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Tanfield Y, Burrows K, Middllemiss M. Assessing and supporting children and young people with probable or diagnosed fetal alcohol spectrum disorder: The experience of clinicians working within child and adolescent mental health services. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39138612 DOI: 10.1111/acer.15376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Fetal alcohol spectrum disorders (FASD) are a group of conditions that occur due to prenatal alcohol exposure (PAE), which impacts physical, behavioral, and cognitive ability. The literature demonstrates that healthcare professionals lack knowledge and understanding of FASD, resulting in children and young people (CYP) often getting misdiagnosed with neurodevelopmental disorders or the diagnosis of FASD missed, increasing their risk of experiencing secondary mental health difficulties. Child and Adolescent Mental Health Services (CAMHS) are the commissioned service to diagnose neurodevelopmental conditions and support CYP with mental health difficulties, therefore, it is likely that CYP with probable or diagnosed FASD will present in CAMHS. There is currently no research exploring the awareness and understanding of FASD within these services. METHODS Constructivist grounded theory was utilized to explore the barriers and facilitators clinicians experience when assessing and supporting CYP with probable or diagnosed FASD within CAMHS. A sample of 12 CAMHS clinicians from an NHS Mental Health Trust situated in the Northeast of England were interviewed. Interviews were transcribed and analyzed and grounded theory techniques were utilized to generate an end model. RESULTS The end model was developed on a box analogy with four categories. 'Unable to Open the Box' captures barriers CAMHS clinicians experience when exploring FASD, 'Things that Help Open the Box' captures facilitators CAMHS clinicians experience when exploring FASD, 'Asking Others About the Box' captures systemic influences CAMHS clinicians may experience when exploring FASD, and 'Making the Box Easier to Open in Future' captures how we can support CAMHS clinicians moving forward to explore FASD. CONCLUSIONS This model provides new insights into the barriers and facilitators CAMHS clinicians experience when assessing and supporting CYP with probable or diagnosed FASD, highlighting key clinical implications. Recommendations for future research are outlined to expand the knowledge base for this area.
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Affiliation(s)
- Yasmin Tanfield
- Medical Psychology Service, South Tees NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
- School of Social Sciences, Humanities and Law, Teesside University, Teesside, UK
| | - Kathy Burrows
- School of Social Sciences, Humanities and Law, Teesside University, Teesside, UK
| | - Megan Middllemiss
- Singe Point of Access Service, Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, Darlington, UK
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2
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Barry CV, Chrysanthopoulou SA, Tallo V, Jarilla B, Vargas Z, McDonald E, Gundogan F, Friedman JF. The Impact of Prenatal Alcohol Exposure on Longitudinal Growth, Nutritional Status, and Insulin-Like Growth Factor 1 in Early Childhood in Leyte, the Philippines. J Pediatr 2024; 269:113977. [PMID: 38401788 PMCID: PMC11096041 DOI: 10.1016/j.jpeds.2024.113977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/24/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To assess the impact and potential mechanistic pathways of prenatal alcohol exposure (PAE) on longitudinal growth and nutritional status in early childhood. STUDY DESIGN A cohort of 296 mother-infant dyads (32% with PAE vs 68% unexposed) were recruited in Leyte, the Philippines, and followed from early gestation through 24 months of age. PAE was assessed using serum phosphatidylethanol (PEth) captured twice prenatally and in cord blood and supplemented with self-reported alcohol consumption. Linear mixed models were used to examine longitudinal effects of PAE on growth from birth through 2 years including key potential mediating factors (placental histopathology, and infant serum leptin and Insulin-like Growth Factor 1 [IGF-1]). RESULTS After adjusting for potential confounders, we found that PAE was significantly associated with a delayed blunting of linear growth trajectories (height-for-age z-score, body length) and weight (weight-for-age z-score, body weight) that manifested between 4 and 6 months and continued through 12-24 months. PAE was also associated with a decreased rate of mid-upper-arm circumference growth from birth to 12 months, and a lower mean IGF-1 levels at birth and 6 months. CONCLUSION This study demonstrates a delayed impact of PAE on growth that manifested around 6 months of age, underscoring the importance of routine clinical monitoring in early childhood. Furthermore, the findings supported prior animal model findings that suggest a mechanistic role for IGF-1 in PAE-induced growth delay.
