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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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Chu JTW, McCormack J, Marsh S, Wells A, Wilson H, Bullen C. Impact of prenatal alcohol exposure on neurodevelopmental outcomes: a systematic review. Health Psychol Behav Med 2022; 10:973-1002. [PMID: 36238426 PMCID: PMC9553152 DOI: 10.1080/21642850.2022.2129653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Prenatal exposure to alcohol (PAE) represents a significant public health concern. Previous research linking PAE to neurodevelopmental outcomes has been mixed and often has limited focus on residual confounding or moderating factors. Methods A systematic review of prospective cohort studies (n = >1000) assessing the impact of PAE on neurodevelopmental outcomes was undertaken (neurophysiology, motor skills, cognition, language, academic achievement, memory, attention, executive function, affect regulation, and adaptive behaviour, social skills, or communication). Electronic searches of EMBASE, Medline, CINAHL, and Psychinfo were conducted in May 2021. A quality assessment was conducted using an adapted version of the Newcastle-Ottawa Scale (NOS). Results Thirty longitudinal cohort studies met the inclusion criteria. Evidence of the impact of PAE was mixed across domains. We found no evidence that PAE affects executive function, but there were impacts on motor skills, cognition, language, academic achievement, attention, affect regulation, and adaptive behaviour. The most consistent adverse effect was on affect regulation (nine out of thirteen studies, six of which found an association between heavy alcohol consumption or binge drinking during pregnancy). We found no protective factors. Few studies controlled for variables in the postnatal environment. Discussion This review was unable to conclude a safe level of alcohol consumption during pregnancy. Methodological improvements are needed to improve the quality and consistency in which PAE is studied. Further research into residual confounding variables is vital, including a greater focus on the postpartum environment.
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Affiliation(s)
- Joanna Ting Wai Chu
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jessica McCormack
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Samantha Marsh
- Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Alesha Wells
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Holly Wilson
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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Peixinho J, Toseeb U, Mountford HS, Bermudez I, Newbury DF. The effects of prenatal smoke exposure on language development ‐ a systematic review. INFANT AND CHILD DEVELOPMENT 2022. [DOI: 10.1002/icd.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica Peixinho
- Faculty of Health and Life Sciences Oxford Brookes University Headington Campus Oxford UK
| | - Umar Toseeb
- Department of Education University of York York UK
| | - Hayley S. Mountford
- Faculty of Health and Life Sciences Oxford Brookes University Headington Campus Oxford UK
| | - Isabel Bermudez
- Faculty of Health and Life Sciences Oxford Brookes University Headington Campus Oxford UK
| | - Dianne F. Newbury
- Faculty of Health and Life Sciences Oxford Brookes University Headington Campus Oxford UK
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Corrêa ML, da Silva BGC, Wehrmeister FC, Horta BL, Gonçalves H, Anselmi L, Barros F, Menezes AMB. Maternal smoking during pregnancy and intelligence quotient of offspring aged 18 and 30 years: Evidence from two birth cohorts in southern Brazil. Prev Med 2022; 156:106983. [PMID: 35150754 DOI: 10.1016/j.ypmed.2022.106983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/07/2022] [Accepted: 02/06/2022] [Indexed: 11/25/2022]
Abstract
Maternal smoking during pregnancy causes several harmful effects, including deficits in the intelligence quotient (IQ), a measure associated with academic achievements and higher socioeconomic position. We aimed to measure the association between maternal smoking during pregnancy and offspring's IQ in two birth cohorts from Pelotas, Brazil. Data from the 1982 and 1993 birth cohorts were analyzed. Smoking during pregnancy was ascertained at the perinatal follow-up, and IQ was measured at 30 years (1982) and 18 years (1993). Simple and multiple linear regressions were used for crude and adjusted analysis. Mediation analysis was performed using birth weight and breastfeeding as possible mediators. Data analysis was conducted in 2020. There were 3611 and 4050 participants from the 1982 and 1993 cohorts, respectively. After adjustment for potential confounders, the inverse association between smoking during pregnancy and children's IQ remained significant in both cohorts. Offspring of mothers who smoked during pregnancy had an average of 1.32 less IQ points (95%CI: -2.23, -0.242) in the 1982 cohort, and an average of 1.66 less IQ points (95%CI: -2.42, -0.90) in the 1993 cohort. Neither cohort showed association with paternal smoking (negative controls) after adjustment. Breastfeeding's mediated effects accounted for 26.2% and 23.9% of the association in the 1982 and 1993 cohorts, respectively, while birth weight's accounted for 6.8% and 30.1%, respectively; indirect effects were not significant. The inverse association between maternal smoking and IQ and the lack of association with paternal smoking reinforces our findings of a negative association between exposure and outcome.
