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Stevens MWR, Cooper M, Cusack L, Ali RL, Holmwood C, Briley AL. Screening and early intervention for substance use during pregnancy: A retrospective case note review of antenatal care records. Drug Alcohol Rev 2024. [PMID: 39138132 DOI: 10.1111/dar.13927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care. METHODS A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital-based antenatal clinics, from July 2019-September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed. RESULTS The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e-cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients. DISCUSSION AND CONCLUSIONS Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e-cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services.
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Affiliation(s)
- Matthew W R Stevens
- School of Biomedicine (Pharmacology), The University of Adelaide, Adelaide, Australia
| | - Megan Cooper
- Caring Futures Institute Flinders University, Adelaide, Australia
| | - Lynette Cusack
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Robert L Ali
- School of Biomedicine (Pharmacology), The University of Adelaide, Adelaide, Australia
| | - Chris Holmwood
- School of Biomedicine (Pharmacology), The University of Adelaide, Adelaide, Australia
| | - Annette L Briley
- Caring Futures Institute Flinders University, Adelaide, Australia
- Northern Adelaide Local Health Network, Lyell McEwin Hospital, Adelaide, Australia
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Hatai D, Levenson MT, Rehan VK, Allard P. Inter- and trans-generational impacts of environmental exposures on the germline resolved at the single-cell level. CURRENT OPINION IN TOXICOLOGY 2024; 38:100465. [PMID: 38586548 PMCID: PMC10993723 DOI: 10.1016/j.cotox.2024.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Reproduction is a remarkably intricate process involving the interaction of multiple cell types and organ systems unfolding over long periods of time and that culminates with the production of gametes. The initiation of germ cell development takes place during embryogenesis but only completes decades later in humans. The complexity inherent to reproduction and its study has long hampered our ability to decipher how environmental agents disrupt this process. Single-cell approaches provide an opportunity for a deeper understanding of the action of toxicants on germline function and analyze how the response to their exposure is differentially distributed across tissues and cell types. In addition to single-cell RNA sequencing, other single-cell or nucleus level approaches such as ATAC-sequencing and multi-omics have expanded the strategies that can be implemented in reproductive toxicological studies to include epigenomic and the nuclear transcriptomic data. Here we will discuss the current state of single-cell technologies and how they can best be utilized to advance reproductive toxicological studies. We will then discuss case studies in two model organisms (Caenorhabditis elegans and mouse) studying different environmental exposures (alcohol and e-cigarettes respectively) to highlight the value of single-cell and single-nucleus approaches for reproductive biology and reproductive toxicology.
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Affiliation(s)
- Dylan Hatai
- UCLA Molecular Toxicology Interdepartmental Program, University of California Los Angeles, Los Angeles, CA, USA
| | - Max T. Levenson
- UCLA Molecular Toxicology Interdepartmental Program, University of California Los Angeles, Los Angeles, CA, USA
| | - Virender K. Rehan
- UCLA Molecular Toxicology Interdepartmental Program, University of California Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Patrick Allard
- UCLA Molecular Toxicology Interdepartmental Program, University of California Los Angeles, Los Angeles, CA, USA
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
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Mudyanselage AW, Wijamunige BC, Kocoń A, Turner R, McLean D, Morentin B, Callado LF, Carter WG. Alcohol Triggers the Accumulation of Oxidatively Damaged Proteins in Neuronal Cells and Tissues. Antioxidants (Basel) 2024; 13:580. [PMID: 38790685 PMCID: PMC11117938 DOI: 10.3390/antiox13050580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/30/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Alcohol is toxic to neurons and can trigger alcohol-related brain damage, neuronal loss, and cognitive decline. Neuronal cells may be vulnerable to alcohol toxicity and damage from oxidative stress after differentiation. To consider this further, the toxicity of alcohol to undifferentiated SH-SY5Y cells was compared with that of cells that had been acutely differentiated. Cells were exposed to alcohol over a concentration range of 0-200 mM for up to 24 h and alcohol effects on cell viability were evaluated via MTT and LDH assays. Effects on mitochondrial morphology were examined via transmission electron microscopy, and mitochondrial functionality was examined using measurements of ATP and the production of reactive oxygen species (ROS). Alcohol reduced cell viability and depleted ATP levels in a concentration- and exposure duration-dependent manner, with undifferentiated cells more vulnerable to toxicity. Alcohol exposure resulted in neurite retraction, altered mitochondrial morphology, and increased the levels of ROS in proportion to alcohol concentration; these peaked after 3 and 6 h exposures and were significantly higher in differentiated cells. Protein carbonyl content (PCC) lagged behind ROS production and peaked after 12 and 24 h, increasing in proportion to alcohol concentration, with higher levels in differentiated cells. Carbonylated proteins were characterised by their denatured molecular weights and overlapped with those from adult post-mortem brain tissue, with levels of PCC higher in alcoholic subjects than matched controls. Hence, alcohol can potentially trigger cell and tissue damage from oxidative stress and the accumulation of oxidatively damaged proteins.
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Affiliation(s)
- Anusha W. Mudyanselage
- Clinical Toxicology Research Group, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK; (A.W.M.); (B.C.W.); (A.K.); (R.T.)
- Department of Export Agriculture, Faculty of Agricultural Sciences, Sabaragamuwa University of Sri Lanka, Belihuloya 70140, Sri Lanka
| | - Buddhika C. Wijamunige
- Clinical Toxicology Research Group, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK; (A.W.M.); (B.C.W.); (A.K.); (R.T.)
- Department of Export Agriculture, Faculty of Agricultural Sciences, Sabaragamuwa University of Sri Lanka, Belihuloya 70140, Sri Lanka
| | - Artur Kocoń
- Clinical Toxicology Research Group, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK; (A.W.M.); (B.C.W.); (A.K.); (R.T.)
| | - Ricky Turner
- Clinical Toxicology Research Group, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK; (A.W.M.); (B.C.W.); (A.K.); (R.T.)
| | - Denise McLean
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Benito Morentin
- Section of Forensic Pathology, Basque Institute of Legal Medicine, E-48001 Bilbao, Spain;
| | - Luis F. Callado
- Department of Pharmacology, University of the Basque Country-UPV/EHU, E-48940 Leioa, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Wayne G. Carter
- Clinical Toxicology Research Group, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK; (A.W.M.); (B.C.W.); (A.K.); (R.T.)
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Zottis LFF, de Souza MA, Hartmann JK, Gama TKK, Rizental LB, Maciel AM, Gresele M, da Rosa EB, Nunes MR, da Rocha JT, Telles JAB, da Cunha AC, Zen PRG, Rosa RFM. Alcohol consumption during pregnancy by women from southern Brazil: a cross-sectional study. SAO PAULO MED J 2024; 142:e2023186. [PMID: 38655982 PMCID: PMC11034884 DOI: 10.1590/1516-3180.2023.0186.r1.08022024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Some maternal characteristics are related to alcohol intake during pregnancy, which irreversibly compromises the maternal-fetal binomial integrity. OBJECTIVES To identify the frequency, impact, and factors associated with alcohol consumption during pregnancy. DESIGN AND SETTING A cross-sectional study was performed at the Hospital Materno Infantil Presidente Vargas (HMIPV) in Porto Alegre/RS between March and December 2016. METHODS A structured questionnaire was administered along with a medical records review. They refer to the maternal sociodemographic and gestational status, alcohol consumption patterns, and characteristics of the fetus/newborn. In the statistical analysis, P values < 0.05 were considered significant. RESULTS The frequency of alcohol intake was 37.3%; this was characterized by the consumption of fermented beverages (89.3%), especially during the first trimester (79.6%). Risky consumption (high and/or early) occurred for 30.2% of participants. Risk factors associated with maternal alcohol consumption during pregnancy were tobacco use (P < 0.001) and abortion attempt (P = 0.023). Living with a partner (P = 0.002) and planning pregnancy (P = 0.009) were protective factors. Risky consumption was related to all of the aforementioned variables as well as threatened abortion (P = 0.023). CONCLUSIONS Alcohol intake during pregnancy is common and affects nearly one-third of pregnant women. Knowledge of the population at risk and protective factors is essential for the development of campaigns that seek to reduce consumption and, therefore, its consequences for the mother and fetus.
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Affiliation(s)
- Laira Francielle Ferreira Zottis
- Undergraduate Student, Department of Clinical Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
| | - Mateus Arenhardt de Souza
- Undergraduate Student, Department of Clinical Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
| | - Jéssica Karine Hartmann
- Undergraduate Student, Department of Clinical Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
| | - Thiago Kenji Kurogi Gama
- MD. Physician, Resident Doctor of Anesthesiology, Universidade de São Paulo (USP), São Paulo (SP), Brazil
| | - Laís Borges Rizental
- MD. Physician, Resident Doctor of Trauma Surgery, Hospital de Pronto Socorro de Porto Alegre (HPS), Porto Alegre (RS), Brazil
| | - Anita Machado Maciel
- BSc. Biomedical, Clinical Research Data Manager, Santa Casa de Misericórdia de Porto Alegre (SCMPA), Porto Alegre (RS), Brazil
| | - Merialine Gresele
- MD. Physician, Resident Doctor of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
| | - Ernani Bohrer da Rosa
- BSc. Nurse, Doctoral Student, Postgraduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
| | - Maurício Rouvel Nunes
- BSc. Nurse, Doctoral Student, Postgraduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
| | - Juliana Trevisan da Rocha
- PhD. Biomedical, Professor, Discipline of Histology and Embryology, Department of Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
| | - Jorge Alberto Bianchi Telles
- MSc. Fetologist and Obstetrician, Department of Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre (RS), Brazil
| | - André Campos da Cunha
- MD. Obstetrician, Department of Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre (RS), Brazil
| | - Paulo Ricardo Gazzola Zen
- PhD. Clinical Geneticist and Pediatrician, Professor, Departments of Clinical Medicine and Clinical Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
| | - Rafael Fabiano Machado Rosa
- PhD. Clinical Geneticist, Professor, Departments of Clinical Medicine and Clinical Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
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Lubrano C, Parisi F, Cetin I. Impact of Maternal Environment and Inflammation on Fetal Neurodevelopment. Antioxidants (Basel) 2024; 13:453. [PMID: 38671901 PMCID: PMC11047368 DOI: 10.3390/antiox13040453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
During intrauterine life, external stimuli including maternal nutrition, lifestyle, socioeconomic conditions, anxiety, stress, and air pollution can significantly impact fetal development. The human brain structures begin to form in the early weeks of gestation and continue to grow and mature throughout pregnancy. This review aims to assess, based on the latest research, the impact of environmental factors on fetal and neonatal brain development, showing that oxidative stress and inflammation are implied as a common factor for most of the stressors. Environmental insults can induce a maternal inflammatory state and modify nutrient supply to the fetus, possibly through epigenetic mechanisms, leading to significant consequences for brain morphogenesis and neurological outcomes. These risk factors are often synergic and mutually reinforcing. Fetal growth restriction and preterm birth represent paradigms of intrauterine reduced nutrient supply and inflammation, respectively. These mechanisms can lead to an increase in free radicals and, consequently, oxidative stress, with well-known adverse effects on the offspring's neurodevelopment. Therefore, a healthy intrauterine environment is a critical factor in supporting normal fetal brain development. Hence, healthcare professionals and clinicians should implement effective interventions to prevent and reduce modifiable risk factors associated with an increased inflammatory state and decreased nutrient supply during pregnancy.
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Affiliation(s)
- Chiara Lubrano
- Nutritional Sciences, Doctoral Programme (PhD), Università degli Studi di Milano, 20157 Milan, Italy;
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Parisi
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Irene Cetin
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
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Candelaria-Cook FT, Schendel ME, Romero LL, Cerros C, Hill DE, Stephen JM. Sex-specific Differences in Resting Oscillatory Dynamics in Children with Prenatal Alcohol Exposure. Neuroscience 2024; 543:121-136. [PMID: 38387734 PMCID: PMC10954390 DOI: 10.1016/j.neuroscience.2024.02.016] [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: 10/04/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024]
Abstract
At rest children with prenatal alcohol exposure (PAE) exhibit impaired static and dynamic functional connectivity, along with decreased alpha oscillations. Sex-specific information regarding the impact of PAE on whole-brain resting-state gamma spectral power remains unknown. Eyes-closed and eyes-open MEG resting-state data were examined in 83 children, ages 6-13 years of age. Using a matched design, the sample consisted of 42 typically developing children (TDC) (22 males/20 females) and 41 children with PAE and/or a fetal alcohol spectrum disorders (FASD) diagnosis (21 males/20 females). Whole-brain source resting-state spectral power was examined to determine group and sex specific relationships. Within gamma, we found sex and group specific changes such that female participants with PAE/FASD had increased gamma power when compared to female TDC and male participants with PAE/FASD. These differences were detected in most source regions analyzed during both resting-states, and were observed across the age spectrum examined. Within delta, we found sex and group specific changes such that female participants with PAE/FASD had decreased delta power when compared to female TDC and male participants with PAE/FASD. The reduced delta oscillations in female participants with PAE/FASD were detected in several source regions during eyes-closed rest and were evident at younger ages. These results indicate PAE alters neural oscillations during rest in a sex-specific manner, with females with PAE/FASD showing the largest perturbations. These results further demonstrate PAE has global effects on resting-state spectral power and connectivity, creating long-term consequences by potentially disrupting the excitation/inhibition balance in the brain, interrupting normative neurodevelopment.