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Affiliation(s)
- Christopher V Barry
- Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Blanca Jarilla
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Zorimel Vargas
- Center for International Health Research, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Emily McDonald
- Center for International Health Research, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
| | - Fusun Gundogan
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, RI; Women and Infants' Hospital, Care New England, Providence, RI
| | - Jennifer F Friedman
- Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI; Center for International Health Research, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
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Erng MN, Reid N, Moritz KM, van Driel M. Prenatal alcohol exposure risk perception dimensions and influencing factors: A systematic review and conceptual model. Aust N Z J Public Health 2023; 47:100047. [PMID: 37075515 DOI: 10.1016/j.anzjph.2023.100047] [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] [Received: 02/12/2023] [Accepted: 02/26/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE This paper aims to explore the available literature to understand how risks regarding prenatal alcohol exposure are perceived. METHODS A systematic review (PROSPERO; CRD 42020212887) was undertaken. PubMed, Embase, PsycINFO, and CINAHL were searched for relevant quantitative and qualitative studies. A thematic analysis of the studies was performed. RESULTS Fifteen articles-nine quantitative and six qualitative studies met the inclusion criteria. Three dimensions of risk perceptions were identified-perceived susceptibility, perceived severity, and affective risk perception. Three influencing factors of these dimensions were also identified: information (i.e., consistency, confirmation bias, strength of the evidence, and perceived relevance), sociocultural (i.e., social inclusivity, cultural context, and risk interpretation), and individual (i.e., risks versus benefits, controllability, and experience). These dimensions and influencing factors were brought together to create the proposed novel Pregnancy Alcohol Risk Perception (PARP) conceptual model. CONCLUSIONS The novel PARP conceptual model developed from the current literature provides a framework to guide understanding of risk perceptions, which includes a wide range of potential influencing factors. IMPLICATIONS FOR PUBLIC HEALTH The novel PARP conceptual model provides the groundwork for further refinement with stakeholders, which could in turn be used to inform the design of interventions and health promotional materials to support harm reduction approaches and prevention of prenatal alcohol exposure.
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Affiliation(s)
- May N Erng
- The University of Queensland, Child Health Research Centre, South Brisbane, 4101, Australia.
| | - Natasha Reid
- The University of Queensland, Child Health Research Centre, South Brisbane, 4101, Australia
| | - Karen M Moritz
- The University of Queensland, School of Biomedical Sciences, St Lucia, 4067, Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, The University of Queensland, Herston, 4006, Australia
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Alcohol Withdrawal and the Associated Mood Disorders-A Review. Int J Mol Sci 2022; 23:ijms232314912. [PMID: 36499240 PMCID: PMC9738481 DOI: 10.3390/ijms232314912] [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: 10/17/2022] [Accepted: 11/02/2022] [Indexed: 11/30/2022] Open
Abstract
Recreational use of alcohol is a social norm in many communities worldwide. Alcohol use in moderation brings pleasure and may protect the cardiovascular system. However, excessive alcohol consumption or alcohol abuse are detrimental to one's health. Three million deaths due to excessive alcohol consumption were reported by the World Health Organization. Emerging evidence also revealed the danger of moderate consumption, which includes the increased risk to cancer. Alcohol abuse and periods of withdrawal have been linked to depression and anxiety. Here, we present the effects of alcohol consumption (acute and chronic) on important brain structures-the frontal lobe, the temporal lobe, the limbic system, and the cerebellum. Apart from this, we also present the link between alcohol abuse and withdrawal and mood disorders in this review, thus drawing a link to oxidative stress. In addition, we also discuss the positive impacts of some pharmacotherapies used. Due to the ever-rising demands of life, the cycle between alcohol abuse, withdrawal, and mood disorders may be a never-ending cycle of destruction. Hence, through this review, we hope that we can emphasise the importance and urgency of managing this issue with the appropriate approaches.
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Pervin Z, Pinner J, Flynn L, Cerros CM, Williams ME, Hill DE, Stephen JM. School-aged children diagnosed with an FASD exhibit visuo-cortical network disturbance: A magnetoencephalography (MEG) study. Alcohol 2022; 99:59-69. [PMID: 34915151 PMCID: PMC9113084 DOI: 10.1016/j.alcohol.2021.12.001] [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: 07/13/2021] [Revised: 08/30/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022]
Abstract
Children with prenatal alcohol exposure (PAE) often suffer from cognitive and neurobehavioral dysfunction throughout their lives, which may rise to a level of concern such that children receive a diagnosis under the fetal alcohol spectrum disorders (FASD) umbrella. Magnetoencephalography (MEG) contributes direct insight into neural processing and functional connectivity measures with temporal precision to understand cortical processing disorders that manifest during development. The impairment of perception may become more consequential among school-aged children with an FASD in the process of intellectual functioning and behavioral maturation. Fifty participants with the age range of 8-13 years participated in our study following parental informed consent and child assent. For each participant, visual responses were recorded using magnetoencephalography (MEG) while performing a prosaccade task with central stimuli (fovea centralis) and peripheral stimuli (left and right of central) presented on a screen, requiring participants to shift their gaze to the stimuli. After source analysis using minimum norm estimation (MNE), we investigated visual responses from each participant by measuring the latency and amplitude of visual evoked fields. Delayed peak latency of the visual response was identified in the primary visual area (calcarine fissure) and visual association areas (v2, v3) in young children with an FASD for both stimulus types (central and peripheral). But the difference in visual response latency was only statistically significant (p ≤ 0.01) for the peripheral (right) stimulus. We also observed reduced amplitude (p ≤ 0.006) of visual evoked response in children with an FASD for the central stimulus type in both primary and visual association areas. Multiple visual areas show impairment in children with an FASD, with visual delay and conduction disturbance more prominent in response to peripheral stimuli. Children with an FASD also exhibit significantly reduced amplitude of neural activation to central stimuli. These sensory deficits may lead to slow cognitive processing speed through continued intra-cortical network disturbance in children with an FASD.