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Affiliation(s)
- Mariana Lima Corrêa
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil; Centro de Epidemiologia Ufpel Dr. Amilcar Gigante, R. Mal. Deodoro, 1160 - Centro, Pelotas, Brazil.
| | | | | | - Bernardo L Horta
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil
| | - Helen Gonçalves
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil
| | - Luciana Anselmi
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil
| | - Fernando Barros
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil
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Kenyhercz F, Kósa K, Nagy BE. Perinatal, neonatal, developmental and demographic predictors of intelligence at 4 years of age among low birth weight children: a panel study with a 2-year follow-up. BMC Pediatr 2022; 22:88. [PMID: 35151289 PMCID: PMC8840789 DOI: 10.1186/s12887-022-03156-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/12/2021] [Indexed: 12/03/2022] Open
Abstract
Intoduction Childhood intelligence is an important predictor of later outcomes in life such as socioeconomic status or health. Hence, a deeper understanding of predictors of child intelligence should suggest points of intervention for children facing adversities. Objectives The purpose of this study is to examine the predictive value of demographic, perinatal and neonatal variables after birth and developmental characteristics at age 2 for 4-year intelligence as outcome among low birth weight children. Methods We designed a panel study with a 2-year follow-up with 114 child-mother pairs. The outcome variable was IQ intelligence quotient at 4 years of age of LBW low birth weight children measured by the Wechsler Primary and Preschool Scales of Intelligence. Potential predictors were maternal education, family wealth, ethnic identity; sex, twin pregnancy, gestational age, birth weight, Apgar scores, maternal smoking during pregnancy; diagnosis of intravetricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia after birth and cognitive, language and motor development at age 2 measured by one composite score of the three Bayley Scales of Infant and Toddler Development aggregated. Results Stepwise backward regression was carried out including significant variables from the bivariate analysis. The best model included 4 predictors which accounted for 57% of the variance of the full IQ intelligence at 4-years of age. Maternal higher education was significant positive, below average family wealth and neonatal diagnosis of bronchopulmonary dysplasia were significant negative predictors in the model after birth. 2-year developmental characteristics such as cognitive, motor and language skills were positive predictors of the IQ intelligence at age 4. Conclusion Sociodemographic assessment at birth and developmental assessment at two years of age are of crucial importance to recognize children at high risk for delayed cognitive development. High-risk children should be directed to supportive interventions and their development should be regulary monitored.
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Corrêa ML, Soares PSM, da Silva BGC, Wehrmeister F, Horta BL, Menezes AMB. Maternal smoking during pregnancy and intelligence quotient in offspring: A systematic review and meta-analysis. Neurotoxicology 2021; 85:99-114. [PMID: 34004235 DOI: 10.1016/j.neuro.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Exposure to tobacco during pregnancy may disrupt fetal brain development and impact offspring cognitive development. AIMS To perform a systematic review and meta-analysis on maternal smoking during pregnancy and intelligence quotient (IQ) in childhood, adolescence, and adulthood. METHODS We searched PubMed, Lilacs, PsycINFO, and Web of Science. Original articles evaluating tobacco use/exposure during pregnancy and the offspring's IQ as the outcome. The review protocol is registered in PROSPERO (number CRD 42,019,116,257). For the meta-analysis, we included studies with information on the regression coefficient and its confidence interval (CI) or standard error. Random effects model was used for pooling the estimates. RESULTS 25 studies were included in the review, and of these 14 met the inclusion criteria for the meta-analysis. The overall pooled estimate showed that subjects who were exposed to maternal smoking during pregnancy presented lower IQ scores, compared to those not exposed to maternal smoking (β -1.30; 95 % CI -1.74, -0.86; I2 = 87.8 %); IQ scores were also lower in crude (β -5.46; 95 % CI -7.31, -3.60; I²: 79.0 %) and adjusted pooled estimates (β =-0.45; 95 % CI -0.76, -0.13; I2 = 80.4 %), for the group exposed to maternal smoking. In the stratified analysis, an inverse association was also observed in studies with large sample size (n≥1000 participants) (β=-0.49; 95 % CI -0.96, -0.02), among those performed with adolescents (β=-1.16; 95 % CI -2.18, -0.14), and among those adjusted for maternal education (β=-0.57; 95 % CI -1.05, -0.08). CONCLUSIONS Our findings suggest that exposure to tobacco during pregnancy may have negative effects on IQ. However, the findings of this meta-analysis should be interpreted with caution.
