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Perez RF, Conner KE, Erickson MA, Nabatanzi M, Huffman KJ. Alcohol and lactation: Developmental deficits in a mouse model. Front Neurosci 2023; 17:1147274. [PMID: 36992847 PMCID: PMC10040541 DOI: 10.3389/fnins.2023.1147274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
It is well documented that prenatal ethanol exposure via maternal consumption of alcohol during pregnancy alters brain and behavioral development in offspring. Thus, the Centers for Disease Control (CDC) advises against maternal alcohol consumption during pregnancy. However, little emphasis has been placed on educating new parents about alcohol consumption while breastfeeding. This is partly due to a paucity of research on lactational ethanol exposure (LEE) effects in children; although, it has been shown that infants exposed to ethanol via breast milk frequently present with reduced body mass, low verbal IQ scores, and altered sleeping patterns. As approximately 36% of breastfeeding mothers in the US consume alcohol, continued research in this area is critical. Our study employed a novel murine LEE model, where offspring were exposed to ethanol via nursing from postnatal day (P) 6 through P20, a period correlated with infancy in humans. Compared to controls, LEE mice had reduced body weights and neocortical lengths at P20 and P30. Brain weights were also reduced in both ages in males, and at P20 for females, however, female brain weights recovered to control levels by P30. We investigated neocortical features and found that frontal cortex thickness was reduced in LEE males compared to controls. Analyses of dendritic spines in the prelimbic subdivision of medial prefrontal cortex revealed a trend of reduced densities in LEE mice. Results of behavioral tests suggest that LEE mice engage in higher risk-taking behavior, show abnormal stress regulation, and exhibit increased hyperactivity. In summary, our data describe potential adverse brain and behavioral developmental outcomes due to LEE. Thus, women should be advised to refrain from consuming alcohol during breastfeeding until additional research can better guide recommendations of safe maternal practices in early infancy.
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Affiliation(s)
- Roberto F. Perez
- Department of Psychology, University of California, Riverside, Riverside, CA, United States
| | - Kathleen E. Conner
- Interdepartmental Neuroscience Program, University of California, Riverside, Riverside, CA, United States
| | - Michael A. Erickson
- Department of Psychology, University of California, Riverside, Riverside, CA, United States
| | - Mirembe Nabatanzi
- Department of Psychology, University of California, Riverside, Riverside, CA, United States
| | - Kelly J. Huffman
- Department of Psychology, University of California, Riverside, Riverside, CA, United States
- Interdepartmental Neuroscience Program, University of California, Riverside, Riverside, CA, United States
- *Correspondence: Kelly J. Huffman,
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Popova S, Dozet D, Akhand Laboni S, Brower K, Temple V. Why do women consume alcohol during pregnancy or while breastfeeding? Drug Alcohol Rev 2021; 41:759-777. [PMID: 34963039 PMCID: PMC9305227 DOI: 10.1111/dar.13425] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Issue Alcohol consumption during pregnancy and breastfeeding cause adverse health outcomes to the mother and child, including Fetal Alcohol Spectrum Disorder (FASD). Approach Systematic literature review and thematic synthesis. Original studies that contained reasons for alcohol consumption in pregnancy and while breastfeeding were included. The Mixed Methods Appraisal Tool (MMAT) and the Confidence in the Evidence of Reviews of Qualitative Research (CerQUAL) approach were utilised. The review protocol is available on PROSPERO (registration number: CRD42018116998). Key Findings Forty‐two eligible studies comprising women from 16 countries were included. Most commonly reported reasons of alcohol use in pregnancy were societal pressure and the belief that only “strong” alcohol and alcohol in large quantities is harmful. Other reasons were: a lack of awareness of adverse effects on the fetus; coping with adverse life experiences; consumption based on intuitive decision‐making and influenced by personal/peer experiences; belief in the beneficial properties of alcohol; advice from medical practitioners; unwanted or unplanned pregnancy; alcohol dependence; and consumption as a cultural/traditional custom. Reasons for alcohol use during breastfeeding included the belief that alcohol stimulates breast milk production, unclear advice from medical practitioners, unawareness of the risks of infant exposure and to improve mood and celebrate events. Implications Understanding the context of reasons for alcohol use in pregnancy is crucial for implementing prenatal health education, and preventing FASD and other adverse maternal and child health outcomes. Conclusion Individual beliefs, knowledge/advice, culture and personal circumstances influence alcohol use in pregnancy. Data are limited for reasons surrounding alcohol use while breastfeeding.