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Affiliation(s)
- Zinia Pervin
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, Albuquerque, NM 87106, USA.,Department of Biomedical Engineering, University of New Mexico, Albuquerque, NM 87131, USA
| | - John Pinner
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, Albuquerque, NM 87106, USA
| | - Lucinda Flynn
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, Albuquerque, NM 87106, USA
| | - Cassandra M. Cerros
- Health Sciences Center, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Mareth E. Williams
- Health Sciences Center, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Dina E. Hill
- Health Sciences Center, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Julia M. Stephen
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, Albuquerque, NM 87106, USA.,Corresponding author Julia M. Stephen, Ph.D., MEG Core Director, Prof. of Translational Neuroscience, The Mind Research Network, Pete & Nancy Domenici hall, 1101 Yale Blvd. NE, Albuquerque, New Mexico 87106, Tel: (505)-504-1053.
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Marlow M, Christie H, Skeen S, Rabie S, Louw JG, Swartz L, Mofokeng S, Makhetha M, Tomlinson M. Alcohol use during pregnancy in rural Lesotho: "There is nothing else except alcohol". Soc Sci Med 2021; 291:114482. [PMID: 34700117 DOI: 10.1016/j.socscimed.2021.114482] [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: 06/16/2021] [Revised: 09/19/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Reducing alcohol use during pregnancy is a pressing public health priority in Sub-Saharan Africa, but insight into the factors that influence prenatal drinking practices is lacking. This study investigated perceptions of, and motivations for, alcohol consumption during pregnancy and associated practices in a rural district of Lesotho. METHODS A combination of purposive and snowball sampling methods were used to identify pregnant women and mothers with young children from the general community, as well as from alcohol-serving venues. Between September 2016 and March 2017, a trained data collector conducted in-depth interviews with 40 women on reasons why pregnant women drink, what they know about the risk of drinking alcohol during pregnancy, and perceptions of women who drink during pregnancy. RESULTS Sixty-five percent of women (n = 26) reported that they consumed alcohol during pregnancy. Findings were clustered into four themes: 1) alcohol use in daily and cultural life; 2) alcohol as relief from stress and hunger; 3) alcohol's effect on the baby; and 4) access to information about alcohol consumption. Our data suggest that alcohol use was a prominent feature of daily life and a key part of traditional events and ceremonies. Other than potentially harming the baby through falling on their stomachs while inebriated, women did not mention other risks associated with prenatal alcohol use. Rather, there were prominent beliefs that drinking alcohol - home-brewed alcohol in particular - had cleansing or protective benefits for the baby. Experiences of food insecurity were prominent, and women reported that alcohol helped curb their hunger and allowed them to save food to give to their children. CONCLUSIONS Within this context of chronic poverty and food insecurity, alcohol use during pregnancy will continue to represent a valid, though tragic choice if the structural conditions and current social arrangements that facilitate prenatal alcohol use remain unchanged.
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Affiliation(s)
- Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Hope Christie
- Department of Clinical Psychology, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Stephan Rabie
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
| | - Jacobus G Louw
- Foundation for Alcohol Related Research, 42 Bloemhof Rd, Bloemhof, Cape Town, 7530, South Africa; Department of Psychology, Stellenbosch University, Stellenbosch, RW Wilcocks Building, 2nd Floor, Ryneveld Street, Stellenbosch, 7600, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, RW Wilcocks Building, 2nd Floor, Ryneveld Street, Stellenbosch, 7600, South Africa.
| | - Shoeshoe Mofokeng
- Department of Social Work, Sociology and Anthropology, National University of Lesotho, P.O Roma 180, Maseru, Lesotho, Lesotho.
| | - Moroesi Makhetha
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, 7505, South Africa; School of Nursing and Midwifery, Queens University, Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, United Kingdom.
