1
|
Oei JL. Alcohol use in pregnancy and its impact on the mother and child. Addiction 2020; 115:2148-2163. [PMID: 32149441 DOI: 10.1111/add.15036] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/23/2020] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
Abstract
AIMS To review the impact of prenatal alcohol exposure on the outcomes of the mother and child. DESIGN Narrative review. SETTING Review of literature. PARTICIPANTS Mothers and infants affected by prenatal alcohol use. MEASUREMENTS Outcomes of mothers and children. FINDINGS Prenatal alcohol exposure is one of the most important causes of preventable cognitive impairment in the world. The developing neurological system is exquisitely sensitive to harm from alcohol and there is now also substantial evidence that alcohol-related harm can extend beyond the individual person, leading to epigenetic changes and intergenerational vulnerability and disadvantage. There is no known safe level or timing of drinking for pregnant or lactating women and binge drinking (> four drinks within 2 hours for women) is the most harmful. Alcohol-exposure increases the risk of congenital problems, including Fetal Alcohol Spectrum Disorder (FASD) and its most severe form, Fetal Alcohol Syndrome (FAS). CONCLUSION The impact of FASD and FAS is enduring and life-long with no current treatment or cure. Emerging therapeutic options may mitigate the worst impact of alcohol exposure but significant knowledge gaps remain. This review discusses the history, epidemiology and clinical presentations of prenatal alcohol exposure, focusing on FASD and FAS, and the impact of evidence on future research, practice and policy directions.
Collapse
Affiliation(s)
- Ju Lee Oei
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.,Department of Newborn Care, the Royal Hospital for Women, Randwick, NSW, Australia.,Drug and Alcohol Services, Murrumbidgee Local Health District, NSW, Australia
| |
Collapse
|
2
|
Fan J, Jacobson SW, Taylor PA, Molteno CD, Dodge NC, Stanton ME, Jacobson JL, Meintjes EM. White matter deficits mediate effects of prenatal alcohol exposure on cognitive development in childhood. Hum Brain Mapp 2016; 37:2943-58. [PMID: 27219850 DOI: 10.1002/hbm.23218] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 11/09/2022] Open
Abstract
Fetal alcohol spectrum disorders comprise the spectrum of cognitive, behavioral, and neurological impairments caused by prenatal alcohol exposure (PAE). Diffusion tensor imaging (DTI) was performed on 54 children (age 10.1 ± 1.0 years) from the Cape Town Longitudinal Cohort, for whom detailed drinking histories obtained during pregnancy are available: 26 with full fetal alcohol syndrome (FAS) or partial FAS (PFAS), 15 nonsyndromal heavily exposed (HE), and 13 controls. Using voxelwise analyses, children with FAS/PFAS showed significantly lower fractional anisotropy (FA) in four white matter (WM) regions and higher mean diffusivity (MD) in seven; three regions of FA and MD differences (left inferior longitudinal fasciculus (ILF), splenium, and isthmus) overlapped, and the fourth FA cluster was located in the same WM bundle (right ILF) as an MD cluster. HE children showed lower FA and higher MD in a subset of these regions. Significant correlations were observed between three continuous alcohol measures and DTI values at cluster peaks, indicating that WM damage in several regions is dose dependent. Lower FA in the regions of interest was attributable primarily to increased radial diffusivity rather than decreased axonal diffusivity, suggesting poorer axon packing density and/or myelination. Multiple regression models indicated that this cortical WM impairment partially mediated adverse effects of PAE on information processing speed and eyeblink conditioning. Hum Brain Mapp 37:2943-2958, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jia Fan
- MRC/UCT Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Sandra W Jacobson
- Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Paul A Taylor
- MRC/UCT Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.,African Institute for Mathematical Sciences, Muizenberg, Western Cape, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Neil C Dodge
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Mark E Stanton
- Department of Psychology, University of Delaware, Newark, Delaware
| | - Joseph L Jacobson
- Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Ernesta M Meintjes
- MRC/UCT Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| |
Collapse
|