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Bandoli G, Hayes S, Delker E. Low to Moderate Prenatal Alcohol Exposure and Neurodevelopmental Outcomes: A Narrative Review and Methodological Considerations. Alcohol Res 2023; 43:01. [PMID: 36950180 PMCID: PMC10027299 DOI: 10.35946/arcr.v43.1.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
PURPOSE Although abstinence is recommended in pregnancy, many pregnancies are exposed to alcohol. Observational studies of the effects of low to moderate prenatal alcohol exposure (PAE) and neurodevelopmental outcomes have yielded inconsistent results, with some studies finding an increased risk of adverse neurobehavioral and cognitive outcomes, and other studies finding no changes or reduced risk of the same outcomes. The purpose of this narrative review is to summarize these inconsistencies and apply a methodological framework to discuss how different parameters contribute to the findings. The authors also provide recommendations on how to advance future research in this area. SEARCH METHODS The PubMed, Web of Science, and Embase databases were searched, along with reference lists of selected systematic reviews and meta-analyses. Search terms used were (infant or child or children or adolescent or offspring) AND (low or light or mild or moderate or low-to-moderate) AND (drinking or alcohol or drinks) AND (pregnancy or prenatal or fetal) AND (neurodevelopment or behavioral or psychological or cognitive or developmental) NOT (mice or rat or fish or animal) NOT (meta-analysis or review). Peer-reviewed original research studies were included if they analyzed associations between an exposure defined and characterized as low/light or moderate PAE with offspring neurodevelopmental outcomes. Animal studies, studies that did not provide clear cutoff points to classify PAE categories, studies lacking an abstinence control group, and studies that did not present a multivariable-adjusted measure of association were excluded. SEARCH RESULTS The searches identified 2,422 papers, with 36 papers meeting eligibility criteria. These studies were carried out across nine countries and included samples ranging from approximately 500 to 40,000 participants. Cognitive, academic, socioemotional, and behavioral outcomes were assessed from infancy through age 19. DISCUSSION AND CONCLUSION When the findings from the selected articles were summarized by geographic region, exposure definition, or neurodevelopmental outcome, no consistent observations or patterns emerged between low to moderate PAE and offspring outcomes. Although some studies found positive (i.e., beneficial) associations between low to moderate PAE and outcomes (primarily outcomes related to cognition) and others found negative (i.e., detrimental) associations (primarily for behavioral outcomes), most findings were null (i.e., showed no effect of PAE). The heterogeneity in study results is likely due to methodological issues, including residual confounding, effect measure modification, and exposure misclassification that make synthesis of studies difficult. Alternative study designs, including longitudinal trajectory analysis, sibling design, negative controls, and instrumental variable analyses, may reduce biases and are discussed. To date, the consequences of light to moderate levels of PAE on neurodevelopment remain unresolved; studies that advance methodological rigor will be important contributions to the field.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Shana Hayes
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Erin Delker
- Department of Pediatrics, University of California San Diego, La Jolla, California
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2
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Periconceptual and prenatal alcohol consumption and neurodevelopment at age two and five years. Eur J Obstet Gynecol Reprod Biol 2022; 274:197-203. [PMID: 35667175 DOI: 10.1016/j.ejogrb.2022.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Examine the association between alcohol consumption before and during pregnancy and neurodevelopmental outcomes in the offspring at two and five years. STUDY DESIGN Retrospective analysis of a prospective longitudinal cohort; SCOPE-BASELINE. Data on pre-conception and prenatal alcohol consumption were obtained at 15 weeks' gestation and categorised as abstinent, occasional-low (1-7units/week) and moderate-heavy (≥8units/week). Binge drinking was defined as ≥6 units/session. Outcome measures (Child Behaviour Checklist and Kaufman Brief Intelligence Test) were obtained at two and five years. Linear regression examined an alcohol consumption and Child Behaviour Checklist and Kaufman Brief Intelligence Test relationship, adjusting for several potential confounders. RESULTS Data on alcohol consumption was available for 1,507 women. Adjusted linear regression suggested few associations: pre-pregnancy occasional-low alcohol consumption was associated with lower log externalizing Child Behaviour Checklist scores (-0.264, 95% CI: -0.009, -0.520), while pre-pregnancy moderate-high levels of alcohol consumption was associated with lower Kaufman Brief Intelligence Test verbal standard scores (-0.034, 95% CI: -0.001, -0.068) and composite IQ scores (-0.028, 95% CI: -0.056, -0.0004) at five-years. In the first trimester, moderate-high levels of alcohol consumption was associated with lower internalizing Child Behaviour Checklist scores at two-years (-0.252, 95% CI: -0.074, -0.430). No significant associations were observed between number of binge episodes pre-pregnancy or binge drinking in the first trimester and Child Behaviour Checklist or Kaufman Brief Intelligence Test. CONCLUSIONS We did not find strong evidence of associations between pre-pregnancy and early pregnancy maternal alcohol consumption and adverse neurodevelopmental outcomes at age two and five years overall. Further research examining alcohol consumption (including binge drinking) beyond 15 weeks' gestation and subsequent neurodevelopmental outcomes is needed to examine the potential effect of alcohol consumption in later pregnancy.
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3
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Yaesoubi R, Mahin M, Martin G, Paltiel AD, Sharifi M. Reducing the Prevalence of Alcohol-Exposed Pregnancies in the United States: A Simulation Modeling Study. Med Decis Making 2021; 42:217-227. [PMID: 34166146 DOI: 10.1177/0272989x211023203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Public health efforts to prevent alcohol-exposed pregnancies (AEPs) primarily focus on promoting abstinence from alcohol among women if pregnant or seeking pregnancy and using effective contraception to prevent unintended pregnancies if consuming alcohol. Little is known about how programs to improve adherence to these recommendations would affect the prevalence of AEPs. METHODS We developed an individual-based simulation model of US women of reproductive age to project the prevalence of AEPs under different public health strategies. The model varies each woman's risk of an AEP over time depending on fertility, contraceptive use, awareness of pregnancy, sexual activity, and drinking patterns. We used the 2013-2015 National Survey on Family Growth data set to parameterize the model. RESULTS We estimate that 54% (95% uncertainty interval: 48%-59%) of pregnancies that result in a live birth in the United States are exposed to alcohol, 12% (10%-15%) are ever exposed to ≥5 alcoholic drinks in a week, and 3.0% (1.3%-4.2%) to ≥9 drinks. Unintended pregnancies (either due to contraceptive failure or sex without contraceptives) account for 80% (75%-87%) of pregnancies unknowingly exposed to alcohol. We project that public health efforts that focus only on promoting alcohol abstinence among women who are aware of their pregnancy or seeking pregnancy could reduce the prevalence of AEPs by at most 42% (36%-48%). Augmenting this strategy with efforts to avert unintended pregnancies could yield an 80% (73%-86%) reduction in the prevalence of AEPs. CONCLUSIONS Promoting alcohol abstinence among women who are aware of their pregnancy or seeking pregnancy offers limited potential to reduce the prevalence of AEPs. Programs to avert unintended pregnancies are essential to achieve more substantial reductions in AEPs in the United States.
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Affiliation(s)
- Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Maya Mahin
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.,Analysis Group, Inc., Boston, MA
| | | | - A David Paltiel
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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4
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Hoang HH, Tran ATN, Nguyen VH, Nguyen TTB, Nguyen TAP, Le DD, Jatho A, Onchonga D, Duong TV, Nguyen MT, Tran BT. Attention Deficit Hyperactivity Disorder (ADHD) and Associated Factors Among First-Year Elementary School Students. J Multidiscip Healthc 2021; 14:997-1005. [PMID: 33958873 PMCID: PMC8096448 DOI: 10.2147/jmdh.s301091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Attention deficit hyperactivity disorder (ADHD) is a mental health disorder commonly in children. This study aimed to examine the prevalence of ADHD and risk factors among first-year pupils in Vietnam's urban city. PATIENTS AND METHODS A cross-sectional study was conducted in four randomly selected primary schools. Information on 525 pupils in grade 1 (ages 6 to 7 years) was collected from 525 parents/caregivers and 28 teachers. We used the Vanderbilt Assessment Scales with two separate versions for parents and teachers to screen children with ADHD symptoms. RESULTS Among the total of 525 pupils, 24 (4.6%) were found to have ADHD symptom types (boy: 6.5%; girl: 2.1%). The combined ADHD type accounted for the highest proportion of 3.4%, followed by predominantly inattentive and predominantly hyperactivity type. ADHD prevalence rated by teachers was higher than those rated by parents. High agreement between parents and teachers was reported (κ > 0.6). The risk of ADHD increased in male participants (aOR=4.90, 95% CI 1.51-15.85), those having a first-degree relative with ADHD (aOR=85.2, 95% CI 1.66-4371.8), in-utero exposure to tobacco smoke (aOR=4.78, 95% CI 1.31-17.44), and prenatal alcohol drinking (aOR=8.87, 95% CI 2.29-34.42). CONCLUSION These findings suggest the importance of ADHD screening for pupils attending elementary schools, particularly those with a family history of ADHD. Public health programs should reduce prenatal exposure to the potential risk factors of ADHD (smoking and alcohol consumption).