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7
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Abstract
OBJECTIVES A number of commonly used performance validity tests (PVTs) may be prone to high failure rates when used for individuals with severe neurocognitive deficits. This study investigated the validity of 10 PVT scores in justice-involved adults with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disability stemming from prenatal alcohol exposure and linked with severe neurocognitive deficits. METHOD The sample comprised 80 justice-involved adults (ages 19-40) including 25 with confirmed or possible FASD and 55 where FASD was ruled out. Ten PVT scores were calculated, derived from Word Memory Test, Genuine Memory Impairment Profile, Advanced Clinical Solutions (Word Choice), the Wechsler Adult Intelligence Scale - Fourth Edition (Reliable Digit Span and age-corrected scaled scores (ACSS) from Digit Span, Coding, Symbol Search, Coding - Symbol Search, Vocabulary - Digit Span), and the Wechsler Memory Scale - Fourth Edition (Logical Memory II Recognition). RESULTS Participants with diagnosed/possible FASD were more likely to fail any single PVT, and failed a greater number of PVTs overall, compared to those without FASD. They were also more likely to fail based on Word Memory Test, Digit Span ACSS, Coding ACSS, Symbol Search ACSS, and Logical Memory II Recognition, compared to controls (35-76%). Across both groups, substantially more participants with IQ <70 failed two or more PVTs (90%), compared to those with an IQ ≥70 (44%). CONCLUSIONS Results highlight the need for additional research examining the use of PVTs in justice-involved populations with FASD.
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Easey KE, Timpson NJ, Munafò MR. Association of Prenatal Alcohol Exposure and Offspring Depression: A Negative Control Analysis of Maternal and Partner Consumption. Alcohol Clin Exp Res 2020; 44:1132-1140. [PMID: 32315093 PMCID: PMC7341445 DOI: 10.1111/acer.14324] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous research has suggested that intrauterine alcohol exposure is associated with a variety of adverse outcomes in offspring. However, few studies have investigated its association with offspring internalizing disorders in late adolescence. METHODS Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated the associations of maternal drinking in pregnancy with offspring depression at age 18 and 24 (n = 13,480). We also examined partner drinking as a negative control for intrauterine exposure for comparison. RESULTS Offspring of mothers that consumed any alcohol at 18 weeks gestation were at increased risk of having a diagnosis of depression (fully adjusted model: OR 1.17, 95% CI 1.02 to 1.34), but there was no clear evidence of association between partners' alcohol consumption at 18 weeks gestation during pregnancy and increased risk of offspring depression (fully adjusted model: OR 0.87, 95% CI 0.74 to 1.01). Postestimation tests found a positive difference between the association of maternal and partner alcohol use on offspring depression, showing a stronger association for maternal compared with partner alcohol use (OR 1.41, CI 1.07 to 1.84). CONCLUSIONS Maternal drinking in pregnancy was associated with increased risk of offspring depression at age 18. Residual confounding may explain this association, but the negative control comparison of paternal drinking provides some evidence that it may be causal, and this warrants further investigation.
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Affiliation(s)
- Kayleigh E. Easey
- UK Centre for Tobacco and Alcohol StudiesSchool of Psychological ScienceUniversity of BristolBristolUK
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
- Bristol Medical SchoolUniversity of BristolBristolUK
| | - Nicholas J. Timpson
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
- Bristol Medical SchoolUniversity of BristolBristolUK
| | - Marcus R. Munafò
- UK Centre for Tobacco and Alcohol StudiesSchool of Psychological ScienceUniversity of BristolBristolUK
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
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9
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Abstract
Alcohol exposure during pregnancy results in impaired growth, stillbirth, and fetal alcohol spectrum disorder. Fetal alcohol deficits are lifelong issues with no current treatment or established diagnostic or therapeutic tools to prevent and/or ameliorate some of these adverse outcomes. Despite the recommendation to abstain, almost half of the women consume alcohol in pregnancy in the United States. This review focuses on the trends in prenatal alcohol exposure, implications for maternal and fetal health, and evidence suggesting that preconception and the prenatal period provide a window of opportunity to intervene, mitigate, and ideally curtail the lifetime effects of fetal alcohol spectrum disorder.