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Affiliation(s)
- Svetlana Popova
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Danijela Dozet
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shahela Akhand Laboni
- Center for Clinical and Translational Science, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Krista Brower
- Edmonton Oliver Primary Care Network, Edmonton, Alberta, Canada.,Department of Educational Research, Lancaster University, Lancaster, UK
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Modjadji P, Pitso M. Maternal Tobacco and Alcohol Use in Relation to Child Malnutrition in Gauteng, South Africa: A Retrospective Analysis. CHILDREN-BASEL 2021; 8:children8020133. [PMID: 33670265 PMCID: PMC7918556 DOI: 10.3390/children8020133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/16/2022]
Abstract
Tobacco and alcohol use among mothers is associated with numerous adverse consequences for affected offspring, including poor growth and development. This study determined the association between maternal tobacco and alcohol use, and malnutrition, among infants aged ≤ 12 months (n = 300), in selected health facilities situated in Gauteng, South Africa. Data on alcohol and tobacco use were collected using a validated questionnaire, in addition to mothers’ socio-demographic characteristics and obstetric history. Stunting (low height/length-for-age), underweight (low weight-for-age) and thinness (low body mass index-for-age) were calculated using z-scores based on the World Health Organization child growth standards. The association of tobacco and alcohol use with stunting, underweight and thinness was analysed using logistic regression analysis. The results showed a mean age of 29 years (24.0; 35.0) for mothers and 7.6 ± 3 months for infants, and over half of the mothers were unemployed (63%). Approximately 18.7% of mothers had used tobacco and 3% had used alcohol during pregnancy. The prevalence of current tobacco and alcohol use among mothers were estimated at 14.3% and 49.7%, respectively, and almost three-quarters (67.3%) of them were still breastfeeding during the study period. Stunting (55%) was the most prevalent malnutrition indicator among infants, while underweight was 41.7%, and thinness was 22%. Current tobacco use was associated with increased odds of being thin [OR = 2.40, 95% CI: 1.09–5.45), and after adjusting for confounders, current alcohol use was associated with the likelihood of being underweight [AOR = 1.96, 95% CI: 1.06–3.63] among infants. Future prospective cohort studies that examine growth patterns among infants who are exposed to maternal tobacco and alcohol use from the intrauterine life to infancy are necessary to inform, partly, the public health programmes, to reduce malnutrition among children.
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Drinking or Smoking While Breastfeeding and Later Academic Outcomes in Children. Nutrients 2020; 12:nu12030829. [PMID: 32244947 PMCID: PMC7146206 DOI: 10.3390/nu12030829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/09/2020] [Accepted: 03/14/2020] [Indexed: 12/15/2022] Open
Abstract
Alcohol consumed by breastfeeding mothers has been associated with reduced grammatical comprehension and cognition in children. This study examined whether drinking or smoking while breastfeeding was associated with reductions in Australian National Assessment Program–Literacy and Numeracy assessments. Data was sourced from The Growing Up in Australia Study. This is an ongoing longitudinal study of 5107 infants and mothers recruited in 2004 and followed over time every two years. Multivariable linear regression found that maternal alcohol consumption at study entry was associated with reductions in Grade 3 (age 7–10 years) National Assessment Program–Literacy and Numeracy writing (b = −1.56, 95% CI: −2.52; −0.60, p = 0.01), spelling (b = −2.06, 95% CI: −3.31; −0.81, p < 0.0001) and grammar and punctuation (b = −2.11, 95% CI: −3.59; −0.64, p = 0.01) scores, as well as Grade 5 (age 9–11 years) spelling scores (b = −1.58, 95% CI: −2.74; −0.43, p = 0.03) in children who had been breastfed at any time. This was not evident in babies who had never breastfed, or in the smaller group of infants who were actively breastfeeding at study entry. Smoking was not associated with any outcome variable. Drinking alcohol while breastfeeding may result in dose-dependent reductions in children’s academic abilities. While reductions are small, they may be of clinical significance if mothers drink large quantities. Further analyses are planned to assess developmental, physical and behavioural outcomes in children.