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Affiliation(s)
| | - Megan E Schendel
- The Mind Research Network and Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - Lucinda L Romero
- The Mind Research Network and Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - Cassandra Cerros
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Dina E Hill
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Julia M Stephen
- The Mind Research Network and Lovelace Biomedical Research Institute, Albuquerque, NM, USA
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Asarnow LD, Norwood PP, Christodoulou J, Tomlinson M, Rotheram-Borus MJ. The Concurrent and Longitudinal Relationship between Perinatal Sleep Difficulties and Depression in a Large Sample of High-Risk Women in South Africa. Matern Child Health J 2024; 28:700-707. [PMID: 38110851 DOI: 10.1007/s10995-023-03850-x] [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] [Accepted: 10/31/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Perinatal depression and sleep difficulties are common among studies conducted in high income countries (HIC). This study examines the relationship between sleep difficulties and depression during the perinatal period and over an eight-year follow-up period in South Africa, a middle income country. METHOD A population cohort of 1238 pregnant women (mean age = 26.33) in 24 township neighborhoods in South Africa were recruited and reassessed six times over the next 8 years post birth with follow-up rates of 96-83%. The relationship between maternal depressed mood and sleep difficulties was examined over time, as well as the relationship of sleep with other socioeconomic, environmental, and psychiatric risk factors. RESULTS Thirty-five percent of the women reported sleep difficulties during the perinatal period; whereas only 8% reported sleep difficulties at 8-year follow-up. Perinatal sleep difficulties were associated with lower income, lower educational attainment, less access to electricity, more food insecurity, higher rates of interpersonal violence and HIV, alcohol consumption, and depressed mood at 8 years. However, the severity of depressed mood was the strongest predictor of sleep problems longitudinally and cross-sectionally, after accounting for all other risk factors. CONCLUSIONS We found that the severity of depressed mood is highly associated with sleep difficulties from pregnancy to 8 years post-birth and in a linear relationship, so that higher depressed mood is associated with more sleep problems. TRIAL REGISTRATION ClinicalTrials.gov registration: # NCT00996528.
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Affiliation(s)
- L D Asarnow
- Department of Psychiatry & Behavioral Science, University of California, San Francisco, USA.
| | - P P Norwood
- Semel Institute Center for Community Health, University of California, Los Angeles, USA
| | - J Christodoulou
- Department of Psychology, Palo Alto University, Palo Alto, USA
| | - M Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - M J Rotheram-Borus
- Semel Institute Center for Community Health, University of California, Los Angeles, USA
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May PA, Hasken JM, de Vries MM, Marais AS, Abdul-Rahman O, Robinson LK, Adam MP, Manning MA, Kalberg WO, Buckley D, Snell CL, Seedat S, Parry CD, Hoyme HE. Maternal risk factors for fetal alcohol spectrum disorders: Distal variables. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:319-344. [PMID: 38105110 PMCID: PMC10922553 DOI: 10.1111/acer.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND A variety of maternal risk factors for fetal alcohol spectrum disorders (FASD) have been described in the literature. Here, we conducted a multivariate analysis of a large array of potential distal influences on FASD risk. METHODS Interviews were conducted with 2515 mothers of first-grade students whose children were evaluated to assess risk for FASD. Topics included: physical/medical status, childbearing history, demographics, mental health, domestic violence, and trauma. Regression modeling utilized usual level of alcohol consumption by trimester and six selected distal variables (maternal head circumference, body mass index, age at pregnancy, gravidity, marital status, and formal years of education) to differentiate children with FASD from control children. RESULTS Despite individual variation in distal maternal risk factors among and within the mothers of children with each of the common diagnoses of FASD, patterns emerged that differentiated risk among mothers of children with FASD from mothers whose children were developing typically. Case-control comparisons indicate that mothers of children with FASD were significantly smaller physically, had higher gravidity and parity, and experienced more miscarriages and stillbirths, were less likely to be married, reported later pregnancy recognition, more depression, and lower formal educational achievement. They were also less engaged with a formal religion, were less happy, suffered more childhood trauma and interpersonal violence, were more likely to drink alone or with her partner, and drank to deal with anxiety, tension, and to be part of a group. Regression analysis showed that the predictor variables explain 57.5% of the variance in fetal alcohol syndrome (FAS) diagnoses, 30.1% of partial FAS (PFAS) diagnoses, and 46.4% of alcohol-related neurodevelopmental disorder (ARND) diagnoses in children with FASD compared to controls. While the proximal variables explained most of the diagnostic variance, six distal variables explained 16.7% (1 /6 ) of the variance in FAS diagnoses, 13.9% (1 /7 ) of PFAS, and 12.1% (1 /8 ) of ARND. CONCLUSIONS Differences in distal FASD risks were identified. Complex models to quantify risk for FASD hold promise for guiding prevention/intervention.
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Affiliation(s)
- Philip A. May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Julie M. Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
| | - Marlene M. de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Omar Abdul-Rahman
- Department of Pediatrics, New York- Presbyterian Weill Cornell Medicine, Columbia University, 505 E 70 St, New York, NY 10021
| | - Luther K. Robinson
- Department of Pediatrics, State University of New York, 1001 Main Street, Buffalo, NY 14203, United States
| | - Margaret P. Adam
- Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Seattle, WA 98175, USA
| | - Melanie A. Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, United States
| | - Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Cudore L. Snell
- School of Social Work, Howard University, Washington D.C., 20059, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Charles D.H. Parry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, 7505, South Africa
| | - H. Eugene Hoyme
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Sanford Children’s Genomic Medicine Consortium, Sanford Health, 1600 W. 22 St. Sioux Falls, SD, 57117, United States
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Stevens MWR, Cooper M, Cusack L, Ali RL, Briley AL. Improving the quality of antenatal screening and early intervention for alcohol and other drug use: protocol for a multi-stage approach to systems reform. Addict Sci Clin Pract 2024; 19:2. [PMID: 38183129 PMCID: PMC10768159 DOI: 10.1186/s13722-023-00434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Alcohol, tobacco and illicit drug use during pregnancy can cause significant harm to women and their developing fetuses. Despite recommendations for abstinence during pregnancy, some women continue to use, making screening for substance use during antenatal clinic attendances an important strategy for reducing risk. This study aims to improve the rates of screening and intervention for substance use among pregnant women, including appropriate referral for those who may be substance-dependent. The protocol outlined here focuses on a multi-stage implementation study. METHODS This study will occur in four phases. Phase 1 will identify a baseline rate of screening and subsequent care at the antenatal clinics of two, South Australian hospital-based maternity services, through a retrospective case note audit. Rates of self-reported substance use identified in the case notes will also be compared against representative data from Adelaide Primary Health Network to establish rates of over or underreporting. Phase 2 will involve an online Training Needs Analysis of midwifery staff working at those services, to assess their knowledge, attitudes, beliefs, and commitment to the care of women who use substances during pregnancy. Phase 3 will involve a training package for all midwifery staff at those services, focused on routine screening for substance use, and how to provide appropriate care. Outcome measures from phase 2 will be reassessed during phase 3 and any changes since training will be evaluated. Phase 4 will then repeat phase 1 to compare the changes in rates of both screening and any associated intervention before and after training. DISCUSSION From a public health perspective, this project has the potential to make a significant impact on reducing risk of harm from substance use disorders among pregnant women, and contribute to better health outcomes for their children. TRIAL REGISTRATION This trial has been pre-registered under the Open Science Framework. REGISTRATION https://doi.org/10.17605/OSF.IO/73FDZ .
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Affiliation(s)
- Matthew W R Stevens
- School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Megan Cooper
- Caring Futures Institute Flinders University, Bedford Park, South Australia, Australia
| | - Lynette Cusack
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert L Ali
- School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Annette L Briley
- Caring Futures Institute Flinders University, Bedford Park, South Australia, Australia
- Northern Adelaide Local Health Network, Lyell McEwin Hospital, Elizabeth, South Australia, Australia
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10
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Maxwell JR, DiDomenico J, Roberts MH, Marquez LE, Rai R, Weinberg J, Jacobson SW, Stephen J, Bakhireva LN. Impact of low-level prenatal alcohol exposure and maternal stress on autonomic regulation. Pediatr Res 2024; 95:350-358. [PMID: 37674025 PMCID: PMC11089775 DOI: 10.1038/s41390-023-02799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/07/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) impacts the neurodevelopment of the fetus, including the infant's ability to self-regulate. Heart rate variability (HRV), that is, the beat-to-beat variability in heart rate, is a non-invasive measurement that can indicate autonomic nervous system (ANS) function/dysfunction. METHODS The study consisted of a subset of our ENRICH-2 cohort: 80 participants (32 PAE and 48 Controls) who had completed three visits during pregnancy. The participants completed a comprehensive assessment of PAE and other substances throughout pregnancy and assessments for stress, anxiety, and depression in the third trimester. At 24 h of age, infant HRV was assessed in the hospital during the clinically indicated heel lance; 3- to 5-min HRV epochs were obtained during baseline, heel lancing, and recovery episodes. RESULTS Parameters of HRV differed in infants with PAE compared to Controls during the recovery phase of the heel lance (respiratory sinus arrhythmia (RSA) and high-frequency (HF), p < 0.05). Increased maternal stress was also strongly associated with abnormalities in RSA, HF, and low-frequency / high-frequency (LF/HF, p's < 0.05). CONCLUSIONS Alterations in ANS regulation associated with PAE and maternal stress may reflect abnormal development of the hypothalamic-pituitary-adrenal axis and have long term implications for infant responsiveness and self-regulation. IMPACT Previous studies have focused on effects of moderate to heavy prenatal alcohol exposure (PAE) on autonomic dysregulation, but little is known about the effects of lower levels of PAE on infant self-regulation and heart rate variability (HRV). Prenatal stress is another risk factor for autonomic dysregulation. Mild PAE impacts infant self-regulation, which can be assessed using HRV. However, the effect of prenatal stress is stronger than that of mild PAE or other mental health variables on autonomic dysregulation.
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Affiliation(s)
- Jessie R Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, Mexico.
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, Mexico.
| | - Jared DiDomenico
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Melissa H Roberts
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Lidia Enriquez Marquez
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Rajani Rai
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Julia Stephen
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, University of New Mexico, Albuquerque, NM, Mexico
| | - Ludmila N Bakhireva
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
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May PA, Marais AS, Kalberg WO, de Vries MM, Buckley D, Hasken JM, Snell CL, Barnard Röhrs R, Hedrick DM, Bezuidenhout H, Anthonissen L, Bröcker E, Robinson LK, Manning MA, Hoyme HE, Seedat S, Parry CDH. Multifaceted case management during pregnancy is associated with better child outcomes and less fetal alcohol syndrome. Ann Med 2023; 55:926-945. [PMID: 36919586 PMCID: PMC10026770 DOI: 10.1080/07853890.2023.2185808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Pregnant women participated in multifaceted case management (MCM) to prevent Fetal Alcohol Spectrum Disorders (FASD). METHODS Women recruited from antenatal clinics for a longitudinal child development study were screened for alcohol use. Forty-four pregnant women were defined as high-risk drinkers on the Alcohol Use Disorder Identification Test (AUDIT) by an AUDIT score ≥8 and participated in 18 months of MCM to facilitate reduction or cessation of alcohol consumption. Forty-one women completed MCM. Fifty-five equally high-risk women who received standard antenatal care comprised the comparison/control group. Development in offspring was evaluated by a blinded interdisciplinary team of examiners through 5 years of age. RESULTS At five years of age, more children (34%) of MCM participating women did not meet the criteria for FASD vs. non-MCM offspring (22%). Furthermore, a statistically significant (p = .01) lower proportion of MCM offspring (24%) was diagnosed with fetal alcohol syndrome (FAS) compared to controls (49%). Children of MCM participants had significantly (p < .05) better physical outcomes: lower total dysmorphology scores, larger head circumferences, longer palpebral fissures, and higher midfacial measurements. Neurodevelopment results showed mixed outcomes. While Bayley developmental scores indicated that MCM offspring were performing significantly worse on most domains through 18 months, group scores equalized and were not significantly different on Kaufman Assessment Battery neurobehavioral measures by five years. Regression analyses indicated that offspring of women who received standard antenatal care were associated with significantly more negative outcomes than MCM offspring: a diagnosis of FAS (OR = 3.2; 95% CI: 1.093-9.081), microcephaly (OR = 5.3; 95% CI: 2.1-13.5), head circumference ≤10th centile (OR = 4.3; 95%CI: 1.8-10.4), and short palpebral fissures (OR = 2.5; 95% CI: 1.0-5.8). CONCLUSION At age five, proportionally fewer children of MCM participants qualified for a diagnosis of FAS, and proportionally more had physical outcomes indicating better prenatal brain development. Neurobehavioral indicators were not significantly different from controls by age five.KEY MESSAGESMultifaceted Case Management (MCM) was designed and employed for 18 months during the prenatal and immediate postpartum period to successfully meet multiple needs of women who had proven to be very high risk for birthing children with fetal alcohol spectrum disorders (FASD).Offspring of the women who participated in MCM were followed up through age five years and were found to have significantly better physical outcomes on multiple variables associated with fetal alcohol syndrome (FAS) and FASD, such as larger head circumferences and fewer minor anomalies, than those children born to equally at-risk women not receiving MCM.Fewer children of women receiving MCM were diagnosed with FASD than the offspring of equally-at-risk controls, and significantly (p = .01) fewer MCM offspring had FAS, the most severe FASD diagnosis.
