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Akison LK, Hayes N, Vanderpeet C, Logan J, Munn Z, Middleton P, Moritz KM, Reid N. Prenatal alcohol exposure and associations with physical size, dysmorphology and neurodevelopment: a systematic review and meta-analysis. BMC Med 2024; 22:467. [PMID: 39407296 PMCID: PMC11477020 DOI: 10.1186/s12916-024-03656-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 09/25/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a significant public health concern, yet there is no internationally agreed set of diagnostic criteria or summary of underlying evidence to inform diagnostic decision-making. This systematic review assesses associations of prenatal alcohol exposure (PAE) and outcomes of diagnostic assessments, providing an evidence base for the improvement of FASD diagnostic criteria. METHODS Six databases were searched (inception-February 2023). Case-controls or cohort studies examining associations between participants with/without PAE or a FASD diagnosis and the domains of physical size, dysmorphology, functional neurodevelopment and/or brain structure/neurology were included. Excluded studies were non-empirical, sample size < 10, PAE determined via biological markers only, or no suitable comparison group. Summary data were extracted and associations between outcomes and standardised levels of PAE or FASD diagnosis determined using random-effects meta-analyses. Certainty of the evidence was assessed using GRADE. RESULTS Of the 306 included studies, 106 reported physical size, 43 dysmorphology, 195 functional neurodevelopment and 110 structural/neurological outcomes, with 292 different outcomes examined. There was a dose-response relationship between PAE and head circumference, as well as measures of physical size, particularly at birth. There was also an association between higher PAE levels and characteristic sentinel facial dysmorphology, as well as many of the current functional neurodevelopmental outcomes considered during diagnosis. However, data were often lacking across the full range of exposures. There was a lack of evidence from studies examining PAE to support inclusion of non-sentinel dysmorphic features, social cognition, speech-sound impairments, neurological conditions, seizures, sensory processing or structural brain abnormalities (via clinical MRI) in diagnostic criteria. GRADE ratings ranged from very low to moderate certainty of evidence. CONCLUSIONS This comprehensive review provides guidance on which components are most useful to consider in the diagnostic criteria for FASD. It also highlights numerous gaps in the available evidence. Future well-designed pregnancy cohort studies should specifically focus on dose-response relationships between PAE and dysmorphology, neurodevelopment and brain structure/neurological outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42021230522.
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Affiliation(s)
- Lisa K Akison
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Nicole Hayes
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, QLD, Australia
| | - Chelsea Vanderpeet
- Child Health Research Centre, The University of Queensland, South Brisbane, Brisbane, QLD, 4121, Australia
| | - Jayden Logan
- Child Health Research Centre, The University of Queensland, South Brisbane, Brisbane, QLD, 4121, Australia
| | - Zachary Munn
- Health Evidence Synthesis, Recommendations, and Impact (HESRI), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Karen M Moritz
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, Brisbane, QLD, 4121, Australia.
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Myrick A, Jimenez D, Jacquez B, Sun MS, Noor S, Milligan ED, Valenzuela CF, Linsenbardt DN. Maternal alcohol drinking patterns predict offspring neurobehavioral outcomes. Neuropharmacology 2024; 257:110044. [PMID: 38878859 PMCID: PMC11284739 DOI: 10.1016/j.neuropharm.2024.110044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
The timing, rate, and quantity of gestational alcohol consumption, collectively referred to here as Maternal Drinking Patterns (MDPs), are of known importance to fetal developmental outcomes. However, few studies have directly evaluated the impact of MDPs on offspring behavior. To do so, we used specialized equipment to record the precise amount and timing of alcohol consumption in pregnant dams, and then characterized MDPs using Principle Component Analysis (PCA). We next tested offspring on behaviors we have previously identified as impacted by prenatal alcohol exposure, and evaluated them where possible in the context of MDPs. Male alcohol exposed mice exhibited longer latencies to fall on the rotarod compared to their controls, which we attribute to a delayed decrease in body weight-gain. This effect was mediated by MDPs within the first 15 min of alcohol access (i.e. alcohol frontloading), where the highest performing male offspring came from dams exhibiting the highest rate of alcohol frontloading. Female alcohol exposed mice displayed reduced locomotor activity in the open field compared to controls, which was mediated by MDPs encompassing the entire drinking session. Surprisingly, total gestational alcohol exposure alone was not associated with any behavioral outcomes. Finally, we observed allodynia in alcohol exposed mice that developed more quickly in males compared to females, and which was not observed in controls. To our knowledge, this report represents the highest resolution assessment of alcohol drinking throughout gestation in mice, and one of few to have identified relationships between specific alcohol MDPs and neurobehavioral outcomes in offspring.