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Brown RA, Dakkak H, Seabrook JA. Is Breast Best? Examining the effects of alcohol and cannabis use during lactation. J Neonatal Perinatal Med 2019; 11:345-356. [PMID: 29843260 DOI: 10.3233/npm-17125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Maternal drug use during lactation may have adverse effects on the health of their children. Two common drugs used during this period are alcohol and cannabis. A literature search was conducted using PubMed, CINAHL, Nursing and Allied Health, and Google Scholar with the following search terms: marijuana, cannabis, THC, alcohol, ethanol, breastfeeding, lactation, and breastmilk. The search strategy was restricted to papers since the year 2000, and limited to English language journals. Reference lists were also used to capture any articles that were missed from the database searches. In total, 19 articles were found related to alcohol and breastfeeding (n = 17 original research papers; n = 2 systematic reviews), and 4 articles were specific to cannabis (n = 2 original papers; n = 2 systematic reviews). The most common outcomes associated with alcohol consumption and breastfeeding included changes in sleep patterns, reduced milk production and flow, lower milk intake, and impaired immune function. Maternal outcomes related to cannabis consumption included panic attacks, delayed response time, increased heart rate, reduced short-term memory, dizziness, and impaired motor performance; infant outcomes associated with maternal cannabis use and breastfeeding were reduced muscular tonus, poor sucking, and growth delay and restriction. Mothers should be advised to refrain from substance use during the lactation period for the health and safety of their children.
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Affiliation(s)
- R A Brown
- School of Food and Nutritional Sciences, Brescia University College, London, ON, Canada
| | - H Dakkak
- School of Food and Nutritional Sciences, Brescia University College, London, ON, Canada
| | - J A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, ON, Canada.,Department of Paediatrics, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Human Environments Analysis Laboratory, London, ON, Canada
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Gibson L, Porter M. Drinking or Smoking While Breastfeeding and Later Cognition in Children. Pediatrics 2018; 142:peds.2017-4266. [PMID: 30061301 DOI: 10.1542/peds.2017-4266] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although prenatal alcohol and nicotine exposure are associated with reduced cognition in children, associations between consumption of alcohol during lactation and cognition have not been examined. We aimed to examine whether drinking or smoking while breastfeeding lowers children's cognitive scores. We hypothesized that increased drinking or smoking would be associated with dose-dependent cognitive reductions. METHODS Data were sourced from Growing Up in Australia: The Longitudinal Study of Australian Children. Participants were 5107 Australian infants recruited in 2004 and assessed every 2 years. Multivariable linear regression analyses assessed relationships between drinking and smoking habits of breastfeeding mothers and children's Matrix Reasoning, Peabody Picture Vocabulary Test-Third Edition and Who Am I? scores at later waves. RESULTS Increased or riskier wave 1 maternal alcohol consumption was associated with reductions in Matrix Reasoning scores at age 6 to 7 years in children who had been breastfed (B = -0.11; SE = 0.03; 95% confidence interval: -0.18 to -0.04; P = .01). This relationship was not evident in infants who had never breastfed (B = -0.02; SE = 0.10; 95% confidence interval = -0.20 to 0.17; P = .87). Smoking during lactation was not associated with any outcome variable. CONCLUSIONS Exposing infants to alcohol through breastmilk may cause dose-dependent reductions in their cognitive abilities. This reduction was observed at age 6 to 7 years but was not sustained at age 10 to 11 years. Although the relationship is small, it may be clinically significant when mothers consume alcohol regularly or binge drink. Further analyses will assess relationships between alcohol consumption or tobacco smoking during lactation and academic, developmental, physical, and behavioral outcomes in children.
