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Thompson DK, Kelly CE, Dhollander T, Muggli E, Hearps S, Lewis S, Nguyen TNN, Spittle A, Elliott EJ, Penington A, Halliday J, Anderson PJ. Associations between low-moderate prenatal alcohol exposure and brain development in childhood. Neuroimage Clin 2024; 42:103595. [PMID: 38555806 PMCID: PMC10998198 DOI: 10.1016/j.nicl.2024.103595] [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: 11/21/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The effects of low-moderate prenatal alcohol exposure (PAE) on brain development have been infrequently studied. AIM To compare cortical and white matter structure between children aged 6 to 8 years with low-moderate PAE in trimester 1 only, low-moderate PAE throughout gestation, or no PAE. METHODS Women reported quantity and frequency of alcohol consumption before and during pregnancy. Magnetic resonance imaging was undertaken for 143 children aged 6 to 8 years with PAE during trimester 1 only (n = 44), PAE throughout gestation (n = 58), and no PAE (n = 41). T1-weighted images were processed using FreeSurfer, obtaining brain volume, area, and thickness of 34 cortical regions per hemisphere. Fibre density (FD), fibre cross-section (FC) and fibre density and cross-section (FDC) metrics were computed for diffusion images. Brain measures were compared between PAE groups adjusted for age and sex, then additionally for intracranial volume. RESULTS After adjustments, the right caudal anterior cingulate cortex volume (pFDR = 0.045) and area (pFDR = 0.008), and right cingulum tract cross-sectional area (pFWE < 0.05) were smaller in children exposed to alcohol throughout gestation compared with no PAE. CONCLUSION This study reports a relationship between low-moderate PAE throughout gestation and cingulate cortex and cingulum tract alterations, suggesting a teratogenic vulnerability. Further investigation is warranted.
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Affiliation(s)
- Deanne K Thompson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Claire E Kelly
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Thijs Dhollander
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Evelyne Muggli
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | | | - Alicia Spittle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia; Kids Research, Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Anthony Penington
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Peter J Anderson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.
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Marchei E, Gomez-Ruiz LM, Acosta-López A, Ramos-Gutiérrez RY, Varela-Busaka MB, Lombroni C, Andreu-Fernandez V, Pichini S, Garcia-Algar O. Assessment of alcohol consumption in mexican pregnant women by hair testing of ethyl glucuronide. Alcohol 2023; 111:59-65. [PMID: 37302618 DOI: 10.1016/j.alcohol.2023.06.001] [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: 03/06/2023] [Revised: 05/09/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
There are no studies that have utilized both biomarkers and self-reported data to evaluate maternal alcohol use during pregnancy in Mexico. Therefore, we aimed to describe the prevalence of alcohol consumption in a cohort of 300 Mexican pregnant women. We used a validated ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method to measure hair ethyl glucuronide (EtG) in hair segments that corresponded to the first and second half of pregnancy. We compared the hair EtG values to a self-reported questionnaire on maternal drinking habits and evaluated whether the gestational alcohol use was associated with psychotropic drug use. Based on the EtG measurements, 263 women (87.7%) were alcohol-abstinent during the entire pregnancy, while 37 (12.3%) had used alcohol at least once during the pregnancy. Of these, only two women were found to have problematic alcoholic behavior during the entire pregnancy. No significant differences in sociodemographic characteristics were observed between alcohol-abstinent women and women with drinking habits. The self-reporting data and hair EtG gave heterogeneous results: although 37 women had self-reported alcohol use during pregnancy, only 54.1% of these women tested positive for hair EtG. Of the women who tested positive for hair EtG, 54.1% tested positive for psychoactive substances. In our cohort, the use of drugs of abuse was independent of gestational drinking. This study provided the first objective evidence of prenatal ethanol consumption in a cohort of Mexican pregnant women.
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Affiliation(s)
- Emilia Marchei
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, V.Le Regina Elena 299, 00161 Rome, Italy
| | - Larissa-Maria Gomez-Ruiz
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico; Departamento de Cirugía y Especialidades Médico-quirúrgicas, Universidad de Barcelona, Barcelona, Spain
| | - Aracely Acosta-López
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Ruth-Yesica Ramos-Gutiérrez
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Mary-Buhya Varela-Busaka
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Claudia Lombroni
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, V.Le Regina Elena 299, 00161 Rome, Italy; Univesità Degli Studi di Torino, Via Pietro Giuria 5, 10125, Torino, Italy
| | - Vicente Andreu-Fernandez
- Grup de Recerca Infancia i Entorn (GRIE), Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Faculty of Health Sciences, Valencian International University (VIU), 46002 Valencia, Spain
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, V.Le Regina Elena 299, 00161 Rome, Italy.
| | - Oscar Garcia-Algar
- Departamento de Cirugía y Especialidades Médico-quirúrgicas, Universidad de Barcelona, Barcelona, Spain; Grup de Recerca Infancia i Entorn (GRIE), Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Neonatology Unit, Hospital Clinic-Maternitat, ICGON, BCNatal, C/Sabino Arana 1, 08028 Barcelona, Spain.
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Cabral VP, Moraes CLD, Bastos FI, Abreu AMM, Domingues RMSM. Prevalence of alcohol use during pregnancy, Brazil, 2011-2012. CAD SAUDE PUBLICA 2023; 39:e00232422. [PMID: 37556615 PMCID: PMC10494674 DOI: 10.1590/0102-311xpt232422] [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: 12/08/2022] [Revised: 03/20/2023] [Accepted: 04/10/2023] [Indexed: 08/11/2023] Open
Abstract
This is a national cross-sectional, hospital-based study, which interviewed 23,894 postpartum women in 2011-2012 aiming to estimate the prevalence of alcohol use during pregnancy and identifying more vulnerable groups. Alcohol use during pregnancy was identified using the TWEAK scale, and women with a score of ≥ 2 were classified as having a "presumable diagnosis of inadequate alcohol use". The national prevalence of alcohol use and the prevalence in subgroups were calculated according to maternal characteristics, with respective 95% confidence intervals (95%CI). Coexistence of smoking, inadequate prenatal consultations, and alcohol use during pregnancy were graphically identified. The prevalence of alcohol use was 14% (95%CI: 13.3-14.7), with 10% (95%CI: 9.3-10.6) of women presenting presumable diagnosis of inadequate alcohol us during pregnancy. Higher prevalence of alcohol use and presumable diagnosis of inadequate alcohol us was observed in black women, aged 12-19 years, with lower educational level, from a lower economic class, without a partner, without paid work, with more than three previous births, who did not want to get pregnant, with inadequate prenatal care, with previous delivery in public services, and who reported smoking during pregnancy. Among the interviewees, 1.2% presented all three risk factors for negative perinatal outcomes at the same time: smoking, alcohol use, and inadequate prenatal care. The results showed a high prevalence of alcohol use during pregnancy and presumable diagnosis of inadequate alcohol us, especially among women with worse social conditions. These data are relevant for the formulation of public policies to prevent alcohol use and provide support services to help this population stop alcohol use during pregnancy.
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Affiliation(s)
- Vanderlea Poeys Cabral
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Claudia Leite de Moraes
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Francisco I Bastos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Doherty E, Wiggers J, Wolfenden L, Tully B, Lecathelinais C, Attia J, Elliott EJ, Dunlop A, Symonds I, Rissel C, Tsang TW, Kingsland M. Differential effectiveness of a practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: Exploratory subgroup analyses within a randomised stepped-wedge controlled trial. Midwifery 2023; 116:103528. [PMID: 36334528 DOI: 10.1016/j.midw.2022.103528] [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: 04/28/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A practice change intervention demonstrated improvements in the provision of antenatal care addressing alcohol consumption. The aim of this study was to explore whether the effectiveness of the intervention differed between subgroups of pregnant women and types and location of maternity services. DESIGN AND SETTING Post-hoc exploratory subgroup analyses of the outcomes from a randomised stepped-wedge controlled trial conducted with all public maternity services within three sectors of a local health district in Australia. MEASUREMENTS Two outcomes (receipt of alcohol assessment and complete care) measured at two visit types (initial and subsequent) were included in analyses. Logistic regression models explored interactions between pre-post differences and subgroups of women (age, Aboriginal origin, education level, disadvantage, gravidity and alcohol consumption in pregnancy) and services (geographic remoteness, service and provider type/s) that have been reported to be associated with variation in guideline implementation. FINDINGS Surveys from 5694 women were included in the analyses. For the initial visit, no significant differential intervention effects between subgroups of women or type/location of services were found for either outcome. For subsequent visits, the intervention effect differed significantly only between Aboriginal origin subgroups (Aboriginal OR: 1.95; 95% CI: 0.99-3.85; non-Aboriginal OR: 5.34; 95% CI: 4.17-6.83; p<0.01) and women's alcohol consumption in pregnancy subgroups (consumed alcohol OR: 1.28; 95% CI: 0.59-2.78; not consumed alcohol OR: 5.22; 95% CI: 4.11-6.65; p<0.001) for assessment of alcohol consumption. KEY CONCLUSIONS These exploratory results suggest that the intervention may have had similar effects between different subgroups of women and types and location of services, with the exception of women who were non-Aboriginal and women who had not consumed alcohol, for whom the intervention was potentially more effective. IMPLICATIONS FOR PRACTICE The practice change intervention could be implemented with different maternity service and provider types to effectively support improvements in antenatal care addressing alcohol consumption. These exploratory results provide further data for hypothesis generation regarding targeted areas for the testing of additional strategies that enable Aboriginal women to benefit equally from the intervention, and to ensure those women most in need of care, those consuming alcohol during pregnancy, have their care needs met.