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Affiliation(s)
- Abbey Myrick
- University of New Mexico, Department of Neurosciences, Albuquerque, NM, 87131, USA
| | - Diane Jimenez
- University of New Mexico, Department of Neurosciences, Albuquerque, NM, 87131, USA
| | - Belkis Jacquez
- University of New Mexico, Department of Neurosciences, Albuquerque, NM, 87131, USA
| | - Melody S Sun
- University of New Mexico, Department of Neurosciences, Albuquerque, NM, 87131, USA
| | - Shahani Noor
- University of New Mexico, Department of Neurosciences, Albuquerque, NM, 87131, USA
| | - Erin D Milligan
- University of New Mexico, Department of Neurosciences, Albuquerque, NM, 87131, USA
| | | | - David N Linsenbardt
- University of New Mexico, Department of Neurosciences, Albuquerque, NM, 87131, USA.
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Kable JA, Potter AS, Akshoomoff N, Blasco PM, Bodson S, Ciciolla L, DeGray S, Hulce Z, Kuschner ES, Learnard B, Luciana M, Perez A, Novack MA, Riggins T, Shin SY, Smith S, Vannest J, Zimak EH. Measurement of emerging neurocognitive and language skills in the HEALthy Brain and Child Development (HBCD) study. Dev Cogn Neurosci 2024; 70:101461. [PMID: 39368284 PMCID: PMC11489150 DOI: 10.1016/j.dcn.2024.101461] [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: 03/07/2024] [Revised: 09/12/2024] [Accepted: 09/25/2024] [Indexed: 10/07/2024] Open
Abstract
The HEALthy Brain and Child Development (HBCD) study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. The study plans enrolling over 7000 families across 27 sites. This manuscript presents the measures from the Neurocognition and Language Workgroup. Constructs were selected for their importance in normative development, evidence for altered trajectories associated with environmental influences, and predictive validity for child outcomes. Evaluation of measures considered psychometric properties, brevity, and developmental and cultural appropriateness. Both performance measures and caregiver report were used wherever possible. A balance of norm-referenced global measures of development (e.g., Bayley Scales of Infant Development-4) and more specific laboratory measures (e.g., deferred imitation) are included in the HBCD study battery. Domains of assessment include sensory processing, visual-spatial reasoning, expressive and receptive language, executive function, memory, numeracy, adaptive behavior, and neuromotor. Strategies for staff training and quality control procedures, as well as anticipated measures to be added as the cohort ages, are reviewed. The HBCD study presents a unique opportunity to examine early brain and neurodevelopment in young children through a lens that accounts for prenatal exposures, health and socio-economic disparities.
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Affiliation(s)
- Julie A Kable
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, United States.
| | - Alexandra S Potter
- Clinical Neuroscience Research Unit, Department of Psychiatry, 1 South Prospect Street Arnold 6, Burlington, VT 05401, United States.
| | | | - Patricia M Blasco
- Department of Pediatrics, School of Medicine, Institute on Development & Disability, Oregon Health & Science University, United States.
| | - Stefanie Bodson
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32611, United States.
| | - Lucia Ciciolla
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74074, United States.
| | - Sherry DeGray
- Department of Psychiatry, Clinical Neuroscience Research Unit, University of Vermont, Burlington, VT 05401, United States.
| | - Zoe Hulce
- Department of Psychiatry, Clinical Neuroscience Research Unit, University of Vermont, Burlington, VT 05401, United States.
| | - Emily S Kuschner
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Scientist and Licensed Psychologist, Departments of Radiology and Psychiatry, The Children's Hospital of Philadelphia Philadelphia, PA 19146, United States.