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Affiliation(s)
- Mariana Lima Corrêa
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil; Centro de Epidemiologia Ufpel Dr. Amilcar Gigante, R. Mal. Deodoro, 1160, Centro, Pelotas, Brazil.
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Mamluk L, Jones T, Ijaz S, Edwards HB, Savović J, Leach V, Moore THM, von Hinke S, Lewis SJ, Donovan JL, Lawlor DA, Davey Smith G, Fraser A, Zuccolo L. Evidence of detrimental effects of prenatal alcohol exposure on offspring birthweight and neurodevelopment from a systematic review of quasi-experimental studies. Int J Epidemiol 2021; 49:1972-1995. [PMID: 31993631 PMCID: PMC7825937 DOI: 10.1093/ije/dyz272] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/25/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Systematic reviews of prenatal alcohol exposure effects generally only include conventional observational studies. However, estimates from such studies are prone to confounding and other biases. OBJECTIVES To systematically review the evidence on the effects of prenatal alcohol exposure from randomized controlled trials (RCTs) and observational designs using alternative analytical approaches to improve causal inference. SEARCH STRATEGY Medline, Embase, Web of Science, PsychINFO from inception to 21 June 2018. Manual searches of reference lists of retrieved papers. SELECTION CRITERIA RCTs of interventions to stop/reduce drinking in pregnancy and observational studies using alternative analytical methods (quasi-experimental studies e.g. Mendelian randomization and natural experiments, negative control comparisons) to determine the causal effects of prenatal alcohol exposure on pregnancy and longer-term offspring outcomes in human studies. DATA COLLECTION AND ANALYSIS One reviewer extracted data and another checked extracted data. Risk of bias was assessed using customized risk of bias tools. A narrative synthesis of findings was carried out and a meta-analysis for one outcome. MAIN RESULTS Twenty-three studies were included, representing five types of study design, including 1 RCT, 9 Mendelian randomization and 7 natural experiment studies, and reporting on over 30 outcomes. One study design-outcome combination included enough independent results to meta-analyse. Based on evidence from several studies, we found a likely causal detrimental role of prenatal alcohol exposure on cognitive outcomes, and weaker evidence for a role in low birthweight. CONCLUSION None of the included studies was judged to be at low risk of bias in all domains, results should therefore be interpreted with caution. SYSTEMATIC REVIEW REGISTRATION This study is registered with PROSPERO, registration number CRD42015015941.
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Affiliation(s)
- Loubaba Mamluk
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Timothy Jones
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sharea Ijaz
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Hannah B Edwards
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jelena Savović
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Verity Leach
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Theresa H M Moore
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Stephanie von Hinke
- Department of Economics, School of Economics, Finance and Management, University of Bristol, Bristol, UK
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Luisa Zuccolo
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Van Landingham C, Fuller WG, Schoof RA. The effect of confounding variables in studies of lead exposure and IQ. Crit Rev Toxicol 2020; 50:815-825. [PMID: 33300851 DOI: 10.1080/10408444.2020.1842851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Methods proposed to address confounding variables frequently do not adequately distinguish confounding from covariation. A confounder is a variable that correlates both with the outcome and the major exposure variable. Accurate treatment of confounding is crucial to low dose extrapolation of the effects of chemical exposures based on epidemiology studies. This study explores the limitations of current regression models in extrapolation to the low dose region of the dose-response curve due to the existence of unrecognized and uncontrolled confounding, using epidemiological data for lead. Based on the reported data in analyses by Lanphear and colleagues and Crump and colleagues, and drawing on other studies, Wilson and Wilson considered maternal IQ, HOME score, SES, parental education, birthweight, smoking, and race as characteristic variables which may have interaction effects. This analysis identifies confounding variables based on the seven longitudinal cohorts in analyses conducted by Lanphear and colleagues and by Crump and colleagues and confirms maternal IQ, HOME score, maternal education and maternal marital status at birth are "Highly Likely" confounders, while race is a "Likely" confounder. The cohort data were reanalyzed using the methods presented by Crump and colleagues while also considering the interaction among the identified confounding variables. This analysis determined that confounders influence IQ estimates in a quantifiable way that may exceed or at least obscure previously-reported effects of blood lead on IQ with blood lead levels below 5 µg/dL; however, limitations in the datasets make predictions of the low dose dose-response analysis questionable.