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Affiliation(s)
- Hai Huu Hoang
- Student’s Affairs Office, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | | | - Van Hung Nguyen
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Thi Thanh Binh Nguyen
- Department of Paediatrics, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Thi Anh Phuong Nguyen
- Faculty of Nursing, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Dinh Duong Le
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Alfred Jatho
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - David Onchonga
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, 110-31, Taiwan
| | - Minh Tu Nguyen
- Undergraduate Training Office, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Binh Thang Tran
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
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Pyman P, Collins SE, Muggli E, Testa R, Anderson PJ. Cognitive and Behavioural Attention in Children with Low-Moderate and Heavy Doses of Prenatal Alcohol Exposure: a Systematic Review and Meta-analysis. Neuropsychol Rev 2021; 31:610-627. [PMID: 33656703 DOI: 10.1007/s11065-021-09490-8] [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: 08/19/2020] [Accepted: 02/18/2021] [Indexed: 01/02/2023]
Abstract
Attention problems are thought to be a hallmark feature of prenatal alcohol exposure (PAE). Despite decades of research however, these findings have never been pooled to assess the association between PAE and the different domains of attention functioning. This systematic review and meta-analysis aimed to examine the relationships between low-moderate, binge and heavy PAE with domains of attention functioning (encode, focus, shift, sustain and behavioural) in children. Thirteen studies compared children with PAE to abstinent controls. A significant adverse effect of any PAE on shifting attention (Cohen's d = -0.61), and a trend towards an adverse effect of heavy PAE on encoding attention (Cohen's d = -0.79) were identified. Compared to controls, there were trends showing that low-moderate PAE (odds ratio = 1.21) was associated with greater odds of behavioural attention problems. Remaining analyses were limited by insufficient studies or were non-significant. In summary, a vulnerability of higher-level attention skills to PAE was found. Urgent investigation into the effects of low to moderate PAE is needed given the prevalence of this drinking pattern, trends towards behavioural attention problems, the lack of comprehensive and high-quality research and the known impacts of attention difficulties on academic and social development in children.
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Affiliation(s)
- Philippa Pyman
- Monash University, Turner Institute for Brain and Mental Health, Melbourne, VIC, Australia. .,Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Simonne E Collins
- Monash University, Turner Institute for Brain and Mental Health, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Evelyne Muggli
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Renee Testa
- Department of Mental Health, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter J Anderson
- Monash University, Turner Institute for Brain and Mental Health, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
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My partner and my neighbourhood: The built environment and social networks’ impact on alcohol consumption during early pregnancy. Health Place 2020; 61:102239. [DOI: 10.1016/j.healthplace.2019.102239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022]
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7
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Weile LKK, Wu C, Hegaard HK, Kesmodel US, Henriksen TB, Nohr EA. Alcohol Intake in Early Pregnancy and Risk of Attention-Deficit/Hyperactivity Disorder in Children Up to 19 Years of Age: A Cohort Study. Alcohol Clin Exp Res 2019; 44:168-177. [PMID: 31742728 DOI: 10.1111/acer.14243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/08/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Little is known about maternal alcohol intake in early pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) in children beyond 5 years of age. We examined the association between alcohol binge drinking and weekly alcohol intake in early pregnancy and the risk of ADHD in children followed from birth to 19 years of age. METHODS We included 48,072 children born between 1998 and 2012, whose mothers participated in the Aarhus Birth Cohort. Maternal alcohol intake was obtained from a self-administered questionnaire completed in early pregnancy. ADHD diagnoses were retrieved from the Danish Psychiatric Central Research Register and the Danish National Patient Register. Crude hazard ratio and adjusted hazard ratio (aHR) of ADHD according to alcohol binge drinking or weekly intake of alcohol were calculated using the Cox regression. RESULTS Compared to children of women with no binge drinking episodes, we observed an aHR for ADHD of 0.91 (95% CI 0.76 to 1.08), 0.73 (95% CI 0.56 to 0.96), and 0.77 (95% CI 0.57 to 1.06) among children of women reporting 1, 2, and 3 or more binge drinking episodes, respectively. Among children of women drinking <1 drink per week, 1 drink per week, 2 drinks per week, and 3 or more drinks per week, we observed an aHR for ADHD of 0.87 (95% CI 0.74 to 1.03), 0.63 (95% CI 0.40 to 0.98), 1.30 (95% CI 0.89 to 1.92), and 0.78 (95% CI 0.38 to 1.59), respectively, when compared to children of women not drinking on a weekly basis. CONCLUSION We found no evidence that binge drinking or low alcohol intake in early pregnancy was associated with the risk of ADHD in children.
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Affiliation(s)
- Louise Katrine Kjaer Weile
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Chunsen Wu
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Hanne Kristine Hegaard
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark.,The Research Unit Women's and Children's Health, Section 7821 Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ulrik Schiøler Kesmodel
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Tine Brink Henriksen
- Department of Pediatrics (Intensive Care Neonatology), Aarhus University Hospital, Aarhus N, Denmark.,Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark
| | - Ellen Aagaard Nohr
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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8
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Sejer EPF, Bruun FJ, Slavensky JA, Mortensen EL, Schiøler Kesmodel U. Impact of gestational age on child intelligence, attention and executive function at age 5: a cohort study. BMJ Open 2019; 9:e028982. [PMID: 31501108 PMCID: PMC6738700 DOI: 10.1136/bmjopen-2019-028982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Preterm birth can affect cognition, but other factors including parental education and intelligence may also play a role, but few studies have adjusted for these potential confounders. We aimed to assess the impact of gestational age (GA), late preterm birth (34 to <37 weeks GA) and very to moderately preterm birth (<34 weeks GA) on intelligence, attention and executive function in a population of Danish children aged 5 years. DESIGN Population-based prospective cohort study. SETTING Denmark 2003-2008. PARTICIPANTS A cohort of 1776 children and their mothers sampled from the Danish National Birth Cohort with information on GA, family and background factors and completed neuropsychological assessment at age 5. PRIMARY OUTCOME MEASURES Wechsler Preschool and Primary Scale of Intelligence-Revised, Test of Everyday Attention for Children at Five and Behaviour Rating Inventory of Executive Function scores. RESULTS For preterm birth <34 weeks GA (n=8), the mean difference in full-scale intelligence quotient(IQ) was -10.6 points (95% CI -19.4 to -1.8) when compared with the term group ≥37 weeks GA (n=1728), and adjusted for potential confounders. For the teacher-assessed Global Executive Composite, the mean difference was 5.3 points (95% CI 2.4 to 8.3) in the adjusted analysis, indicating more executive function difficulties in the preterm group <34 weeks GA compared with the term group. Maternal intelligence and parental education were weak confounders. No associations between late preterm birth 34 to <37 weeks GA (n=40) and poor cognition were shown. CONCLUSIONS This study showed substantially lower intelligence and poorer executive function in children born <34 weeks GA compared with children born at term. GA may play an important role in determining cognitive abilities independent of maternal intelligence and parental education. Studies with larger sample sizes are needed to confirm these findings, as the proportion of children born preterm in this study population was small.
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Affiliation(s)
| | - Frederik Jager Bruun
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
| | - Julie Anna Slavensky
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
| | - Erik Lykke Mortensen
- Unit of Medical Psychology, Department of Public Health and Center for Healthy Ageing, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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9
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Low–moderate prenatal alcohol exposure and offspring attention-deficit hyperactivity disorder (ADHD): systematic review and meta-analysis. Arch Gynecol Obstet 2019; 300:269-277. [DOI: 10.1007/s00404-019-05204-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/30/2019] [Indexed: 01/21/2023]
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10
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Kesmodel US, Nygaard SS, Mortensen EL, Bertrand J, Denny CH, Glidewell A, Astley Hemingway S. Are Low-to-Moderate Average Alcohol Consumption and Isolated Episodes of Binge Drinking in Early Pregnancy Associated with Facial Features Related to Fetal Alcohol Syndrome in 5-Year-Old Children? Alcohol Clin Exp Res 2019; 43:1199-1212. [PMID: 30977899 PMCID: PMC6691727 DOI: 10.1111/acer.14047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/14/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fetal alcohol syndrome (FAS) typically is observed among individuals with high prenatal alcohol exposures (PAE), but exposure histories obtained in clinical diagnostic settings are often inaccurate. The present analysis used the Lifestyle During Pregnancy Study (LDPS) to assess the potential effects of low-to-moderate average weekly alcohol consumption and binge drinking in early pregnancy on facial features associated with FAS among children 5 years of age. METHODS The analysis is a prospective follow-up study of 670 women and their children sampled from the LDPS cohort based on maternal alcohol consumption during pregnancy. The 4-Digit Code FAS Facial Photographic Analysis Software was used to measure the magnitude of expression of the 3 diagnostic facial features of FAS from standardized digital photographs. Logistic regression was used to estimate the odds of presenting with the FAS/partial fetal alcohol syndrome (PFAS) facial phenotypes relative to different patterns of prenatal alcohol exposure. RESULTS Ten children presented with the FAS/PFAS facial phenotypes. None of the children sampled met the central nervous system (CNS) criteria for FAS or PFAS at age 5 years. All remained at risk for PFAS since some types of CNS dysfunction associated with this diagnosis may only be assessed at older ages. The FAS/PFAS facial phenotypes were 8.5-fold more likely among children exposed to an average of 1 to 4 drinks/wk and 2.5-fold more likely among children with a single binge exposure in gestational weeks 3 to 4 compared to children with no such exposures. The magnitude of expression of the FAS facial phenotype was significantly correlated with all other diagnostic features of FAS: growth deficiency, microcephaly, and measures of CNS dysfunction. CONCLUSIONS These findings suggest that low-to-moderate levels of PAE or isolated binge exposures may place some fetuses at risk for FAS/PFAS. Thus, conservative advice is still for women to abstain from alcohol consumption during pregnancy.