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Affiliation(s)
- Philip A May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC, USA
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, NM, USA
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Wendy O Kalberg
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, NM, USA
| | - Marlene M de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Buckley
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, NM, USA
| | - Julie M Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Cudore L Snell
- School of Social Work, Howard University, Washington, DC, USA
| | - Ronel Barnard Röhrs
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dixie M Hedrick
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Heidre Bezuidenhout
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lise Anthonissen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Erine Bröcker
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luther K Robinson
- Department of Pediatrics, State University of New York, Buffalo, NY, USA
| | - Melanie A Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - H Eugene Hoyme
- Sanford Children's Genomic Medicine Consortium, Sanford Health, Sioux Falls, SD, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Charles D H Parry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
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12
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May PA, Hasken JM, de Vries MM, Marais AS, Abdul-Rahman O, Robinson LK, Adam MP, Manning MA, Kalberg WO, Buckley D, Seedat S, Parry CD, Hoyme HE. Maternal and paternal risk factors for fetal alcohol spectrum disorders: Alcohol and other drug use as proximal influences. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2090-2109. [PMID: 38226752 PMCID: PMC10792253 DOI: 10.1111/acer.15193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/16/2023] [Accepted: 09/11/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To explore and analyze the significance of proximal influences of maternal and paternal traits associated with bearing a child with a fetal alcohol spectrum disorder (FASD). METHODS Aggregated, maternal interview-collected data (N = 2515) concerning alcohol, tobacco, and other drug use were examined to determine risk for FASD from seven cross-sectional samples of mothers of first-grade students who were evaluated for a possible diagnosis of FASD. RESULTS Mothers of children with fetal alcohol syndrome (FAS) reported the highest alcohol use throughout pregnancy, proportion of binge drinking, drinks per drinking day (DDD), drinking days per week, and total drinks per week. Mothers of children with FAS also consumed significantly more alcohol than mothers of children with partial FAS (PFAS), alcohol-related neurodevelopmental disorder (ARND), or typically developing controls. Mothers of children with PFAS and ARND reported similar drinking patterns, which exposed fetuses to 3-4 times more alcohol than mothers of controls, but the PFAS group was more likely than the ARND group to abstain in latter trimesters. Fathers of all children were predominantly drinkers (70%-85%), but more fathers of children with FASD binged heavily on more days than fathers of controls. Compared to the few mothers of controls who used alcohol during pregnancy, the ARND group binge drank more (3+ DDD) throughout pregnancy and drank more DDD before pregnancy and first trimester. Regression analysis, controlling for tobacco use, indicated that mothers who reported drinking <1 DDD were significantly more likely than abstainers to bear a child with FASD (OR = 2.75) as were those reporting higher levels such as 5-5.9 DDD (OR = 32.99). Exclusive, first-trimester maternal drinking increased risk for FASD five times over that of abstinence (p < 0.001, OR = 5.05, 95% CI: 3.88-6.58), first- and second-trimester drinking by 12.4 times, and drinking all trimesters by 16 times (p < 0.001, OR = 15.69, 95% CI: 11.92-20.64). Paternal drinking during and prior to pregnancy, without adjustment, increased the likelihood of FASD significantly (OR = 1.06 and 1.11, respectively), but the significance of both relationships disappeared when maternal alcohol and tobacco use were controlled. CONCLUSIONS Differences in FASD risk emerged from the examination of multiple proximal variables of maternal alcohol and tobacco use, reflecting increased FASD risk at greater levels of maternal alcohol consumption.
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Affiliation(s)
- Philip A. May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Julie M. Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
| | - Marlene M. de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Omar Abdul-Rahman
- Department of Pediatrics, New York- Presbyterian Weill Cornell Medicine, Columbia University, 505 E 70 St, New York, NY 10021
| | - Luther K. Robinson
- Department of Pediatrics, State University of New York, 1001 Main Street, Buffalo, NY 14203, United States
| | - Margaret P. Adam
- Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Seattle, WA 98175, USA
| | - Melanie A. Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, United States
| | - Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Charles D.H. Parry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, 7505, South Africa
| | - H. Eugene Hoyme
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Sanford Children’s Genomic Medicine Consortium, Sanford Health, 1600 W. 22 St. Sioux Falls, SD, 57117, United States
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Podgórski R, Galiniak S, Mazur A, Podgórska D, Domin A. Serum Levels of Hormones Regulating Appetite in Patients with Fetal Alcohol Spectrum Disorders. Nutrients 2023; 15:4215. [PMID: 37836499 PMCID: PMC10574197 DOI: 10.3390/nu15194215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Prenatal alcohol exposure is the cause of impaired growth and a wide range of developmental and behavioral disorders in the child. Improper eating patterns are commonly associated with fetal alcohol spectrum disorders (FASD) and may contribute to poor nutrition and growth restriction. To date, there have been only a few studies investigating the hormonal regulation of appetite in patients with FASD. We analyzed the levels of neuropeptide Y (NPY), Agouti signaling protein (ASP), alpha-melanocyte-stimulating hormone (α-MSH), and kisspeptin (KISS1) in 57 patients with FASD and 23 healthy controls. A comparison of the hormone levels studied was also performed in subgroups of fetal alcohol syndrome (FAS) and neurobehavioral disorder associated with prenatal alcohol exposure (ND PAE), as well as in males and females. We have found no differences in hormone levels tested between affected individuals and the controls and between FASD subgroups. In addition, sex had no effect on hormone levels. However, we identified some associations between hormone concentrations and parameters describing the clinical status of patients with FASD. Most of them concerned ASP, which has shown a positive correlation with age and hormones involved in appetite and metabolism, such as proopiomelanocortin (POMC) and adrenocorticotropic hormone (ACTH). We have also found a negative correlation of α-MSH with age, BMI percentile, and glycated hemoglobin (HbA1c). Furthermore, we found a weak negative correlation of NPY with HbA1c. Although FASD has been associated with impaired child growth and development, including nutrition and puberty onset, we did not identify differences in the levels of the hormones studied, which may suggest that prenatal alcohol exposure does not affect the levels of these metabolites.
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Affiliation(s)
- Rafał Podgórski
- Department of Biochemistry, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
| | - Sabina Galiniak
- Department of Biochemistry, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
| | - Artur Mazur
- Department of Pediatric, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland; (A.M.); (A.D.)
| | - Dominika Podgórska
- Department of Rheumatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
| | - Agnieszka Domin
- Department of Pediatric, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland; (A.M.); (A.D.)
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Grzywacz E, Brzuchalski B, Śmiarowska M, Malinowski D, Machoy-Mokrzyńska A, Białecka MA. Significance of Selected Environmental and Biological Factors on the Risk of FASD in Women Who Drink Alcohol during Pregnancy. J Clin Med 2023; 12:6185. [PMID: 37834828 PMCID: PMC10573427 DOI: 10.3390/jcm12196185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Prenatal alcohol exposure (PAE), which refers to alcohol consumption by pregnant women, is associated with the risk of numerous severe complications during fetal development. The State Agency for Alcohol Problem Solving reports that the incidence of fetal alcohol spectrum disorder (FASD) in Poland's general population is over 1.7%, and the incidence of fetal alcohol syndrome (FAS) is estimated at more than 0.5%. This study aimed to evaluate the significance of alcohol exposure and focused on the pattern of alcohol intoxication exhibited by the mother during pregnancy and other environmental factors of the maternal environment contributing to the development of FASD. The study covered 554 subjects, including 251 mothers and 303 children (213 girls and 90 boys). The mother's drinking problem was determined based on the information obtained from the case history. All children qualified for the study fulfilled the h-PAE (high alcohol exposure) criteria during their fetal life. The clinical diagnosis of FAS and pFAS (occurrence of morphological symptoms of fetal alcohol syndrome) was made using a four-digit diagnostic questionnaire validated in the Polish version of the Washington Questionnaire for the assessment of the spectrum of alcohol-related neurodevelopmental disorders or alcohol-related cognitive impairment (ARND/C). Statistical analysis of the obtained research results was developed using statistical software-STATISTICA PL, version 13.1 (StatSoft, Inc., Szczecin, Poland 2016, STATISTICA-data analysis software system, version 13.1). The most destructive drinking behaviors are compulsive intoxication (BD, binge drinking) during the first 6 weeks of pregnancy and chronic addiction throughout its duration (CHD, chronic drinking). Chronic alcohol intoxication (CHD) leads to a poorer nutritional status in mothers, which is reflected in a lower body mass index (BMI) (<18 kg/m2).
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Affiliation(s)
- Elżbieta Grzywacz
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (E.G.); (B.B.); (M.Ś.); (M.A.B.)
| | - Bogusław Brzuchalski
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (E.G.); (B.B.); (M.Ś.); (M.A.B.)
| | - Małgorzata Śmiarowska
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (E.G.); (B.B.); (M.Ś.); (M.A.B.)
| | - Damian Malinowski
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (E.G.); (B.B.); (M.Ś.); (M.A.B.)
| | - Anna Machoy-Mokrzyńska
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland;
| | - Monika Anna Białecka
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (E.G.); (B.B.); (M.Ś.); (M.A.B.)
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Balena T, Lillis K, Rahmati N, Bahari F, Dzhala V, Berdichevsky E, Staley K. A Dynamic Balance between Neuronal Death and Clearance in an in Vitro Model of Acute Brain Injury. J Neurosci 2023; 43:6084-6107. [PMID: 37527922 PMCID: PMC10451151 DOI: 10.1523/jneurosci.0436-23.2023] [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: 03/09/2023] [Revised: 06/15/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
In in vitro models of acute brain injury, neuronal death may overwhelm the capacity for microglial phagocytosis, creating a queue of dying neurons awaiting clearance. Neurons undergoing programmed cell death are in this queue, and are the most visible and frequently quantified measure of neuronal death after injury. However, the size of this queue should be equally sensitive to changes in neuronal death and the rate of phagocytosis. Using rodent organotypic hippocampal slice cultures as a model of acute perinatal brain injury, serial imaging demonstrated that the capacity for microglial phagocytosis of dying neurons was overwhelmed for 2 weeks. Altering phagocytosis rates (e.g., by changing the number of microglia) dramatically changed the number of visibly dying neurons. Similar effects were generated when the visibility of dying neurons was altered by changing the membrane permeability for stains that label dying neurons. Canonically neuroprotective interventions, such as seizure blockade, and neurotoxic maneuvers, such as perinatal ethanol exposure, were mediated by effects on microglial activity and the membrane permeability of neurons undergoing programmed cell death. These canonically neuroprotective and neurotoxic interventions had either no or opposing effects on healthy surviving neurons identified by the ongoing expression of transgenic fluorescent proteins.SIGNIFICANCE STATEMENT In in vitro models of acute brain injury, microglial phagocytosis is overwhelmed by the number of dying cells. Under these conditions, the assumptions on which assays for neuroprotective and neurotoxic effects are based are no longer valid. Thus, longitudinal assays of healthy cells, such as serial assessment of the fluorescence emission of transgenically expressed proteins, provide more accurate estimates of cell death than do single-time point anatomic or biochemical assays of the number of dying neurons. More accurate estimates of death rates in vitro will increase the translatability of preclinical studies of neuroprotection and neurotoxicity.
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Affiliation(s)
- Trevor Balena
- Department of Neurology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Kyle Lillis
- Department of Neurology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Negah Rahmati
- Department of Neurology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Fatemeh Bahari
- Department of Neurology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Volodymyr Dzhala
- Department of Neurology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Eugene Berdichevsky
- Department of Electrical and Computer Engineering, Lehigh University, Bethlehem, Pennsylvania 18015
| | - Kevin Staley
- Department of Neurology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114
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16
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Oh SS, Kuang I, Jeong H, Song JY, Ren B, Moon JY, Park EC, Kawachi I. Predicting Fetal Alcohol Spectrum Disorders Using Machine Learning Techniques: Multisite Retrospective Cohort Study. J Med Internet Res 2023; 25:e45041. [PMID: 37463016 PMCID: PMC10394506 DOI: 10.2196/45041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/22/2023] [Accepted: 06/18/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Fetal alcohol syndrome (FAS) is a lifelong developmental disability that occurs among individuals with prenatal alcohol exposure (PAE). With improved prediction models, FAS can be diagnosed or treated early, if not completely prevented. OBJECTIVE In this study, we sought to compare different machine learning algorithms and their FAS predictive performance among women who consumed alcohol during pregnancy. We also aimed to identify which variables (eg, timing of exposure to alcohol during pregnancy and type of alcohol consumed) were most influential in generating an accurate model. METHODS Data from the collaborative initiative on fetal alcohol spectrum disorders from 2007 to 2017 were used to gather information about 595 women who consumed alcohol during pregnancy at 5 hospital sites around the United States. To obtain information about PAE, questionnaires or in-person interviews, as well as reviews of medical, legal, or social service records were used to gather information about alcohol consumption. Four different machine learning algorithms (logistic regression, XGBoost, light gradient-boosting machine, and CatBoost) were trained to predict the prevalence of FAS at birth, and model performance was measured by analyzing the area under the receiver operating characteristics curve (AUROC). Of the total cases, 80% were randomly selected for training, while 20% remained as test data sets for predicting FAS. Feature importance was also analyzed using Shapley values for the best-performing algorithm. RESULTS Overall, there were 20 cases of FAS within a total population of 595 individuals with PAE. Most of the drinking occurred in the first trimester only (n=491) or throughout all 3 trimesters (n=95); however, there were also reports of drinking in the first and second trimesters only (n=8), and 1 case of drinking in the third trimester only (n=1). The CatBoost method delivered the best performance in terms of AUROC (0.92) and area under the precision-recall curve (AUPRC 0.51), followed by the logistic regression method (AUROC 0.90; AUPRC 0.59), the light gradient-boosting machine (AUROC 0.89; AUPRC 0.52), and XGBoost (AUROC 0.86; AURPC 0.45). Shapley values in the CatBoost model revealed that 12 variables were considered important in FAS prediction, with drinking throughout all 3 trimesters of pregnancy, maternal age, race, and type of alcoholic beverage consumed (eg, beer, wine, or liquor) scoring highly in overall feature importance. For most predictive measures, the best performance was obtained by the CatBoost algorithm, with an AUROC of 0.92, precision of 0.50, specificity of 0.29, F1 score of 0.29, and accuracy of 0.96. CONCLUSIONS Machine learning algorithms were able to identify FAS risk with a prediction performance higher than that of previous models among pregnant drinkers. For small training sets, which are common with FAS, boosting mechanisms like CatBoost may help alleviate certain problems associated with data imbalances and difficulties in optimization or generalization.