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Nilsen FM, Ruiz JD, Tulve NS. A Meta-Analysis of Stressors from the Total Environment Associated with Children's General Cognitive Ability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155451. [PMID: 32751096 PMCID: PMC7432904 DOI: 10.3390/ijerph17155451] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022]
Abstract
General cognitive ability, often referred to as ‘general intelligence’, comprises a variety of correlated abilities. Childhood general cognitive ability is a well-studied area of research and can be used to predict social outcomes and perceived success. Early life stage (e.g., prenatal, postnatal, toddler) exposures to stressors (i.e., chemical and non-chemical stressors from the total (built, natural, social) environment) can impact the development of childhood cognitive ability. Building from our systematic scoping review (Ruiz et al., 2016), we conducted a meta-analysis to evaluate more than 100 stressors related to cognitive development. Our meta-analysis identified 23 stressors with a significant increase in their likelihood to influence childhood cognitive ability by 10% or more, and 80 stressors were observed to have a statistically significant effect on cognitive ability. Stressors most impactful to cognition during the prenatal period were related to maternal health and the mother’s ability to access information relevant to a healthy pregnancy (e.g., diet, lifestyle). Stressors most impactful to cognition during the early childhood period were dietary nutrients (infancy), quality of social interaction (toddler), and exposure to toxic substances (throughout early childhood). In conducting this analysis, we examined the relative impact of real-world exposures on cognitive development to attempt to understand the inter-relationships between exposures to both chemical and non-chemical stressors and early developmental life stages. Our findings suggest that the stressors observed to be the most influential to childhood cognitive ability are not permanent and can be broadly categorized as activities/behaviors which can be modified to improve childhood cognition. This meta-analysis supports the idea that there are complex relationships between a child’s total environment and early cognitive development.
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Affiliation(s)
- Frances M. Nilsen
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
- Correspondence: ; Tel.: +1-919-541-2574
| | - Jazmin D.C. Ruiz
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
- Honeywell International, Buffalo, NY 14210, USA
| | - Nicolle S. Tulve
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
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Skakkebæk A, Gravholt CH, Chang S, Moore PJ, Wallentin M. Psychological functioning, brain morphology, and functional neuroimaging in Klinefelter syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:506-517. [DOI: 10.1002/ajmg.c.31806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Anne Skakkebæk
- Department of Clinical GeneticsAarhus University Hospital Aarhus Denmark
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus Denmark
| | - Claus H. Gravholt
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus Denmark
- Department of Molecular MedicineAarhus University Hospital Aarhus Denmark
| | - Simon Chang
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus Denmark
- Department of Internal MedicineLillebaelt Hospital Kolding Denmark
| | - Philip J. Moore
- Department of Psychological and Brain SciencesThe George Washington University Washington DC USA
| | - Mikkel Wallentin
- Department of Linguistics, Cognitive Science, and SemioticsAarhus University Aarhus Denmark
- Center of Functionally Integrative NeuroscienceAarhus University Hospital Aarhus Denmark