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Affiliation(s)
- Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynecology, (USK, SSN), Herlev University Hospital, Herlev, Denmark
- Department of Clinical Medicine, (USK), University of Copenhagen, Copenhagen, Denmark
| | - Siv Steffen Nygaard
- Department of Obstetrics and Gynecology, (USK, SSN), Herlev University Hospital, Herlev, Denmark
| | - Erik Lykke Mortensen
- Center for Healthy Aging, (ELM), Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jacquelyn Bertrand
- Centers for Disease Control and Prevention (CDC), (JB, CHD), Atlanta, Georgia
| | - Clark H Denny
- Centers for Disease Control and Prevention (CDC), (JB, CHD), Atlanta, Georgia
| | | | - Susan Astley Hemingway
- Departments of Epidemiology and Pediatrics, (SAH), University of Washington, Seattle, Washington
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11
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Hallit S, Haddad C, Zeidan RK, Obeid S, Kheir N, Khatchadourian T, Salameh P. Cognitive function among schoolchildren in Lebanon: association with maternal alcohol drinking and smoking during pregnancy and domestic use of detergents and pesticides during childhood. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:14373-14381. [PMID: 30868458 DOI: 10.1007/s11356-019-04797-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 03/05/2019] [Indexed: 06/09/2023]
Abstract
To evaluate the relation between caregiver exposure to toxics during pregnancy and childhood and the child's cognitive function in Lebanese children. This was a cross-sectional study conducted on Lebanese students in public and private schools from November 2017 to May 2018, enrolling 464 children. A first linear regression, taking the Cattell total score as the dependent variable and taking sociodemographic characteristics and the family history of the child as independent variables, showed that higher age (Beta = 1.65) was significantly associated with higher cognition, whereas a history of eczema in any of the parents (Beta = -7.32) was significantly associated with lower cognition in the child. A second linear regression, taking the Cattell total score as the dependent variable and taking sociodemographic characteristics and the family history of the child, and the exposure to toxics as independent variables, showed that maternal alcohol intake during pregnancy (Beta = -1.07) and detergent mixing (Beta = -1.48) were significantly associated with lower cognition in the child. A third linear regression, taking the Cattell total score as the dependent variable and taking sociodemographic characteristics and the family history of the child, the exposure to toxics and the diseases in the child as independent variables, showed that maternal alcohol intake during pregnancy (Beta = -1.07) and detergent mixing (Beta = -1.45) were significantly associated with lower cognition in the child, whereas a history of eczema in the child before the age of 2 years (Beta = 8.72) was significantly associated with higher cognition in the child. This study is the first to examine the association of a child's prenatal exposure and their exposure during childhood to environmental toxicants with their cognitive function in Lebanon. We consider this study to be important as it shows the possible effect of cleaning products mixing and maternal alcohol consumption on cognitive functions among children in Lebanon.
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Affiliation(s)
- Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- INSPECT-LB:, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.
| | - Chadia Haddad
- Psychiatric Hospital of the Cross, Jal Eddib, 60096, Lebanon
| | - Rouba Karen Zeidan
- INSPECT-LB:, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Sahar Obeid
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- Faculty of Philosophy and Human Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- Faculty of Pedagogy, Lebanese University, Beirut, Lebanon
| | - Nelly Kheir
- Faculty of Pedagogy, Université de la Sainte Famille, Batroun, Lebanon
| | | | - Pascale Salameh
- INSPECT-LB:, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
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12
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Subramoney S, Eastman E, Adnams C, Stein DJ, Donald KA. The Early Developmental Outcomes of Prenatal Alcohol Exposure: A Review. Front Neurol 2018; 9:1108. [PMID: 30619064 PMCID: PMC6305542 DOI: 10.3389/fneur.2018.01108] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/04/2018] [Indexed: 02/05/2023] Open
Abstract
Aim: This paper systematically reviews the literature on the effects of prenatal alcohol exposure on early child development from birth to 5 years with the aim to synthesize the developmental outcomes associated with prenatal alcohol exposure, and inform further research to improve our knowledge of the manifestations of prenatal alcohol exposure. Methods: Electronic databases (MEDLINE, Psych INFO, and Psych ARTICLES) were searched to find papers on the developmental outcomes of prenatal alcohol exposure in neonates, infants and toddlers and pre-school aged children. Studies were selected based on participants self-reporting alcohol consumption during pregnancy (either prospectively or retrospectively) and/or children being diagnosed with FASD based on a standardized assessment that includes a dysmorphology examination. The search was limited to peer-reviewed, English language studies involving human subjects, up to 5.5 years old. Results: Out of the 1,684 titles screened, a total of 71 papers were identified as relevant and included in this review. The majority of studies were prospective longitudinal studies. A range of assessment modalities (or tools) was used to determine neurodevelopmental outcomes of prenatal exposure to alcohol in the age group under review, the most frequently described being the Bayley Scales of Infant and Toddler Development (BSID) (n = 19). Studies varied in terms of the dose, frequency, and timing of alcohol consumption during pregnancy and methodology used to assess alcohol consumption. Findings demonstrate extensive evidence for poor global developmental outcomes in children prenatally exposed to alcohol, particularly with moderate to severe levels of prenatal alcohol exposure. Conclusion: The outcomes related to lower levels of prenatal alcohol exposure as well as outcomes in specific developmental domains, are poorly understood. Further research should aim to clarify the more subtle or less easily measurable manifestations of prenatal alcohol exposure on early development when the potential for greatest impact of interventions is highest.
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Affiliation(s)
- Sivenesi Subramoney
- Division of Developmental Pediatrics, Department of Pediatrics, and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Emma Eastman
- Division of Developmental Pediatrics, Department of Pediatrics, and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Colleen Adnams
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Kirsten A. Donald
- Division of Developmental Pediatrics, Department of Pediatrics, and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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13
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Eilertsen EM, Gjerde LC, Reichborn-Kjennerud T, Ørstavik RE, Knudsen GP, Stoltenberg C, Czajkowski N, Røysamb E, Kendler KS, Ystrom E. Maternal alcohol use during pregnancy and offspring attention-deficit hyperactivity disorder (ADHD): a prospective sibling control study. Int J Epidemiol 2018; 46:1633-1640. [PMID: 28449133 DOI: 10.1093/ije/dyx067] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 11/14/2022] Open
Abstract
Background Maternal alcohol use during pregnancy has repeatedly been associated with development of attention-deficit hyperactivity disorder (ADHD) in the offspring. It is, however not known whether this reflects a direct casual intra-uterine effect or a non-causal relationship due to confounding. We used three different approaches to control for measured and unmeasured confounding: statistical adjustment for covariates, negative control comparison against maternal pre-pregnancy alcohol use, and comparison among differentially exposed siblings. Methods The sample comprised 114 247 children (34 283 siblings) from 94 907 mothers, recruited to the Norwegian Mother and Child Birth Cohort Study between 1999 and 2008. Self-reported measurements of alcohol use were obtained in week 30 during the pregnancy. Mothers rated offspring ADHD symptoms at 5 years on two measures. Clinical ADHD diagnoses were obtained from the Norwegian Patient Registry. Results We found an overall positive association between maternal alcohol use during pregnancy and offspring ADHD symptoms, which was only marginally attenuated after inclusion of measured covariates. Both the negative control and the sibling comparison analysis further attenuated the estimated association, but it remained greater than zero [β = 0.017, 95% confidence interval (CI) = 0.005-0.030). No association was found between maternal alcohol use during pregnancy and offspring ADHD diagnosis. Conclusions For offspring ADHD symptoms we found a weak, but possibly causal association with maternal alcohol use during pregnancy, but no such effect was observed for clinical ADHD diagnosis.
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Affiliation(s)
| | - Line C Gjerde
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology
| | - Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nikolai Czajkowski
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology
| | - Espen Røysamb
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioural Genetics.,Departments of Psychiatry and Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Eivind Ystrom
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology.,PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
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14
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Reid N, Petrenko CLM. Applying a Developmental Framework to the Self-Regulatory Difficulties of Young Children with Prenatal Alcohol Exposure: A Review. Alcohol Clin Exp Res 2018; 42:987-1005. [PMID: 29672859 DOI: 10.1111/acer.13756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/08/2018] [Indexed: 12/31/2022]
Abstract
Prenatal alcohol exposure (PAE) can be associated with significant difficulties in self-regulatory abilities. As such, interventions have been developed that focus on improving varying aspects of self-regulation for this population. The application of a multilevel theoretical framework that describes the development of self-regulation during early childhood could further advance the field. First, this framework could assist in elucidating mechanisms in the trajectories of early adjustment problems in this population and, second, informing the development of more precise assessment and interventions for those affected by PAE. The aims of the current review were to provide an overview of the self-regulatory framework proposed by Calkins and colleagues (e.g., Calkins, 2007; Calkins and Fox, 2002); examine the self-regulatory difficulties that are commonly experienced during infancy (i.e., 0 to 2 years) and early childhood (i.e., 3 to 8 years) in children with PAE in the context of the developmental framework; and describe how the framework can inform the development of future assessment and intervention provision for young children with PAE. The application of a developmental framework, such as proposed by Calkins and colleagues, allows for a systematic and theoretically driven approach to assessment and intervention programs for young children with PAE.