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Affiliation(s)
- Sarah Soyeon Oh
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Irene Kuang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Hyewon Jeong
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Jin-Yeop Song
- Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Boyu Ren
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jong Youn Moon
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States
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Fraize J, Fischer C, Elmaleh-Bergès M, Kerdreux E, Beggiato A, Ntorkou A, Duchesnay E, Bekha D, Boespflug-Tanguy O, Delorme R, Hertz-Pannier L, Germanaud D. Enhancing fetal alcohol spectrum disorders diagnosis with a classifier based on the intracerebellar gradient of volumetric undersizing. Hum Brain Mapp 2023. [PMID: 37209313 DOI: 10.1002/hbm.26348] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023] Open
Abstract
In fetal alcohol spectrum disorders (FASD), brain growth deficiency is a hallmark of subjects both with fetal alcohol syndrome (FAS) and with non-syndromic FASD (NS-FASD, i.e., those without specific diagnostic features). However, although the cerebellum was suggested to be more severely undersized than the rest of the brain, it has not yet been given a specific place in the FASD diagnostic criteria where neuroanatomical features still count for little if anything in diagnostic specificity. We applied a combination of cerebellar segmentation tools on a 1.5 T 3DT1 brain MRI dataset from a monocentric population of 89 FASD (52 FAS, 37 NS-FASD) and 126 typically developing controls (6-20 years old), providing 8 volumes: cerebellum, vermis and 3 lobes (anterior, posterior, inferior), plus total brain volume. After adjustment of confounders, the allometric scaling relationship between these cerebellar volumes (Vi ) and the total brain or cerebellum volume (Vt ) was fitted (Vi = bVt a ), and the effect of group (FAS, control) on allometric scaling was evaluated. We then estimated for each cerebellar volume in the FAS population the deviation from the typical scaling (v DTS) learned in the controls. Lastly, we trained and tested two classifiers to discriminate FAS from controls, one based on the total cerebellum v DTS only, the other based on all the cerebellar v DTS, comparing their performance both in the FAS and the NS-FASD group. Allometric scaling was significantly different between FAS and control group for all the cerebellar volumes (p < .001). We confirmed the excess of total cerebellum volume deficit (v DTS = -10.6%) and revealed an antero-inferior-posterior gradient of volumetric undersizing in the hemispheres (-12.4%, 1.1%, 2.0%, repectively) and the vermis (-16.7%, -9.2%, -8.6%, repectively). The classifier based on the intracerebellar gradient of v DTS performed more efficiently than the one based on total cerebellum v DTS only (AUC = 92% vs. 82%, p = .001). Setting a high probability threshold for >95% specificity of the classifiers, the gradient-based classifier identified 35% of the NS-FASD to have a FAS cerebellar phenotype, compared to 11% with the cerebellum-only classifier (pFISHER = 0.027). In a large series of FASD, this study details the volumetric undersizing within the cerebellum at the lobar and vermian level using allometric scaling, revealing an anterior-inferior-posterior gradient of vulnerability to prenatal alcohol exposure. It also strongly suggests that this intracerebellar gradient of volumetric undersizing may be a reliable neuroanatomical signature of FAS that could be used to improve the specificity of the diagnosis of NS-FASD.
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Affiliation(s)
- Justine Fraize
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, UNIACT, Centre d'études de Saclay, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
| | - Clara Fischer
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, BAOBAB, Centre d'études de Saclay, Gif-sur-Yvette, France
| | - Monique Elmaleh-Bergès
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
- Department of Pediatric Radiology, Centre of Excellence InovAND, AP-HP, Robert-Debré Hospital, Paris, France
| | - Eliot Kerdreux
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, UNIACT, Centre d'études de Saclay, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
| | - Anita Beggiato
- Department of Child and Adolescent Psychiatry, Centre of Excellence InovAND, AP-HP, Robert-Debré Hospital, Paris, France
| | - Alexandra Ntorkou
- Department of Pediatric Radiology, Centre of Excellence InovAND, AP-HP, Robert-Debré Hospital, Paris, France
| | - Edouard Duchesnay
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, BAOBAB, Centre d'études de Saclay, Gif-sur-Yvette, France
| | - Dhaif Bekha
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, UNIACT, Centre d'études de Saclay, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
| | | | - Richard Delorme
- Department of Child and Adolescent Psychiatry, Centre of Excellence InovAND, AP-HP, Robert-Debré Hospital, Paris, France
| | - Lucie Hertz-Pannier
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, UNIACT, Centre d'études de Saclay, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
| | - David Germanaud
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, UNIACT, Centre d'études de Saclay, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
- Department of Genetics, Centre of Excellence InovAND, AP-HP, Robert-Debré Hospital, Paris, France
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18
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Breton-Larrivée M, Elder E, Legault LM, Langford-Avelar A, MacFarlane AJ, McGraw S. Mitigating the detrimental developmental impact of early fetal alcohol exposure using a maternal methyl donor-enriched diet. FASEB J 2023; 37:e22829. [PMID: 36856720 DOI: 10.1096/fj.202201564r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
Fetal alcohol exposure at any stage of pregnancy can lead to fetal alcohol spectrum disorder (FASD), a group of life-long conditions characterized by congenital malformations, as well as cognitive, behavioral, and emotional impairments. The teratogenic effects of alcohol have long been publicized; yet fetal alcohol exposure is one of the most common preventable causes of birth defects. Currently, alcohol abstinence during pregnancy is the best and only way to prevent FASD. However, alcohol consumption remains astoundingly prevalent among pregnant women; therefore, additional measures need to be made available to help protect the developing embryo before irreparable damage is done. Maternal nutritional interventions using methyl donors have been investigated as potential preventative measures to mitigate the adverse effects of fetal alcohol exposure. Here, we show that a single acute preimplantation (E2.5; 8-cell stage) fetal alcohol exposure (2 × 2.5 g/kg ethanol with a 2h interval) in mice leads to long-term FASD-like morphological phenotypes (e.g. growth restriction, brain malformations, skeletal delays) in late-gestation embryos (E18.5) and demonstrate that supplementing the maternal diet with a combination of four methyl donor nutrients, folic acid, choline, betaine, and vitamin B12, prior to conception and throughout gestation effectively reduces the incidence and severity of alcohol-induced morphological defects without altering DNA methylation status of imprinting control regions and regulation of associated imprinted genes. This study clearly supports that preimplantation embryos are vulnerable to the teratogenic effects of alcohol, emphasizes the dangers of maternal alcohol consumption during early gestation, and provides a potential proactive maternal nutritional intervention to minimize FASD progression, reinforcing the importance of adequate preconception and prenatal nutrition.
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Affiliation(s)
- Mélanie Breton-Larrivée
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada
| | - Elizabeth Elder
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada
| | - Lisa-Marie Legault
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada
| | - Alexandra Langford-Avelar
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada
| | - Amanda J MacFarlane
- Agriculture, Food, and Nutrition Evidence Center, Texas A&M University, Texas, Fort Worth, USA.,Department of Nutrition, Texas A&M University, College Station, Texas, USA
| | - Serge McGraw
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada.,Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Canada
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19
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Milbocker KA, Smith IF, Brengel EK, LeBlanc GL, Roth TL, Klintsova AY. Exercise in Adolescence Enhances Callosal White Matter Refinement in the Female Brain in a Rat Model of Fetal Alcohol Spectrum Disorders. Cells 2023; 12:cells12070975. [PMID: 37048047 PMCID: PMC10092997 DOI: 10.3390/cells12070975] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
A total of 1 in 20 infants born annually are exposed to alcohol prenatally, which disrupts neurodevelopment and results in several disorders categorized under the umbrella term Fetal Alcohol Spectrum Disorders (FASD). Children and adolescents affected by FASD exhibit delayed maturation of cerebral white matter, which contributes to deficits in executive function, visuospatial processing, sensory integration, and interhemispheric communication. Research using animal models of FASD have uncovered that oligoglia proliferation, differentiation, and survival are vulnerable to alcohol teratogenesis in the male brain due in part to the activation of the neuroimmune system during gestation and infancy. A comprehensive investigation of prenatal alcohol exposure on white matter development in the female brain is limited. This study demonstrated that the number of mature oligodendrocytes and the production of myelin basic protein were reduced first in the female corpus callosum following alcohol exposure in a rat model of FASD. Analysis of myelin-related genes confirmed that myelination occurs earlier in the female corpus callosum compared to their counterparts, irrespective of postnatal treatment. Moreover, dysregulated oligodendrocyte number and myelin basic protein production was observed in the male and female FASD brain in adolescence. Targeted interventions that support white matter development in FASD-affected youth are nonexistent. The capacity for an adolescent exercise intervention to upregulate corpus callosum myelination was evaluated: we discovered that volunteer exercise increases the number of mature oligodendrocytes in alcohol-exposed female rats. This study provides critical evidence that oligoglia differentiation is difficult but not impossible to induce in the female FASD brain in adolescence following a behavioral intervention.
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Affiliation(s)
- Katrina A Milbocker
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, USA
| | - Ian F Smith
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, USA
| | - Eric K Brengel
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, USA
| | - Gillian L LeBlanc
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, USA
| | - Tania L Roth
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, USA
| | - Anna Y Klintsova
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, USA
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20
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Rotheram-Borus MJ, le Roux KW, Norwood P, Stansert Katzen L, Snyman A, le Roux I, Dippenaar E, Tomlinson M. The effect of supervision on community health workers' effectiveness with households in rural South Africa: A cluster randomized controlled trial. PLoS Med 2023; 20:e1004170. [PMID: 36862754 PMCID: PMC9980736 DOI: 10.1371/journal.pmed.1004170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 01/06/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Community health workers (CHWs) can supplement professional medical providers, especially in rural settings where resources are particularly scarce. Yet, outcomes of studies evaluating CHWs effectiveness have been highly variable and lack impact when scaled nationally. This study examines if child and maternal outcomes are better when existing government CHWs, who are perinatal home visitors, receive ongoing enhanced supervision and monitoring, compared to standard care. METHODS AND FINDINGS A cluster randomized controlled effectiveness trial was conducted comparing outcomes over 2 years when different supervision and support are provided. Primary health clinics were randomized by clinic to receive monitoring and supervision from either (1) existing supervisors (Standard Care (SC); n = 4 clinics, 23 CHWs, 392 mothers); or (2) supervisors from a nongovernmental organization that provided enhanced monitoring and supervision (Accountable Care [AC]; n = 4 clinic areas, 20 CHWs, 423 mothers). Assessments were conducted during pregnancy and at 3, 6, 15, and 24 months post-birth with high retention rates (76% to 86%). The primary outcome was the number of statistically significant intervention effects among 13 outcomes of interest; this approach allowed us to evaluate the intervention holistically while accounting for correlation among the 13 outcomes and considering multiple comparisons. The observed benefits were not statistically significant and did not show the AC's efficacy over the SC. Only the antiretroviral (ARV) adherence effect met the significance threshold established a priori (SC mean 2.3, AC mean 2.9, p < 0.025; 95% CI = [0.157, 1.576]). However, for 11 of the 13 outcomes, we observed an improvement in the AC compared to the SC. While the observed outcomes were not statistically significant, benefits were observed for 4 outcomes: increasing breastfeeding for 6 months, reducing malnutrition, increasing ARV adherence, and improving developmental milestones. The major study limitation was utilizing existing CHWs and being limited to a sample of 8 clinics. There were no major study-related adverse events. CONCLUSIONS Supervision and monitoring were insufficient to improve CHWs' impact on maternal and child outcomes. Alternative strategies for staff recruitment and narrowing the intervention outcomes to the specific local community problems are needed for consistently high impact. TRIAL REGISTRATION Clinicaltrials.gov, NCT02957799.
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Affiliation(s)
- Mary Jane Rotheram-Borus
- Dept. of Psychiatry and Biobehavioral Sciences, Semel Institute, University of CA, Los Angeles, California, United States of America
| | - Karl W. le Roux
- Institute for Life Course Health Research, Dept. of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Dept. of Family Medicine, Walter Sisulu University, Mthatha, South Africa
- Primary Health Care Directorate, Old Main Building, Groote Schuur Hospital, Cape Town, South Africa
- Zithulele Training and Research Centre, Zithulele Hospital, Mqanduli District, Eastern Cape, South Africa
| | - Peter Norwood
- Dept. of Psychiatry and Biobehavioral Sciences, Semel Institute, University of CA, Los Angeles, California, United States of America
| | - Linnea Stansert Katzen
- Institute for Life Course Health Research, Dept. of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Andre Snyman
- Zithulele Training and Research Centre, Zithulele Hospital, Mqanduli District, Eastern Cape, South Africa
| | - Ingrid le Roux
- Philani Maternal, Child Health and Nutrition Trust, Khayelitsha, Cape Town, South Africa
| | - Elaine Dippenaar
- Zithulele Training and Research Centre, Zithulele Hospital, Mqanduli District, Eastern Cape, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Dept. of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
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21
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Balena T, Lillis K, Rahmati N, Bahari F, Dzhala V, Berdichevsky E, Staley K. A dynamic balance between neuronal death and clearance after acute brain injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.14.528332. [PMID: 36824708 PMCID: PMC9948967 DOI: 10.1101/2023.02.14.528332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
After acute brain injury, neuronal apoptosis may overwhelm the capacity for microglial phagocytosis, creating a queue of dying neurons awaiting clearance. The size of this queue should be equally sensitive to changes in neuronal death and the rate of phagocytosis. Using rodent organotypic hippocampal slice cultures as a model of acute perinatal brain injury, serial imaging demonstrated that the capacity for microglial phagocytosis of dying neurons was overwhelmed for two weeks. Altering phagocytosis rates, e.g. by changing the number of microglia, dramatically changed the number of visibly dying neurons. Similar effects were generated when the visibility of dying neurons was altered by changing the membrane permeability for vital stains. Canonically neuroprotective interventions such as seizure blockade and neurotoxic maneuvers such as perinatal ethanol exposure were mediated by effects on microglial activity and the membrane permeability of apoptotic neurons, and had either no or opposing effects on healthy surviving neurons. Significance After acute brain injury, microglial phagocytosis is overwhelmed by the number of dying cells. Under these conditions, the assumptions on which assays for neuroprotective and neurotoxic effects are based are no longer valid. Thus longitudinal assays of healthy cells, such as assessment of the fluorescence emission of transgenically-expressed proteins, provide more accurate estimates of cell death than do single-time-point anatomical or biochemical assays. More accurate estimates of death rates will increase the translatability of preclinical studies of neuroprotection and neurotoxicity.