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Prenatal alcohol exposure and risk of attention deficit hyperactivity disorder in offspring: A retrospective analysis of the millennium cohort study. J Affect Disord 2020; 269:94-100. [PMID: 32250868 DOI: 10.1016/j.jad.2020.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the relationship between prenatal maternal alcohol consumption and the risk of attention deficit hyperactivity disorder (ADHD), the strengths and difficulties questionnaire (SDQ) score and abnormal hyperactivity score in seven-year-old children. METHODS This study is a retrospective analysis of the Millennium Cohort Study (MCS). Questionnaires were used to gather data on gestational alcohol consumption when children were 9 months old and neurodevelopmental outcomes in offspring at 7 years of age (N = 13,004). Alcohol consumption was classified into never, light, moderate and heavy. Crude and adjusted logistic regression models were used for data analysis. RESULTS The total number of women who reported drinking alcohol in pregnancy (the light, moderate and heavy drinking group) was 3916 (30.1%). No significant association was found between light, moderate or heavy gestational alcohol consumption and ADHD (adjusted odds ratio [aOR] for light = 0.80, 95% confidence interval [CI] = [0.53,1.22], aOR for moderate = 0.83, [0.40, 1.74]; aOR for heavy = 1.27, [0.54, 2.98]); for abnormal SDQ score (aOR for light = 0.94, [0.78,1.13], aOR for moderate = 0.70, [0.49,1.00]; aOR for heavy = 1.08, [0.70, 1.66]); for abnormal Hyperactivity score (aOR for light = 1.02, [0.89,1.17]; aOR for moderate = 1.05, [0.82, 1.34]; aOR for heavy = 0.90, [0.62, 1.32]), in offspring. CONCLUSION Light, moderate or heavy antenatal alcohol consumption was not associated with an increased susceptibility to ADHD or behavioural outcomes in this study. However, due to the limited number of cases we cannot rule out an increased risk of ADHD in relation to heavy alcohol consumption.
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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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Miranda-Morales RS, D'Aloisio G, Anunziata F, Abate P, Molina JC. Fetal Alcohol Programming of Subsequent Alcohol Affinity: A Review Based on Preclinical, Clinical and Epidemiological Studies. Front Behav Neurosci 2020; 14:33. [PMID: 32210775 PMCID: PMC7077749 DOI: 10.3389/fnbeh.2020.00033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/17/2020] [Indexed: 12/20/2022] Open
Abstract
The anatomo-physiological disruptions inherent to different categories of the Fetal Alcohol Spectrum Disorder do not encompass all the negative consequences derived from intrauterine ethanol (EtOH) exposure. Preclinical, clinical and epidemiological studies show that prenatal EtOH exposure also results in early programming of alcohol affinity. This affinity has been addressed through the examination of how EtOH prenatally exposed organisms recognize and prefer the drug’s chemosensory cues and their predisposition to exhibit heightened voluntary EtOH intake during infancy and adolescence. In altricial species these processes are determined by the interaction of at least three factors during stages equivalent to the 2nd and 3rd human gestational trimester: (i) fetal processing of the drug’s olfactory and gustatory attributes present in the prenatal milieu; (ii) EtOH’s recruitment of central reinforcing effects that also imply progressive sensitization to the drug’s motivational properties; and (iii) an associative learning process involving the prior two factors. This Pavlovian learning phenomenon is dependent upon the recruitment of the opioid system and studies also indicate a significant role of EtOH’s principal metabolite (acetaldehyde, ACD) which is rapidly generated in the brain via the catalase system. The central and rapid accumulation of this metabolite represents a major factor involved in the process of fetal alcohol programming. According to recent investigations, it appears that ACD exerts early positive reinforcing consequences and antianxiety effects (negative reinforcement). Finally, this review also acknowledges human clinical and epidemiological studies indicating that moderate and binge-like drinking episodes during gestation result in neonatal recognition of EtOH’s chemosensory properties coupled with a preference towards these cues. As a whole, the studies under discussion emphasize the notion that even subteratogenic EtOH exposure during fetal life seizes early functional sensory and learning capabilities that pathologically shape subsequent physiological and behavioral reactivity towards the drug.