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Affiliation(s)
- Natasha Reid
- Centre for Child Health Research, University of Queensland, Brisbane, Queensland
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15
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16
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Kapur BM, Baber M. FASD: folic acid and formic acid — an unholy alliance in the alcohol abusing mother. Biochem Cell Biol 2018; 96:189-197. [DOI: 10.1139/bcb-2017-0079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Alcohol consumption during pregnancy remains a significant cause of preventable birth defects and developmental disabilities; however, the mechanism of toxicity remains unclear. Methanol is present as a congener in many alcoholic beverages and is formed endogenously. Because ethanol is preferentially metabolized over methanol, it has been found in the sera and cerebro-spinal fluid of alcoholics. Toxicity resulting from methanol has been attributed to formic acid. Formic acid is present in significantly higher quantities in the biofluids of alcoholics. These higher levels can be cytotoxic and cause neuronal cell death. However, the adverse effects can be mitigated by adequate levels of hepatic folic acid, because formic acid elimination depends on folic acid. During pregnancy, folate concentrations are at least 2-fold higher in cord blood then in maternal blood, owing to increased folate requirements. The reverse has been demonstrated in pregnancies with alcohol abuse, suggesting downregulation of folate transporters and low fetal folate levels. Moreover, formic acid can cross the placenta and its adverse effects can be mitigated by folic acid. Thus, the combination of low fetal folate levels and presence of formic acid form a potent cytotoxic combination that may play a significant role in the etiology of fetal alcohol spectrum disorder.
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Affiliation(s)
- Bhushan M. Kapur
- Department of Clinical Pathology, Sunnybrook Health Science Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Marta Baber
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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17
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Comasco E, Rangmar J, Eriksson UJ, Oreland L. Neurological and neuropsychological effects of low and moderate prenatal alcohol exposure. Acta Physiol (Oxf) 2018; 222. [PMID: 28470828 DOI: 10.1111/apha.12892] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/17/2017] [Accepted: 04/27/2017] [Indexed: 01/18/2023]
Abstract
Several explanations for the diverse results in research on foetal alcohol spectrum disorders or alcohol-related neurodevelopmental disorder might be at hand: timing, amount and patterns of alcohol exposure, as well as complex epigenetic responses. The genetic background of the offspring and its interaction with other prenatal and post-natal environmental cues are likely also of importance. In the present report, key findings about the possible effects of low and moderate doses of maternal alcohol intake on the neuropsychological development of the offspring are reviewed and plausible mechanisms discussed. Special focus is put on the serotonergic system within developmental and gene-environment frameworks. The review also suggests guidelines for future studies and also summarizes some of to-be-answered questions of relevance to clinical practice. Contradictory findings and paucity of studies on the effects of exposure to low alcohol levels during foetal life for the offspring's neuropsychological development call for large prospective studies, as well as for studies including neuroimaging and multi-omics analyses to dissect the neurobiological underpinnings of alcohol exposure-related phenotypes and to identify biomarkers. Finally, it remains to be investigated whether any safe threshold of alcohol drinking during pregnancy can be identified.
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Affiliation(s)
- E. Comasco
- Department of Neuroscience; Uppsala University; Uppsala Sweden
| | - J. Rangmar
- Department of Psychology; University of Gothenburg; Gothenburg Sweden
| | - U. J. Eriksson
- Department of Medical Cell Biology; Uppsala University; Uppsala Sweden
| | - L. Oreland
- Department of Neuroscience; Uppsala University; Uppsala Sweden
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18
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Zuccolo L, DeRoo LA, Wills AK, Davey Smith G, Suren P, Roth C, Stoltenberg C, Magnus P. Pre-conception and prenatal alcohol exposure from mothers and fathers drinking and head circumference: results from the Norwegian Mother-Child Study (MoBa). Sci Rep 2016; 7:39535. [PMID: 28008975 PMCID: PMC5180191 DOI: 10.1038/srep39535] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/24/2016] [Indexed: 11/23/2022] Open
Abstract
Although microcephaly is a feature of Fetal Alcohol Syndrome, it is currently unknown whether low-to-moderate prenatal alcohol exposure affects head circumference. Small magnitude associations reported in observational studies are likely to be misleading due to confounding and misclassification biases. Alternative analytical approaches such as the use of family negative controls (e.g. comparing the effects of maternal and paternal exposure) could help disentangle causal effects. We investigated the association of maternal and paternal alcohol drinking before and early in pregnancy with infant head circumference, using data from 68,244 mother-father-offspring trios from the Norwegian Mother and Child Cohort Study (MoBa) (1999-2009). In analyses adjusted for potential confounders, we found no consistent pattern of association between maternal or paternal alcohol intake before or during pregnancy and offspring head circumference modelled as a continuous outcome. However, we found higher odds of microcephaly at birth for higher paternal, but not maternal, alcohol consumption before pregnancy, and similar but weaker effect estimates for first trimester drinking. Associations with paternal drinking before pregnancy were unexpected and should be regarded as hypothesis generating, until independently replicated, although potentially important given the absence of guidelines on safe drinking levels for men in couples trying for a pregnancy.
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Affiliation(s)
- Luisa Zuccolo
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Lisa A. DeRoo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Andrew K. Wills
- School of Clinical Sciences & School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Pål Suren
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Christine Roth
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Epidemiology, Columbia University, New York, USA
- Nic Waals Institute, Lovisenberg Hospital, Oslo, Norway
| | | | - Per Magnus
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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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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20
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Abstract
Prenatal exposure to alcohol can damage the developing fetus and is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities. In 1973, fetal alcohol syndrome was first described as a specific cluster of birth defects resulting from alcohol exposure in utero. Subsequently, research unequivocally revealed that prenatal alcohol exposure causes a broad range of adverse developmental effects. Fetal alcohol spectrum disorder (FASD) is the general term that encompasses the range of adverse effects associated with prenatal alcohol exposure. The diagnostic criteria for fetal alcohol syndrome are specific, and comprehensive efforts are ongoing to establish definitive criteria for diagnosing the other FASDs. A large and growing body of research has led to evidence-based FASD education of professionals and the public, broader prevention initiatives, and recommended treatment approaches based on the following premises:▪ Alcohol-related birth defects and developmental disabilities are completely preventable when pregnant women abstain from alcohol use.▪ Neurocognitive and behavioral problems resulting from prenatal alcohol exposure are lifelong.▪ Early recognition, diagnosis, and therapy for any condition along the FASD continuum can result in improved outcomes.▪ During pregnancy:◦no amount of alcohol intake should be considered safe;◦there is no safe trimester to drink alcohol;◦all forms of alcohol, such as beer, wine, and liquor, pose similar risk; and◦binge drinking poses dose-related risk to the developing fetus.
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21
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Jensen LU, Eriksen HLF, Marchetta C, Reynolds M, Owens JR, Denny CH, Kesmodel US, Mortensen EL, Bertrand J. THE EFFECT OF LOW TO MODERATE PRENATAL ALCOHOL EXPOSURE AND BINGE DRINKING EPISODES ON DRAW-A-PERSON AT AGE 5 YEARS. MEDICAL RESEARCH ARCHIVES 2015; 2:dx.doi.org/10.18103/mra.v2i2.326. [PMID: 27933317 PMCID: PMC5139916 DOI: 10.18103/mra.v0i4.326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study examined the effects of maternal alcohol consumption and binge drinking during pregnancy on children's Draw-A-Person (DAP) scores. Participants were 1,533 5-year-olds from the Danish National Birth Cohort. Regression analyses revealed an adverse effect of nine or more drinks per week. A drop in mean DAP score of 6.26 (95 % CI: -12.24; -0.39) was observed in the fully adjusted model. A significant interaction between average weekly consumption and binge episodes also was observed. Findings suggest that prenatal exposure to moderate weekly doses of alcohol and binge drinking episodes are associated with lowered scores on the DAP.