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Affiliation(s)
- Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia
| | - Christophe Lecathelinais
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, New South Wales 2006, Australia; Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales 2145, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales 2302, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Casuarina, Northern Territory 0909, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, New South Wales 2006, Australia; Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales 2145, Australia
| | - Melanie Kingsland
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
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Voutilainen T, Rysä J, Keski-Nisula L, Kärkkäinen O. Self-reported alcohol consumption of pregnant women and their partners correlates both before and during pregnancy: A cohort study with 21,472 singleton pregnancies. Alcohol Clin Exp Res 2022; 46:797-808. [PMID: 35569108 PMCID: PMC9321706 DOI: 10.1111/acer.14806] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Background The partners’ role in determining the alcohol consumption behavior of pregnant women is not well studied. We measured alcohol use before and during pregnancy in pregnant women and their partners to evaluate the correlation in their levels of consumption. Methods We evaluated the self‐reported alcohol use of 14,822 women and their partners during 21,472 singleton pregnancies delivered in Kuopio University Hospital, Finland during the period 2009‒2018. The information was gathered during pregnancy and at the time of childbirth and recorded in two databases that were merged to yield a single cohort. Missing data were accounted for by multiple imputation using the predictive mean matching method. Results In 86% of the pregnancies, women reported alcohol use before pregnancy, whereas in 4.5% of the pregnancies women reported alcohol use during pregnancy. In contrast, no decrease was detected in their partners’ alcohol use before or during pregnancy. In 26% of the pregnancies, the woman reported stopping alcohol use only after recognizing that she was pregnant. Before pregnancy, there were strong correlations between the pregnant women and their partners in the total Alcohol Use Disorders Identification Test score (rs = 0.69, p < 0.0001) and the self‐reported average weekly amount of alcohol consumed (rs = 0.56, p < 0.0001). During pregnancy, there were weak correlations between the pregnant women and their partners in the frequency of drinking (rs = 0.20, p < 0.0001) and the average weekly amount of alcohol consumed (rs = 0.18, p < 0.0001). Conclusions The self‐reported alcohol consumption of pregnant women and their partners was positively correlated both before and during pregnancy, though the correlation declined substantially during pregnancy. Evaluating the alcohol consumption of both parents before pregnancy could assist in identifying women at risk of prenatal alcohol exposure. Supporting a reduction in partners' alcohol use could help to reduce pregnant women's alcohol consumption and prevent its associated harms.
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Affiliation(s)
- Taija Voutilainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jaana Rysä
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Leea Keski-Nisula
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Olli Kärkkäinen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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“Now, with a bit more knowledge, I understand why I'm asking those questions.” Midwives’ perspectives on their role in the Greater Manchester Health and Social Care Partnership's programme to Reduce Alcohol Exposed Pregnancies (AEP). Midwifery 2022; 110:103335. [DOI: 10.1016/j.midw.2022.103335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/09/2022] [Accepted: 04/02/2022] [Indexed: 11/22/2022]
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Muggli E, Hearps S, Halliday J, Elliott EJ, Penington A, Thompson DK, Spittle A, Forster DA, Lewis S, Anderson PJ. A data driven approach to identify trajectories of prenatal alcohol consumption in an Australian population-based cohort of pregnant women. Sci Rep 2022; 12:4353. [PMID: 35288617 PMCID: PMC8921195 DOI: 10.1038/s41598-022-08190-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/09/2022] [Indexed: 01/08/2023] Open
Abstract
Accurate information on dose, frequency and timing of maternal alcohol consumption is critically important when investigating fetal risks from prenatal alcohol exposure. Identification of distinct alcohol use behaviours can also assist in developing directed public health messages about possible adverse child outcomes, including Fetal Alcohol Spectrum Disorder. We aimed to determine group-based trajectories of time-specific, unit-level, alcohol consumption using data from 1458 pregnant women in the Asking Questions about Alcohol in Pregnancy (AQUA) longitudinal study in Melbourne, Australia. Six alcohol consumption trajectories were identified incorporating four timepoints across gestation. Labels were assigned based on consumption in trimester one and whether alcohol use was continued throughout pregnancy: abstained (33.8%); low discontinued (trimester one) (14.4%); moderate discontinued (11.7%); low sustained (13.0%); moderate sustained (23.5%); and high sustained (3.6%). Median weekly consumption in trimester one ranged from 3 g (low discontinued) to 184 g of absolute alcohol (high sustained). Alcohol use after pregnancy recognition decreased dramatically for all sustained drinking trajectories, indicating some awareness of risk to the unborn child. Further, specific maternal characteristics were associated with different trajectories, which may inform targeted health promotion aimed at reducing alcohol use in pregnancy.
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Association of prenatal alcohol exposure with offspring DNA methylation in mammals: a systematic review of the evidence. Clin Epigenetics 2022; 14:12. [PMID: 35073992 PMCID: PMC8785586 DOI: 10.1186/s13148-022-01231-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/06/2022] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background
Prenatal alcohol exposure (PAE) is associated with a range of adverse offspring neurodevelopmental outcomes. Several studies suggest that PAE modifies DNA methylation in offspring cells and tissues, providing evidence for a potential mechanistic link to Fetal Alcohol Spectrum Disorder (FASD). We systematically reviewed existing evidence on the extent to which maternal alcohol use during pregnancy is associated with offspring DNA methylation.
Methods
A systematic literature search was conducted across five online databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Web of Science, EMBASE, Google Scholar and CINAHL Databases were searched for articles relating to PAE in placental mammals. Data were extracted from each study and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) was used to assess the potential for bias in human studies.
Results
Forty-three articles were identified for inclusion. Twenty-six animal studies and 16 human studies measured offspring DNA methylation in various tissues using candidate gene analysis, methylome-wide association studies (MWAS), or total nuclear DNA methylation content. PAE dose and timing varied between studies. Risk of bias was deemed high in nearly all human studies. There was insufficient evidence in human and animal studies to support global disruption of DNA methylation from PAE. Inconclusive evidence was found for hypomethylation at IGF2/H19 regions within somatic tissues. MWAS assessing PAE effects on offspring DNA methylation showed inconsistent evidence. There was some consistency in the relatively small number of MWAS conducted in populations with FASD. Meta-analyses could not be conducted due to significant heterogeneity between studies.
Conclusion
Considering heterogeneity in study design and potential for bias, evidence for an association between PAE and offspring DNA methylation was inconclusive. Some reproducible associations were observed in populations with FASD although the limited number of these studies warrants further research.
Trail Registration: This review is registered with PROSPERO (registration number: CRD42020167686).
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Muggli E, Halliday J, Elliott EJ, Penington A, Thompson D, Spittle AJ, Forster D, Lewis S, Hearps S, Anderson PJ. Cohort profile: early school years follow-up of the Asking Questions about Alcohol in Pregnancy Longitudinal Study in Melbourne, Australia (AQUA at 6). BMJ Open 2022; 12:e054706. [PMID: 35039298 PMCID: PMC8765013 DOI: 10.1136/bmjopen-2021-054706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The Asking Questions about Alcohol in Pregnancy (AQUA) study, established in 2011, is a prebirth cohort of 1570 mother and child pairs designed to assess the effects of low to moderate prenatal alcohol exposure and sporadic binge drinking on long-term child development. Women attending general antenatal clinics in public hospitals in Melbourne, Australia, were recruited in their first trimester, followed up three times during pregnancy and at 12 and 24 months postpartum. The current follow-up of the 6-8-year-old children aims to strengthen our understanding of the relationship between these levels of prenatal alcohol exposure and neuropsychological functioning, facial dysmorphology, brain structure and function. PARTICIPANTS Between June 2018 and April 2021, 802 of the 1342 eligible AQUA study families completed a parent-report questionnaire (60%). Restrictions associated with COVID-19 pandemic disrupted recruitment, but early school-age neuropsychological assessments were undertaken with 696 children (52%), and 482 (36%) craniofacial images were collected. A preplanned, exposure-representative subset of 146 children completed a brain MRI. An existing biobank was extended through collection of 427 (32%) child buccal swabs. FINDINGS TO DATE Over half (59%) of mothers consumed some alcohol during pregnancy, with one in five reporting at least one binge-drinking episode prior to pregnancy recognition. Children's craniofacial shape was examined at 12 months of age, and low to moderate prenatal alcohol exposure was associated with subtle midface changes. At 2 years of age, formal developmental assessments showed no evidence that cognitive, language or motor outcome was associated with any of exposure level. FUTURE PLANS We will investigate the relationship between prenatal alcohol exposure and specific aspects of neurodevelopment at 6-8 years, including craniofacial shape, brain structure and function. The contribution of genetics and epigenetics to individual variation in outcomes will be examined in conjunction with national and international collaborations.
