulted in decreased activities of SDH and LDH at ages 40 and 44 days, and of GDH at ages 34, 40, and 44 days. These decreases were consistent with an arrest in the developmental increase in SDH, LDH, and GDH at ages 31 +/- 0.6, 31 +/- 2.6, and 24 +/- 0.5 days, respectively. After 29 days of ethanol treatment (age 50 days), testicular weights, epididymal sperm content, and sperm motility were reduced, relative to controls, by 37, 83, and 60%, respectively (p less than 0.05). Epididymal weights were unaffected. Light microscopic evaluation of testes revealed disorganization of spermatogenesis, germ cell degeneration, decreased tubular luminal diameter, and vacuolation of Sertoli cells in ethanol-treated mice at age 50 days. Electron microscopic analysis showed that germ cell degeneration was not restricted to a specific cell type. Stage IX-XI tubules were observed in which spermatids had been retained and underwent phagocytosis within the Sertoli cell. Sertoli cells showed evidence of atypical nuclear invaginations. Sertoli cells underwent degenerative changes and were sloughed into the rete testis. However, relative Leydig cell size, as well as fractional volume occupied by the nucleus, mitochondria, and endoplasmic reticulum were unaffected by ethanol. The data (1) confirm previous findings suggesting ethanol-induced delayed testicular development; (2) suggest that certain aspects of testicular development are arrested relatively early in ethanol treatment (4-11 days); and (3) indicate that the Sertoli cell, rather than the Leydig cell, is the primary target with regard to the deleterious effect of chronic ethanol treatment on testicular maturation.

Ethanol-induced delayed male puberty in mice is not due to impaired Leydig cell function

The present study was performed to evaluate the involvement of reduced testosterone in ethanol-induced impairment of male reproductive tract development. In vivo and in vitro gonadotropin (hCG)-stimulated steroidogenesis were examined in CFW mice as a function of chronic ethanol treatment during pubertal development. Chronic ethanol treatment from ages 20 to 49 days impaired testicular growth from ages 35 days (29 +/- 2 mg vs 37 +/- 2 mg for pair-fed controls) to 50 days (42 +/- 2 mg vs 63 +/- 2 mg for pair-fed controls). Consistent with a reduction in testicular weight, testicular content of androstenedione, testosterone, and dihydrotestosterone (DHT) was depressed in ethanol-treated mice. At age 50 days, the content (expressed as pg/testis) of androstenedione, testosterone, and DHT was reduced in ethanol-treated animals by 49%, 31%, and 38%, respectively, as compared to that of their respective controls. However, no difference in plasma (ng/mL) or testicular (pg/mg protein) concentrations of steroids was observed. Except for the DHT response at ages 35 to 40 days, neither in vivo nor in vitro steroidogenesis was impaired by chronic ethanol treatment at ages 26 to 50 days; similarly, the acute ethanol effect on steroidogenesis was unaffected. However, an adaptive increase (54%-173%) in the in vivo testosterone response to hCG was seen at ages 26 to 40 days. The data indicate that 1) chronic ethanol treatment does not impair gonadotropin-stimulated steroidogenesis or result in tolerance to acute ethanol effects on steroidogenesis in older animals; and 2) ethanol-induced reduction in testosterone is not a likely mechanism for delayed sexual maturation.