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Affiliation(s)
- Roberto Sebastián Miranda-Morales
- Instituto de Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET- Universidad Nacional de Córdoba, Córdoba, Argentina.,Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Genesis D'Aloisio
- Instituto de Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET- Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Florencia Anunziata
- Instituto de Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET- Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Paula Abate
- Instituto de Investigaciones Psicológicas, Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Juan Carlos Molina
- Instituto de Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET- Universidad Nacional de Córdoba, Córdoba, Argentina.,Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
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Flensborg-Madsen T, Falgreen Eriksen HL, Mortensen EL. Early life predictors of intelligence in young adulthood and middle age. PLoS One 2020; 15:e0228144. [PMID: 31990952 PMCID: PMC6986721 DOI: 10.1371/journal.pone.0228144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 01/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies on early predictors of intelligence often focus on single or few predictors and often on childhood intelligence. This study compared the contributions of a broad selection of potential early predictors of intelligence at different adult ages. METHODS Information on predictors was recorded prospectively in the Copenhagen Perinatal Cohort during pregnancy, at delivery, and at 1- and 3-year examinations for children born between 1959-61. Adult intelligence was assessed at three independent follow-ups using three different tests of intelligence: Børge Priens Prøve, Wechsler Adult Intelligence Scale, and Intelligenz-Struktur-Test 2000R. From a total of 4697 cohort members, three non-overlapping samples were derived. RESULTS The included predictors explained between 22.2-24.3% of the variance in adult IQ, with parental socioeconomic status and sex explaining 16.2-17.0%. Other consistent predictors were head circumference at birth, increase in head circumference head during the first three years, and 3-year milestones. Head circumference was the most important anthropometric measure compared to measures of weight and length. CONCLUSION Besides social status and sex, the strongest and most consistent early predictors of adult intelligence were physical or behavioural characteristics that to some extent reflect brain-and cognitive development.
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Affiliation(s)
- Trine Flensborg-Madsen
- Unit of Medical Psychology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | | | - Erik Lykke Mortensen
- Unit of Medical Psychology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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15
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McQuire C, Daniel R, Hurt L, Kemp A, Paranjothy S. The causal web of foetal alcohol spectrum disorders: a review and causal diagram. Eur Child Adolesc Psychiatry 2020; 29:575-594. [PMID: 30648224 PMCID: PMC7250957 DOI: 10.1007/s00787-018-1264-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022]
Abstract
Foetal alcohol spectrum disorders (FASDs) are a leading cause of developmental disability. Prenatal alcohol use is the sole necessary cause of FASD, but it is not always sufficient. Multiple factors influence a child's susceptibility to FASD following prenatal alcohol exposure. Much of the FASD risk factor literature has been limited to discussions of association, rather than causation. While knowledge of predictor variables is important for identifying who is most at risk of FASD and for targeting interventions, causal knowledge is important for identifying effective mechanisms for prevention and intervention programmes. We conducted a systematic search and narrative synthesis of the evidence and used this to create a causal diagram (directed acyclic graph; DAG) to describe the causal pathways to FASD. Our results show that the aetiology of FASD is multifaceted and complex. FASD risk is determined by a range of lifestyle, sociodemographic, maternal, social, gestational, and genetic factors. The causal diagram that we present in this review provides a comprehensive summary of causal risk factors for FASD and can be used as a tool to inform data collection and statistical modelling strategies to minimise bias in future studies of FASD.
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Affiliation(s)
- Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - R. Daniel
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - L. Hurt
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - A. Kemp
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - S. Paranjothy
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
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16
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Light drinking during pregnancy: Social advantages explain positive correlates with child and early adolescent adjustment. Addict Behav 2019; 98:106003. [PMID: 31415972 DOI: 10.1016/j.addbeh.2019.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/05/2019] [Accepted: 05/23/2019] [Indexed: 11/20/2022]
Abstract
Maternal heavy alcohol use during pregnancy is harmful to offspring's health and adjustment. However, findings from studies on lower levels of prenatal drinking are mixed; a few even predict positive cognitive and psychosocial outcomes. Given that alcohol is a neurotoxin and teratogen, scholars question developmental benefits and point to residual confounding as a potential explanation, particularly as light drinkers are positively selected with respect to health and socioeconomic status. Using prospective, intergenerational data from the nationally-representative Millennium Cohort Study (MCS) in the United Kingdom, we studied associations between mother's drinking during pregnancy and children's cognitive and psychosocial outcomes at ages 3, 5, 7, 11, and 14 years (n = 10,454). We included early life confounders (e.g., maternal education, health, smoking) and mother's cognitive ability, and assessed robustness of relationships across outcomes and alternate drinking classifications. Results of a series of multivariable regression models found no association between light drinking and cognitive and psychosocial outcomes up to and including the age of 14, after controlling for key confounders. Light drinking during pregnancy was linked to higher socioeconomic advantages (e.g., mothers' higher education, professional/managerial occupation, home ownership, cognitive scores), which together accounted for positive associations between light drinking and children's outcomes. Mother's cognitive ability was an especially important confounder.