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Affiliation(s)
- Evelyne Muggli
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Halliday
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Reproductive Epidemiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Elizabeth J Elliott
- Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Anthony Penington
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Plastic and Maxillofacial Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Deanne Thompson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia Jane Spittle
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Della Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Sharon Lewis
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Reproductive Epidemiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
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Steane SE, Young SL, Clifton VL, Gallo LA, Akison LK, Moritz KM. Prenatal alcohol consumption and placental outcomes: a systematic review and meta-analysis of clinical studies. Am J Obstet Gynecol 2021; 225:607.e1-607.e22. [PMID: 34181895 DOI: 10.1016/j.ajog.2021.06.078] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE A systematic review was conducted to determine placental outcomes following prenatal alcohol exposure in women. DATA SOURCES The search terms "maternal OR prenatal OR pregnant OR periconception" AND "placenta" AND "alcohol OR ethanol" were used across 5 databases (PubMed, Embase, Cochrane Library, Web of Science, and CINAHL) from inception until November 2020. STUDY ELIGIBILITY CRITERIA Articles were included if they reported placental outcomes in an alcohol exposure group compared with a control group. Studies were excluded if placentas were from elective termination before 20 weeks' gestation, animal studies, in vitro studies, case studies, or coexposure studies. METHODS Study quality was assessed by 2 reviewers using the Newcastle-Ottawa Quality Assessment Scale. Title and abstract screening was conducted by 2 reviewers to remove duplicates and irrelevant studies. Remaining full text articles were screened by 2 reviewers against inclusion and exclusion criteria. Placental outcome data were extracted and tabulated separately for studies of placentation, placental weight, placental morphology, and placental molecular studies. Meta-analyses were conducted for outcomes reported by >3 studies. RESULTS Database searching retrieved 640 unique records. Screening against inclusion and exclusion criteria resulted in 33 included studies. The quality assessment identified that 61% of studies were high quality, 30% were average quality, and 9% were low quality. Meta-analyses indicated that prenatal alcohol exposure increased the likelihood of placental abruption (odds ratio, 1.48; 95% confidence interval, 1.37-1.60) but not placenta previa (odds ratio, 1.14; 95% confidence interval, 0.84-1.34) and resulted in a reduction in placental weight of 51 g (95% confidence interval, -82.8 to -19.3). Reports of altered placental vasculature, placental DNA methylation, and gene expression following prenatal alcohol exposure were identified. A single study examined placentas from male and female infants separately and found sex-specific placental outcomes. CONCLUSION Prenatal alcohol exposure increases the likelihood of placental abruption and is associated with decreased placental weight, altered placental vasculature, DNA methylation, and molecular pathways. Given the critical role of the placenta in determining pregnancy outcomes, further studies investigating the molecular mechanisms underlying alcohol-induced placental dysfunction are required. Sex-specific placental adaptations to adverse conditions in utero have been well documented; thus, future studies should examine prenatal alcohol exposure-associated placental outcomes separately by sex.
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11
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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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12
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Maschke J, Roetner J, Bösl S, Plank AC, Rohleder N, Goecke TW, Fasching PA, Beckmann MW, Kratz O, Moll GH, Lenz B, Kornhuber J, Eichler A. Association of Prenatal Alcohol Exposure and Prenatal Maternal Depression with Offspring Low-Grade Inflammation in Early Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157920. [PMID: 34360212 PMCID: PMC8345560 DOI: 10.3390/ijerph18157920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 12/27/2022]
Abstract
(1) This longitudinal study aimed to investigate the link between prenatal alcohol exposure and prenatal maternal depression with the offspring’s low-grade inflammatory status. (2) Prenatal alcohol exposure was determined via maternal self-report during the 3rd trimester of pregnancy (self-report+: n = 29) and the meconium alcohol metabolite Ethyl Glucuronide (EtG), collected at birth (≥30 ng/g: n = 23). The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for prenatal maternal depressive symptoms during the 3rd trimester (≥10: n = 35). Fifteen years later, 122 adolescents (M = 13.32 years; 48.4% female) provided blood samples for the analysis of high sensitivity C-reactive protein (hsCRP; M = 0.91; SD = 1.28). (3) Higher hsCRP levels were found in EtG positive adolescents (p = 0.036, ηp2 = 0.04) and an inverse non-significant dose–response relation with hsCRP (r = −0.35, p = 0.113). For maternal self-reported prenatal alcohol consumption (p = 0.780, ηp2 = 0.00) and prenatal depressive symptoms (p = 0.360, ηp2 = 0.01) no differences for hsCRP levels between the affected and unaffected groups were found. (4) Adolescents with prenatal alcohol exposure are at risk for low-grade systemic inflammation. The EtG biomarker may be more accurate compared to self-reports. The findings suggest that prenatal maternal depression does not evoke low-grade systemic inflammation.
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Affiliation(s)
- Janina Maschke
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.R.); (S.B.); (A.-C.P.); (O.K.); (G.H.M.); (A.E.)
- Correspondence: ; Tel.: +49-9131-8544657
| | - Jakob Roetner
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.R.); (S.B.); (A.-C.P.); (O.K.); (G.H.M.); (A.E.)
| | - Sophia Bösl
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.R.); (S.B.); (A.-C.P.); (O.K.); (G.H.M.); (A.E.)
| | - Anne-Christine Plank
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.R.); (S.B.); (A.-C.P.); (O.K.); (G.H.M.); (A.E.)
| | - Nicolas Rohleder
- Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, 91052 Erlangen, Germany;
| | - Tamme W. Goecke
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (T.W.G.); (P.A.F.); (M.W.B.)
- Department of Obstetrics and Gynecology, RoMed Klinikum Rosenheim, 83022 Rosenheim, Germany
| | - Peter A. Fasching
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (T.W.G.); (P.A.F.); (M.W.B.)
| | - Matthias W. Beckmann
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (T.W.G.); (P.A.F.); (M.W.B.)
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.R.); (S.B.); (A.-C.P.); (O.K.); (G.H.M.); (A.E.)
| | - Gunther H. Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.R.); (S.B.); (A.-C.P.); (O.K.); (G.H.M.); (A.E.)
| | - Bernd Lenz
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (B.L.); (J.K.)
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (B.L.); (J.K.)
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.R.); (S.B.); (A.-C.P.); (O.K.); (G.H.M.); (A.E.)
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13
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Schölin L, Mukherjee RAS, Aiton N, Blackburn C, Brown S, Flemming KM, Gard PR, Howlett H, Plant M, Price AD, Shields J, Smith LA, Suttie M, Zammitt DC, Cook PA. Fetal alcohol spectrum disorders: an overview of current evidence and activities in the UK. Arch Dis Child 2021; 106:636-640. [PMID: 33441316 DOI: 10.1136/archdischild-2020-320435] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/03/2022]
Abstract
Estimates for the UK suggest that alcohol consumption during pregnancy and prevalence of fetal alcohol spectrum disorder (FASD)-the most common neurodevelopmental condition-are high. Considering the significant health and social impacts of FASD, there is a public health imperative to prioritise prevention, interventions and support. In this article, we outline the current state of play regarding FASD knowledge and research in the UK, which is characterised by a lack of evidence, a lack of dedicated funding and services, and consequently little policy formulation and strategic direction. We highlight progress made to date, as well as current knowledge and service gaps to propose a way forward for UK research.
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Affiliation(s)
- Lisa Schölin
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Raja A S Mukherjee
- Fetal Alcohol Syndrome Specialist Behaviour Clinic, Surrey and Borders Partnership NHS Foundation Trust, Surrey, UK
| | - Neil Aiton
- One Stop Clinic, Royal Sussex County Hospital, Brighton, Brighton and Hove, UK
| | - Carolyn Blackburn
- Centre for the Study of Practice and Culture in Education, Birmingham City University, Birmingham, West Midlands, UK
| | - Sarah Brown
- Fetal Alcohol Advisory and Support Team, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - Kate M Flemming
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
- Liverpool Centre for Alcohol Research, Liverpool, UK
| | - Paul R Gard
- School of Pharmacy and Biomolecular Science, University of Brighton, Brighton, East Sussex, UK
| | - Helen Howlett
- Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Moira Plant
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Alan D Price
- School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Jennifer Shields
- Fetal Alcohol Advisory and Support Team, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - Lesley A Smith
- Institute of Clinical and Applied Health Research, University of Hull, Hull, Kingston upon Hull, UK
| | - Michael Suttie
- Nuffield Department of Women's and Reproductive Health, Oxford University, Oxford, Oxfordshire, UK
| | - David C Zammitt
- Fetal Alcohol Advisory and Support Team, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - Penny A Cook
- School of Health Sciences, University of Salford, Salford, UK
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14
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Bakhireva LN, Leeman L, Roberts M, Rodriguez DE, Jacobson SW. You Didn't Drink During Pregnancy, Did You? Alcohol Clin Exp Res 2021; 45:543-547. [PMID: 33393695 DOI: 10.1111/acer.14545] [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: 10/15/2020] [Accepted: 12/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurate characterization of prenatal alcohol exposure (PAE) is challenging due to inconsistent use of screening questionnaires in routine prenatal care and substantial underreporting due to stigma associated with alcohol use in pregnancy. The aim of this study was to identify self-report tools that are efficient in accurately characterizing PAE. METHODS Participants meeting eligibility criteria for mild-to-moderate PAE were recruited into the University of New Mexico Ethanol, Neurodevelopment, Infant and Child Health cohort (N = 121) and followed prospectively. Timeline follow-back (TLFB) interviews were administered at baseline to capture alcohol use in the periconceptional period and 30 days before enrollment; reported quantity was converted to oz absolute alcohol (AA), multiplied by frequency of use and averaged across 2 TLBF calendars. The interview also included questions about timing and number of drinks at the most recent drinking episode, maximum number of drinks in a 24-hour period since the last menstrual period, and number of drinks on "special occasions" (irrespective of whether these occurred within the TLFB reported period). Continuous measures of alcohol use were analyzed to yield the number of binge episodes by participants who consumed ≥4 drinks/occasion. The proportion of women with ≥1 binge episode was also tabulated for each type of assessment. RESULTS Average alcohol consumption was 0.6 ± 1.3 oz of AA/day (≈ 8.4 drinks/wk). Only 3.3% of participants reported ≥1 binge episode on the TLFB, 19.8% had ≥1 binge episode when asked about "special occasions," and 52.1% when asked about the number of drinks the last time they drank alcohol. An even higher prevalence (89.3%) of bingeing was obtained based on the maximum number of drinks consumed in a 24-hour period. CONCLUSIONS Self-reported quantity of alcohol use varies greatly based on type of questions asked. Brief targeted questions about maximum number of drinks in 24 hours and total number of drinks during the most recent drinking episode provide much higher estimates of alcohol use and thus might be less affected by self-reporting bias.