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22
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Meombe Mbolle A, Thapa S, Bukiya AN, Jiang H. High-resolution imaging in studies of alcohol effect on prenatal development. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2023; 3:10790. [PMID: 37593366 PMCID: PMC10433240 DOI: 10.3389/adar.2023.10790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Fetal alcohol syndrome represents the leading known preventable cause of mental retardation. FAS is on the most severe side of fetal alcohol spectrum disorders that stem from the deleterious effects of prenatal alcohol exposure. Affecting as many as 1 to 5 out of 100 children, FASD most often results in brain abnormalities that extend to structure, function, and cerebral hemodynamics. The present review provides an analysis of high-resolution imaging techniques that are used in animals and human subjects to characterize PAE-driven changes in the developing brain. Variants of magnetic resonance imaging such as magnetic resonance microscopy, magnetic resonance spectroscopy, diffusion tensor imaging, along with positron emission tomography, single-photon emission computed tomography, and photoacoustic imaging, are modalities that are used to study the influence of PAE on brain structure and function. This review briefly describes the aforementioned imaging modalities, the main findings that were obtained using each modality, and touches upon the advantages/disadvantages of each imaging approach.
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Affiliation(s)
- Augustine Meombe Mbolle
- Department Medical Engineering, College of Engineering and Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Shiwani Thapa
- Department Pharmacology, Addiction Science and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Anna N. Bukiya
- Department Pharmacology, Addiction Science and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Huabei Jiang
- Department Medical Engineering, College of Engineering and Morsani College of Medicine, University of South Florida, Tampa, FL, United States
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23
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Basavarajappa BS, Subbanna S. Synaptic Plasticity Abnormalities in Fetal Alcohol Spectrum Disorders. Cells 2023; 12:442. [PMID: 36766783 PMCID: PMC9913617 DOI: 10.3390/cells12030442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/10/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
The brain's ability to strengthen or weaken synaptic connections is often termed synaptic plasticity. It has been shown to function in brain remodeling following different types of brain damage (e.g., drugs of abuse, alcohol use disorders, neurodegenerative diseases, and inflammatory conditions). Although synaptic plasticity mechanisms have been extensively studied, how neural plasticity can influence neurobehavioral abnormalities in alcohol use disorders (AUDs) is far from being completely understood. Alcohol use during pregnancy and its harmful effects on the developing offspring are major public health, social, and economic challenges. The significant attribute of prenatal alcohol exposure on offspring is damage to the central nervous system (CNS), causing a range of synaptic structural, functional, and behavioral impairments, collectively called fetal alcohol spectrum disorder (FASD). Although the synaptic mechanisms in FASD are limited, emerging evidence suggests that FASD pathogenesis involves altering a set of molecules involved in neurotransmission, myelination, and neuroinflammation. These studies identify several immediate and long-lasting changes using many molecular approaches that are essential for synaptic plasticity and cognitive function. Therefore, they can offer potential synaptic targets for the many neurobehavioral abnormalities observed in FASD. In this review, we discuss the substantial research progress in different aspects of synaptic and molecular changes that can shed light on the mechanism of synaptic dysfunction in FASD. Increasing our understanding of the synaptic changes in FASD will significantly advance our knowledge and could provide a basis for finding novel therapeutic targets and innovative treatment strategies.
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Affiliation(s)
- Balapal S. Basavarajappa
- Center for Dementia Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY 10032, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Psychiatry, New York University Langone Medical Center, New York, NY 10016, USA
| | - Shivakumar Subbanna
- Center for Dementia Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
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24
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Epigenetics in fetal alcohol spectrum disorder. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2023; 197:211-239. [PMID: 37019593 DOI: 10.1016/bs.pmbts.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
During pregnancy, alcohol abuse and its detrimental effects on developing offspring are major public health, economic and social challenges. The prominent characteristic attributes of alcohol (ethanol) abuse during pregnancy in humans are neurobehavioral impairments in offspring due to damage to the central nervous system (CNS), causing structural and behavioral impairments that are together named fetal alcohol spectrum disorder (FASD). Development-specific alcohol exposure paradigms were established to recapitulate the human FASD phenotypes and establish the underlying mechanisms. These animal studies have offered some critical molecular and cellular underpinnings likely to account for the neurobehavioral impairments associated with prenatal ethanol exposure. Although the pathogenesis of FASD remains unclear, emerging literature proposes that the various genomic and epigenetic components that cause the imbalance in gene expression can significantly contribute to the development of this disease. These studies acknowledged numerous immediate and enduring epigenetic modifications, such as methylation of DNA, post-translational modifications (PTMs) of histone proteins, and regulatory networks related to RNA, using many molecular approaches. Methylated DNA profiles, PTMs of histone proteins, and RNA-regulated expression of genes are essential for synaptic and cognitive behavior. Thus, offering a solution to many neuronal and behavioral impairments reported in FASD. In the current chapter, we review the recent advances in different epigenetic modifications that cause the pathogenesis of FASD. The information discussed can help better explain the pathogenesis of FASD and thereby might provide a basis for finding novel therapeutic targets and innovative treatment strategies.
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25
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Hasken JM, de Vries MM, Marais AS, May PA, Parry CDH, Seedat S, Mooney SM, Smith SM. Untargeted Metabolome Analysis of Alcohol-Exposed Pregnancies Reveals Metabolite Differences That Are Associated with Infant Birth Outcomes. Nutrients 2022; 14:nu14245367. [PMID: 36558526 PMCID: PMC9786146 DOI: 10.3390/nu14245367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Prenatal alcohol exposure can produce offspring growth deficits and is a leading cause of neurodevelopmental disability. We used untargeted metabolomics to generate mechanistic insight into how alcohol impairs fetal development. In the Western Cape Province of South Africa, 52 women between gestational weeks 5-36 (mean 18.5 ± 6.5) were recruited, and they provided a finger-prick fasting bloodspot that underwent mass spectrometry. Metabolomic data were analyzed using partial least squares-discriminant analyses (PLS-DA) to identify metabolites that correlated with alcohol exposure and infant birth outcomes. Women who consumed alcohol in the past seven days were distinguished by a metabolite profile that included reduced sphingomyelins, cholesterol, and pregnenolones, and elevated fatty acids, acyl and amino acyl carnitines, and androsterones. Using PLS-DA, 25 of the top 30 metabolites differentiating maternal groups were reduced by alcohol with medium-chain free fatty acids and oxidized sugar derivatives having the greatest influence. A separate ortho-PLS-DA analysis identified a common set of 13 metabolites that were associated with infant length, weight, and head circumference. These included monoacylglycerols, glycerol-3-phosphate, and unidentified metabolites, and most of their associations were negative, implying they represent processes having adverse consequences for fetal development.
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Affiliation(s)
- Julie M. Hasken
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Correspondence: ; Tel.: +1-(704)-250-5002
| | - Marlene M. de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7602, South Africa
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7602, South Africa
| | - Philip A. May
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7602, South Africa
- Department of Nutrition, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM 87131, USA
| | - Charles D. H. Parry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7602, South Africa
- Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town 7760, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7602, South Africa
| | - Sandra M. Mooney
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
| | - Susan M. Smith
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
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26
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Chanal C, Mazurier E, Doray B. Use of Psychoactive Substances during the Perinatal Period: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S17-S37. [PMID: 36480661 DOI: 10.1111/jmwh.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
Based on their clinical practice and an extensive review of the literature, the authors propose a framework of procedures to be followed to provide services to all women of childbearing age who use psychoactive substances (alcohol, cannabis, cocaine, amphetamines, and opioids), especially during pregnancy or during the postpartum and breastfeeding periods, in view of their individual situations and environmental contexts.
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Affiliation(s)
- Corinne Chanal
- Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 avenue du Doyen Gaston Giraud cedex 5, Montpellier, 34295, France.,Réseau de Périnatalité Occitanie Espace Henri BERTIN SANS, Bat A, 59 avenue de Fès-34080, Montpellier, France
| | - Evelyne Mazurier
- Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 avenue du Doyen Gaston Giraud cedex 5, Montpellier, 34295, France
| | - Bérénice Doray
- Service de génétique, CHU de La Réunion, allée des Topazes, cedex, 97405, SAINT-DENIS.,Centre Ressource Troubles du Spectre de l'Alcoolisation Fœtale (TSAF) - Fondation Père Favron - 43 rue du Four à Chaux, Saint-Pierre, 97410, Réunion
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Young SL, Steane SE, Kent NL, Reid N, Gallo LA, Moritz KM. Prevalence and Patterns of Prenatal Alcohol Exposure in Australian Cohort and Cross-Sectional Studies: A Systematic Review of Data Collection Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13144. [PMID: 36293721 PMCID: PMC9603223 DOI: 10.3390/ijerph192013144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
This study sought to determine data collection approaches in Australian cohort studies and explore the potential impact on reported prenatal alcohol exposure (PAE) prevalence and patterns. Inclusion criteria were that studies related to a general Australian antenatal population where PAE was assessed and reported. Studies were excluded if they were not peer reviewed, examined the prevalence of PAE in pregnancies complicated by alcohol-use disorders, or were published in a language other than English. A systematic search of five electronic databases (PubMed, Embase, CINAHL, Web of Science, and Scopus) was conducted. Risk of bias was assessed using the Effective Public Health Practice Project quality assessment tool. Results were synthesised using MetaXL. Data from 16 separate birth cohorts (n = 78 articles) were included. Included cohorts were either general cohorts that included alcohol as a variable or alcohol-focused cohorts that were designed with a primary focus on PAE. PAE prevalence was estimated as 48% (95% CI: 38 to 57%). When subgroup analysis was performed, estimates of PAE prevalence when self-administered surveys and interviews were used for data collection were 53% (95% CI: 41% to 64%) and 43% (95% CI: 28% to 59%), respectively. Use of trained assessors was an influencing factor of the prevalence estimates when data were collected via interview. Alcohol-focused studies reported higher prevalence of PAE, regardless of method of survey administration. Where interviewer training is not possible, self-administered questionnaires will likely provide the most reliable PAE estimates. No funding sources are relevant to mention. Review was registered with PROSPERO (CRD42020204853).
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Affiliation(s)
- Sophia L. Young
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Sarah E. Steane
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Nykola L. Kent
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Linda A. Gallo
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Petrie, QLD 4502, Australia
| | - Karen M. Moritz
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
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Binder A, Preiser C, Hanke S, Banabak M, Huber C, Petersen KU, Batra A. Researching Alcohol Consumption During Pregnancy. Opportunities and Challenges With Two Methods of Data Acquisition. QUALITATIVE HEALTH RESEARCH 2022; 32:1809-1827. [PMID: 36017584 PMCID: PMC9511243 DOI: 10.1177/10497323221119005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Qualitative research methods, primarily interviews, have become more common in the field of addiction research. Other data sources were often neglected, although sources such as social media can offer insights into the realities of people, since social media also plays a relevant role in today's living environments. This article examines the use of online forums as an underutilized data source in contrast to telephone interviews, to identify methodological opportunities and challenges. We analyzed nine discussion threads and seven interviews about 'alcohol consumption during pregnancy'. Discursive comparison of the results was performed with a focus on sampling issues, comparability and risks for participants and researchers. Key issues were present in both data sources. People with different opinions were openly hostile in forums, while tolerance was more often expressed in interviews. The interviews showed a rather mild communication style, which could be attributed to social desirability. In the forum discussions, the participants often expressed themselves very directly. To comprehensively grasp the subject matter of the research, it is important to recognize the types of communication promoted by different data sources. These results have implications for research about female substance use. Knowledge of the issues will bestow a valuable contribution to researchers working in the field of substance use to help develop appropriate research approaches, as they engage in research into this highly stigmatized and controversial area.
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Affiliation(s)
- Annette Binder
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Christine Preiser
- Centre for Public Health and Health Services Research, Core Facility for Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Sara Hanke
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Meryem Banabak
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Clara Huber
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Kay Uwe Petersen
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Anil Batra
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
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May PA, de Vries MM, Marais AS, Kalberg WO, Buckley D, Hasken JM, Abdul-Rahman O, Robinson LK, Manning MA, Seedat S, Parry CD, Hoyme HE. The prevalence of fetal alcohol spectrum disorders in rural communities in South Africa: A third regional sample of child characteristics and maternal risk factors. Alcohol Clin Exp Res 2022; 46:1819-1836. [PMID: 35971629 PMCID: PMC9588757 DOI: 10.1111/acer.14922] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/13/2022] [Accepted: 08/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study is the ninth cross-sectional community study of fetal alcohol spectrum disorders (FASD) conducted by the multidisciplinary Fetal Alcohol Syndrome Epidemiology Research team in the Western Cape Province of South Africa. It is the third comprehensive study of FASD in a rural, agricultural region of South Africa. METHODS Population-based, active case ascertainment methods were employed among a school-based cohort to assess child physical and neurobehavioral traits, and maternal risk factor interviews were conducted to identify all children with FASD to determine its prevalence. RESULTS Consent was obtained for 76.7% of 1158 children attending first grade in the region's public schools. Case-control results are presented for 95 with fetal alcohol syndrome (FAS), 64 with partial fetal alcohol syndrome (PFAS), 77 with alcohol-related neurodevelopmental disorder (ARND), 2 with alcohol-related birth defects (ARBD), and 213 randomly-selected controls. Four techniques estimating FASD prevalence from in-person examinations and testing yielded a range of total FASD prevalence of 206-366 per 1000. The final weighted, estimated prevalence of FAS was 104.5 per 1000, PFAS was 77.7 per 1000, ARND was 125.2 per 1000, and total FASD prevalence was 310 per 1000 (95% CI = 283.4-336.7). Expressed as a percentage, 31% had FASD. Although the rate of total FASD remained steady over 9 years, the proportion of children within the FASD group has changed significantly: FAS trended down and ARND trended up. A detailed evaluation is presented of the specific child physical and neurobehavioral traits integral to assessing the full continuum of FASD. The diagnosis of a child with FASD was significantly associated with maternal proximal risk factors such as: co-morbid prenatal use of alcohol and tobacco (OR = 19.1); maternal drinking of two (OR = 5.9), three (OR = 5.9), four (OR = 38.3), or more alcoholic drinks per drinking day; and drinking in the first trimester (OR = 8.4), first and second trimesters (OR = 17.7), or throughout pregnancy (OR = 18.6). Distal maternal risk factors included the following: slight or small physical status (height, weight, and head circumference), lower BMI, less formal education, late recognition of pregnancy, and higher gravidity, parity, and older age during the index pregnancy. CONCLUSION The prevalence of FASD remained a significant problem in this region, but the severity of physical traits and anomalies within the continuum of FASD is trending downwards.