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10
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Easey KE, Dyer ML, Timpson NJ, Munafò MR. Prenatal alcohol exposure and offspring mental health: A systematic review. Drug Alcohol Depend 2019; 197:344-353. [PMID: 30827758 PMCID: PMC6446223 DOI: 10.1016/j.drugalcdep.2019.01.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/26/2018] [Accepted: 01/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND High levels of alcohol use in pregnancy have been shown to be associated with negative physical health consequences in offspring. However, the literature is less clear on the association of alcohol use in pregnancy and offspring mental health, specifically for low levels of prenatal alcohol exposure. We conducted a systematic review to evaluate studies examining this association. METHODS Studies were identified by searching PsycINFO, PubMed and Web of Science, and were included if they examined alcohol use during pregnancy as an exposure and offspring mental health at age 3 or older as an outcome. We excluded non-English language publications and studies of fetal alcohol syndrome. RESULTS Thirty-three studies were included and were categorized by mental health outcomes: anxiety/depression, emotional problems, total internalizing problems, total problem score, and conduct disorder. Over half of the analyses reported a positive association of prenatal alcohol exposure and offspring mental health problems. CONCLUSIONS Our review suggests that maternal alcohol use during pregnancy is associated with offspring mental health problems, even at low to moderate levels of alcohol use. Future investigation using methods that allow stronger causal inference is needed to further investigate if these associations shown are causal.
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Affiliation(s)
- Kayleigh E Easey
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, UK.
| | - Maddy L Dyer
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit, University of Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Marcus R Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, UK
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Howlett H, Mackenzie S, Strehle EM, Rankin J, Gray WK. A Survey of Health Care Professionals' Knowledge and Experience of Foetal Alcohol Spectrum Disorder and Alcohol Use in Pregnancy. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2019; 13:1179558119838872. [PMID: 30944523 PMCID: PMC6437318 DOI: 10.1177/1179558119838872] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/27/2019] [Indexed: 01/18/2023]
Abstract
Background Foetal alcohol spectrum disorders (FASDs) are one of the most common preventable forms of developmental disability and congenital abnormalities globally, particularly in countries where alcohol is considered socially acceptable. Screening for alcohol use early in pregnancy can facilitate the detection of alcohol-exposed pregnancies and identify women who require further assessment. However, only a small percentage of children with FASD are identified in the United Kingdom. This may be partly attributed to a lack of awareness of the condition by National Health Service (NHS) health professionals. Methods We developed an online survey to determine health care professionals' (midwives, health visitors, obstetricians, paediatricians, and general practitioners) perceived knowledge, attitudes, and clinical practices relating to alcohol in pregnancy and FASD. Results There were a total of 250 responses to the surveys (78 midwives, 60 health visitors, 55 obstetricians, 31 paediatricians, and 26 general practitioners). About 58.1% of paediatricians had diagnosed a patient with foetal alcohol syndrome (FAS) or FASD and 36.7% worried about stigmatisation with diagnosis. Paediatricians reported the highest levels of FASD training (54.8%), with much lower levels in midwives (21.3%). This was reflected in perceived knowledge levels; overall, only 19.8% of respondents knew the estimated UK prevalence of FASD for example. Conclusions We identified a need for training in alcohol screening in pregnancy and FASD to improve awareness and recognition by UK professionals. This could improve patient care from the antenatal period and throughout childhood.
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Affiliation(s)
- Helen Howlett
- Department of Research and Development, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Shonag Mackenzie
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Eugen-Matthias Strehle
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - William K Gray
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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12
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Brown JM, Bland R, Jonsson E, Greenshaw AJ. The Standardization of Diagnostic Criteria for Fetal Alcohol Spectrum Disorder (FASD): Implications for Research, Clinical Practice and Population Health. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:169-176. [PMID: 29788774 PMCID: PMC6405816 DOI: 10.1177/0706743718777398] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Fetal Alcohol Spectrum Disorder (FASD) is a preventable disorder caused by maternal alcohol consumption and marked by a range of physical and mental disabilities. Although recognized by the scientific and medical community as a clinical disorder, no internationally standardized diagnostic tool yet exists for FASD. METHODS AND RESULTS This review seeks to analyse the discrepancies in existing diagnostic tools for FASD, and the repercussions these differences have on research, public health, and government policy. CONCLUSIONS Disagreement on the adoption of a standardised tool is reflective of existing gaps in research on the conditions and factors that influence fetal vulnerability to damage from exposure. This discordance has led to variability in research findings, inconsistencies in government messaging, and misdiagnoses or missed diagnoses. The objective measurement of the timing and level of prenatal alcohol exposure is key to bridging these gaps; however, there is conflicting or limited evidence to support the use of existing measures.