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Affiliation(s)
- Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, Substace Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.,Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.,Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Lawrence Leeman
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Melissa Roberts
- Department of Pharmacy Practice and Administrative Sciences, Substace Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Dominique E Rodriguez
- Department of Pharmacy Practice and Administrative Sciences, Substace Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA
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15
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Young SL, Saif Z, Meakin AS, McMaster ES, Hayes N, Gallo LA, Reid N, Moritz KM, Clifton VL. Alterations to Placental Glucocorticoid Receptor Expression with Alcohol Consumption. Reprod Sci 2021; 28:1390-1402. [PMID: 33409870 DOI: 10.1007/s43032-020-00413-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022]
Abstract
Maternal alcohol consumption during pregnancy results in elevated vulnerability to intrauterine growth restriction, preterm birth, miscarriage, and stillbirth. Many of the detrimental effects of fetal alcohol exposure may be mediated through placental dysfunction; however, the exact mechanisms remain unknown. Here, we aimed to determine the effect of maternal alcohol exposure prior to and during early pregnancy on placental glucocorticoid receptor (GR) isoforms, associated GR regulated genes, and infant outcomes. Participants carrying singleton fetuses (n = 113) were recruited during early pregnancy. Amount and type of alcohol consumed over the last 12 months were obtained at 18 weeks of gestation. The level of drinking was separated into none (0 g/day), low (< 10 g/day), moderate (10-100 g/day), and heavy (> 100 g/day). At delivery, placental weight, infant sex, birthweight, and head circumference were recorded. Placental GR isoforms and genes involved in downstream signalling pathways were quantified. The majority of women (70.8%) consumed alcohol. Of these, most consumed low (48.8%) or moderate (37.5%) amounts. Placental weight was unaffected by alcohol consumption, but infants born to heavy drinkers tended to be lighter at birth. In female, but not male, placentae, maternal alcohol consumption resulted in increased GRαC and decreased GRαD1 cytoplasmic expression. In both female and male placentae, a dampened inflammatory response was evident with maternal alcohol consumption, involving downregulated IL6R and upregulated POU2F2 gene expression, respectively. Maternal alcohol consumption in the months prior to, and/or during early, pregnancy alters placental GR isoform and expression of some inflammatory genes in a sex-specific manner.
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Affiliation(s)
- S L Young
- School of Biomedical Sciences, The University of Queensland, St Lucia, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Z Saif
- Mater Research Institute-University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - A S Meakin
- Mater Research Institute-University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - E S McMaster
- School of Chemical and Molecular Biosciences, The University of Queensland, St Lucia, Australia
| | - N Hayes
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - L A Gallo
- School of Biomedical Sciences, The University of Queensland, St Lucia, Australia
| | - N Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - K M Moritz
- School of Biomedical Sciences, The University of Queensland, St Lucia, Australia.
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia.
| | - V L Clifton
- Mater Research Institute-University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
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16
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Vichitkunakorn P, Conigrave KM, Geater AF, Assanangkornchai S. A Context-Specific Instrument to Record Drinking Behaviour: A Pilot Study on Implications of Identifying the Context of Risky Drinking. Community Ment Health J 2021; 57:167-177. [PMID: 32399600 DOI: 10.1007/s10597-020-00629-0] [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: 01/11/2019] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
A context-specific quantity-frequency (CSQF) questionnaire has been developed to accurately measure alcohol consumption using probing questions on drinking context. The study aimed to describe the drinking context associated with different drinking intensities in a community of southern Thailand using the CSQF. A cross-sectional survey was conducted among adults aged > 15 years in Songkhla Province, Thailand. Among 804 participants, there were 183 current drinkers with 412 drinking events (215 low-, 79 medium-, and 118 high-intensity). More than half of these events occurred in special situations (i.e., holiday, party, and cultural drinking). About half of the drinking events occurred outside the drinker's house and most drinking events occurred among friends. Higher drinking intensity was associated with higher level of education [adjusted odds ratio (aOR) 4.74 for medium- and aOR 5.23 for high-intensity] and with a special drinking situation (aOR 2.46 for medium- and aOR 2.78 for high-intensity).
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Affiliation(s)
- Polathep Vichitkunakorn
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Katherine M Conigrave
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Alan F Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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17
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Symons M, Carter M, Oscar J, Pearson G, Bruce K, Newett K, Fitzpatrick JP. A reduction in reported alcohol use in pregnancy in Australian Aboriginal communities: a prevention campaign showing promise. Aust N Z J Public Health 2020; 44:284-290. [PMID: 32628358 DOI: 10.1111/1753-6405.13012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Aboriginal leaders in remote Western Australian communities with high rates of prenatal alcohol exposure invited researchers to evaluate the community-led Marulu foetal alcohol spectrum disorder (FASD) Prevention Strategy initiated in 2010. METHODS The proportion of women reporting alcohol use during pregnancy to midwives was compared between 2008, 2010 and 2015. Initial midwife appointments were calculated by weeks of gestation. The proportions of women reporting alcohol use by age at birth were compared. RESULTS Alcohol use reduced significantly from 2010 (61.0%) to 2015 (31.9%) with first-trimester use reducing significantly from 2008 (45.1%) to 2015 (21.6%). Across all years, 40.8% reported alcohol use during pregnancy and 14.8% reported use in both first and third trimesters. Most women attended the midwife in the first trimester. There was a significant relationship between increased maternal age and third-trimester alcohol use. CONCLUSIONS The reduction in reported prenatal alcohol exposure in an Aboriginal community setting during a period of prevention activities provides initial evidence for a community-led strategy that might be applicable to similar communities. Implications for public health: The reductions in alcohol use reduce the risk of children being born with FASD in an area with high prevalence, with possible resultant reductions in associated health, economic and societal costs.
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Affiliation(s)
- Martyn Symons
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia.,National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, Telethon Kids Institute, Perth, Western Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia
| | - Glenn Pearson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
| | - Kaashifah Bruce
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
| | | | - James P Fitzpatrick
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia.,School of Psychological Sciences, The University of Western Australia, Perth, Western Australia
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18
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New approach for the measurement of long-term alcohol consumption trends: Application of wastewater-based epidemiology in an Australian regional city. Drug Alcohol Depend 2020; 207:107795. [PMID: 31865059 DOI: 10.1016/j.drugalcdep.2019.107795] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/21/2019] [Accepted: 12/01/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Wastewater-based epidemiology (WBE) provides complementary information to traditional self-report methods for estimating substance use within a population. WBE was applied to estimate the consumption of alcohol in an Australian rural city (population estimated 100,000) over 6 years. METHODS A total of 352 wastewater samples were analysed from a wastewater treatment plant located in South-East Queensland, Australia, from 2012 to 2017. The concentration of an alcohol biomarker, ethyl sulphate, was quantified by liquid chromatography tandem mass spectrometry and used to estimate per-capita consumption. The WBE results were compared with alcohol consumption estimates based on national taxation data and self-reported national survey data in Australia. RESULTS Average daily alcohol consumption estimated by WBE was between 19 and 30 mL/person/day for the population aged 15 years and older during the six-year period. Alcohol consumption decreased 4 % per annum on average over the study period. Our data showed higher rates of consumption on weekends and public holidays when compared to consumption between Monday and Thursday. The comparative trend of WBE data was consistent with the national alcohol survey and taxation statistics on alcoholic beverages over the same period. CONCLUSIONS A clear decline in alcohol consumption in the catchment was observed during the sampling period, which reflected similar changes in consumption from taxation statistics and self-report survey data. Expected variations in weekly consumption and public holidays were also identified. This study demonstrates the potential of WBE for long-term monitoring of alcohol consumption in evaluating the effectiveness of local and national alcohol policies and prevention programs.