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Affiliation(s)
- Linda Uglvig Jensen
- Institute of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
| | | | - Claire Marchetta
- Oak Ridge Institute for Science and Education, Oak Ridge Tennessee, USA
| | - Megan Reynolds
- Oak Ridge Institute for Science and Education, Oak Ridge Tennessee, USA
| | - Jasmine R. Owens
- Oak Ridge Institute for Science and Education, Oak Ridge Tennessee, USA
| | - Clark H. Denny
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Ulrik Schiøler Kesmodel
- Departments of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Erik Lykke Mortensen
- Institute of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
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22
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Kilburn TR, Eriksen HLF, Underbjerg M, Thorsen P, Mortensen EL, Landrø NI, Bakketeig LS, Grove J, Sværke C, Kesmodel US. Low to Moderate Average Alcohol Consumption and Binge Drinking in Early Pregnancy: Effects on Choice Reaction Time and Information Processing Time in Five-Year-Old Children. PLoS One 2015; 10:e0138611. [PMID: 26382068 PMCID: PMC4575046 DOI: 10.1371/journal.pone.0138611] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/31/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Deficits in information processing may be a core deficit after fetal alcohol exposure. This study was designed to investigate the possible effects of weekly low to moderate maternal alcohol consumption and binge drinking episodes in early pregnancy on choice reaction time (CRT) and information processing time (IPT) in young children. METHOD Participants were sampled based on maternal alcohol consumption during pregnancy. At the age of 60-64 months, 1,333 children were administered a modified version of the Sternberg paradigm to assess CRT and IPT. In addition, a test of general intelligence (WPPSI-R) was administered. RESULTS Adjusted for a wide range of potential confounders, this study showed no significant effects of average weekly maternal alcohol consumption during pregnancy on CRT or IPT. There was, however, an indication of slower CRT associated with binge drinking episodes in gestational weeks 1-4. CONCLUSION This study observed no significant effects of average weekly maternal alcohol consumption during pregnancy on CRT or IPT as assessed by the Sternberg paradigm. However, there were some indications of CRT being associated with binge drinking during very early pregnancy. Further large-scale studies are needed to investigate effects of different patterns of maternal alcohol consumption on basic cognitive processes in offspring.
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Affiliation(s)
- Tina R. Kilburn
- Department of Research, Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
- * E-mail:
| | | | | | - Poul Thorsen
- Department of Obstetrics and Gynaecology, Lillebælt Hospital, Kolding, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
| | - Leiv S. Bakketeig
- National Institute of Public Health, University of Oslo, Oslo, Norway
| | - Jakob Grove
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Claus Sværke
- Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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23
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Safety assessment for ethanol-based topical antiseptic use by health care workers: Evaluation of developmental toxicity potential. Regul Toxicol Pharmacol 2015. [PMID: 26212636 DOI: 10.1016/j.yrtph.2015.07.015] [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] [Indexed: 12/14/2022]
Abstract
Ethanol-based topical antiseptic hand rubs, commonly referred to as alcohol-based hand sanitizers (ABHS), are routinely used as the standard of care to reduce the presence of viable bacteria on the skin and are an important element of infection control procedures in the healthcare industry. There are no reported indications of safety concerns associated with the use of these products in the workplace. However, the prevalence of such alcohol-based products in healthcare facilities and safety questions raised by the U.S. FDA led us to assess the potential for developmental toxicity under relevant product-use scenarios. Estimates from a physiologically based pharmacokinetic modeling approach suggest that occupational use of alcohol-based topical antiseptics in the healthcare industry can generate low, detectable concentrations of ethanol in blood. This unintended systemic dose probably reflects contributions from both dermal absorption and inhalation of volatilized product. The resulting internal dose is low, even under hypothetical, worst case intensive use assumptions. A significant margin of exposure (MOE) exists compared to demonstrated effect levels for developmental toxicity under worst case use scenarios, and the MOE is even more significant for typical anticipated occupational use patterns. The estimated internal doses of ethanol from topical application of alcohol-based hand sanitizers are also in the range of those associated with consumption of non-alcoholic beverages (i.e., non-alcoholic beer, flavored water, and orange juice), which are considered safe for consumers. Additionally, the estimated internal doses associated with expected exposure scenarios are below or in the range of the expected internal doses associated with the current occupational exposure limit for ethanol set by the Occupational Safety and Health Administration. These results support the conclusion that there is no significant risk of developmental or reproductive toxicity from repeated occupational exposures and high frequency use of ABHSs or surgical scrubs. Overall, the data support the conclusion that alcohol-based hand sanitizer products are safe for their intended use in hand hygiene as a critical infection prevention strategy in healthcare settings.
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Liebschutz J, Crooks D, Rose-Jacobs R, Cabral HJ, Heeren TC, Gerteis J, Appugliese DP, Heymann OD, Lange AV, Frank DA. Prenatal substance exposure: What predicts behavioral resilience by early adolescence? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 29:329-37. [PMID: 26076097 PMCID: PMC4593628 DOI: 10.1037/adb0000082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Understanding behavioral resilience among at-risk adolescents may guide public policy decisions and future programs. We examined factors predicting behavioral resilience following intrauterine substance exposure in a prospective longitudinal birth-cohort study of 136 early adolescents (ages 12.4-15.9 years) at risk for poor behavioral outcomes. We defined behavioral resilience as a composite measure of lack of early substance use initiation (before age 14), lack of risky sexual behavior, or lack of delinquency. Intrauterine substance exposures included in this analysis were cocaine, tobacco, alcohol, and marijuana. We recruited participants from Boston Medical Center as mother-infant dyads between 1990 and 1993. The majority of the sample was African American/Caribbean (88%) and 49% female. In bivariate analyses, none and lower intrauterine cocaine exposure level predicted resilience compared with higher cocaine exposure, but this effect was not found in an adjusted model. Instead, strict caregiver supervision (adjusted odds ratio [AOR] = 6.02, 95% confidence interval (CI) [1.90, 19.00], p = .002), lower violence exposure (AOR = 4.07, 95% CI [1.77, 9.38], p < .001), and absence of intrauterine tobacco exposure (AOR = 3.71, 95% CI [1.28, 10.74], p = .02) predicted behavioral resilience. In conclusion, caregiver supervision in early adolescence, lower violence exposure in childhood, and lack of intrauterine tobacco exposure predicted behavioral resilience among a cohort of early adolescents with significant social and environmental risk. Future interventions should work to enhance parental supervision as a way to mitigate the effects of adversity on high-risk groups of adolescents. (PsycINFO Database Record
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Affiliation(s)
- Jane Liebschutz
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Denise Crooks
- Department of Family Medicine, Boston Medical Center, 840 Harrison Avenue, Boston, MA, 02118
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine, Boston, 72 East Concord Street, MA, 02118
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Timothy C Heeren
- Data Coordinating Center, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Jessie Gerteis
- Abt Associates, Inc., 55 Wheeler Street, Cambridge, MA, 02138
| | - Danielle P. Appugliese
- Data Coordinating Center, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Orlaith D. Heymann
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Allison V. Lange
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Deborah A. Frank
- Department of Family Medicine, Boston Medical Center, 840 Harrison Avenue, Boston, MA, 02118
- Department of Pediatrics, Boston University School of Medicine, Boston, 72 East Concord Street, MA, 02118
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25
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Polańska K, Muszyński P, Sobala W, Dziewirska E, Merecz-Kot D, Hanke W. Maternal lifestyle during pregnancy and child psychomotor development - Polish Mother and Child Cohort study. Early Hum Dev 2015; 91:317-25. [PMID: 25846841 DOI: 10.1016/j.earlhumdev.2015.03.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/03/2015] [Accepted: 03/12/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nowadays special attention is paid to prenatal exposures to maternal lifestyle factors and their impact on a child development. AIM The objective of this study was to evaluate the impact of modifiable maternal lifestyle factors on child neurodevelopment based on the Polish Mother and Child Cohort study. MATERIAL AND METHODS The current analysis included 538 mother-child pairs. The following factors related to maternal lifestyle were considered: smoking and environmental tobacco smoke (ETS) exposure (based on the cotinine level in maternal saliva measured using LC-ESI+MS/MS method), alcohol consumption and leisure-time physical activity (LTPA) in pregnancy, pre-pregnancy BMI, and folic acid supplementations before and during pregnancy based on questionnaire data. Psychomotor development was assessed in children at the ages of one and two by the Bayley Scales of Infant and Toddler Development. RESULTS Significant association was observed between prenatal exposure to tobacco constituents and a decreased child motor development in assessments performed at both ages (β=-0.8, p=0.01; β=-1.4, p<0.001). Maternal pre-pregnancy underweight was associated with decreased language abilities at 12 months of age (β=-5.2, p=0.01) and cognitive and motor development at 24 months of age, for which the associations were of borderline significance (p=0.06). The recommended level of LTPA during pregnancy was beneficial for child language development at two years of age (β=4.8, p=0.02). For alcohol and folic acid consumption there were no significant associations with any of the analyzed domains of child neurodevelopment. CONCLUSIONS Children prenatally exposed to tobacco compounds and those of underweight mothers had a decreased psychomotor development. The recommended level of LTPA during pregnancy had positive impact on child development. These results underscore the importance of policies and public health interventions promoting healthy lifestyle among women in reproductive age and during pregnancy.