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Affiliation(s)
- Jasmine M. Brown
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Roger Bland
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Egon Jonsson
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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13
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Ghazi Sherbaf F, Aarabi MH, Hosein Yazdi M, Haghshomar M. White matter microstructure in fetal alcohol spectrum disorders: A systematic review of diffusion tensor imaging studies. Hum Brain Mapp 2019; 40:1017-1036. [PMID: 30289588 PMCID: PMC6865781 DOI: 10.1002/hbm.24409] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022] Open
Abstract
Diffusion tensor imaging (DTI) has revolutionized our understanding of the neural underpinnings of alcohol teratogenesis. This technique can detect alterations in white matter in neurodevelopmental disorders, such as fetal alcohol spectrum disorder (FASD). Using Prisma guidelines, we identified 23 DTI studies conducted on individuals with prenatal alcohol exposure (PAE). These studies confirm the widespread nature of brain damage in PAE by reporting diffusivity alterations in commissural, association, and projection fibers; and in relation to increasing cognitive impairment. Reduced integrity in terms of lower fractional anisotropy (FA) and higher mean diffusivity (MD) and radial diffusivity (RD) is reported more consistently in the corpus callosum, cerebellar peduncles, cingulum, and longitudinal fasciculi connecting frontal and temporoparietal regions. Although these interesting results provide insight into FASD neuropathology, it is important to investigate the clinical diversity of this disorder for better treatment options and prediction of progression. The aim of this review is to provide a summary of different patterns of neural structure between PAE and typically developed individuals. We further discuss the association of alterations in diffusivity with demographic features and symptomatology of PAE. With the accumulated knowledge of the neural correlates of FASD presenting symptoms, a comprehensive understanding of the heterogeneity in FASD will potentially improve the disease management and will highlight the diagnostic challenges and potential areas of future research avenues, where neural markers may be beneficial.
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Affiliation(s)
| | | | - Meisam Hosein Yazdi
- Namazee Hospital, Imaging Research Center, Department of RadiologyShiraz University of Medical SciencesShirazIran
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Mohamed Z, Carlisle ACS, Livesey AC, Mukherjee RAS. Comparisons of the BRIEF parental report and neuropsychological clinical tests of executive function in Fetal Alcohol Spectrum Disorders: data from the UK national specialist clinic. Child Neuropsychol 2018; 25:648-663. [PMID: 30251596 DOI: 10.1080/09297049.2018.1516202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Extant literature is sparse with regards to the relationship between caregiver reports and neuropsychological tests of executive functioning in Fetal Alcohol Spectrum Disorders (FASD). The goal of this paper was determining the clinical utilities of executive functioning measures used in the United Kingdom national FASD clinic. We examined relationships between outcomes on the Behavior Rating Inventory of Executive Function (BRIEF) and the Delis-Kaplan Executive Function System (D-KEFS), as part of an ongoing service evaluation. Profiles of executive functioning measures were reported in order to contribute to delineating a profile of executive dysfunction in FASD. Caregivers of 49 people with FASD completed the Parent BRIEF, and 61 people with FASD were administered the D-KEFS. Pearson's Correlations between all 11 BRIEF scales and the 18 selected D-KEFS subscales showed little relationship. The BRIEF showed a profile of clinically significant elevations in all three Index scores and seven out of the eight Scale scores. Several D-KEFS tests showed below average executive functioning. Both executive function measures have separate clinical utility in demonstrating executive function deficits in FASD. The sample population used in this study also show a similar pattern to FASD populations internationally, suggesting a similar neuropsychological profile is seen in the United Kingdom. However, caregiver reports display little relationship to neuropsychological tests. These measures likely monitor different aspects of executive functioning in different settings. Future research should focus on identifying tests that better relate findings from clinical settings to behavior in daily life.