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19
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Schölin L, Fitzgerald N. The conversation matters: a qualitative study exploring the implementation of alcohol screening and brief interventions in antenatal care in Scotland. BMC Pregnancy Childbirth 2019; 19:316. [PMID: 31481011 PMCID: PMC6724251 DOI: 10.1186/s12884-019-2431-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022] Open
Abstract
Background Alcohol screening and brief intervention (SBI) in antenatal care is internationally recommended to prevent harm caused by alcohol exposure during pregnancy. There is, however, limited understanding of how SBI is implemented within antenatal care; particularly the approach taken by midwives. This study aimed to explore the implementation of a national antenatal SBI programme in Scotland. Methods Qualitative interviews were conducted with antenatal SBI implementation leaders (N = 8) in eight Scottish health boards. Interviews were analysed thematically and using the ‘practical, robust implementation and sustainability model’ (PRISM) to understand differences in implementation across health boards and perceived setting-specific barriers and challenges. Results In several health boards, where reported maternal alcohol use was lower than expected, implementation leaders sought to optimize enquires about women’s alcohol use to facilitate honest disclosure. Strategies focused on having positive conversations, exploring pre-pregnancy drinking habits, and building a trusting relationship between pregnant women and midwives. Women’s responses were encouraging and disclosure rates appeared improved, though with some unexpected variation over time. Adapting the intervention to the local context was also considered important. Conclusions This is the first study to explore implementation leaders’ experiences of antenatal SBI delivery and identify possible changes in disclosure rates arising from the approach taken. In contrast with current antenatal alcohol screening recommendations, a conversational approach was advocated to enhance the accuracy and honesty of reporting. This may enable provision of support to more women to prevent Fetal Alcohol Spectrum Disorders (FASD) and will therefore be of international interest.
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Affiliation(s)
- Lisa Schölin
- School of Health in Social Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Niamh Fitzgerald
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, UK.
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20
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Blanck-Lubarsch M, Dirksen D, Feldmann R, Sauerland C, Kirschneck C, Hohoff A. 3D Analysis of Philtrum Depth in Children with Fetal Alcohol Syndrome. Alcohol Alcohol 2019; 54:152-158. [PMID: 30608520 DOI: 10.1093/alcalc/agy088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS Diagnosis of fetal alcohol spectrum disorder (FASD) is complex and difficult. The estimated number of unreported FASD is thus assumed to be substantial. In our cross-sectional study, we aimed to identify possible metric differences in philtrum depth in children with fetal alcohol syndrome (FAS) compared to healthy controls based on non-invasive 3D facial scanning in order to provide an objective, metrical tool improving FASD diagnosis. METHODS Twenty-five children with confirmed FAS and 30 healthy school children without FAS, both in the mixed dentition, were prospectively recruited and 3D facial scans were performed after recording body length, weight and head circumference. Philtrum surface data were extracted and metric philtrum depth was determined at four geometrically defined measuring points (P1-P4) along the vertical length of the philtrum. RESULTS Philtrum depths at P1 (P = 0.025), P2 (P = 0.001), P3 (P < 0.001) and P4 (P = 0.001) as well as mean philtrum depth P1-P4 (P < 0.001) differed significantly between patients with and without FAS. Compared to controls, the philtrum was shallower in patients with FAS by on average 0.4 mm at each of the respective points. Whereas no differences could be determined for body height and weight, head circumference was significantly smaller in patients with FAS (P = 0.001), particularly in girls (P = 0.008). CONCLUSIONS Apart from head circumference, philtrum depth is significantly reduced in children with FAS and can thus be used as diagnostic indicator to aid and confirm FAS diagnosis. In contrast to visual assessments, 3D face scan methods allow a more objective quantification and can thus provide additional evidence in FAS diagnosis.
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Affiliation(s)
- Moritz Blanck-Lubarsch
- Department of Orthodontics, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Dieter Dirksen
- Department of Prosthodontics and Biomaterials, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Reinhold Feldmann
- Department of Pediatrics, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstraße 56, Münster, Germany
| | - Christian Kirschneck
- Department of Orthodontics, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Ariane Hohoff
- Department of Orthodontics, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
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21
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Poole N, Schmidt RA, Bocking A, Bergeron J, Fortier I. The Potential for Fetal Alcohol Spectrum Disorder Prevention of a Harmonized Approach to Data Collection about Alcohol Use in Pregnancy Cohort Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2019. [PMID: 31174290 PMCID: PMC6603946 DOI: 10.3390/ijerph16112019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/24/2019] [Accepted: 06/05/2019] [Indexed: 11/16/2022]
Abstract
Prenatal alcohol exposure is a leading cause of disability, and a major public health concern in Canada. There are well-documented barriers for women and for service providers related to asking about alcohol use in pregnancy. Confidential research is important for learning about alcohol use before, during and after pregnancy, in order to inform fetal alcohol spectrum disorder (FASD) prevention strategies. The Research Advancement through Cohort Cataloguing and Harmonization (ReACH) initiative provides a unique opportunity to leverage the integration of the Canadian pregnancy and birth cohort information regarding women's drinking during pregnancy. In this paper, we identify: The data that can be collected using formal validated alcohol screening tools; the data currently collected through Canadian provincial/territorial perinatal surveillance efforts; and the data currently collected in the research context from 12 pregnancy cohorts in the ReACH Catalogue. We use these findings to make recommendations for data collection about women's alcohol use by future pregnancy cohorts, related to the frequency and quantity of alcohol consumed, the number of drinks consumed on an occasion, any alcohol consumption before pregnancy, changes in use since pregnancy recognition, and the quit date. Leveraging the development of a Canadian standard to measure alcohol consumption is essential to facilitate harmonization and co-analysis of data across cohorts, to obtain more accurate data on women's alcohol use and also to inform FASD prevention strategies.
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Affiliation(s)
- Nancy Poole
- Centre of Excellence for Women's Health, Vancouver, BC V6H 3N1, Canada.
| | - Rose A Schmidt
- Centre of Excellence for Women's Health, Vancouver, BC V6H 3N1, Canada.
| | - Alan Bocking
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5G 1X5, Canada.
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON M5G 1X5, Canada.
| | - Julie Bergeron
- Research Institute of the McGill University Health Center, Montreal, QC H3H 2R9, Canada.
| | - Isabel Fortier
- Research Institute of the McGill University Health Center, Montreal, QC H3H 2R9, Canada.
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22
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Freeman J, Condon C, Hamilton S, Mutch RC, Bower C, Watkins RE. Challenges in Accurately Assessing Prenatal Alcohol Exposure in a Study of Fetal Alcohol Spectrum Disorder in a Youth Detention Center. Alcohol Clin Exp Res 2019; 43:309-316. [PMID: 30427546 PMCID: PMC6590127 DOI: 10.1111/acer.13926] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/03/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) can result in permanent disability, including physical, neurodevelopmental, and cognitive impairments, known as fetal alcohol spectrum disorder (FASD). Individuals with FASD are more likely to engage with the law, including being placed in detention, than individuals without FASD. Young people who were sentenced to detention participated in a FASD prevalence study in Western Australia. The diagnosis of FASD requires a multidisciplinary assessment and confirmation of maternal alcohol consumption during pregnancy. Obtaining accurate assessment of PAE for young people participating in the study was challenging. METHODS An interview with the birth mother or other responsible adult for young people sentenced to detention in Western Australia was conducted as part of the FASD assessment. The Alcohol Use Disorders Identification Test consumption subset (AUDIT-C), other relevant questions, and documentary evidence were used to assess PAE. PAE was categorized according to the Australian Guide to the Diagnosis of FASD: no PAE reported, confirmed or confirmed high-risk, or unknown. RESULTS Among the 101 participants, information on PAE was unable to be obtained for 13 (13%) young people. Of the remaining 88 participants with information of PAE, 41 reported no PAE and 47 had confirmed PAE. CONCLUSIONS Accurately assessing prenatal alcohol consumption is challenging in any setting, but it is exceptionally challenging when assessed 13 to 17 years retrospectively as part of a FASD assessment for a young person sentenced to detention. Recording and recoding detailed qualitative responses was required to provide an accurate assessment of PAE using the AUDIT-C. Standardized recording of PAE in antenatal and birth records would facilitate later assessments for FASD and provide opportunities for advice and support for women who continue to drink during pregnancy.
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Affiliation(s)
- Jacinta Freeman
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Carmen Condon
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Sharynne Hamilton
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
- School of Paediatrics and Child HealthUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Raewyn C. Mutch
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
- School of Paediatrics and Child HealthUniversity of Western AustraliaPerthWestern AustraliaAustralia
- School of MedicineDentistry and Health SciencesUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Child and Adolescent Health ServiceDepartment of Health Western AustraliaPerthWestern AustraliaAustralia
| | - Carol Bower
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Rochelle E. Watkins
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
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23
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Symons M, Pedruzzi RA, Bruce K, Milne E. A systematic review of prevention interventions to reduce prenatal alcohol exposure and fetal alcohol spectrum disorder in indigenous communities. BMC Public Health 2018; 18:1227. [PMID: 30390661 PMCID: PMC6215602 DOI: 10.1186/s12889-018-6139-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/22/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a preventable, lifelong neurodevelopmental disorder caused by prenatal alcohol exposure. FASD negatively impacts individual Indigenous communities around the world. Although many prevention interventions have been developed and implemented, they have not been adequately evaluated. This systematic review updates the evidence for the effectiveness of FASD prevention interventions in Indigenous/Aboriginal populations internationally, and in specific populations in North America and New Zealand, and offers recommendations for future work. METHOD The MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO, SocINDEX, and Informit databases were searched from inception to 22/08/2017 for all prevention and intervention papers published in peer-reviewed scientific journals, with results, targeting prenatal alcohol exposure and FASD in Indigenous populations. This review was limited to studies published in English and excluded interventions focusing on the workforce. All steps were completed independently by two reviewers with discrepancies resolved via consensus with the senior author. RESULTS There was significant heterogeneity in the ten included studies. Populations targeted included non-pregnant women of child-bearing age, pregnant women, school children and the general public. Study designs included one randomised controlled trial, five cohort studies with pre-post design, one cross-sectional study with different pre- and post-intervention groups, and four studies collected post-intervention data. Studies assessed changes in knowledge, and/or changes in risk for prenatal alcohol exposure including self-reported alcohol consumption, use of birth control or a combination of both. One study was conducted in Australia and nine in the US. The methodological quality of all studies was rated as 'Poor' using the systematic review assessment tools developed by The National Heart, Lung and Blood Institute. Studies were subject to substantial bias due to issues such as high loss to follow-up, lack of control groups and the reliance on self-report measures to assess the main outcome. CONCLUSION Overall, there is little evidence that previous interventions aiming to reduce the risk of prenatal alcohol exposure or FASD in Indigenous populations have been effective. Future intervention studies should address the cultural factors and historical context that are fundamental to successful work with Indigenous populations, and be designed, implemented and evaluated using rigorous methods. This systematic review was registered with PROSPERO, CRD42018086212.