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Affiliation(s)
- Kinga Polańska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, 8 Teresy Street, 91-348 Lodz, Poland.
| | - Paweł Muszyński
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, 8 Teresy Street, 91-348 Lodz, Poland
| | - Wojciech Sobala
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, 8 Teresy Street, 91-348 Lodz, Poland
| | - Emila Dziewirska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, 8 Teresy Street, 91-348 Lodz, Poland
| | - Dorota Merecz-Kot
- Department of Health and Work Psychology, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland
| | - Wojciech Hanke
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, 8 Teresy Street, 91-348 Lodz, Poland
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Kesmodel US, Kjaersgaard MIS, Denny CH, Bertrand J, Skogerbø Å, Eriksen HLF, Bay B, Underbjerg M, Mortensen EL. The association of pre-pregnancy alcohol drinking with child neuropsychological functioning. BJOG 2014; 122:1728-38. [PMID: 25395365 DOI: 10.1111/1471-0528.13172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the effects of pre-pregnancy alcohol drinking on child neuropsychological functioning. DESIGN Prospective follow-up study. SETTING AND POPULATION 154 women and their children sampled from the Danish National Birth Cohort. METHODS Participants were sampled based on maternal alcohol consumption before pregnancy. At 5 years of age, the children were tested with the Wechsler Preschool and Primary Scale of Intelligence-Revised, the Test of Everyday Attention for Children at Five (TEACh-5), and the Movement Assessment Battery for Children (MABC). The Behaviour Rating Inventory of Executive Function (BRIEF) was completed by the mothers and a preschool teacher. Parental education, maternal IQ, prenatal maternal smoking, child's age at testing, child's sex, and maternal alcohol intake during pregnancy were considered potential confounders. MAIN OUTCOME MEASURES Performance on the Wechsler Preschool and Primary Scale of Intelligence-Revised, the TEACh-5, the MABC, and the BRIEF. RESULTS Intake of 15-21 drinks/week on average prior to pregnancy was not associated with any of the outcomes, but intake of ≥22 drinks/week on average was associated with a significantly lower adjusted mean full scale IQ and lower adjusted means in overall attention and sustained attention score, but not in selective attention score or any of the BRIEF index scores or MABC scores. CONCLUSIONS Intake of ≥22 drinks/week before pregnancy was associated with lower mean full scale IQ, overall attention and sustained attention. Assessment of pre-pregnancy drinking provides additional information regarding potential prenatal alcohol exposure and its implications for child neurodevelopment.
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Affiliation(s)
- U S Kesmodel
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M I S Kjaersgaard
- Section of Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - C H Denny
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - J Bertrand
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Å Skogerbø
- Division of Psychiatry, University of Stavanger, Stavanger, Norway
| | - H-L F Eriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - B Bay
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M Underbjerg
- Children's Neurocenter at Vejlefjord Rehabilitation Center, Stouby, Denmark
| | - E L Mortensen
- Institute of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Muggli E, Cook B, O'Leary C, Forster D, Halliday J. Increasing accurate self-report in surveys of pregnancy alcohol use. Midwifery 2014; 31:e23-8. [PMID: 25467595 DOI: 10.1016/j.midw.2014.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/01/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND pregnancy alcohol research relies on self-reports of alcohol consumption. Reporting bias may contribute to ambiguous and conflicting findings on fetal effects of low to moderate pregnancy alcohol exposure. OBJECTIVE this study aimed to identify the determinants which would enable women to provide accurate data in surveys of alcohol use in pregnancy. DESIGN AND PARTICIPANTS six focus groups were held with a total of 26 pregnant women and new mothers. Participants reviewed a set of alcohol survey questions followed by a guided discussion. Transcripts were analysed using inductive content analysis. SETTING public hospital antenatal clinics and Mother & Child Health Centres, Melbourne, Victoria, Australia. FINDINGS women's emotional responses were generally favourable, although the potential for anxiety and fear of judgement was acknowledged. Barriers to accurate self-report were recall, complexity and use of subjective language. Facilitators were appropriate drink choices, occasional drinking options and contextualising of questions. Confidentiality and survey method, including a preference for methods other than face-to face, were also important factors. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE questions embedded in clear context may reduce anxiety around questions about alcohol use in pregnancy. Methods using shorter recall periods, a list of drinks choices, measures of special occasion drinking and minimising complex and subjective language will increase accurate self-report. A setting perceived as confidential and anonymous may reduce a desire to provide socially acceptable answers.
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Affiliation(s)
- Evelyne Muggli
- Murdoch Childrens Research Institute, Parkville 3052, Vic., Australia; Department of Paediatrics, The University of Melbourne, 3010 Vic., Australia.
| | - Brendan Cook
- Murdoch Childrens Research Institute, Parkville 3052, Vic., Australia; Central Australian Aboriginal Congress, Alice Springs, 0870 NT, Australia
| | | | - Della Forster
- La Trobe University, Melbourne 3000, Vic., Australia; Midwifery and Maternity Services Research, The Royal Women׳s Hospital, Parkville, 3052 Vic., Australia
| | - Jane Halliday
- Murdoch Childrens Research Institute, Parkville 3052, Vic., Australia; Department of Paediatrics, The University of Melbourne, 3010 Vic., Australia
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O’Connor MJ. Mental Health Outcomes Associated with Prenatal Alcohol Exposure: Genetic and Environmental Factors. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2014. [DOI: 10.1007/s40474-014-0021-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kodituwakku P, Kodituwakku E. Cognitive and Behavioral Profiles of Children with Fetal Alcohol Spectrum Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2014. [DOI: 10.1007/s40474-014-0022-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kwak HS, Han JY, Choi JS, Ahn HK, Ryu HM, Chung HJ, Cho DH, Shin CY, Velazquez-Armenta EY, Nava-Ocampo AA. Characterization of phosphatidylethanol blood concentrations for screening alcohol consumption in early pregnancy. Clin Toxicol (Phila) 2014; 52:25-31. [DOI: 10.3109/15563650.2013.859263] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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May PA, Blankenship J, Marais AS, Gossage JP, Kalberg WO, Joubert B, Cloete M, Barnard R, De Vries M, Hasken J, Robinson LK, Adnams CM, Buckley D, Manning M, Parry CDH, Hoyme HE, Tabachnick B, Seedat S. Maternal alcohol consumption producing fetal alcohol spectrum disorders (FASD): quantity, frequency, and timing of drinking. Drug Alcohol Depend 2013; 133:502-12. [PMID: 23932841 PMCID: PMC3829200 DOI: 10.1016/j.drugalcdep.2013.07.013] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/11/2013] [Accepted: 07/11/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Concise, accurate measures of maternal prenatal alcohol use are needed to better understand fetal alcohol spectrum disorders (FASD). METHODS Measures of drinking by mothers of children with specific FASD diagnoses and mothers of randomly-selected controls are compared and also correlated with physical and cognitive/behavioral outcomes. RESULTS Measures of maternal alcohol use can differentiate maternal drinking associated with FASD from that of controls and some from mothers of alcohol-exposed normals. Six variables that combine quantity and frequency concepts distinguish mothers of FASD children from normal controls. Alcohol use variables, when applied to each trimester and three months prior to pregnancy, provide insight on critical timing of exposure as well. Measures of drinking, especially bingeing, correlate significantly with increased child dysmorphology and negative cognitive/behavioral outcomes in children, especially low non-verbal IQ, poor attention, and behavioral problems. Logistic regression links (p<.001) first trimester drinking (vs. no drinking) with FASD, elevating FASD likelihood 12 times; first and second trimester drinking increases FASD outcomes 61 times; and drinking in all trimesters 65 times. Conversely, a similar regression (p=.008) indicates that drinking only in the first trimester makes the birth of a child with an FASD 5 times less likely than drinking in all trimesters. CONCLUSIONS There is significant variation in alcohol consumption both within and between diagnostic groupings of mothers bearing children diagnosed within the FASD continuum. Drinking measures are empirically identified and correlated with specific child outcomes. Alcohol use, especially heavy use, should be avoided throughout pregnancy.
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Affiliation(s)
- Philip A May
- Department of Nutrition, Gillings School of Global Public Health, Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, United States; Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, NM 87106, United States.
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Niclasen J, Niclasen J, Nybo Andersen AM, Teasdale TW, Strandberg-Larsen K. Prenatal exposure to alcohol, and gender differences on child mental health at age seven years. J Epidemiol Community Health 2013; 68:224-32. [PMID: 24218073 DOI: 10.1136/jech-2013-202956] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND It remains uncertain whether exposure to lower doses of alcohol is damaging to the developing fetus. The present study aimed to investigate associations for boys and girls between prenatal exposure to binge drinking and lower doses of alcohol in pregnancy, and parent-reported behavioural and emotional development at age seven. METHODS This study used data from the Danish National Birth Cohort. Associations between cumulated alcohol exposure and binge drinking from full pregnancy and parent scores on the Strengths and Difficulties Questionnaire (SDQ) measured at age seven were investigated. The SDQ was used as continuous externalising/internalising scores, and as above/below cut-off for the specific scales of hyperactivity/inattention, conduct, emotional and peer problems. Inclusion criteria were information on alcohol exposure from three interviews, SDQ scores at age seven and being born full term (n=37 152). RESULTS Controlling for relevant confounders, small positive associations were observed between binge drinking and internalising (relative change in mean: 1.04-1.06), externalising scores (relative change in mean: 1.01-1.07), and conduct scores (OR 1.12 to 1.23) for boys. No associations were observed with lower doses of alcohol. CONCLUSIONS Exposure to binge drinking is weakly associated with impaired behavioural and emotional development measured at age seven. Large differences in background characteristics were observed between the groups defined by cumulated alcohol exposure, leaving the interpretations of findings uncertain.
