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Green CR, Harding KD, Unsworth K, Kaminsky K, Roberts N, Nagpal TS, Cook JL. Reporting on Health Care and Social Service Provider Approaches to Promoting Alcohol Abstinence During Pregnancy. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:422-433. [PMID: 38713493 DOI: 10.1080/19371918.2024.2323136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Despite the known detrimental health effects of alcohol use during pregnancy, there are still health care (HCP) and social service providers (SSP) who do not promote complete abstinence. The purpose of this study was to explore the current practices of HCPs and SSPs when discussing alcohol use during pregnancy, and to understand their rationale for their specific recommendations. An online survey was completed by 1123 HCPs (n = 588) and SSPs (n = 535) that asked them to identify their approach to discussing alcohol and pregnancy. Participants had the option to further explain their current recommendations regarding alcohol use during pregnancy in an open-ended format. Open-ended responses were analyzed using a content analysis approach (n = 156). The majority of respondents recommend abstinence (83.9% of HCPs, n = 493; 78.4% of SSPs, n = 419), while 9.8% of HCPs (n = 57) and 2.2% of SSPs (n = 12) responded that low levels of consumption may be acceptable. HCPs may recommend low levels of consumption based on other international guidelines, limited evidence to suggest that one unit of alcohol is harmful, and as a harm reduction strategy. SSPs stated that they refer clients to HCPs for recommendations related to alcohol consumption, and that they prefer to provide information based on public health guidelines. This exploratory work may inform the development of resources to support HCPs and SSPs to recommend abstinence from alcohol throughout gestation.
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Affiliation(s)
- Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
| | - Kelly D Harding
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
- Psychology Department, Laurentian University, Sudbury, ON, Canada
| | - Kathy Unsworth
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
| | - Kyla Kaminsky
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
| | | | - Taniya S Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
- The University of Ottawa, Ottawa, ON, Canada
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Wielders JPM, Porpiglia NM, Schellenberg F, Deenmamode J, Delanghe J, Anton RF, Bortolotti F, Siebelder C, Tagliaro F, Weykamp C, Helander A. Recommendations on the measurement and use of the alcohol consumption biomarker CDT. A position paper from the IFCC Working Group on CDT standardisation. Clin Chim Acta 2024; 555:117800. [PMID: 38309557 DOI: 10.1016/j.cca.2024.117800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Carbohydrate deficient transferrin (CDT) is a biomarker for excessive alcohol consumption utilized in clinical and forensic medicine and workplace testing. Previously, many different analytical methods for CDT were used and the measurand varied considerably, making direct comparison of test results difficult. To end this confusion, the IFCC established a working group on CDT standardisation (WG-CDT) which completed its tasks in 2017. METHODS This IFCC position paper by the WG-CDT summarizes state of the art information about the measurand and the analytical methods and gives concise recommendations for its utilization. RESULTS The results achieved by the CDT standardisation process led to accuracy improvements in national external quality assessment schemes over the years. A brief review of ROC based comparison studies with the traditional biomarkers (GGT, MCV, ALT and AST) discusses the bias resulting from inadequate study populations. In large groups of the general population the superior diagnostic performance of CDT is confirmed. CONCLUSION The relationship between alcohol intake versus resulting CDT is discussed as well as the cutoff and measurement uncertainty. Concerning the application in practice, potential pitfalls are considered and recommendations handling both analytical and preanalytical caveats are given. Finally, some examples of serious misunderstandings in publications about CDT are addressed.
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Affiliation(s)
- J P M Wielders
- Joseph Peter Marie Wielders, Amersfoort, the Netherlands.
| | - N M Porpiglia
- Nadia Maria Porpiglia, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy.
| | | | | | - J Delanghe
- Joris Delanghe, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - R F Anton
- Raymond Francis Anton, Medical University of South Carolina, Charleston, SC, USA
| | - F Bortolotti
- Federica Bortolotti, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - C Siebelder
- Carla Siebelder, MCA Laboratory, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - F Tagliaro
- Franco Tagliaro, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - C Weykamp
- Cas Weykamp, MCA Laboratory, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - A Helander
- Anders Helander, Karolinska Institutet, Karolinska University Laboratory, Stockholm, Sweden
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Segers S, Mertes H, Pennings G. An ethical exploration of pregnancy related mHealth: does it deliver? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:677-685. [PMID: 34228303 DOI: 10.1007/s11019-021-10039-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 05/21/2023]
Abstract
Many pregnant women use pregnancy related mHealth (PRmHealth) applications, encompassing a variety of pregnancy apps and wearables. These are mostly directed at supporting a healthier fetal development. In this article we argue that the increasing dominance of PRmHealth stands in want of empirical knowledge affirming its beneficence in terms of improved pregnancy outcomes. This is a crucial ethical issue, especially in the light of concerns about increasing pressures and growing responsibilities ascribed to pregnant women, which may, in turn, be reinforced by PRmHealth. A point can be made that it would be ethically askew if PRmHealth does not lead to improved pregnancy outcomes, while at the same time increasing maternal duties to closely monitor fetal development. We conclude that more research is needed to get a view on the benefits and burdens of PRmHealth in order to ethically assess whether the latter are proportionate to the former. If not, there is a case in saying that endorsement of PRmHealth is overdemanding.
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Affiliation(s)
- Seppe Segers
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent & METAMEDICA, Ghent University, Ghent, Belgium.