| | - Britley Learnard
- Department of Psychiatry, Clinical Neuroscience Research Unit, University of Vermont, Burlington, VT 05401, United States.
| | - Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, United States
| | - Alexandra Perez
- Department of Psychiatry & Behavioral Sciences Emory University School of Medicine, Atlanta, GA 30329, United States.
| | - Miriam A Novack
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States.
| | - Tracy Riggins
- Department of Psychology, 4094 Campus Drive, University of Maryland, College Park, MD 20742, United States.
| | - So Yeon Shin
- Department of Human Development and Quantitative Psychology, University of Maryland, College Park, MD 20742, United States.
| | - Sidney Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, United States.
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, University of Cincinnati, Speech-Language Pathologist, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Eric H Zimak
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
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Scholten C, Ghasoub M, Geeraert B, Joshi S, Wedderburn CJ, Roos A, Subramoney S, Hoffman N, Narr K, Woods R, Zar HJ, Stein DJ, Donald K, Lebel C. Prenatal tobacco and alcohol exposure, white matter microstructure, and early language skills in toddlers from a South African birth cohort. Front Integr Neurosci 2024; 18:1438888. [PMID: 39286039 PMCID: PMC11402807 DOI: 10.3389/fnint.2024.1438888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Tobacco and alcohol are the two most common substances used during pregnancy, and both can disrupt neurodevelopment, resulting in cognitive and behavioral deficits including language difficulties. Previous studies show that children with prenatal substance exposure exhibit microstructural alterations in major white matter pathways, though few studies have investigated the impact of prenatal substance exposure on white matter microstructure and language skills during the toddler years. Methods In this study, 93 children (34 exposed to alcohol and/or tobacco) aged 23 years from the Drakenstein Child Health Study, South Africa, completed Expressive and Receptive Communication assessments from the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and underwent diffusion MRI scans. Diffusion images were preprocessed, and 11 major white matter tracts were isolated. Fractional anisotropy (FA) and mean diffusivity (MD) were extracted for each white matter tract. Linear regression was used to examine differences between the tobacco/alcohol exposed group and unexposed controls for FA, MD, and language scores, as well as relationships between brain metrics and language. There were no significant group differences in language scores or FA. Results Children with alcohol or tobacco exposure had lower average MD in the splenium of the corpus callosum compared to unexposed controls. Significant interactions between prenatal substance exposure and language scores were seen in 7 tracts but did not survive multiple comparisons correction. Discussion Our findings show that prenatal alcohol and/or tobacco exposure appear to alter the relationship between white matter microstructure and early language skills in this population of toddlers, potentially laying the basis of language deficits observed later in older children with prenatal substance exposure, which may have implications for learning and interventions.
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Affiliation(s)
- Chloe Scholten
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Mohammad Ghasoub
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Bryce Geeraert
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Shantanu Joshi
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Catherine J Wedderburn
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Annerine Roos
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC), Unit of Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Sivenesi Subramoney
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Nadia Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Narr
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roger Woods
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- The Semel Institute for Neuroscience and Human Behaviour, University of California, Los Angeles, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - 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 (SAMRC), Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC), Unit of Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Kirsten Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Catherine Lebel
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
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5
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Lowe JR, DiDomenico J, Stephen JM, Roberts MH, Rodriguez DE, Bakhireva LN. Early developmental trajectory of children with prenatal alcohol and opioid exposure. Pediatr Res 2024; 96:471-479. [PMID: 35948606 PMCID: PMC9911560 DOI: 10.1038/s41390-022-02252-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND With significant increases in opioid use/misuse and persistent high prevalence of prenatal alcohol exposure (PAE), identifying infants at risk for long-term developmental sequelae due to these exposures remains an urgent need. This study reports on developmental outcomes in young children from a prospective cohort, ENRICH-1, which recruited pregnant women and followed up maternal-infant pairs. METHODS Subjects were assigned to four study groups based on prenatal use of medications for opioid use disorder (MOUD), PAE, MOUD+PAE, and unexposed controls (UC). Mixed effects modeling was used to evaluate changes in the Bayley Scales of Infant Development-III (BSID-III) Cognitive, Language, and Motor scores between 6 and 20 months. RESULTS There was a significant three-way interaction (MOUD-by-PAE-by-Time) with respect to the BSID-III Cognitive (p = 0.045) and Motor (p = 0.033) scales. Significant changes between the two evaluations were observed for MOUD group in Cognitive and Language scores; for PAE group in Cognitive, Language, and Motor scores, and for MOUD+PAE group in Language scores after adjusting for child sex and family socio-economic status. The developmental scores for the UC remained stable. CONCLUSION Observed decline in neurodevelopmental scores during the first 2 years of life emphasizes the importance of a longitudinal approach when evaluating children with prenatal polysubstance exposure. IMPACT BSID-III scores were stable during the first 2 years of life for unexposed children. BSID-III scores declined for children with prenatal exposures to alcohol and/or opioids. Standard developmental tests may not be sensitive enough during the first year of life. Findings emphasize the need for repeated evaluations of children who are at high risk.