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Affiliation(s)
- Zameer Mohamed
- a FASD Specialist Behaviour Clinic , Surrey and Borders Partnership NHS Foundation Trust , Surrey , UK
| | - Alexandra C S Carlisle
- a FASD Specialist Behaviour Clinic , Surrey and Borders Partnership NHS Foundation Trust , Surrey , UK
| | - Alexandra C Livesey
- a FASD Specialist Behaviour Clinic , Surrey and Borders Partnership NHS Foundation Trust , Surrey , UK
| | - Raja A S Mukherjee
- a FASD Specialist Behaviour Clinic , Surrey and Borders Partnership NHS Foundation Trust , Surrey , UK
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15
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Dylag KA, Fidalgo SVS, Gard PR, Patel BA. Prenatal alcohol exposure reduces 5-HT concentration in mouse intestinal muscle and mucosa. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2018; 61:24-29. [PMID: 29807310 DOI: 10.1016/j.etap.2018.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 06/08/2023]
Abstract
The influence of prenatal alcohol exposure on the serotoninergic system in the brain has been well studied, however its influence on the serotoninergic system in the gastrointestinal system remains unknown. The objective of the study was to use a mouse model of prenatal alcohol exposure to investigate the effects on serotonin and its metabolites and precursors in colonic tissue. This study used treatment of mouse breeding harems with 5% ethanol with saccharin via drinking water throughout pregnancy and compared the results with a saccharin control group. Tryptophan, serotonin (5-HT) and 5- hydroxyindoleacetic acid (5-HIAA) concentrations were measured in the longitudinal muscle myenteric plexus (LMMP) and mucosa of intestinal tissue by high-performance liquid chromatography (HPLC). Decreased 5-HT concentrations in mucosa and LMMP (females only) were observed in prenatally exposed mice compared to controls. Increases in mucosal and LMMP tryptophan concentration were only observed in prenatally exposed female mice. In conclusion, prenatal alcohol exposure causes a decrease in conversion of tryptophan to 5-HT in both muscle and mucosa although the effect is more pronounced in females. The observed sex difference may be related to changes associated with the estrous cycle.
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Affiliation(s)
| | - Sara V S Fidalgo
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Paul R Gard
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Bhavik Anil Patel
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
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16
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Barclay GA, Barbour J, Stewart S, Day CP, Gilvarry E. Adverse physical effects of alcohol misuse. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.105.001263] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article outlines the majority of the adverse physical effects that have been described secondary to the consumption of alcohol at levels above recommended sensible limits. These conditions are cited according to the organ system they belong to. Only brief descriptions are provided because of the vastness of this topic. The underlying pathophysiology of tolerance and withdrawal is touched upon as this is of relevance to the psychiatrist. Definitions of the terms used describing alcohol misuse, and sensible upper limits of alcohol consumption are also mentioned.
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17
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Guo Z, Li J. Chlorogenic Acid Prevents Alcohol-induced Brain Damage in Neonatal Rat. Transl Neurosci 2017; 8:176-181. [PMID: 29318034 PMCID: PMC5757402 DOI: 10.1515/tnsci-2017-0024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 10/17/2017] [Indexed: 01/13/2023] Open
Abstract
The present investigation evaluates the neuroprotective effect of chlorogenic acid (CA) in alcohol-induced brain damage in neonatal rats. Ethanol (12 % v/v, 5 g/kg) was administered orally in the wistar rat pups on postnatal days (PD) 7-9. Chlorogenic acid (100 and 200 mg/kg, p.o.) was administered continuously from PD 6 to 28. Cognitive function was estimated by Morris water maze (MWM) test. However, activity of acetylcholinesterase, inflammatory mediators, parameters of oxidative stress and activity of caspase-3 enzyme was estimated in the tissue homogenate of cerebral cortex and hippocampus of ethanol-exposed pups. It has been observed that treatment with CA attenuates the altered cognitive function in ethanol-exposed pups. There was a significant decrease in the activity of acetylcholinesterase in the CA treated group compared to the negative control group. However, treatment with CA significantly ameliorates the increased oxidative stress and concentration of inflammatory mediators in the brain tissues of ethanol-exposed pups. Activity of caspase-3 enzyme was also found significantly decreased in the CA treated group compared to the negative control group. The present study concludes that CA attenuates the neuronal damage induced in alcohol exposed neonatal rat by decreasing the apoptosis of neuronal cells.
