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Rocha AG, de Souza PRA, Wachholz GE, Fraga LR, Sanseverino MTV, Terra AP, da Silva AA, Vianna FSL, Abeche AM, Larrandaburu M, Del Campo M, Schuler-Faccini L. Fetal Alcohol Spectrum Disorders: Health Needs Assessment in Brazil. Alcohol Clin Exp Res 2020; 44:660-668. [PMID: 31984499 DOI: 10.1111/acer.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal alcohol syndrome (FAS) is a disorder caused by alterations in embryo-fetal development due to prenatal alcohol exposure. It is estimated that between 0.5 and 2 per 1,000 individuals are born with FAS every year. In Brazil, there are few studies addressing the extent of the problem of FAS/fetal alcohol spectrum disorders (FASD); these studies are confined to limited geographic areas. Therefore, we decided to perform a health needs assessment for FAS/FASD in Brazil. METHODS To estimate the prevalence of FAS and FASD in Brazil, we used information from the literature, which estimates between 0.5 and 2/1,000 births per year for FAS and 10 to 50/1,000 for FASD. RESULTS We estimated that approximately 1,500 to 6,000 children are born with FAS every year. Considering the whole population, the prevalence would be 95,377 to 380,000 affected people. However, when we consider FASD as a whole, we estimate that between 1,900,000 and 9,500,000 Brazilians might suffer the more severe consequences of alcohol exposure during pregnancy and be living with FASD. CONCLUSION The results of the current study indicate that FAS and FASD are prevalent disorders in Brazil, and more policies targeting alcohol intake during pregnancy must be developed.
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Affiliation(s)
- Anastácia Guimarães Rocha
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo Ricardo Assis de Souza
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Elis Wachholz
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Rosa Fraga
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Morphological Sciences, Institute of Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Teresa V Sanseverino
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Anna Pires Terra
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Anjos da Silva
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Univates University, Lajeado, Brazil
| | - Fernanda Sales Luiz Vianna
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alberto Mantovani Abeche
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Miguel Del Campo
- Department of Pediatrics, University of California San Diego, San Diego, California
| | - Lavínia Schuler-Faccini
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Pombo-de-Oliveira MS, Andrade FG. Early-age Acute Leukemia: Revisiting Two Decades of the Brazilian Collaborative Study Group. Arch Med Res 2017; 47:593-606. [PMID: 28476187 DOI: 10.1016/j.arcmed.2016.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/24/2016] [Indexed: 12/20/2022]
Abstract
The understanding of leukemogenesis in early-age acute leukemia (EAL) has improved remarkably. Initiating somatic mutations detected in dried neonatal blood spots (DNBS) and in cord blood samples of affected children with leukemia have been proven to be acquired prenatally. However, to date, few epidemiological studies have been carried out exploring EAL that include infants and children 13-24 months of age at the diagnosis. Maternal exposure to transplacental DNA-damaging substances during pregnancy has been suggested to be a risk factor for EAL. Most cases of infants with acute lymphoblastic (i-ALL) or myeloid leukemia (i-AML) have KMT2A gene rearrangements (KMT2A-r), which disturb its essential role as an epigenetic regulator of hematopoiesis. Due to the short latency period for EAL and the fact that KMT2A-r resembles those found in secondary AML, exposure to topoisomerase II inhibitors has been associated with transplacental risk as proxi for causality. EAL studies have been conducted in Brazil for over two decades, combining observational epidemiology, leukemia biology, and clinical data. EAL was investigated considering (i) age strata (infants vs. 13-24 months-old); (ii) somatic mutations associated with i-ALL and i-AML; (iii) ethnic-geographic variations; (iv) contribution of maternal genotypes; and (v) time latency of exposures and mutations in DNBS. Interactions of acquired and constitutive gene mutations are challenging tools to test risk factor associations for EAL. In this review we summarize the EAL scenario (including B-cell precursor-ALL, T-ALL, and AML) results combining environmental and genetic susceptibility risk factors and we raise questions that should be considered for further action.
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Affiliation(s)
- Maria S Pombo-de-Oliveira
- Pediatric Hematology-Oncology Research Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
| | - Francianne Gomes Andrade
- Pediatric Hematology-Oncology Research Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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- Pediatric Hematology-Oncology Research Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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Abiri B, Kelishadi R, Sadeghi H, Azizi-Soleiman F. Effects of Maternal Diet During Pregnancy on the Risk of Childhood Acute Lymphoblastic Leukemia: A Systematic Review. Nutr Cancer 2016; 68:1065-72. [PMID: 27472187 DOI: 10.1080/01635581.2016.1206581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in children that can be affected by maternal diet. The aim of this study was to evaluate maternal dietary risk factors of ALL. We searched MEDLINE, Cochrane Library, Springer Link, Wiley Online, Science Direct, Mosby, ISI Web of Science, OVID, ProQuest, and Scopus from database inception until February 2, 2016. Two reviewers scanned titles, abstracts, and keywords of articles after excluding duplicates. We included case-control studies evaluating the relationship between maternal diet during pregnancy and childhood ALL. The search resulted in 2,940 papers, of which 11 full-text articles met the criteria for inclusion in the review and were analyzed. The finding of these studies suggest that maternal diet composed largely of vegetables, fruits, and protein sources before and during pregnancy can reduce the risk of ALL in offspring. Maternal alcohol intake had no effect. Nevertheless, inherent limitations of case-control studies like measurement error, random error, recall bias, and selection bias preclude conclusive evidence. Persuading pregnant women to follow a healthy diet rich in fruits, vegetables, and protein may reduce the risk of childhood ALL. Avoiding alcohol intake seems prudent.
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Affiliation(s)
- Behnaz Abiri
- a Department of Nutrition , School of Public Health, Iran University of Medical Sciences , Tehran , Iran
| | - Roya Kelishadi
- b Department of Pediatrics , Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences , Isfahan , Iran
| | - Homa Sadeghi
- c Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Finland
| | - Fatemeh Azizi-Soleiman
- a Department of Nutrition , School of Public Health, Iran University of Medical Sciences , Tehran , Iran
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