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Affiliation(s)
- Philip A. May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Marlene M. de Vries
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anna-Susan Marais
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Julie M. Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
| | - Omar Abdul-Rahman
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska
| | - Luther K. Robinson
- Department of Pediatrics, State University of New York, 1001 Main Street, Buffalo, NY 14203, United States
| | - Melanie A. Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, United States
| | - Soraya Seedat
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Charles D.H. Parry
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, 7505, South Africa
| | - H. Eugene Hoyme
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Sanford Children’s Genomic Medicine Consortium, Sanford Health, 1600 W. 22 St. Sioux Falls, SD, 57117, United States
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Franceschetto L, Perilli M, Cinquetti A, Giraudo C, Gardi M, Cecchetto G, Viel G. Phosphatidylethanol in Maternal or Neonatal Blood to Detect Alcohol Exposure during Pregnancy: A Systematic Review. Life (Basel) 2022; 12:life12101528. [PMID: 36294962 PMCID: PMC9604963 DOI: 10.3390/life12101528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/23/2022] [Accepted: 09/27/2022] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Alcohol consumption during pregnancy, even at low doses, may damage the fetus. Pregnant women tend to underreport their alcohol consumption generating the need for sensitive and specific biomarkers, among which PEth has emerged due to its high specificity and possibility to be measured in both maternal and neonatal blood. The aim of this study is to systematically review the latest 20 years of literature for depicting the state of the art, the limitations, and the prospects of PEth for estimating alcohol consumption during pregnancy. MATERIALS AND METHODS A systematic search, adhering to PRISMA guidelines, of the latest 20 years of literature through "MeSH" and "free-text" protocols in the databases PubMed, SCOPUS, and Web of Science, with time limits 1 January 2002-1 March 2022, was performed. The inclusion criteria were as follows: PEth used for detecting alcohol consumption during pregnancy, quantified in blood through liquid chromatography coupled to mass spectrometry, and full texts in the English language. Opinion papers, editorials, and narrative reviews were excluded. RESULTS Sixteen (16) papers were included in the present review (0.81% of total retrieved records). All the included records were original articles, of which there were seven prospective cohort/longitudinal studies, six cross-sectional studies, two observational-descriptive studies, and one retrospective study. All studies assayed PEth in at least one biological matrix; seven (7) studies quantified PEth in maternal blood, seven studies in newborn blood, and only two studies in both maternal and neonatal blood. In several included papers, PEth proved more sensitive than self-reports for identifying pregnant women with an active alcohol intake with the diagnostic efficiency improving with the increase of the maternal alcohol intake. CONCLUSIONS Further studies, performed on wider and well-stratified populations, are needed to drive any definitive conclusion. PEth is a promising marker for monitoring alcohol use in pregnancy; however, at the present time, its use is still limited mainly by the absence of a globally agreed interpretative cut-off, the paucity of data regarding its specificity/sensitivity, and the lack of standardization on the diagnostic efficiency of the different isoforms.
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Affiliation(s)
- Lisa Franceschetto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Matteo Perilli
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Alessandro Cinquetti
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Chiara Giraudo
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy
| | - Mario Gardi
- Unit of Urology, Sant’Antonio Hospital, University Hospital of Padua, 35100 Padua, Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
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Abrishamcar S, Chen J, Feil D, Kilanowski A, Koen N, Vanker A, Wedderburn CJ, Donald KA, Zar HJ, Stein DJ, Hüls A. DNA methylation as a potential mediator of the association between prenatal tobacco and alcohol exposure and child neurodevelopment in a South African birth cohort. Transl Psychiatry 2022; 12:418. [PMID: 36180424 PMCID: PMC9525659 DOI: 10.1038/s41398-022-02195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/09/2022] [Accepted: 09/20/2022] [Indexed: 01/12/2023] Open
Abstract
Prenatal tobacco exposure (PTE) and prenatal alcohol exposure (PAE) have been associated with an increased risk of delayed neurodevelopment in children as well as differential newborn DNA methylation (DNAm). However, the biological mechanisms connecting PTE and PAE, DNAm, and neurodevelopment are largely unknown. Here we aim to determine whether differential DNAm mediates the association between PTE and PAE and neurodevelopment at 6 (N = 112) and 24 months (N = 184) in children from the South African Drakenstein Child Health Study. PTE and PAE were assessed antenatally using urine cotinine measurements and the ASSIST questionnaire, respectively. Cord blood DNAm was measured using the EPIC and 450 K BeadChips. Neurodevelopment (cognitive, language, motor, adaptive behavior, socioemotional) was measured using the Bayley Scales of Infant and Toddler Development, Third Edition. We constructed methylation risk scores (MRS) for PTE and PAE and conducted causal mediation analysis (CMA) with these MRS as mediators. Next, we conducted a high-dimensional mediation analysis to identify individual CpG sites as potential mediators, followed by a CMA to estimate the average causal mediation effects (ACME) and total effect (TE). PTE and PAE were associated with neurodevelopment at 6 but not at 24 months. PTE MRS reached a prediction accuracy (R2) of 0.23 but did not significantly mediate the association between PTE and neurodevelopment. PAE MRS was not predictive of PAE (R2 = 0.006). For PTE, 31 CpG sites and eight CpG sites were identified as significant mediators (ACME and TE P < 0.05) for the cognitive and motor domains at 6 months, respectively. For PAE, 16 CpG sites and 1 CpG site were significant mediators for the motor and adaptive behavior domains at 6 months, respectively. Several of the associated genes, including MAD1L1, CAMTA1, and ALDH1A2 have been implicated in neurodevelopmental delay, suggesting that differential DNAm may partly explain the biological mechanisms underlying the relationship between PTE and PAE and child neurodevelopment.
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Affiliation(s)
- Sarina Abrishamcar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Junyu Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dakotah Feil
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Kilanowski
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Nastassja Koen
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Catherine J Wedderburn
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kirsten A Donald
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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32
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Weerakoon SM, Chen B, Harrell MB, Vidot DC, Messiah SE. Longitudinal effect of prenatal polydrug use and birthweight status on pediatric growth. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2078826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sitara M. Weerakoon
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Children’s Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
| | - Baojiang Chen
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin, TX, USA
| | - Melissa B. Harrell
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin, TX, USA
| | - Denise C. Vidot
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Sarah E. Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Children’s Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
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Yu X, Dunstan J, Jacobson SW, Molteno CD, Lindinger NM, Turesky TK, Meintjes EM, Jacobson JL, Gaab N. Distinctive neural correlates of phonological and reading impairment in fetal alcohol-exposed adolescents with and without facial dysmorphology. Neuropsychologia 2022; 169:108188. [PMID: 35218791 PMCID: PMC9922095 DOI: 10.1016/j.neuropsychologia.2022.108188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/26/2021] [Accepted: 02/21/2022] [Indexed: 01/25/2023]
Abstract
Prenatal alcohol exposure (PAE) has been linked to atypical brain and cognitive development, including poor academic performance in reading. This study utilized functional magnetic resonance imaging and diffusion tensor imaging to characterize functional and structural mechanisms mediating reading deficits in 26 adolescents with PAE-related facial dysmorphology (fetal alcohol syndrome (FAS)/partial FAS (PFAS)), 29 heavily-exposed (HE) non-syndromal adolescents, in comparison with 19 typically developing controls. The FAS/PFAS and HE groups were balanced in terms of levels of PAE and reading (dis)ability. While neural alterations in the posterior association cortices were evident in both PAE groups, distinctive neural correlates of reading (dis)abilities were observed between adolescents with and without facial dysmorphology. Specifically, compared to the HE and control groups, the syndromal adolescents showed greater activation in the right precentral gyrus during phonological processing and rightward lateralization in an important reading-related tract (inferior longitudinal fasciculus, ILF), suggesting an atypical reliance on the right hemisphere. By contrast, in the HE, better reading skills were positively correlated with neural activation in the left angular gyrus and white matter organization of the left ILF, although the brain function-behavior relation was weaker than among the controls, suggesting less efficient function of the typical reading network. Our findings provide converging evidence at both the neural functional and structural levels for distinctive brain mechanisms underlying atypical reading and phonological processing in PAE adolescents with and without facial dysmorphology.
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Affiliation(s)
- Xi Yu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China; Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, MA, 02115, USA.
| | - Jade Dunstan
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, MA, 02115, USA
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, 48201, USA; Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa; Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa
| | - Nadine M Lindinger
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa
| | - Ted K Turesky
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, MA, 02115, USA; Harvard Medical School, Boston, MA, 02115, USA; Harvard Graduate School of Education, Cambridge, MA, 02138, USA
| | - Ernesta M Meintjes
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, 48201, USA; Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa.
| | - Nadine Gaab
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, MA, 02115, USA; Harvard Medical School, Boston, MA, 02115, USA; Harvard Graduate School of Education, Cambridge, MA, 02138, USA.
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Hasken JM, Adair LS, Martin SL, Thompson AL, Marais AS, de Vries MM, Kalberg WO, Buckley D, Eugene Hoyme H, Seedat S, Parry CD, May PA. The Influence of Maternal Weight and Alcohol Exposure on Infant Physical Characteristics and Neurodevelopmental Outcomes. Curr Res Toxicol 2022; 3:100076. [PMID: 35694418 PMCID: PMC9178472 DOI: 10.1016/j.crtox.2022.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/23/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022] Open
Abstract
Maternal weight was inversely related with infant dysmorphology score. The rate of change was similar among all infants regardless of maternal weight. Maternal weight may be protective but does not eliminate adverse effects of alcohol. Regardless of maternal weight during pregnancy, alcohol remains a teratogen.
Background Mothers of children with fetal alcohol spectrum disorders tend to have lower weight compared to other mothers. Yet how alcohol and maternal weight may predispose infants to poorer physical growth and neurodevelopmental trajectories is relatively unexplained. Methods South African mothers (n = 406) were recruited prenatally and their offspring were provided standardized dysmorphology and neurodevelopment examinations at 6 weeks and 9 months of age. Maternal weight was obtained postpartum, and linear mixed modeling determined whether postpartum maternal weight and prenatal alcohol exposure significantly influenced infant growth, dysmorphology, and neurodevelopment within the first year of life. Results Postpartum maternal weight was positively associated with birth length, weight, and head circumference centile, but the rate of growth from birth to nine months was similar among all infants. Maternal weight was inversely associated with dysmorphology. Many infants in this population were performing within the borderline or extremely low range. Higher maternal weight was associated with significantly better cognitive and motor performance at 6 weeks; however, the rate of developmental growth was similar among all infants, regardless of postpartum maternal weight. Conclusion Higher postpartum maternal weight may be a protective factor but does not eliminate the adverse effects of alcohol on infant growth and dysmorphology. Regardless of maternal weight, alcohol remains a powerful teratogen and moderate to high use prenatally can result in adverse infant physical and neurocognitive development.
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Trajectories of prenatal alcohol exposure and behavioral outcomes: Findings from a community-based sample. Drug Alcohol Depend 2022; 233:109351. [PMID: 35228080 PMCID: PMC9310559 DOI: 10.1016/j.drugalcdep.2022.109351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To characterize patterns of prenatal alcohol exposure (PAE), and determine whether PAE trajectories were associated with behavior from a community-based sample of first-grade children. METHODS Using data collected as part of the Collaboration of Fetal Alcohol Spectrum Disorders Prevalence study (n = 1663), we performed longitudinal cluster analysis on prenatal alcohol use reported for four time points around conception and pregnancy. From the sample, 638 respondents reported any alcohol use in pregnancy and were included in trajectories for average daily and maximum drinks per drinking day (max DDD). We then estimated the association with behavioral problems measured by the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) with multivariable linear regression. The reference group had 1025 children with no reported PAE. RESULTS Five trajectories were selected to describe max DDD patterns: very low/discontinuing (n = 186), low/discontinuing (n = 111), very low/continuing (n = 47), med/high (n = 245), and high (n = 49). Six trajectories best described average daily alcohol use: very low/discontinuing (n = 378), very low/continuing (n = 98), low/continuing (n = 56), low/discontinuing (n = 37), medium/high (n = 35), and high (n = 31). When assessing max DDD trajectories for both the CBCL and TRF, individuals with PAE in the two highest trajectories and the very low/continuing trajectory had more behavioral problems relative to children with no PAE, although confidence intervals for most estimates included the null. PAE modeled as average drinks per day did not predict behavior in any consistent pattern. CONCLUSIONS In this community-based sample, select PAE trajectories were associated with behavior, even at relatively low levels of PAE that continued later in gestation.