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Affiliation(s)
- Janni Niclasen
- Department of Psychology, University of Copenhagen, , Copenhagen, Denmark
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Niclasen J. Drinking or not drinking in pregnancy: the multiplicity of confounding influences. Alcohol Alcohol 2013; 49:349-55. [PMID: 24105631 DOI: 10.1093/alcalc/agt141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Studies investigating associations between prenatal exposure to low-moderate doses of alcohol and mental health development in childhood are inconsistent. The aim of the present study was to compare women who drink and who do not drink alcohol in pregnancy on a number of potential confounding variables, and to investigate whether any latent variables could be identified among these. METHODS Data were obtained from the Danish National Birth Cohort. EXPOSURE cumulated alcohol intake in full pregnancy (n = 63,464). The women were subdivided into intake groups 0, >0-10, >10-30, >30-90 and >90 units of alcohol in full pregnancy. Hereafter, the abstainers were subdivided into an all-time and a pregnancy-abstaining group, and the high intakers (>90) were subdivided into a high (>90-180) and a very high (>180) intake group. OUTCOME self-reported and register-based information on socio-demographic and lifestyle factors, and latent variables from an exploratory factor analysis. RESULTS Significant differences were observed between the intake groups on virtually all parameters. Significant differences were observed between the abstaining groups and the high-intake groups. The exploratory factor analyses identified a number of latent variables between the potential confounding variables. CONCLUSION Differences on confounding factors may in part explain the lack of consistency in the literature investigating prenatal exposure to low-moderate doses of alcohol and mental health development. It is cautiously concluded that the failure to control for these factors introduces residual and/or unmeasured confounding into the analyses, and thus masks the potential (small) effect of being exposed to low doses of alcohol in pregnancy. It is recommended that future studies control for factor scores rather than for the observed variables as is practice today.
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Zuccolo L, Lewis SJ, Davey Smith G, Sayal K, Draper ES, Fraser R, Barrow M, Alati R, Ring S, Macleod J, Golding J, Heron J, Gray R. Prenatal alcohol exposure and offspring cognition and school performance. A 'Mendelian randomization' natural experiment. Int J Epidemiol 2013; 42:1358-70. [PMID: 24065783 PMCID: PMC3807618 DOI: 10.1093/ije/dyt172] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is substantial debate as to whether moderate alcohol use during pregnancy could have subtle but important effects on offspring, by impairing later cognitive function and thus school performance. The authors aimed to investigate the unconfounded effect of moderately increased prenatal alcohol exposure on cognitive/educational performance. METHODS We used mother-offspring pairs participating in the Avon Longitudinal Study of Parents and Children (ALSPAC) and performed both conventional observational analyses and Mendelian randomization using an ADH1B variant (rs1229984) associated with reduced alcohol consumption. Women of White European origin with genotype and self-reported prenatal alcohol consumption, whose offspring's IQ score had been assessed in clinic (N=4061 pairs) or Key Stage 2 (KS2) academic achievement score was available through linkage to the National Pupil Database (N=6268), contributed to the analyses. RESULTS Women reporting moderate drinking before and during early pregnancy were relatively affluent compared with women reporting lighter drinking, and their children had higher KS2 and IQ scores. In contrast, children whose mothers' genotype predisposes to lower consumption or abstinence during early pregnancy had higher KS2 scores (mean difference +1.7, 95% confidence interval +0.4, +3.0) than children of mothers whose genotype predisposed to heavier drinking, after adjustment for population stratification. CONCLUSIONS Better offspring cognitive/educational outcomes observed in association with prenatal alcohol exposure presumably reflected residual confounding by factors associated with social position and maternal education. The unconfounded Mendelian randomization estimates suggest a small but potentially important detrimental effect of small increases in prenatal alcohol exposure, at least on educational outcomes.
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Affiliation(s)
- Luisa Zuccolo
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Sarah J Lewis
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Kapil Sayal
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Elizabeth S Draper
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Robert Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Margaret Barrow
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Rosa Alati
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Sue Ring
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - John Macleod
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Jean Golding
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Jon Heron
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Ron Gray
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK, Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK, Department of Health Sciences, University of Leicester, Leicester, UK, School of Medicine, University of Sheffield, Sheffield, UK, Clinical Genetics, University Hospitals of Leicester, Leicester, UK, School of Population Health, University of Queensland, Brisbane, Queensland, Australia and National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Skagerström J, Alehagen S, Häggström-Nordin E, Årestedt K, Nilsen P. Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden. BMC Public Health 2013; 13:780. [PMID: 23981786 PMCID: PMC3765772 DOI: 10.1186/1471-2458-13-780] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/12/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There is a paucity of research on predictors for drinking during pregnancy among women in Sweden and reported prevalence rates differ considerably between studies conducted at different antenatal care centres. Since this knowledge is relevant for preventive work the aim of this study was to investigate these issues using a multicenter approach. METHODS The study was conducted at 30 antenatal care centers across Sweden from November 2009 to December 2010. All women in pregnancy week 18 or more with a scheduled visit were asked to participate in the study. The questionnaire included questions on sociodemographic data, alcohol consumption prior to and during the pregnancy, tobacco use before and during pregnancy, and social support. RESULTS Questionnaires from 1594 women were included in the study. A majority, 84%, of the women reported alcohol consumption the year prior to pregnancy; about 14% were categorized as having hazardous consumption, here defined as a weekly consumption of > 9 standard drinks containing 12 grams of pure alcohol or drinking more than 4 standard drinks at the same occasion. Approximately 6% of the women consumed alcohol at least once after pregnancy recognition, of which 92% never drank more than 1 standard drink at a time. Of the women who were hazardous drinkers before pregnancy, 19% reduced their alcohol consumption when planning their pregnancy compared with 33% of the women with moderate alcohol consumption prior to pregnancy. Factors predicting alcohol consumption during pregnancy were older age, living in a large city, using tobacco during pregnancy, lower score for social support, stronger alcohol habit before pregnancy and higher score for social drinking motives. CONCLUSIONS The prevalence of drinking during pregnancy is relatively low in Sweden. However, 84% of the women report drinking in the year preceding pregnancy and most of these women continue to drink until pregnancy recognition, which means that they might have consumed alcohol in early pregnancy. Six factors were found to predict alcohol consumption during pregnancy. These factors should be addressed in the work to prevent alcohol-exposed pregnancies.
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Affiliation(s)
- Janna Skagerström
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, SE-581 83, Sweden.
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Alvik A, Aalen OO, Lindemann R. Early fetal binge alcohol exposure predicts high behavioral symptom scores in 5.5-year-old children. Alcohol Clin Exp Res 2013; 37:1954-62. [PMID: 23888929 DOI: 10.1111/acer.12182] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 03/16/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fetal binge alcohol exposure has been associated with neurobehavioral and cognitive symptoms. This study explored whether binge drinking mainly before recognition of pregnancy predicted high symptom scores on the Strengths and Difficulties Questionnaire (SDQ) in 5.5-year-old children. METHODS In a population-based, longitudinal study representative of pregnant women in Oslo, Norway, questionnaires were answered at 17 and 30 weeks of pregnancy, 6 months after term, and at child age 5.5 years (n = 1,116, constituting 66% of the original cohort). Logistic regression analyses identified factors predicting high SDQ scores, and multiple regression analyses identified direct effects on the SDQ Total. RESULTS Binge exposure (≥5 standard units per occasion [SUpo]) during pregnancy week 0 to 6, that is, 0 to 4 weeks after conception, predicted scores in the Abnormal and Borderline range on the SDQ in 5.5-year-olds, after adjusting for other confounding variables. Very early binge exposure less often than once a week predicted high symptom scores on the SDQ Total (p = 0.05) and Hyperactivity/Inattention (significant), while exposure at least once a week demonstrated a 3- to 5-fold significant increase in high symptom scores on Total, Emotional, and Conduct problems. Reporting ≥8 SUpo had stronger predictive power than reporting 5 to 7 SUpo. The results were not explained by participants reporting major lifetime depression. Other predictive factors, although weaker, were maternal symptoms of depression and anxiety during the child's infancy. High education (mother and father), high income (maternal partner), higher child birth weight, and child female sex reduced the likelihood of high SDQ symptom scores. Path analysis demonstrated early binge exposure to have a direct effect on the SDQ Total score. CONCLUSIONS Binge drinking up to 4 weeks after conception had a strong and direct predictive effect on SDQ symptom scores in 5.5-year-olds. These results strongly support the advice to avoid binge drinking when planning pregnancy.