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Affiliation(s)
- Jean R Lowe
- Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jared DiDomenico
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Julia M Stephen
- The Mind Research Network, a Division of the Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - Melissa H Roberts
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Dominique E Rodriguez
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Ludmila N Bakhireva
- Substance 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.
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Zago AC, Trettim JP, Rubin BB, Scholl CC, Coelho FT, Ulguim F, Pinheiro LMDS, de Matos MB, Pinheiro RT, Quevedo LDA. Early motor development: risk factors for delay in a population study in Southern Brazil. Rev Saude Publica 2023; 57:59. [PMID: 37878845 PMCID: PMC10519674 DOI: 10.11606/s1518-8787.2023057004991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/25/2022] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To assess risk factors associated with motor development delay at three months of age. METHODS Cross-sectional study with mothers and their three-month-old babies in Southern Brazil. The Bayley-III Scale of Infant and Toddler Development (BSID-III) and the Alberta Infant Motor Scale (AIMS) were used to assess motor development. RESULTS We evaluated 756 mothers and their three-month-old babies. The overall mean motor development assessed by the BSID-III and the AIMS was 104.7 (SD 13.5) and 55.4 (SD 25.4), respectively. When assessed by the BSID-III, the lowest motor development scores were among babies born by cesarean delivery (p = 0.002), prematurely (p < 0.001), and with low birth weight (p < 0.001). When assessed by the AIMS, babies born prematurely (p = 0.002) and with low birth weight (p=0.004) had the lowest motor development means. After a cluster analysis, we found that babies born by cesarean delivery, with low birth weight, and prematurely had more impaired motor development compared with children born without any risk factors. CONCLUSION Identifying risk factors allows the implementation of early interventions to prevent motor development delay and, therefore, reduce the probability of other future problems.
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Affiliation(s)
- Ana Carolina Zago
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
- Centro Universitário da Região da CampanhaBagéRSBrasilCentro Universitário da Região da Campanha. Bagé, RS, Brasil.