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Biffen SC, Dodge NC, Warton CMR, Molteno CD, Jacobson JL, Meintjes EM, Jacobson SW. Compromised interhemispheric transfer of information partially mediates cognitive function deficits in adolescents with fetal alcohol syndrome. Alcohol Clin Exp Res 2022; 46:517-529. [PMID: 35187666 PMCID: PMC9018477 DOI: 10.1111/acer.14795] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) has been associated with compromised interhemispheric transfer of tactile stimuli in childhood and structural changes to the corpus callosum (CC). In this study, we used a finger localization task (FLT) to investigate whether interhemispheric transfer deficits persist in adolescence; whether effects of PAE on perceptual reasoning, working memory, and executive function are mediated by deficits in interhemispheric transfer of information; and whether CC size in childhood predicts FLT performance in adolescence. METHODS Participants, aged 16 to 17 years, were from the Cape Town Longitudinal Cohort, whose mothers were recruited during pregnancy and interviewed regarding their alcohol use using the timeline follow-back method. Diagnoses of fetal alcohol syndrome (FAS) and partial FAS (PFAS) were determined by two expert dysmorphologists; nonsyndromal exposed children were designated as heavily exposed (HE); those born to abstainers or light drinkers, as controls. The FLT was administered to 74 participants (12 FAS, 16 PFAS, 14 HE and 32 controls). CC size at age 9 to 12 years was available for 35 participants (7 FAS, 13 PFAS, 5 HE and 10 control). RESULTS Although the degree of PAE was similar in the FAS, PFAS, and HE groups, only the adolescents with FAS showed more transfer-related errors than controls in conditions in which one finger was stimulated. FLT performance mediated the effects of FAS on perceptual reasoning and executive function. In the subsample for which neuroimaging data from childhood were available, there was an association among adolescents with PAE of smaller CC volumes with more transfer-related errors on the one-finger/hand hidden condition, suggesting that CC damage previously seen in childhood continues to impact function through adolescence. CONCLUSIONS This study provides evidence of compromised interhemispheric transfer of information in adolescents with FAS, while those with PFAS or heavy exposed nonsyndromal individuals are apparently spared. It is the first to show that PAE effects on important aspects of cognitive function are partially mediated by deficits in the interhemispheric transfer of information.
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Affiliation(s)
- Stevie C Biffen
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
| | - Neil C Dodge
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Christopher M R Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ernesta M Meintjes
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, Cape Town, South Africa
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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May PA, Hasken JM, Manning MA, Robinson LK, Abdul-Rahman O, Adam MP, Jewett T, Elliott AJ, Kalberg WO, Buckley D, Hoyme HE. Characteristic physical traits of first-grade children in the United States with fetal alcohol spectrum disorders (FASD) and associated alcohol and drug exposures. Am J Med Genet A 2022; 188:2019-2035. [PMID: 35357075 DOI: 10.1002/ajmg.a.62738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/20/2022] [Accepted: 03/13/2022] [Indexed: 11/10/2022]
Abstract
We compared growth, physical features, and minor anomalies in 131 first-grade children with fetal alcohol spectrum disorders (FASD) to those of a representative comparison group of typically developing children from the same populations (n = 1212). The data were collected from three regional sites in the NIAAA-funded Collaboration on FASD Prevalence (CoFASP). Dysmorphology examinations were performed by a team of expert clinical geneticists, and FASD diagnoses were assigned according to the Revised Institute of Medicine Guidelines, which include assessments of growth, dysmorphology, neurobehavior, and maternal risk interviews. We present detailed data on 32 physical traits, minor anomalies, and a summary dysmorphology score for children within each of the four diagnostic categories in the continuum of FASD. There were few differences in the frequency of FASD diagnoses by race or Hispanic ethnicity. Children with FASD were born to mothers who reported using alcohol, tobacco (28.3%), and other drugs (14.2%) during pregnancy. Controlling for tobacco and other drug use, risk analysis indicated that women with a drinking pattern of 3 drinks per drinking day prior to pregnancy were 10 times more likely (p < 0.001, OR = 9.92, 95% CI: 4.6-21.5) to bear a child with FASD than those who reported abstinence prior to pregnancy.
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Affiliation(s)
- Philip A May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA.,Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Julie M Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA
| | - Melanie A Manning
- Departments of Pathology and Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Luther K Robinson
- Department of Pediatrics, State University of New York, Buffalo, New York, USA
| | - Omar Abdul-Rahman
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Margaret P Adam
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Tamison Jewett
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Amy J Elliott
- Avera Health, Sioux Falls, South Dakota, USA.,Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Wendy O Kalberg
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico, USA
| | - David Buckley
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico, USA
| | - H Eugene Hoyme
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA.,Sanford Children's Genomic Medicine Consortium, Sanford Health, Sioux Falls, South Dakota, USA
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Habeeb N, Najafi S, Perron JC. Assessment of BMP responses in an in vitro model of acute ethanol toxicity. MethodsX 2022; 9:101631. [PMID: 35242615 PMCID: PMC8857558 DOI: 10.1016/j.mex.2022.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
The assay presented here was designed to assess the immediate effects of ethanol (EtOH) exposure on intracellular signaling activated by BMPs (Bone Morphogenetic Proteins). Previous reports of the relationship between EtOH exposure and BMP-dependent signaling have primarily assessed the expression of individual BMPs, changes in BMP target genes or effects on the phosphorylation level of key downstream mediators after days or weeks of in vivo EtOH exposure. What happens to BMP-stimulated signaling immediately following exposure to EtOH remains largely unexplored. Here, the early events of BMP-evoked intracellular signaling were examined in an in vitro model of acute EtOH toxicity. The BMP/Ethanol Stimulation Assay involved first stimulating cultured cells with recombinant BMPs. BMP-evoked intracellular signaling was then allowed to develop for 30 minutes. Next, the cells were exposed to a range of EtOH concentrations for an additional 30 minutes. Finally, the cultures were processed for Western blot analysis or immunofluorescent labeling. This short-term assay: • Permits investigation of EtOH exposure during the initial signaling events downstream of BMP receptor activation • Enables assessment of how the presence of BMPs might protect against cellular injury caused by toxic EtOH levels
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Licheri V, Brigman JL. Altering Cell-Cell Interaction in Prenatal Alcohol Exposure Models: Insight on Cell-Adhesion Molecules During Brain Development. Front Mol Neurosci 2022; 14:753537. [PMID: 34975396 PMCID: PMC8715949 DOI: 10.3389/fnmol.2021.753537] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Alcohol exposure during pregnancy disrupts the development of the brain and produces long lasting behavioral and cognitive impairments collectively known as Fetal Alcohol Spectrum Disorders (FASDs). FASDs are characterized by alterations in learning, working memory, social behavior and executive function. A large body of literature using preclinical prenatal alcohol exposure models reports alcohol-induced changes in architecture and activity in specific brain regions affecting cognition. While multiple putative mechanisms of alcohol’s long-lasting effects on morphology and behavior have been investigated, an area that has received less attention is the effect of alcohol on cell adhesion molecules (CAMs). The embryo/fetal development represents a crucial period for Central Nervous System (CNS) development during which the cell-cell interaction plays an important role. CAMs play a critical role in neuronal migration and differentiation, synaptic organization and function which may be disrupted by alcohol. In this review, we summarize the physiological structure and role of CAMs involved in brain development, review the current literature on prenatal alcohol exposure effects on CAM function in different experimental models and pinpoint areas needed for future study to better understand how CAMs may mediate the morphological, sensory and behavioral outcomes in FASDs.
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Affiliation(s)
- Valentina Licheri
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Jonathan L Brigman
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, United States.,New Mexico Alcohol Research Center, UNM Health Sciences Center, Albuquerque, NM, United States
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Smiley JF, Bleiwas C, Canals-Baker S, Williams SZ, Sears R, Teixeira CM, Wilson DA, Saito M. Neonatal ethanol causes profound reduction of cholinergic cell number in the basal forebrain of adult animals. Alcohol 2021; 97:1-11. [PMID: 34464696 DOI: 10.1016/j.alcohol.2021.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/24/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
In animal models that mimic human third-trimester fetal development, ethanol causes substantial cellular apoptosis in the brain, but for most brain structures, the extent of permanent neuron loss that persists into adulthood is unknown. We injected ethanol into C57BL/6J mouse pups at postnatal day 7 (P7) to model human late-gestation ethanol toxicity, and then used stereological methods to investigate adult cell numbers in several subcortical neurotransmitter systems that project extensively in the forebrain to regulate arousal states. Ethanol treatment caused especially large reductions (34-42%) in the cholinergic cells of the basal forebrain, including cholinergic cells in the medial septal/vertical diagonal band nuclei (Ch1/Ch2) and in the horizontal diagonal band/substantia innominata/nucleus basalis nuclei (Ch3/Ch4). Cell loss was also present in non-cholinergic basal forebrain cells, as demonstrated by 34% reduction of parvalbumin-immunolabeled GABA cells and 25% reduction of total Nissl-stained neurons in the Ch1/Ch2 region. In contrast, cholinergic cells in the striatum were reduced only 12% by ethanol, and those of the brainstem pedunculopontine/lateral dorsal tegmental nuclei (Ch5/Ch6) were not significantly reduced. Similarly, ethanol did not significantly reduce dopamine cells of the ventral tegmental area/substantia nigra or serotonin cells in the dorsal raphe nucleus. Orexin (hypocretin) cells in the hypothalamus showed a modest reduction (14%). Our findings indicate that the basal forebrain is especially vulnerable to alcohol exposure in the late gestational period. Reduction of cholinergic and GABAergic projection neurons from the basal forebrain that regulate forebrain arousal may contribute to the behavioral and cognitive deficits associated with neonatal ethanol exposure.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe recent findings on the clinical presentation, pathogenesis, and management of fetal alcohol spectrum disorders (FASDs). Alcohol causes a range of physical, developmental, and cognitive impairments on the developing fetus. Individuals exposed to alcohol prenatally have a wide variability in dysmorphic and neurologic features. Hence, a greater understanding of the mechanisms through which alcohol induces defects in the developing fetus is imperative in developing therapies that prevent alcohol-induced effects. RECENT FINDINGS Current research has focused on leveraging technology to developing tools that can aid in the diagnostic process, defining patterns of neurocognition and neuroimaging specific to FASD, developing neurobehavioral and pharmacologic interventions, and expanding access to care. SUMMARY FASDs are a common cause of neurodevelopmental impairment in school-age children, and their recognition is essential to provide early interventions in order to optimize the outcome for these individuals when they reach adulthood. Although previously thought to be the result of irreversible neurologic injury from prenatal alcohol exposure, recent evidence points to the benefits of applying principles regarding neuroplasticity in improving the lives for patients and their families.
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Affiliation(s)
- Diego A Gomez
- Mayo Clinic Alix School of Medicine, Phoenix, Arizona
| | - Omar A Abdul-Rahman
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Loke YJ, Muggli E, Saffery R, Ryan J, Lewis S, Elliott EJ, Halliday J, Craig JM. Sex- and tissue-specific effects of binge-level prenatal alcohol consumption on DNA methylation at birth. Epigenomics 2021; 13:1921-1938. [PMID: 34841896 DOI: 10.2217/epi-2021-0285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Binge-level prenatal alcohol exposure (PAE) causes developmental abnormalities, which may be mediated in part by epigenetic mechanisms. Despite this, few studies have characterised the association of binge PAE with DNA methylation in offspring. Methods: We investigated the association between binge PAE and genome-wide DNA methylation profiles in a sex-specific manner in neonatal buccal and placental samples. Results: We identified no differentially methylated CpGs or differentially methylated regions (DMRs) at false discovery rate <0.05. However, using a sum-of-ranks approach, we identified a DMR in each tissue of female offspring. The DMR identified in buccal samples is located near regions with previously-reported associations to fetal alcohol spectrum disorder (FASD) and binge PAE. Conclusion: Our findings warrant further replication and highlight a potential epigenetic link between binge PAE and FASD.
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Affiliation(s)
- Yuk Jing Loke
- Molecular Immunity, Murdoch Children's Research Institute, Victoria, 3052, Australia.,Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia
| | - Evelyne Muggli
- Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, 3052, Australia.,Reproductive Epidemiology, Murdoch Children's Research Institute, Victoria, 3052, Australia
| | - Richard Saffery
- Molecular Immunity, Murdoch Children's Research Institute, Victoria, 3052, Australia.,Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia
| | - Joanne Ryan
- Molecular Immunity, Murdoch Children's Research Institute, Victoria, 3052, Australia.,Biological Neuropsychiatry & Dementia Unit, School of Public Health, Monash University, Victoria, 3004, Australia
| | - Sharon Lewis
- Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia.,Reproductive Epidemiology, Murdoch Children's Research Institute, Victoria, 3052, Australia
| | - Elizabeth J Elliott
- Specialty of Child & Adolescent Health, Faculty of Medicine & Health, University of Sydney, NSW, 2050, Australia.,The Australian Paediatric Surveillance Unit, Sydney Children's Hospital Network, NSW, 2045, Australia
| | - Jane Halliday
- Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia.,Reproductive Epidemiology, Murdoch Children's Research Institute, Victoria, 3052, Australia
| | - Jeffrey M Craig
- Molecular Immunity, Murdoch Children's Research Institute, Victoria, 3052, Australia.,Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia.,The Institute of Mental & Physical Health & Clinical Translation, Deakin University, Victoria, 3220, Australia
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Non-Smad, BMP-dependent signaling protects against the effects of acute ethanol toxicity. Toxicol Lett 2021; 353:118-126. [PMID: 34687774 DOI: 10.1016/j.toxlet.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 01/20/2023]
Abstract
This study explores the effect of acute Ethanol (EtOH) exposure on Bone Morphogenetic Protein (BMP)-evoked intracellular signaling, and the concomitant morphological changes induced by EtOH in C2C12 cells and DRG (Dorsal root ganglion) neurons in an in vitro model related to Fetal Alcohol Syndrome Disorder (FASD). All assays were performed within 30 min of BMP stimulation to specifically investigate the earliest events occurring in BMP-evoked intracellular signaling pathways. We show that Smad phosphorylation and nuclear translocation stimulated by BMPs was not altered following acute exposure to EtOH. In contrast, acute EtOH exposure alone caused a striking concentration-dependent decrease in Akt phosphorylation, as well as a loss of adhesion in C2C12 cells. The addition of BMPs before exposure to EtOH was associated with maintenance of Akt phosphorylation, greater cell adhesion in C2C12 cells, and preservation of growth cone complexity in DRG neurons. Thus, for both C2C12 cells and DRG neurons, BMPs, acting through non-canonical BMP signaling pathways, appear to impart some protection against the profound effects of acute EtOH exposure on cellular adhesion and structure.