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent & METAMEDICA, Ghent University, Ghent, Belgium
| | - Guido Pennings
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Ghent, Belgium
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Römer P, Mathes B, Reinelt T, Stoyanova P, Petermann F, Zierul C. Systematic review showed that low and moderate prenatal alcohol and nicotine exposure affected early child development. Acta Paediatr 2020; 109:2491-2501. [PMID: 32603488 DOI: 10.1111/apa.15453] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
AIM We systematically reviewed the literature on the influence of low and moderate amounts of prenatal alcohol and nicotine exposure on early child development. This paper also suggests possible directions for future research in order to tackle the controversial findings identified. METHODS The PubMed and Web of Science electronic databases were searched together with the reference lists of the selected papers. Empirical studies were included if they focused on the effects of low or moderate exposure, reported outcomes on child development within the first 2 years of life and were published in English between January 2009 and December 2019. The eligibility of the included studies was based on three authors reading the full text. RESULTS The final sample comprised 17 papers. Of these, 13 focused on the effects of prenatal alcohol exposure and they reported decreased sensory sensibility, smaller body sizes and increased cognitive capacities. The other four looked at prenatal nicotine exposure, and they primarily found impairments in children's orienting, communication and motor skills. CONCLUSION Any amount of prenatal alcohol and nicotine exposure appeared to risk healthy child development. There were many reasons for consumption and numerous effects on the child, but representative data from interdisciplinary research were missing.
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Affiliation(s)
- Pia Römer
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Birgit Mathes
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Tilman Reinelt
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Polina Stoyanova
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Franz Petermann
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Claudia Zierul
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
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Cao S, Dong F, Okekpe CC, Dombrovsky I, Valenzuela GJ, Roloff K. Prevalence of the number of pre-gestational diagnoses and trends in the United States in 2006 and 2016. J Matern Fetal Neonatal Med 2020; 35:1469-1474. [PMID: 32349575 DOI: 10.1080/14767058.2020.1757641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: There is a trend in reproductive-aged women to live with more chronic conditions, likely resulting in pregnancies complicated by one or more pre-gestational diagnoses. The objective of this study is to determine the prevalence of women with pre-gestational diagnoses and pregnancy-related complications, and assess the trends of pre-gestational diagnoses between two time-points, ten-years apart from 2006 to 2016.Materials and methods: We abstracted pregnant patients from the Healthcare Cost and Utilization Project's National Inpatient Sample by the Agency for Healthcare Research and Quality in 2006 and 2016. We classified diagnosis codes, ICD 9 for 2006 and ICD 10 for 2016, as pre-gestational diagnoses or as pregnancy-related complications. Descriptive statistics were presented as frequencies and proportions for categorical variables. Chi-square analysis was performed. All statistical analyses were two-sided and p-value < .05 was considered to be statistically significant.Results: Between 2006 and 2016, the percentage of patients with at least one pre-gestational diagnoses increased from 35.3% in 2006 to 53.8% in 2016 (p < .0001) and the percentage of patients with at least one pregnancy-related complication increased from 62.6% to 69.1% (p < .0001). We found a trend of increasing pregnancy-related complications with an increasing number of pre-gestational diagnoses. The prevalence of asthma and obesity, either alone or in combination were found to rise over the ten-year time span.Conclusion: The percent of patients entering pregnancy with any pre-gestational diagnosis has increased, along with the number of pregnancy-related complications. Future research is needed to understand the effects of these diagnoses in combination and the possible impact on pregnancy outcomes.
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Affiliation(s)
- Suzanne Cao
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Fanglong Dong
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, USA
| | - C Camille Okekpe
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Inessa Dombrovsky
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, CA, USA
| | | | - Kristina Roloff
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, CA, USA
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Oei JL. Risky maternal alcohol consumption during lactation decreases childhood abstract reasoning at school age. Evid Based Nurs 2019; 22:25. [PMID: 30504451 DOI: 10.1136/ebnurs-2018-102999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Ju-Lee Oei
- Department Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
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Correia-Branco A, Keating E, Martel F. Involvement of mTOR, JNK and PI3K in the negative effect of ethanol and metformin on the human first-trimester extravillous trophoblast HTR-8/SVneo cell line. Eur J Pharmacol 2018; 833:16-24. [PMID: 29807029 DOI: 10.1016/j.ejphar.2018.05.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/18/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
Our aim was to investigate the effect of two xenobiotics to which pregnant woman may be exposed, the drug of abuse ethanol (EtOH) (and its metabolite acetaldehyde (ACA)) and the therapeutic agent metformin (METF), on placentation-related processes in an extravillous trophoblastic (EVTs) cell line (HTR-8/SVneo cells). EtOH, ACA and METF (24 h) significantly reduced cell proliferation rates, culture growth, viability and migratory capacity of HTR-8/SVneo cells. Moreover, both EtOH (100 μM) and METF (1 mM) increased the apoptosis index and inhibited 3H-deoxy-D-glucose (3H-DG) and 3H-folic acid (3H-FA) uptake. mTOR, JNK and PI3K intracellular signaling pathways were involved in the effect of EtOH upon 3H-FA uptake and in the effect of METF upon cell viability, and mTOR and JNK in the effect of EtOH upon cell viability and 3H-DG uptake. We show that EtOH and METF have a detrimental effect in placentation-related processes of HTR-8/SVneo cells. Moreover, mTOR, JNK and PI3K appear to mediate some of these negative effects.
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Affiliation(s)
- Ana Correia-Branco
- Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; I3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Elisa Keating
- Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Fátima Martel
- Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; I3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
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Landgren M. How much is too much? The implications of recognising alcohol as a teratogen. Acta Paediatr 2017; 106:353-355. [PMID: 28186372 DOI: 10.1111/apa.13696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Magnus Landgren
- Department of Paediatrics; Unit of Developmental Neurology; Skaraborg Hospital; Mariestad Sweden
- Gillberg Neuropsychiatric Centre; University of Gothenburg; Gothenburg Sweden
- Research and Development Centre; Skaraborg's Hospital; Skövde Sweden
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