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Affiliation(s)
- Martyn Symons
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Perth, WA 6872 Australia
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, Perth, Australia
| | - Rebecca Anne Pedruzzi
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Perth, WA 6872 Australia
| | - Kaashifah Bruce
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Perth, WA 6872 Australia
| | - Elizabeth Milne
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Perth, WA 6872 Australia
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24
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Bakhireva LN, Shrestha S, Garrison L, Leeman L, Rayburn WF, Stephen JM. Prevalence of alcohol use in pregnant women with substance use disorder. Drug Alcohol Depend 2018; 187:305-310. [PMID: 29704852 PMCID: PMC6298752 DOI: 10.1016/j.drugalcdep.2018.02.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/16/2018] [Accepted: 02/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prenatal care programs for women with opioid use disorder (OUD) often focus treatment/counseling plans around illicit substances, while concurrent use of alcohol might present an equal or greater risk to the fetus. METHODS This study evaluated self-reported prevalence of alcohol use in patients participating in a comprehensive prenatal care program for women with substance use disorder (SUD; n = 295), of which 95% are treated for OUD, and pregnant women being served through general obstetrical clinics at the University of New Mexico (n = 365). During the screening phase of a prospective study, patients were asked to report alcohol use in the periconceptional period, and between the last menstrual period and pregnancy recognition. RESULTS The screening interview was conducted at 22.3 (median = 22; Q1 = 16; Q3 = 29) gestational weeks. Among patients screened at the SUD clinic, 28.8% and 24.1% reported at least one binge drinking episode in the periconceptional period and in early pregnancy, respectively. The prevalence of binge drinking was similar in the general obstetrics population (24.7% and 24.4%, respectively). Among those who reported drinking in early pregnancy, median number of binge drinking episodes was higher among patients screened at the SUD clinic (median = 3; Q1 = 1; Q3 = 10) compared to the general obstetrics group (median = 1; Q1 = 1; Q3 = 3; p < 0.001). CONCLUSIONS This study demonstrates a high prevalence of prenatal alcohol use in early pregnancy in both groups, while patients with SUD/OUD consume more alcohol. These findings underscore the need for targeted screening and intervention for alcohol use in all pregnant women, especially those with SUD/OUD.
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Affiliation(s)
- Ludmila N. Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Address: MSC09 5360, 1 University of New Mexico, Albuquerque, NM, 87131, USA,Department of Family and Community Medicine, School of Medicine, University of New Mexico, Address: MSC09 5040, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Shikhar Shrestha
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Address: MSC09 5360, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Laura Garrison
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Address: MSC09 5360, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Lawrence Leeman
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Address: MSC09 5040, 1 University of New Mexico, Albuquerque, NM, 87131, USA,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Address: MSC10 5580, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - William F. Rayburn
- Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Address: MSC10 5580, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Julia M. Stephen
- The Mind Research Network, Address: 1101 Yale Blvd. NE, Albuquerque, NM, 87106, USA,Lovelace Biomedical and Environmental Research Institute 2425 Ridgecrest Dr. SE, Albuquerque, NM, 87108, USA
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25
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Washio Y, Goldstein ND, Butler R, Rogers S, Paul DA, Terplan M, Hoffman MK. Self-report measure as a useful tool to identify prenatal substance use and predict adverse birth outcomes. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1477750918765224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The purpose of the current study was to examine whether a self-report measure identifies prenatal substance use and predicts resulting adverse birth outcomes in a large cohort using electronic medical records. Methods Pregnant patients who were admitted between 2014 and 2015 at Christiana Care Health System and delivered singleton birth were included in the analyses ( N = 11,020). Participant demographic information, pregnancy comorbidities, self-reported substance use, and birth outcomes were retrieved from electronic medical records. Detailed descriptive analyses of prenatal substance use were conducted, and logistic models were evaluated for the associations between substance use and each birth outcome (preterm birth, low birth weight, neonatal intensive care unit admission). Results The average maternal age was 30 years (standard deviation: 6), 37% receiving Medicaid. Over 58% were White, 26% were Black, and 13% were Hispanic. Cigarette smoking only showed the highest prevalence among substance users (53%). Self-reported cigarette smoking and illicit drug use other than marijuana significantly predicted all three adverse birth outcomes (Adjusted Odds Ratio [AOR] range: 1.33 (95% Confidence Interval [CI]: 1.08–1.64)–3.09 (95% CI: 2.03–4.67)). Nonresponders to the cigarette smoking question also significantly predicted two adverse birth outcomes of preterm birth delivery (AOR: 4.16; 95% CI: 1.27–14.71) and having low birth weight babies (AOR: 3.50; 95% CI: 1.04–12.61). Conclusions/Importance: Prenatal cigarette smoking only had the highest prevalence, and co-use with illicit drugs was also high, leading to significant associations with adverse birth outcomes. The study findings indicate that the self-report measurement is a useful tool to identify prenatal substance use and predict resulting adverse birth outcomes.
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Affiliation(s)
- Yukiko Washio
- Christiana Care Health System, University of Delaware, Newark, DE,, USA
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26
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Myers B, Koen N, Donald KA, Nhapi RT, Workman L, Barnett W, Hoffman N, Koopowitz S, Zar HJ, Stein DJ. Effect of Hazardous Alcohol Use During Pregnancy on Growth Outcomes at Birth: Findings from a South African Cohort Study. Alcohol Clin Exp Res 2017; 42:369-377. [PMID: 29197115 PMCID: PMC5887896 DOI: 10.1111/acer.13566] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
Background Cohort studies have noted associations between hazardous alcohol use during pregnancy and infant growth outcomes, but many have not controlled for potential psychosocial confounders. To assess the unique contribution of hazardous alcohol use, we examined its effect on infant growth outcomes while controlling for maternal psychosocial stressors and hazardous tobacco and drug use in a cohort of 986 pregnant South African women enrolled into the Drakenstein Child Health Study between 2012 and 2015. Methods Data on psychosocial stressors and maternal risk behaviors were collected between 28 and 32 weeks of gestation. Participants were categorized as hazardous alcohol users if they obtained moderate or high scores (>10) on the Alcohol, Smoking and Substance Involvement Screening Test at this assessment or retrospectively reported drinking at least 2 drinks weekly during any trimester of pregnancy. Infant growth outcomes were recorded at delivery. Multivariable regression models examined correlates of hazardous alcohol use and associations between hazardous alcohol use and birth outcomes. Results Overall, 13% of mothers reported hazardous alcohol use. Recent exposure to intimate partner violence (adjusted odds ratio (aOR) = 2.08; 95% confidence interval (CI): 1.37, 3.18) and hazardous tobacco use (aOR = 5.03; 95% CI: 2.97, 8.52) were significant correlates of hazardous alcohol use. After controlling for potential psychosocial confounders, hazardous alcohol use remained associated with lower infant weight‐for‐age (B = −0.35, 95% CI: −0.56, −0.14), height‐for‐age (B = −0.46, 95% CI: −0.76, −0.17), and head‐circumference‐for‐age z‐scores (B = −0.43, 95% CI: −0.69, −0.17). Conclusions Interventions to reduce hazardous alcohol use among pregnant women in South Africa are needed to prevent alcohol‐related infant growth restrictions. As these growth deficits may lead to neurodevelopmental consequences, it is critical to identify alcohol‐related growth restrictions at birth and link exposed infants to early interventions for neurodevelopment.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Raymond T Nhapi
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lesley Workman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Nadia Hoffman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Sheri Koopowitz
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Anxiety and Stress Disorders, Cape Town, South Africa
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27
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Halliday JL, Muggli E, Lewis S, Elliott EJ, Amor DJ, O'Leary C, Donath S, Forster D, Nagle C, Craig JM, Anderson PJ. Alcohol consumption in a general antenatal population and child neurodevelopment at 2 years. J Epidemiol Community Health 2017; 71:990-998. [PMID: 28839077 DOI: 10.1136/jech-2017-209165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/05/2017] [Accepted: 08/09/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) is a community health problem with up to 50% of pregnant women drinking alcohol. The relationship between low or sporadic binge PAE and adverse child outcomes is not clear. This study examines the association between PAE in the general antenatal population and child neurodevelopment at 2 years, accounting for relevant contributing factors. METHODS This prospective population-based cohort recruited 1570 pregnant women, providing sociodemographic, psychological and lifestyle information and alcohol use for five time periods. PAE categories were 'low', 'moderate/high', 'binge', in trimester 1 or throughout pregnancy. Measures of cognitive, language and motor development (Bayley Scales of Infant and Toddler Development) were available for 554 children, while measures of sensory processing (Infant/Toddler Sensory Profile) and social-emotional development (Brief Infant Toddler Social Emotional Assessment) were available for 948. RESULTS A positive association in univariate analysis with low-level PAE throughout pregnancy and cognition (β=4.1, 95% CI -0.02 to 8.22, p=0.05) was attenuated by adjusting for environmental/social deprivation risk factors (β=3.06 (-1.19 to 7.30), p=0.16). Early binge drinking, plus continued PAE at lower levels, was associated with the child being more likely to score low in sensation avoidance (adjusted OR 1.88 (1.03 to 3.41), p=0.04). CONCLUSION Early binge exposure, followed by lower-level PAE, demonstrated an increase in sensation-avoiding behaviour. There were, however, no significant associations between PAE and neurodevelopment following adjustment for important confounders and modifiers. Follow-up is paramount to investigate subtle or later onset problems.