| | - Jéssica Puchalski Trettim
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Bárbara Borges Rubin
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Carolina Coelho Scholl
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Fernanda Teixeira Coelho
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Fernanda Ulguim
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Luísa Mendonça de Souza Pinheiro
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Mariana Bonati de Matos
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Ricardo Tavares Pinheiro
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Luciana de Avila Quevedo
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
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Abrishamcar S, Chen J, Feil D, Kilanowski A, Koen N, Vanker A, Wedderburn CJ, Donald KA, Zar HJ, Stein DJ, Hüls A. DNA methylation as a potential mediator of the association between prenatal tobacco and alcohol exposure and child neurodevelopment in a South African birth cohort. Transl Psychiatry 2022; 12:418. [PMID: 36180424 PMCID: PMC9525659 DOI: 10.1038/s41398-022-02195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/09/2022] [Accepted: 09/20/2022] [Indexed: 01/12/2023] Open
Abstract
Prenatal tobacco exposure (PTE) and prenatal alcohol exposure (PAE) have been associated with an increased risk of delayed neurodevelopment in children as well as differential newborn DNA methylation (DNAm). However, the biological mechanisms connecting PTE and PAE, DNAm, and neurodevelopment are largely unknown. Here we aim to determine whether differential DNAm mediates the association between PTE and PAE and neurodevelopment at 6 (N = 112) and 24 months (N = 184) in children from the South African Drakenstein Child Health Study. PTE and PAE were assessed antenatally using urine cotinine measurements and the ASSIST questionnaire, respectively. Cord blood DNAm was measured using the EPIC and 450 K BeadChips. Neurodevelopment (cognitive, language, motor, adaptive behavior, socioemotional) was measured using the Bayley Scales of Infant and Toddler Development, Third Edition. We constructed methylation risk scores (MRS) for PTE and PAE and conducted causal mediation analysis (CMA) with these MRS as mediators. Next, we conducted a high-dimensional mediation analysis to identify individual CpG sites as potential mediators, followed by a CMA to estimate the average causal mediation effects (ACME) and total effect (TE). PTE and PAE were associated with neurodevelopment at 6 but not at 24 months. PTE MRS reached a prediction accuracy (R2) of 0.23 but did not significantly mediate the association between PTE and neurodevelopment. PAE MRS was not predictive of PAE (R2 = 0.006). For PTE, 31 CpG sites and eight CpG sites were identified as significant mediators (ACME and TE P < 0.05) for the cognitive and motor domains at 6 months, respectively. For PAE, 16 CpG sites and 1 CpG site were significant mediators for the motor and adaptive behavior domains at 6 months, respectively. Several of the associated genes, including MAD1L1, CAMTA1, and ALDH1A2 have been implicated in neurodevelopmental delay, suggesting that differential DNAm may partly explain the biological mechanisms underlying the relationship between PTE and PAE and child neurodevelopment.
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Affiliation(s)
- Sarina Abrishamcar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Junyu Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dakotah Feil
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Kilanowski
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Nastassja Koen
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Catherine J Wedderburn
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kirsten A Donald
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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8
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Subramoney S, Joshi SH, Wedderburn CJ, Lee D, Roos A, Woods RP, Zar HJ, Narr K, Stein DJ, Donald KA. The impact of prenatal alcohol exposure on gray matter volume and cortical surface area of 2 to 3-year-old children in a South African birth cohort. Alcohol Clin Exp Res 2022; 46:1233-1247. [PMID: 35581528 PMCID: PMC9357164 DOI: 10.1111/acer.14873] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 04/30/2022] [Accepted: 05/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a growing literature that demonstrates the effects of prenatal alcohol exposure (PAE) on brain development in school-aged children. Less is known, however, on how PAE impacts the brain early in life. We investigated the effects of PAE and child sex on subcortical gray matter volume, cortical surface area (CSA), cortical volume (CV), and cortical thickness (CT) in children aged 2 to 3 years. METHODS The sample was recruited as a nested cross-sectional substudy of the Drakenstein Child Health Study. Images from T1-weighted magnetic resonance imaging were acquired on 47 alcohol-exposed and 124 control children (i.e., with no or minimal alcohol exposure), aged 2 to 3 years, some of whom were scanned as neonates. Brain images were processed through automated processing pipelines using FreeSurfer version 6.0. Subcortical and a priori selected cortical regions of interest were compared. RESULTS Subcortical volume analyses revealed a PAE by child sex interaction for bilateral putamen volumes (Left: p = 0.02; Right: p = 0.01). There was no PAE by child sex interaction effect on CSA, CV, and CT. Analyses revealed an impact of PAE on CSA (p = 0.04) and CV (p = 0.04), but not CT in this age group. Of note, the inferior parietal gyrus CSA was significantly smaller in children with PAE compared to control children. CONCLUSIONS Findings from this subgroup scanned at age 2 to 3 years build on previously described subcortical volume differences in neonates from this cohort. Findings suggest that PAE persistently affects gray matter development through the critical early years of life. The detectable influence of PAE on brain structure at this early age further highlights the importance of brain imaging studies on the impact of PAE on the young developing brain.