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Affiliation(s)
- Astrid Alvik
- Division of Mental Health and Addiction, Institute of Clinical Medicine University of Oslo, Oslo, Norway; Child and Adolescent Mental Health Research Unit, Oslo University Hospital, Oslo, Norway
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Maternal factors predicting cognitive and behavioral characteristics of children with fetal alcohol spectrum disorders. J Dev Behav Pediatr 2013; 34:314-25. [PMID: 23751886 PMCID: PMC3731773 DOI: 10.1097/dbp.0b013e3182905587] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide an analysis of multiple predictors of cognitive and behavioral traits for children with fetal alcohol spectrum disorders (FASDs). METHOD Multivariate correlation techniques were used with maternal and child data from epidemiologic studies in a community in South Africa. Data on 561 first-grade children with fetal alcohol syndrome (FAS), partial FAS (PFAS), and not FASD and their mothers were analyzed by grouping 19 maternal variables into categories (physical, demographic, childbearing, and drinking) and used in structural equation models (SEMs) to assess correlates of child intelligence (verbal and nonverbal) and behavior. RESULTS A first SEM using only 7 maternal alcohol use variables to predict cognitive/behavioral traits was statistically significant (B = 3.10, p < .05) but explained only 17.3% of the variance. The second model incorporated multiple maternal variables and was statistically significant explaining 55.3% of the variance. Significantly correlated with low intelligence and problem behavior were demographic (B = 3.83, p < .05) (low maternal education, low socioeconomic status [SES], and rural residence) and maternal physical characteristics (B = 2.70, p < .05) (short stature, small head circumference, and low weight). Childbearing history and alcohol use composites were not statistically significant in the final complex model and were overpowered by SES and maternal physical traits. CONCLUSIONS Although other analytic techniques have amply demonstrated the negative effects of maternal drinking on intelligence and behavior, this highly controlled analysis of multiple maternal influences reveals that maternal demographics and physical traits make a significant enabling or disabling contribution to child functioning in FASD.
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Cooper DL, Petherick ES, Wright J. The association between binge drinking and birth outcomes: results from the Born in Bradford cohort study. J Epidemiol Community Health 2013; 67:821-8. [PMID: 23729326 DOI: 10.1136/jech-2012-202303] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Various human and animal studies suggest that peak alcohol exposure during a binge episode, rather than total alcohol exposure, may determine fetal development. Research about the impact of binge drinking on birth outcomes is sparse and inconclusive. Data from the Born in Bradford cohort study were used to explore the impact of binge drinking on birth outcomes. METHODS Interview-administered questionnaire data about the lifestyle and social characteristics of 10 851 pregnancies were linked to maternity and birth data. The impact of self-reported binge drinking (5 units: 40 g of pure alcohol) on two birth outcomes (small for gestational age (SGA) and preterm birth (<37 weeks)) was assessed using multivariate logistic regression models, while adjusting for confounders. RESULTS The percentage of women classified as binge drinkers fell from 24.5% before pregnancy to 9% during the first trimester and 3.1% during the second trimester. There was a significant association between SGA birth and binge drinking (all categories combined; OR 1.68, 95% CI 1.15 to 2.47, p=0.01). No association was observed between moderate drinking and either birth outcome, or between binge drinking and preterm birth. CONCLUSIONS Binge drinking during the second trimester of pregnancy was associated with an increased risk of SGA birth. No association was found between any level of alcohol consumption and premature birth. This work supports previous research showing no association between SGA and low-alcohol exposure but adds to evidence of a dose-response relationship with significant risks observed at binge drinking levels.
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Affiliation(s)
- Duncan L Cooper
- Born in Bradford Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, , Bradford, West Yorkshire, UK
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Skogerbø Å, Kesmodel US, Denny CH, Kjaersgaard MIS, Wimberley T, Landrø NI, Mortensen EL. The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on behaviour in 5-year-old children: a prospective cohort study on 1628 children. BJOG 2013; 120:1042-50. [PMID: 23837773 DOI: 10.1111/1471-0528.12208] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine the effects of low to moderate maternal alcohol consumption and binge drinking in early pregnancy on behaviour in children at the age of 5 years. DESIGN Prospective cohort study. SETTING Neuropsychological testing in four Danish cities, 2003-2008. POPULATION A total of 1628 women and their children sampled from the Danish National Birth Cohort. METHODS Participants were sampled based on maternal alcohol drinking patterns during early pregnancy. When the children were 5 years of age the parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ) were completed by the mothers and a preschool teacher, respectively. The full statistical model included the following potential confounding factors: maternal binge drinking or low to moderate alcohol consumption, respectively; parental education; maternal IQ; prenatal maternal smoking; the child's age at testing; the child's gender; maternal age; parity; maternal marital status; family home environment; postnatal parental smoking; prepregnancy maternal body mass index (BMI); and the child's health status. MAIN OUTCOME MEASURE Behaviour among children assessed by the SDQ parent and teacher forms. RESULTS Adjusted for all potential confounding factors, no statistically significant associations were observed between maternal low to moderate average weekly alcohol consumption and SDQ behavioural scores (OR 1.1, 95% CI 0.5-2.3; OR 1.1, 95% CI 0.6-2.1 for the total difficulties scores) or between binge drinking and SDQ behavioural scores (OR 1.2, 95% CI 0.8-1.7; OR 0.8, 95% CI 0.6-1.2). CONCLUSION This study observed no consistent effects of low to moderate alcohol consumption or binge drinking in early pregnancy on offspring behaviour at the age of 5 years.
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Affiliation(s)
- Å Skogerbø
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Day NL, Helsel A, Sonon K, Goldschmidt L. The association between prenatal alcohol exposure and behavior at 22 years of age. Alcohol Clin Exp Res 2013; 37:1171-8. [PMID: 23442183 DOI: 10.1111/acer.12073] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) affects central nervous system development, growth, and morphology at higher exposure levels. Little is known about the effects of PAE at lower exposure levels or in young adults. Research on children with higher levels of PAE has shown that PAE predicts behavior problems. The question remains whether these effects are permanent or ameliorated by maturation into adulthood. METHODS These data are from a longitudinal study of PAE. Mothers were recruited from a prenatal clinic and interviewed during their fourth prenatal month, seventh month, and delivery. In the postpartum, mothers and offspring were seen at 8 and 18 months, and 3, 6, 10, 14, 16, and 22 years. RESULTS At 22 years, PAE significantly predicted behavior as measured with the adult self-report. These findings were significant controlling for covariates. Exposure at each trimester predicted increased behavior problems on the Total Score, Internalizing, Externalizing, Attention, and Critical Items scales. Use across pregnancy predicted a higher rate of behavior problems compared to no use and use in the first trimester only. CONCLUSIONS The effects were dose-response and significant at each trimester of pregnancy. However, duration across pregnancy was a better predictor than drinking during the first trimester only. Binge drinking was not a better predictor of outcome compared to average daily volume (ADV), and within categories of ADV, binge drinking did not predict more problems than nonbinge drinking. Thus, there is no safe level or safe time during pregnancy for women to drink. These data demonstrate that the effects of PAE, even at low to moderate levels, extend into young adulthood and are most likely permanent.
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Affiliation(s)
- Nancy L Day
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Corrigenda. BJOG 2012. [DOI: 10.1111/1471-0528.12097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Parker MO, Brennan CH. Low and moderate alcohol consumption during pregnancy: effects on social behaviour and propensity to develop substance abuse in later life. BJOG 2012; 119:1671-2. [PMID: 23164117 DOI: 10.1111/1471-0528.12006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Garcia-Algar O, Black D, Guerri C, Pichini S. The effect of different alcohol drinking patterns in early to mid-pregnancy. BJOG 2012; 119:1670-1. [DOI: 10.1111/1471-0528.12007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Astley S, Grant T. Another perspective on ‘The effect of different alcohol drinking patterns in early to mid pregnancy on the child’s intelligence, attention, and executive function’. BJOG 2012; 119:1672. [DOI: 10.1111/1471-0528.12008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kesmodel US, Bertrand J, Støvring H, Skarpness B, Denny CH, Mortensen EL. The effect of different alcohol drinking patterns in early to mid pregnancy on the child's intelligence, attention, and executive function. BJOG 2012; 119:1180-90. [PMID: 22712700 DOI: 10.1111/j.1471-0528.2012.03393.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To conduct a combined analysis of the estimated effects of maternal average weekly alcohol consumption, and any binge drinking, in early to mid pregnancy on general intelligence, attention, and executive function in 5-year-old children. DESIGN Follow-up study. SETTING Neuropsychological testing in four Danish cities 2003-2008. POPULATION A cohort of 1628 women and their children sampled from the Danish National Birth Cohort. METHODS Participants were sampled based on maternal alcohol consumption during early pregnancy. At age 5 years, the children were tested for general intelligence, attention, and executive function. The three outcomes were analysed together in a multivariate model to obtain joint estimates and P values for the association of alcohol across outcomes. The effects of low to moderate alcohol consumption and binge drinking in early pregnancy were adjusted for a wide range of potential confounding factors. MAIN OUTCOME MEASURES Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), the Test of Everyday Attention for Children at Five (TEACh-5), and the Behavior Rating Inventory of Executive Functions (BRIEF) scores. RESULTS Multivariate analyses showed no statistically significant effects arising from average weekly alcohol consumption or any binge drinking, either individually or in combination. These results replicate findings from separate analyses of each outcome variable. CONCLUSIONS The present study contributes comprehensive methodological and statistical approaches that should be incorporated in future studies of low to moderate alcohol consumption and binge drinking during pregnancy. Furthermore, as no safe level of drinking during pregnancy has been established, the most conservative advice for women is not to drink alcohol during pregnancy. However, the present study suggests that small volumes consumed occasionally may not present serious concern.
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Affiliation(s)
- U S Kesmodel
- Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark.
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