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Affiliation(s)
- Louisa Gibson
- Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, Australia
| | - Melanie Porter
- Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, Australia
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May PA, Hasken JM, Blankenship J, Marais AS, Joubert B, Cloete M, de Vries MM, Barnard R, Botha I, Roux S, Doms C, Gossage JP, Kalberg WO, Buckley D, Robinson LK, Adnams CM, Manning MA, Parry CDH, Hoyme HE, Tabachnick B, Seedat S. Breastfeeding and maternal alcohol use: Prevalence and effects on child outcomes and fetal alcohol spectrum disorders. Reprod Toxicol 2016; 63:13-21. [PMID: 27174445 PMCID: PMC4987236 DOI: 10.1016/j.reprotox.2016.05.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Determine any effects that maternal alcohol consumption during the breastfeeding period has on child outcomes. METHODS Population-based samples of children with fetal alcohol spectrum disorders (FASD), normally-developing children, and their mothers were analyzed for differences in child outcomes. RESULTS Ninety percent (90%) of mothers breastfed for an average of 19.9 months. Of mothers who drank postpartum and breastfed (MDPB), 47% breastfed for 12 months or more. In case control analyses, children of MDPB were significantly lighter, had lower verbal IQ scores, and more anomalies in comparisons controlling for prenatal alcohol exposure and final FASD diagnosis. Utilizing a stepwise logistic regression model adjusting for nine confounders of prenatal drinking and other maternal risks, MDPB were 6.4 times more likely to have a child with FASD than breastfeeding mothers who abstained from alcohol while breastfeeding. CONCLUSIONS Alcohol use during the period of breastfeeding was found to significantly compromise a child's development.
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Affiliation(s)
- Philip A May
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
| | - Julie M Hasken
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States
| | - Jason Blankenship
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - Anna-Susan Marais
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Belinda Joubert
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marise Cloete
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marlene M de Vries
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Ronel Barnard
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Isobel Botha
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Sumien Roux
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Cate Doms
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - J Phillip Gossage
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - Wendy O Kalberg
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - David Buckley
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - Luther K Robinson
- State University of New York, Buffalo, Department of Pediatrics, United States
| | - Colleen M Adnams
- University of Cape Town, Department of Psychiatry and Mental Health, South Africa
| | - Melanie A Manning
- Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States
| | - Charles D H Parry
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; Medical Research Council of South Africa, Alcohol, Tobacco & Other Drug Research Unit, South Africa
| | - H Eugene Hoyme
- Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States
| | | | - Soraya Seedat
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
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Lange S, Quere M, Shield K, Rehm J, Popova S. Alcohol use and self-perceived mental health status among pregnant and breastfeeding women in Canada: a secondary data analysis. BJOG 2015; 123:900-9. [PMID: 26344418 DOI: 10.1111/1471-0528.13525] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the prevalence of alcohol consumption during pregnancy and while breastfeeding in Canada from 2003 to 2010, and to test the relation between self-perceived mental health status and alcohol consumption during pregnancy and while breastfeeding. DESIGN Secondary analysis of four cycles of the Canadian Community Health Survey, a population-based cross-sectional survey. SETTING Canada. SAMPLE A total of 18 612 pregnant and 15 836 breastfeeding women. METHODS The prevalence of alcohol consumption during pregnancy and while breastfeeding and 95% confidence intervals (CI) were calculated by province and territory, and cycle. The relation between self-perceived mental health status and alcohol consumption during pregnancy and while breastfeeding was explored using quasi-Poisson regression models. MAIN OUTCOME MEASURES Alcohol consumption during pregnancy and while breastfeeding, and self-perceived mental health status. RESULTS In Canada, between 2003 and 2010, approximately one in every ten pregnant women (9.9%; 95%CI 9.2-10.5%) and two in every ten breastfeeding women (20.3%; 95%CI 19.4-21.2%) women consumed alcohol. Women with a lower self-perceived mental health status (i.e. 'good') were 1.40 (95%CI 1.18-1.67, P < 0.001) times more likely to have consumed alcohol during pregnancy, compared with women with an 'excellent' self-perceived mental health. There were no notable differences between the categories of mental health status in regard to alcohol consumption while breastfeeding. CONCLUSION Despite public health efforts in Canada, a significant proportion of pregnant and breastfeeding women consume alcohol. It is imperative that a standard screening protocol be initiated among pregnant and breastfeeding women, especially in high-risk populations (e.g. women utilising substance abuse treatment programs). TWEETABLE ABSTRACT In Canada in 2003-2010, approximately 10% of pregnant and 20% of breastfeeding women consumed alcohol.
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Affiliation(s)
- S Lange
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | - M Quere
- Institut de Santé Publique d'Épidémiologie et de Développement, l'Université Bordeaux Segalen, Bordeaux Cedex, France
| | - K Shield
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | - J Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Epidemiological Research Unit, Klinische Psychologie and Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - S Popova
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
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