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May PA, Hasken JM, Hooper SR, Hedrick DM, Jackson-Newsom J, Mullis CE, Dobbins E, Kalberg WO, Buckley D, Robinson LK, Abdul-Rahman O, Adam MP, Manning MA, Jewett T, Hoyme HE. Estimating the community prevalence, child traits, and maternal risk factors of fetal alcohol spectrum disorders (FASD) from a random sample of school children. Drug Alcohol Depend 2021; 227:108918. [PMID: 34388579 PMCID: PMC8499999 DOI: 10.1016/j.drugalcdep.2021.108918] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Utilize a random sample to estimate the prevalence, child traits, and maternal risk for fetal alcohol spectrum disorders (FASD) in a Southeastern United States county. METHODS From all first-grade students (n = 1073) a simple random sample was drawn, and 32 % (n = 231) were consented. All 231 children were examined for dysmorphology and growth, 84 were tested and rated on neurobehavior, and 72 mothers were interviewed for maternal risk. RESULTS Significant differences (α = .05) between the physical traits of children diagnosed with FASD and the entire sample were height, weight, head circumference, body mass index, and total dysmorphology scores, and all three cardinal features of fetal alcohol syndrome: palpebral fissure length, smooth philtrum, and narrow vermilion. Intellectual function and inhibition were not significantly different between FASD and typically-functioning children, but two executive function measures and one visual/spatial measure approached significance (α = .10). Three behavioral measures were significantly worse for the FASD group: parent-rated problems of communication, daily living, and socialization. Significant maternal risk factors reported were postpartum depression, frequency of drinking, and recovery from problem drinking. The prevalence of FASD was 71.4 per 1,000 or 7.1 %. This rate falls clearly within the prevalence range identified in eight larger samples of other communities in the Collaboration on FASD Prevalence (CoFASP) study in four regions of the United States. CONCLUSION Careful and detailed clinical evaluation of children from small random samples can be useful for estimating the prevalence and traits of FASD in a community.
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Affiliation(s)
- Philip A. May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina,Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico,Corresponding author: Philip A. May, Nutrition Research Institute, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States.
| | - Julie M. Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina
| | - Stephen R. Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dixie M. Hedrick
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina
| | - Julia Jackson-Newsom
- Office of the Vice Chancellor for Research, The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Chalise E. Mullis
- Office of the Vice Chancellor for Research, The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Elizabeth Dobbins
- Office of the Vice Chancellor for Research, The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico
| | - Luther K. Robinson
- Department of Pediatrics, State University of New York, Buffalo, New York
| | - Omar Abdul-Rahman
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska
| | - Margaret P. Adam
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Melanie A. Manning
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Tamison Jewett
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - H. Eugene Hoyme
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona,Sanford Children’s Genomic Medicine Consortium, Sanford Health, Sioux Falls, South Dakota
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Popova S, Dozet D, Shield K, Rehm J, Burd L. Alcohol's Impact on the Fetus. Nutrients 2021; 13:3452. [PMID: 34684453 PMCID: PMC8541151 DOI: 10.3390/nu13103452] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Alcohol is a teratogen and prenatal exposure may adversely impact the developing fetus, increasing risk for negative outcomes, including Fetal Alcohol Spectrum Disorder (FASD). Global trends of increasing alcohol use among women of childbearing age due to economic development, changing gender roles, increased availability of alcohol, peer pressure and social acceptability of women's alcohol use may put an increasing number of pregnancies at risk for prenatal alcohol exposure (PAE). This risk has been exacerbated by the ongoing COVID-19 pandemic in some countries. METHOD This literature review presents an overview on the epidemiology of alcohol use among childbearing age and pregnant women and FASD by World Health Organization regions; impact of PAE on fetal health, including FASD; associated comorbidities; and social outcomes. RESULTS/CONCLUSION The impact of alcohol on fetal health and social outcomes later in life is enormous, placing a huge economic burden on countries. Prevention of prenatal alcohol exposure and early identification of affected individuals should be a global public health priority.
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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.); (K.S.); (J.R.)
- 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
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, 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.); (K.S.); (J.R.)
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Kevin Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (D.D.); (K.S.); (J.R.)
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (D.D.); (K.S.); (J.R.)
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Street 46, 01187 Dresden, Germany
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Street, 8, b. 2, 119992 Moscow, Russia
| | - Larry Burd
- Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd., Grand Forks, ND 58202, USA;
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Screening for Alcohol Use in Pregnancy: a Review of Current Practices and Perspectives. Int J Ment Health Addict 2021; 21:1220-1239. [PMID: 34580577 PMCID: PMC8457028 DOI: 10.1007/s11469-021-00655-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 10/27/2022] Open
Abstract
Global trends of increasing alcohol consumption among women of childbearing age, social acceptability of women's alcohol use, as well as recent changes in alcohol use patterns due to the COVID-19 pandemic may put many pregnancies at higher risk for prenatal alcohol exposure (PAE), which can cause fetal alcohol spectrum disorder (FASD). Therefore, screening of pregnant women for alcohol use has become more important than ever and should be a public health priority. This narrative review presents the state of the science on various existing prenatal alcohol use screening strategies, including the clinical utility of validated alcohol use screening instruments. It also discusses barriers for alcohol use screening in pregnancy, such as practitioner constraints, unplanned pregnancies, delayed access to prenatal care, and stigma associated with substance use in pregnancy, providing recommendations to address these barriers. By implementing consistent alcohol use screening, prenatal care providers have the opportunity to facilitate access to counseling and brief interventions and thus, to prevent new cases of FASD and improve maternal and child health.
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Alcohol induced impairment/abnormalities in brain: Role of MicroRNAs. Neurotoxicology 2021; 87:11-23. [PMID: 34478768 DOI: 10.1016/j.neuro.2021.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/12/2021] [Accepted: 08/28/2021] [Indexed: 12/21/2022]
Abstract
Alcohol is a highly toxic substance and has teratogenic properties that can lead to a wide range of developmental disorders. Excessive use of alcohol can change the structural and functional aspects of developed brain and other organs. Which can further lead to significant health, social and economic implications in many countries of the world. Convincing evidence support the involvement of microRNAs (miRNAs) as important post-transcriptional regulators of gene expression in neurodevelopment and maintenance. They also show differential expression following an injury. MiRNAs are the special class of small non coding RNAs that can modify the gene by targeting the mRNA and fine tune the development of cells to organs. Numerous pieces of evidences have shown the relationship between miRNA, alcohol and brain damage. These studies also show how miRNA controls different cellular mechanisms involved in the development of alcohol use disorder. With the increasing number of research studies, the roles of miRNAs following alcohol-induced injury could help researchers to recognize alternative therapeutic methods to treat/cure alcohol-induced brain damage. The present review summarizes the available data and brings together the important miRNAs, that play a crucial role in alcohol-induced brain damage, which will help in better understanding complex mechanisms. Identifying these miRNAs will not only expand the current knowledge but can lead to the identification of better targets for the development of novel therapeutic interventions.
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Wynn A, Nabukalu D, Lutalo T, Wawer M, Chang LW, Kiene SM, Serwadda DM, Sewankambo N, Nalugoda F, Kigozi G, Wagman JA. Alcohol use during pregnancy in Rakai, Uganda. PLoS One 2021; 16:e0256434. [PMID: 34437616 PMCID: PMC8389483 DOI: 10.1371/journal.pone.0256434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Antenatal alcohol use is linked to adverse maternal and neonatal outcomes. Uganda has one of the highest rates of alcohol use in sub-Saharan Africa, but the prevalence of antenatal alcohol use has not been reported in the Rakai region. Methods We used cross-sectional data from pregnant women in the Rakai Community Cohort Study between March 2017 and September 2018. Using bivariate and multivariable analyses, we assessed associations between self-reported antenatal alcohol use and sociodemographic characteristics, intimate partner violence (IPV), and HIV status. Results Among 960 pregnant women, the median age was 26 years, 35% experienced IPV in the past 12 months, 13% were living with HIV, and 33% reported alcohol use during their current pregnancy. After adjusting for marital status, education, smoking, and HIV status; Catholic religion (AOR: 3.54; 95% CI: 1.89–6.64; compared to other), bar/restaurant work (AOR: 2.40; 95% CI: 1.17–4.92; compared to agriculture), >one sex partner in past year (AOR: 1.92; 95% CI: 1.17–3.16), a partner that drank before sex in past year (AOR: 2.01; 95% CI: 1.48–2.74), and past year IPV (AOR: 1.55; 95% CI: 1.14–2.11) were associated with antenatal alcohol use. Conclusion We found that alcohol use during pregnancy was common and associated with religion, occupation, higher numbers of past year sex partners, having a partner who drank before sex in the past 12 months, and IPV experience. More research is needed to understand the quantity, frequency, and timing of antenatal alcohol use; and potential impacts on neonates; and to identify services that are acceptable and effective among pregnant women.
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Affiliation(s)
- Adriane Wynn
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States of America
- * E-mail:
| | - Dorean Nabukalu
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
| | - Tom Lutalo
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
| | - Maria Wawer
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Larry W. Chang
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Medicine, John Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, United States of America
| | | | | | - Fred Nalugoda
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
| | - Godfrey Kigozi
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
| | - Jennifer A. Wagman
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
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Pinheiro-da-Silva J, Agues-Barbosa T, Luchiari AC. Embryonic Exposure to Ethanol Increases Anxiety-Like Behavior in Fry Zebrafish. Alcohol Alcohol 2021; 55:581-590. [PMID: 32886092 DOI: 10.1093/alcalc/agaa087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/16/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS Fetal alcohol spectrum disorder (FASD) is an umbrella term to describe the effects of ethanol (Eth) exposure during embryonic development, including several conditions from malformation to cognitive deficits. Zebrafish (Danio rerio) are a translational model popularly applied in brain disorders and drug screening studies due to its genetic and physiology homology to humans added to its transparent eggs and fast development. In this study, we investigated how early ethanol exposure affects zebrafish behavior during the initial growth phase. METHODS Fish eggs were exposed to 0.0 (control), 0.25 and 0.5% ethanol at 24 h post-fertilization. Later, fry zebrafish (10 days old) were tested in a novel tank task and an inhibitory avoidance protocol to inquire about morphology and behavioral alterations. RESULTS Analysis of variance showed that ethanol doses of 0.25 and 0.5% do not cause morphological malformations and did not impair associative learning but increased anxiety-like behavior responses and lower exploratory behavior when compared to the control. CONCLUSION Our results demonstrate that one can detect behavioral abnormalities in the zebrafish induced by embryonic ethanol as early as 10 days post-fertilization and that alcohol increases anxious behavior during young development in zebrafish.
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Affiliation(s)
| | - Thais Agues-Barbosa
- Department of Physiology and Behavior, Universidade Federal do Rio Grande do Norte, Rio Grande do Norte, Brazil
| | - Ana Carolina Luchiari
- Department of Physiology and Behavior, Universidade Federal do Rio Grande do Norte, Rio Grande do Norte, Brazil
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Hasken JM, Marais AS, de Vries M, Joubert B, Cloete M, Botha I, Symington SR, Kalberg WO, Buckley D, Robinson LK, Manning MA, Parry CDH, Seedat S, Hoyme HE, May PA. Gestational age and birth growth parameters as early predictors of fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2021; 45:1624-1638. [PMID: 34342019 DOI: 10.1111/acer.14656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate gestational age and growth at birth as predictors of fetal alcohol spectrum disorders (FASD). METHODS The sample analyzed here comprises 737 randomly selected children who were assessed for growth, dysmorphology, and neurobehavior at 7 years of age. Maternal interviews were conducted to ascertain prenatal alcohol exposure and other maternal risk factors. Birth data originated from clinic records and the data at 7 years of age originated from population-based, in-school studies. Binary linear regression assessed the relationship between preterm birth, small for gestational age (SGA), and their combination on the odds of a specific FASD diagnosis or any FASD. RESULTS Among children diagnosed with FASD at 7 years of age (n = 255), a review of birth records indicated that 18.4% were born preterm, 51.4% were SGA, and 5.9% were both preterm and SGA. When compared to non-FASD controls (n = 482), the birth percentages born preterm, SGA, and both preterm and SGA were respectively 12.0%, 27.7%, and 0.5%. Mothers of children with FASD reported more drinking during all trimesters, higher gravidity, lower educational attainment, and older age at pregnancy. After controlling for usual drinks per drinking day in the first trimester, number of trimesters of drinking, maternal education, tobacco use, and maternal age, the odds ratio of an FASD diagnosis by age 7 was significantly associated with SGA (OR = 2.16, 95% CI: 1.35 to 3.45). SGA was also significantly associated with each of the 3 most common specific diagnoses within the FASD continuum: fetal alcohol syndrome (FAS; OR = 3.1), partial FAS (OR = 2.1), and alcohol-related neurodevelopmental disorder (OR = 2.0). CONCLUSION SGA is a robust early indicator for FASD in this random sample of children assessed at 7 years of age.
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Affiliation(s)
- Julie M Hasken
- Gillings School of Global Public Health, Nutrition Research Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Marlene de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Belinda Joubert
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Marise Cloete
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Isobel Botha
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sumien Roux Symington
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Wendy O Kalberg
- Center on Alcohol, Substance Abuse and Addition, University of New Mexico, Albuquerque, NM, USA
| | - David Buckley
- Center on Alcohol, Substance Abuse and Addition, University of New Mexico, Albuquerque, NM, USA
| | - Luther K Robinson
- Department of Pediatrics, University of Buffalo School of Medicine, Buffalo, NY, USA
| | - Melanie A Manning
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Charles D H Parry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - H Eugene Hoyme
- Sanford Health, Sanford Children's Genomic Medicine Consortium, Sioux Falls, SD, USA.,Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Philip A May
- Gillings School of Global Public Health, Nutrition Research Institute, University of North Carolina, Chapel Hill, NC, USA.,Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Center on Alcohol, Substance Abuse and Addition, University of New Mexico, Albuquerque, NM, USA
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