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Affiliation(s)
- Sivenesi Subramoney
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
| | - Shantanu H. Joshi
- Department of NeurologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Department of BioengineeringUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Catherine J. Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
- The Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - David Lee
- Department of BioengineeringUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Annerine Roos
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- The Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of PsychiatryStellenbosch UniversityStellenboschSouth Africa
| | - Roger P. Woods
- Departments of Neurology, Psychiatry and Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- Unit on Child & Adolescent Health, South African Medical Research Council (SAMRC)University of Cape TownCape TownSouth Africa
| | - Katherine L. Narr
- Departments of Neurology, Psychiatry and Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Dan J. Stein
- The Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
- SU/UCT MRC Unit on Risk and Resilience in Mental DisordersUniversity of Cape TownCape TownSouth Africa
| | - Kirsten A. Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- The Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
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9
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Bertran-Cobo C, Wedderburn CJ, Robertson FC, Subramoney S, Narr KL, Joshi SH, Roos A, Rehman AM, Hoffman N, Zar HJ, Stein DJ, Donald KA. A Neurometabolic Pattern of Elevated Myo-Inositol in Children Who Are HIV-Exposed and Uninfected: A South African Birth Cohort Study. Front Immunol 2022; 13:800273. [PMID: 35419007 PMCID: PMC8995436 DOI: 10.3389/fimmu.2022.800273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/22/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Exposure to maternal HIV in pregnancy may be a risk factor for impaired child neurodevelopment during the first years of life. Altered neurometabolites have been associated with HIV exposure in older children and may help explain the mechanisms underlying this risk. For the first time, we explored neurometabolic profiles of children who are HIV-exposed and uninfected (CHEU) compared to children who are HIV-unexposed (CHU) at 2-3 years of age. Methods The South African Drakenstein Child Health Study enrolled women during pregnancy and is following mother-child pairs through childhood. MRI scans were acquired on a sub-group of children at 2-3 years. We used single voxel magnetic resonance spectroscopy to measure brain metabolite ratios to total creatine in the parietal grey matter, and left and right parietal white matter of 83 children (36 CHEU; 47 CHU). Using factor analysis, we explored brain metabolite patterns in predefined parietal voxels in these groups using logistic regression models. Differences in relative concentrations of individual metabolites (n-acetyl-aspartate, myo-inositol, total choline, and glutamate) to total creatine between CHEU and CHU groups were also examined. Results Factor analysis revealed four different metabolite patterns, each one characterized by covarying ratios of a single metabolite in parietal grey and white matter. The cross-regional pattern dominated by myo-inositol, a marker for glial reactivity and inflammation, was associated with HIV exposure status (OR 1.63; 95% CI 1.11-2.50) which held after adjusting for child age, sex, and maternal alcohol use during pregnancy (OR 1.59; 95% CI 1.07 -2.47). Additionally, higher relative concentrations of myo-inositol to total creatine were found in left and right parietal white matter of CHEU compared to CHU (p=0.025 and p=0.001 respectively). Discussion Increased ratios of myo-inositol to total creatine in parietal brain regions at age 2-3 years in CHEU are suggestive of early and ongoing neuroinflammatory processes. Altered relative concentrations of neurometabolites were found predominantly in the white matter, which is sensitive to neuroinflammation, and may contribute to developmental risk in this population. Future work on the trajectory of myo-inositol over time in CHEU, alongside markers of neurocognitive development, and the potential for specific neurodevelopmental interventions will be useful.
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Affiliation(s)
- Cesc Bertran-Cobo
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Research Master Brain and Cognitive Sciences, Faculty of Science, University of Amsterdam, Amsterdam, Netherlands
| | - Catherine J Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Frances C Robertson
- Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre (CUBIC), Cape Town, South Africa
| | - Sivenesi Subramoney
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Katherine L Narr
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shantanu H Joshi
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Annerine Roos
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,SAMRC Unit on Risk and Resilience in Mental Disorders, Stellenbosch University, Cape Town, South Africa
| | - Andrea M Rehman
- MRC International Statistics & Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nadia Hoffman
- 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.,SAMRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,SAMRC Unit on Risk and Resilience in Mental Disorders, 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.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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