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D'Souza S, Crawford CN, Buckley J, Underwood L, Peterson ER, Bird A, Morton SMB, Waldie KE. Antenatal determinants of early childhood talking delay and behavioural difficulties. Infant Behav Dev 2019; 57:101388. [PMID: 31634704 DOI: 10.1016/j.infbeh.2019.101388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 11/26/2022]
Abstract
The determinants of talking delay alone or its comorbidity with behavioural difficulties was examined in 5768 two-year-old members of the Growing Up in New Zealand longitudinal study. Using the MacArthur-Bates Communicative Development inventories and the total difficulties score from the preschool Strengths and Difficulties Questionnaire, a composite measure was created so that children were categorised as showing no language or behavioural concerns (72.5%), behavioural only difficulties (6.1%), language only difficulties (18.1%), and comorbid language and behavioural difficulties (3.3%). Analyses revealed that antenatal factors such as maternal perceived stress, inadequate folate intake, vitamin intake, alcohol consumption during the first trimester and maternal smoking all had a significant effect on child outcomes. In particular, low multivitamin intake and perceived stress during pregnancy were associated with coexisting language and behavioural difficulties. These findings support international research in showing that maternal factors during pregnancy are associated with developmental outcomes in the early childhood period, and demonstrate these associations within a NZ context. Interventions which address maternal stress management and health behaviours during pregnancy could be beneficial to offspring development.
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Affiliation(s)
- Stephanie D'Souza
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | | | - Jude Buckley
- School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Elizabeth R Peterson
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Amy Bird
- School of Psychology, University of Wollongong, NSW, Australia
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.
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Cluver CA, Charles W, Merwe C, Bezuidenhout H, Nel D, Groenewald C, Brink L, Hesselman S, Bergman L, Odendaal H. The association of prenatal alcohol exposure on the cognitive abilities and behaviour profiles of 4‐year‐old children: a prospective cohort study. BJOG 2019; 126:1588-1597. [DOI: 10.1111/1471-0528.15947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Affiliation(s)
- CA Cluver
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
- Mercy Perinatal Mercy Hospital for Women Melbourne Victoria Australia
- Translational Obstetrics Group University of Melbourne Melbourne Victoria Australia
| | - W Charles
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
| | - C Merwe
- Department of Psychiatry Stellenbosch University and Tygerberg Hospital Cape Town South Africa
| | - H Bezuidenhout
- Division of Molecular Biology and Human Genetics Department of Biomedical Sciences Stellenbosch University and Tygerberg Hospital Cape Town South Africa
| | - D Nel
- Centre for Statistical Consultation Stellenbosch University Stellenbosch South Africa
| | - C Groenewald
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
| | - L Brink
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
| | - S Hesselman
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
- Centre for Clinical Research Dalarna Falun Hospital Falun Sweden
| | - L Bergman
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
- Centre for Clinical Research Dalarna Falun Hospital Falun Sweden
- Department of Obstetrics and Gynaecology Institute of Clinical Science Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - H Odendaal
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
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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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20
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Strøm M, Mortensen EL, Kesmodel US, Halldorsson T, Olsen J, Olsen SF. Is breast feeding associated with offspring IQ at age 5? Findings from prospective cohort: Lifestyle During Pregnancy Study. BMJ Open 2019; 9:e023134. [PMID: 31152024 PMCID: PMC6549733 DOI: 10.1136/bmjopen-2018-023134] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/26/2019] [Accepted: 05/01/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Breast feeding is associated with health benefits for both mother and child, but many studies focusing on neurodevelopment have lacked information on important confounders and few randomised trials exist. Our objective was to examine the influence of breast feeding on child IQ at 5 years of age while taking maternal IQ and other relevant factors into account. DESIGN Prospective observational study. SETTING Population-based birth cohort in Denmark. PARTICIPANTS We used data from The Lifestyle During Pregnancy Study 1782 mother-child pairs sampled from the Danish National Birth Cohort (n=101 042). OUTCOME MEASURES Child IQ was assessed at age 5 years by the Wechsler Primary and Preschool Scales of Intelligence-Revised. On the same occasion maternal