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Affiliation(s)
- Zikang Guo
- Department of neurosurgery, Ankang central hospital, Ankang, Shanxi, 725000China
| | - Jiang Li
- Intensive Care Unit, Ankang central hospital, Ankang, Shanxi, 725000China
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18
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Ramlan NF, Sata NSAM, Hassan SN, Bakar NA, Ahmad S, Zulkifli SZ, Abdullah CAC, Ibrahim WNW. Time dependent effect of chronic embryonic exposure to ethanol on zebrafish: Morphology, biochemical and anxiety alterations. Behav Brain Res 2017; 332:40-49. [DOI: 10.1016/j.bbr.2017.05.048] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/04/2017] [Accepted: 05/20/2017] [Indexed: 02/08/2023]
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19
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Murray J, Burgess S, Zuccolo L, Hickman M, Gray R, Lewis SJ. Moderate alcohol drinking in pregnancy increases risk for children's persistent conduct problems: causal effects in a Mendelian randomisation study. J Child Psychol Psychiatry 2016; 57:575-84. [PMID: 26588883 PMCID: PMC4855628 DOI: 10.1111/jcpp.12486] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Heavy alcohol use during pregnancy can cause considerable developmental problems for children, but effects of light-moderate drinking are uncertain. This study examined possible effects of moderate drinking in pregnancy on children's conduct problems using a Mendelian randomisation design to improve causal inference. METHODS A prospective cohort study (ALSPAC) followed children from their mother's pregnancy to age 13 years. Analyses were based on 3,544 children whose mothers self-reported either not drinking alcohol during pregnancy or drinking up to six units per week without binge drinking. Children's conduct problem trajectories were classified as low risk, childhood-limited, adolescence-onset or early-onset-persistent, using six repeated measures of the Strengths and Difficulties Questionnaire between ages 4-13 years. Variants of alcohol-metabolising genes in children were used to create an instrumental variable for Mendelian randomisation analysis. RESULTS Children's genotype scores were associated with early-onset-persistent conduct problems (OR = 1.29, 95% CI = 1.04-1.60, p = .020) if mothers drank moderately in pregnancy, but not if mothers abstained from drinking (OR = 0.94, CI = 0.72-1.25, p = .688). Children's genotype scores did not predict childhood-limited or adolescence-onset conduct problems. CONCLUSIONS This quasi-experimental study suggests that moderate alcohol drinking in pregnancy contributes to increased risk for children's early-onset-persistent conduct problems, but not childhood-limited or adolescence-onset conduct problems.
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Affiliation(s)
- Joseph Murray
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Stephen Burgess
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Luisa Zuccolo
- School of Social and Community MedicineUniversity of BristolBristolUK,MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Matthew Hickman
- School of Social and Community MedicineUniversity of BristolBristolUK
| | - Ron Gray
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Sarah J. Lewis
- School of Social and Community MedicineUniversity of BristolBristolUK
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Quantification of fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) in meconium from newborns for detection of alcohol abuse in a maternal health evaluation study. Anal Bioanal Chem 2010; 396:2469-77. [DOI: 10.1007/s00216-010-3474-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/14/2010] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
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Lebel C, Rasmussen C, Wyper K, Andrew G, Beaulieu C. Brain Microstructure Is Related to Math Ability in Children With Fetal Alcohol Spectrum Disorder. Alcohol Clin Exp Res 2010; 34:354-63. [PMID: 19930234 DOI: 10.1111/j.1530-0277.2009.01097.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Catherine Lebel
- Department of Biomedical Engineering, University of Alberta, Alberta, Canada
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22
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Lebel C, Rasmussen C, Wyper K, Walker L, Andrew G, Yager J, Beaulieu C. Brain diffusion abnormalities in children with fetal alcohol spectrum disorder. Alcohol Clin Exp Res 2008; 32:1732-40. [PMID: 18671811 DOI: 10.1111/j.1530-0277.2008.00750.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children with fetal alcohol spectrum disorder (FASD) have a variety of cognitive, behavioral, and neurological impairments, including structural brain damage. Despite the importance of white matter connections for proper brain function, little is known about how these connections, and the deep gray matter structures that act as relay stations, are affected in children with FASD. The purpose of this study was to use diffusion tensor imaging, an advanced magnetic resonance imaging technique, to examine microstructural differences of white and deep gray matter in children with FASD. METHODS Subjects were 24 children aged 5-13 years previously diagnosed with FASD and 95 healthy children over the same age range. Diffusion tractography was used to delineate 10 major white matter tracts in each individual, and region-of-interest analysis was used to assess 4 deep gray matter structures. Fractional anisotropy, an indicator of white matter integrity, and mean diffusivity, a measure of the average water diffusion, were assessed in all 14 brain structures. RESULTS Diffusion tensor imaging revealed significant differences of diffusion parameters in several areas of the brain, including the genu and splenium of the corpus callosum, cingulum, corticospinal tracts, inferior fronto-occipital fasciculus, inferior and superior longitudinal fasciculi, globus pallidus, putamen, and thalamus. Reduced white and gray matter volumes, as well as total brain volume, were observed in the FASD group. CONCLUSIONS These results demonstrate diffusion abnormalities in FASD beyond the corpus callosum and suggest that several specific white matter regions, particularly commissural and temporal connections, and deep gray matter areas of the brain are sensitive to prenatal alcohol exposure.
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Affiliation(s)
- Catherine Lebel
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Determination of Fatty Acid Ethyl Esters (FAEE) and Ethyl Glucuronide (EtG) in Hair: A Promising Way for Retrospective Detection of Alcohol Abuse During Pregnancy? Ther Drug Monit 2008; 30:255-63. [DOI: 10.1097/ftd.0b013e318167d602] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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