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Affiliation(s)
- Jane L Halliday
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Evelyne Muggli
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon Lewis
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth J Elliott
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Paediatrics and Child Health, Children's Hospital Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Amor
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Colleen O'Leary
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Susan Donath
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Della Forster
- School of Nursing and Midwifery, Judith Lumley Centre, SHE College, La Trobe University, Melbourne, Victoria, Australia.,Midwifery and Maternity Services Research Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Cate Nagle
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia.,Women's and Children's Division, Western Health, St Albans, Victoria, Australia
| | - Jeffrey M Craig
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter J Anderson
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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28
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Muggli E, Matthews H, Penington A, Claes P, O’Leary C, Forster D, Donath S, Anderson PJ, Lewis S, Nagle C, Craig JM, White SM, Elliott EJ, Halliday J. Association Between Prenatal Alcohol Exposure and Craniofacial Shape of Children at 12 Months of Age. JAMA Pediatr 2017; 171:771-780. [PMID: 28586842 PMCID: PMC6583660 DOI: 10.1001/jamapediatrics.2017.0778] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Children who receive a diagnosis of fetal alcohol spectrum disorder may have a characteristic facial appearance in addition to neurodevelopmental impairment. It is not well understood whether there is a gradient of facial characteristics of children who did not receive a diagnosis of fetal alcohol spectrum disorder but who were exposed to a range of common drinking patterns during pregnancy. OBJECTIVE To examine the association between dose, frequency, and timing of prenatal alcohol exposure and craniofacial phenotype in 12-month-old children. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was performed from January 1, 2011, to December 30, 2014, among mothers recruited in the first trimester of pregnancy from low-risk, public maternity clinics in metropolitan Melbourne, Australia. A total of 415 white children were included in this analysis of 3-dimensional craniofacial images taken at 12 months of age. Analysis was performed with objective, holistic craniofacial phenotyping using dense surface models of the face and head. Partial least square regression models included covariates known to affect craniofacial shape. EXPOSURES Low, moderate to high, or binge-level alcohol exposure in the first trimester or throughout pregnancy. MAIN OUTCOMES AND MEASURES Anatomical differences in global and regional craniofacial shape between children of women who abstained from alcohol during pregnancy and children with varying levels of prenatal alcohol exposure. RESULTS Of the 415 children in the study (195 girls and 220 boys; mean [SD] age, 363.0 [8.3] days), a consistent association between craniofacial shape and prenatal alcohol exposure was observed at almost any level regardless of whether exposure occurred only in the first trimester or throughout pregnancy. Regions of difference were concentrated around the midface, nose, lips, and eyes. Directional visualization showed that these differences corresponded to general recession of the midface and superior displacement of the nose, especially the tip of the nose, indicating shortening of the nose and upturning of the nose tip. Differences were most pronounced between groups with no exposure and groups with low exposure in the first trimester (forehead), moderate to high exposure in the first trimester (eyes, midface, chin, and parietal region), and binge-level exposure in the first trimester (chin). CONCLUSIONS AND RELEVANCE Prenatal alcohol exposure, even at low levels, can influence craniofacial development. Although the clinical significance of these findings is yet to be determined, they support the conclusion that for women who are or may become pregnant, avoiding alcohol is the safest option.
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Affiliation(s)
- Evelyne Muggli
- Public Health Genetics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Harold Matthews
- Department of Paediatrics, University of Melbourne, Victoria, Australia,Plastic and Maxillofacial Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia,Plastic Surgery, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Anthony Penington
- Department of Paediatrics, University of Melbourne, Victoria, Australia,Plastic and Maxillofacial Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia,Plastic Surgery, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Peter Claes
- Plastic Surgery, Murdoch Childrens Research Institute, Parkville, Victoria, Australia,Department of Electrical Engineering, Processing Speech and Images, Katholieke Universiteit Leuven, Leuven, Belgium,Medical Imaging Research Center, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Colleen O’Leary
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Della Forster
- Judith Lumley Centre, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia,Midwifery and Maternity Services Research Unit, The Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Susan Donath
- Department of Paediatrics, University of Melbourne, Victoria, Australia,Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Peter J. Anderson
- Department of Paediatrics, University of Melbourne, Victoria, Australia,Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia,Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Sharon Lewis
- Public Health Genetics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Cate Nagle
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia,Women’s and Children’s Division, Western Health, St Albans, Victoria, Australia
| | - Jeffrey M. Craig
- Department of Paediatrics, University of Melbourne, Victoria, Australia,Environmental and Genetic Epidemiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Susan M. White
- Department of Paediatrics, University of Melbourne, Victoria, Australia,Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Elizabeth J. Elliott
- Paediatrics and Child Health, Children’s Hospital Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Jane Halliday
- Public Health Genetics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Victoria, Australia
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Dukes K, Tripp T, Petersen J, Robinson F, Odendaal H, Elliott A, Willinger M, Hereld D, Raffo C, Kinney HC, Groenewald C, Angal J, Young R, Burd L. A modified Timeline Followback assessment to capture alcohol exposure in pregnant women: Application in the Safe Passage Study. Alcohol 2017; 62:17-27. [PMID: 28755748 DOI: 10.1016/j.alcohol.2017.02.174] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 12/14/2022]
Abstract
Prenatal alcohol exposure (PAE) has been linked to poor pregnancy outcomes, yet there is no recognized standard for PAE assessment, and the specific effects of quantity, frequency, and timing remain largely unknown. The Safe Passage Study was designed to investigate the role of PAE in a continuum of poor peri- and postnatal outcomes. The objective of this manuscript is to describe the rationale for, and feasibility of, modifications to the traditional Timeline Followback (TLFB) for collecting PAE information in a large cohort of pregnant women. Participants from the Northern Plains region (in the United States) and Cape Town, South Africa, were followed prospectively using a modified 30-day TLFB interview, administered up to five times, to obtain detailed PAE information. Required modifications for our population included capturing information regarding sharing, type/brand, container size, and duration, in order to accurately record the amount of alcohol consumed. PAE status was defined for 99.9% of the 11,892 enrolled pregnancies at least once during pregnancy and for 92% across all trimesters. Of 53,823 drinks reported, 98% had all items necessary for standard drink computation. Sharing was reported for 74% of drinks in Cape Town, South Africa and for 10% in the Northern Plains. Compared to referent values from the traditional TLFB, 74% and 67% of drinks had different alcohol-by-volume and container size, respectively. Furthermore, a statistically significant difference was found between the number of containers reported and the number of standard drinks computed, using information from the modified TLFB. This is the first study of this size to wholly encompass all of these changes into a single measure in order to more accurately calculate daily consumption and assess patterns over time. The methods used to collect PAE information and create alcohol exposure measures likely increased the accuracy of standard drinks reported and could be generalized to other populations.
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Affiliation(s)
- Kimberly Dukes
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA.
| | - Tara Tripp
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Julie Petersen
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Fay Robinson
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Hein Odendaal
- Stellenbosch University, Department of Obstetrics and Gynecology, Francie van Zijl Avenue, Tygerberg 7505, South Africa
| | - Amy Elliott
- Sanford Research, Center for Health Outcomes and Prevention Research, 2301 E. 60th Street North, Sioux Falls, SD 57104, USA
| | - Marian Willinger
- National Institute of Child Health and Human Development, 31 Center Drive, Building 31, Room 2A32, Bethesda, MD 20892-2425, USA
| | - Dale Hereld
- National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Rockville, MD 20852, USA
| | - Cheryl Raffo
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Hannah C Kinney
- Boston Children's Hospital, Department of Pathology, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Coen Groenewald
- Stellenbosch University, Department of Obstetrics and Gynecology, Francie van Zijl Avenue, Tygerberg 7505, South Africa
| | - Jyoti Angal
- Sanford Research, Center for Health Outcomes and Prevention Research, 2301 E. 60th Street North, Sioux Falls, SD 57104, USA
| | - Rebecca Young
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Larry Burd
- University of North Dakota, Fetal Alcohol Syndrome Center, School of Medicine & Health Sciences, 501 North Columbia Road, Grand Forks, ND 58203-9037, USA
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30
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Bager H, Christensen LP, Husby S, Bjerregaard L. Biomarkers for the Detection of Prenatal Alcohol Exposure: A Review. Alcohol Clin Exp Res 2017; 41:251-261. [PMID: 28098942 DOI: 10.1111/acer.13309] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/03/2016] [Indexed: 01/06/2023]
Abstract
Alcohol exposure during pregnancy can cause adverse effects to the fetus, because it interferes with fetal development, leading to later physical and mental impairment. The most common clinical tool to determine fetal alcohol exposure is maternal self-reporting. However, a more objective and useful method is based on the use of biomarkers in biological specimens alone or in combination with maternal self-reporting. This review reports on clinically relevant biomarkers for detection of prenatal alcohol exposure (PAE). A systematic search was performed to ensure a proper overview in existing literature. Studies were selected to give an overview on clinically relevant neonatal and maternal biomarkers. The direct biomarkers fatty acid ethyl esters (FAEEs), ethyl glucuronide (EtG), ethyl sulfate, and phosphatidylethanol (PEth) were found to be the most appropriate biomarkers in relation to detection of PAE. To review each biomarker in a clinical context, we have compared the advantages and disadvantages of each biomarker, in relation to its window of detectability, ease of collection, and the ease and cost of analysis of each biomarker. The biomarkers PEth, FAEEs, and EtG were found to be applicable for detection of even low levels of alcohol exposure. Meconium is an accessible matrix for determination of FAEEs and EtG, and blood an accessible matrix for determination of PEth.
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Affiliation(s)
- Heidi Bager
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| | - Lars Porskjaer Christensen
- Department of Chemical Engineering, Biotechnology and Environmental Technology, University of Southern Denmark, Odense M, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| | - Lene Bjerregaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
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31
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Symon A, Rankin J, Sinclair H, Butcher G, Barclay K, Gordon R, MacDonald M, Smith L. Peri-conceptual and mid-pregnancy drinking: a cross-sectional assessment in two Scottish health board areas using a 7-day Retrospective Diary. J Adv Nurs 2016; 73:375-385. [PMID: 27555470 DOI: 10.1111/jan.13112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to evaluate the use of a 7-day Retrospective Diary to assess peri-conceptual and mid-pregnancy alcohol consumption. BACKGROUND Alcohol consumption among women has increased significantly and is of international concern. Heavy episodic ('binge') drinking is commonplace and is associated with unintended pregnancy. Pre-pregnancy drinking is strongly associated with continued drinking in pregnancy. Routine antenatal assessment of alcohol history and current drinking is variable; potentially harmful peri-conceptual drinking may be missed if a woman reports low or no drinking during pregnancy. DESIGN Cross-sectional study (n = 510) in two Scottish health board areas. METHODS Face-to-face Retrospective Diary administration from February to June 2015 assessing alcohol consumption in peri-conceptual and mid-pregnancy periods. Women were recruited at the mid-pregnancy ultrasound clinic. RESULTS Of 510 women, 470 (92·0%) drank alcohol before their pregnancy; 187 (39·9%) drank every week. Retrospective assessment of peri-conceptual consumption identified heavy episodic drinking (more than six units on one occasion) in 52·2% (n = 266); 19·6% (n = 100) reported drinking more than 14 units per week, mostly at the weekend; 'mixing' of drinks was associated with significantly higher consumption. While consumption tailed off following pregnancy recognition, 5·5% (n = 28) still exceeded the recommended daily two-unit limit in pregnancy. Multivariable logistic regression identified that women who 'binged' peri-conceptually were 3·2 times more likely to do this. CONCLUSION Statistically significant peri-conceptual consumption levels suggest a substantial proportion of alcohol-exposed pregnancies before pregnancy recognition. Not taking a detailed alcohol history, including patterns of consumption, will result in under-detection of alcohol-exposed pregnancies. The Retrospective Diary offers practitioners a detailed way of enquiring about alcohol history for this population.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, UK
| | - Jean Rankin
- Maternal, Child and Family Health, School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | | | - Kylie Barclay
- School of Nursing and Health Sciences, University of Dundee, UK
| | - Rhona Gordon
- School of Nursing and Health Sciences, University of Dundee, UK
| | | | - Lesley Smith
- Department of Psychology, Social Work and Public Health, Oxford Brookes University, Marston, UK
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32
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Sympathy, shame, and few solutions: News media portrayals of fetal alcohol spectrum disorders. Midwifery 2016; 40:49-54. [DOI: 10.1016/j.midw.2016.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 11/23/2022]
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McQuire C, Paranjothy S, Hurt L, Mann M, Farewell D, Kemp A. Objective Measures of Prenatal Alcohol Exposure: A Systematic Review. Pediatrics 2016; 138:peds.2016-0517. [PMID: 27577579 DOI: 10.1542/peds.2016-0517] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Objective measurement of prenatal alcohol exposure (PAE) is essential for identifying children at risk for adverse outcomes, including fetal alcohol spectrum disorders. Biomarkers have been advocated for use in universal screening programs, but their validity has not been comprehensively evaluated. OBJECTIVE To systematically review the validity of objective measures of PAE. DATA SOURCES Thirteen electronic databases and supplementary sources were searched for studies published between January 1990 and October 2015. STUDY SELECTION Eligible studies were those that evaluated the diagnostic accuracy of objective measures of PAE. DATA EXTRACTION Three reviewers independently verified study inclusion, quality assessments, and extracted data. RESULTS Twelve studies met inclusion criteria. Test performance varied widely across studies of maternal blood (4 studies; sensitivity 0%-100%, specificity 79%-100%), maternal hair (2 studies; sensitivity 19%-87%, specificity 56%-86%) maternal urine (2 studies; sensitivity 5%-15%, specificity 97%-100%), and biomarker test batteries (3 studies; sensitivity 22%-50%, specificity 56%-97%). Tests of the total concentration of 4 fatty acid ethyl esters (in meconium: 2 studies; in placenta: 1 study) demonstrated high sensitivity (82%-100%); however, specificity was variable (13%-98%). LIMITATIONS Risk of bias was high due to self-report reference standards and selective outcome reporting. CONCLUSIONS Current evidence is insufficient to support the use of objective measures of prenatal alcohol exposure in practice. Biomarkers in meconium and placenta tissue may be the most promising candidates for further large-scale population-based research.
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Affiliation(s)
| | | | | | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, United Kingdom
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34
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Muggli E, O'Leary C, Donath S, Orsini F, Forster D, Anderson PJ, Lewis S, Nagle C, Craig JM, Elliott E, Halliday J. "Did you ever drink more?" A detailed description of pregnant women's drinking patterns. BMC Public Health 2016; 16:683. [PMID: 27485120 PMCID: PMC4969642 DOI: 10.1186/s12889-016-3354-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/22/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This paper presents drinking patterns in a prospective study of a population-based cohort of 1570 pregnant women using a combination of dose and timing to give best estimates of prenatal alcohol exposure (PAE). Novel assessments include women's special occasion drinking and alcohol use prior to pregnancy recognition. METHODS Information on up to nine types of alcoholic drink, with separate frequencies and volumes, including drinking on special occasions outside a 'usual' pattern, was collected for the periconceptional period and at four pregnancy time points. Weekly total and maximum alcohol consumption on any one occasion was calculated and categorised. Drinking patterns are described in the context of predictive maternal characteristics. RESULTS 41.3 % of women did not drink during pregnancy, 27 % drank in first trimester only; most of whom stopped once they realised they were pregnant (87 %). When compared to women who abstained from alcohol when pregnant, those who drank in the first trimester only were more likely to have an unplanned pregnancy and not feel the effects of alcohol quickly. Almost a third of women continued to drink alcohol at some level throughout pregnancy (27 %), around half of whom never drank more than at low or moderate levels. When compared with abstainers and to women who only drank in trimester one, those who drank throughout pregnancy tended to be in their early to mid-thirties, smoke, have a higher income and educational attainment. Overall, almost one in five women (18.5 %) binge drank prior to pregnancy recognition, a third of whom were identified with a question about 'special occasion' drinking. Women whose age at first intoxication was less than 18 years (the legal drinking age in Australia), were significantly more likely to drink in pregnancy and at binge levels prior to pregnancy recognition. CONCLUSIONS We have identified characteristics of pregnant women who either abstain, drink until pregnancy awareness or drink throughout pregnancy. These may assist in targeting strategies to enhance adherence to an abstinence policy and ultimately allow for appropriate follow-up and interpretation of adverse child outcomes. Our methodology also produced important information to reduce misclassification of occasional binge drinking episodes and ensure clearly defined comparison groups.
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Affiliation(s)
- Evelyne Muggli
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia. .,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia.
| | | | - Susan Donath
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia
| | - Francesca Orsini
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia
| | - Della Forster
- Judith Lumley Centre, School of Nursing and Midwifery, SHE College, La Trobe University, Melbourne, 3000, VIC, Australia.,The Royal Women's Hospital, Parkville, 3052, VIC, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia
| | - Sharon Lewis
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia
| | - Catherine Nagle
- Quality and Patient Safety Strategic Research Centre, Deakin University, Geelong, 3220, VIC, Australia.,Women's and Children's Division, Western Health, St Albans, 3021, VIC, Australia
| | - Jeffrey M Craig
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia
| | - Elizabeth Elliott
- Paediatrics & Child Health, Children's Hospital Westmead, The University of Sydney, Sydney, 2006, NSW, Australia
| | - Jane Halliday
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia
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