intelligence was assessed by Wechsler Adult Intelligence Scale and Raven's Standard Progressive Matrices. Exposure data on duration of breast feeding (n=1385) were extracted from telephone interviews conducted when the child was 6 and 18 months, and analyses were weighted by relevant sampling fractions. RESULTS In multivariable linear regression analyses adjusted for potential confounders breast feeding was associated with child IQ at 5 years (categorical χ2 test for overall association p=0.03). Compared with children who were breast fed ≤1 month, children breast fed for 2-3, 4-6, 7-9 and 10 or more months had 3.06 (95% CI 0.39 to 5.72), 2.03 (95% CI -0.38 to 4.44), 3.53 (95% CI 1.18 to 5.87) and 3.28 (95% CI 0.88 to 5.67) points higher IQ after adjustment for core confounders, respectively. There was no dose-response relation and further analyses indicated that the main difference in IQ was between breast feeding ≤1 month versus >1 month. CONCLUSIONS Breastfeeding duration of 1 month or shorter compared with longer periods was associated with approximately three points lower IQ, but there was no evidence of a dose-response relation in this prospective birth cohort, where we were able to adjust for some of the most critical confounders, including maternal intelligence.
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Affiliation(s)
- Marin Strøm
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics of Gynecology, Herlev University Hospital, Herlev, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thorhallur Halldorsson
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- Unit for Nutrition Research, Landspitali University Hospital, Reykjavík, Iceland
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Sjurdur F Olsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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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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Yoshida S, Wilunda C, Kimura T, Takeuchi M, Kawakami K. Prenatal Alcohol Exposure and Suspected Hearing Impairment Among Children: A Population-based Retrospective Cohort Study. Alcohol Alcohol 2018; 53:221-227. [PMID: 29145559 DOI: 10.1093/alcalc/agx092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/20/2017] [Indexed: 11/14/2022] Open
Abstract
Aims This study aimed to examine the association between prenatal alcohol exposure and hearing impairment among Japanese children using early childhood health check-up data. Methods This retrospective cohort study used population-based health check-up data for children who were born between April 2000 and March 2013 in Hofu city, Japan. Logistic regression models were used to evaluate the association between prenatal alcohol exposure and hearing impairment among children at the age of 36 months. The models were adjusted for mother's age, smoking habit, child sex, birth weight, birth order, history of otitis media and familial history of hearing impairment. Results Among the 16,211 registered children, 10,680 children had maternal gestational information and underwent a health check-up at the age of 36 months. A total of 10,562 children were included in the analyses, which revealed that 640 children required a re-examination for hearing impairment, 157 children required a detailed examination for hearing impairment and 83 children were receiving treatment for hearing impairment at 36 months. Prenatal alcohol exposure was independently associated with suspected hearing impairment among children after adjusting for potential confounders. Conclusions Our findings suggest that prenatal alcohol exposure may adversely affect the auditory system of children. Short Summary Prenatal alcohol exposure was associated with suspected hearing impairment among children at 36 months, based on the findings of a population-based retrospective cohort study that used health check-up data from 10,562 Japanese children.
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Affiliation(s)
- Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Calistus Wilunda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Takeshi Kimura
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
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McCormack C, Hutchinson D, Burns L, Youssef G, Wilson J, Elliott E, Allsop S, Najman J, Jacobs S, Rossen L, Olsson C, Mattick R. Maternal and partner prenatal alcohol use and infant cognitive development. Drug Alcohol Depend 2018; 185:330-338. [PMID: 29499553 DOI: 10.1016/j.drugalcdep.2017.12.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Teratogenicity of heavy prenatal alcohol exposure is established, but uncertainty remains regarding the impact of moderate alcohol exposure on cognitive deficits in infants. Separating in utero effects from environmental confounding is a challenge for observational studies; consideration of alcohol use by partners as well as mothers may help clarify this. This study examined associations between prenatal alcohol use by both mothers and their partners and infant cognitive developmental outcomes at 12-months. METHODS Pregnant women (n = 1331) and their partners (n = 699) were recruited from antenatal clinics of three metropolitan public hospitals in Australia, and completed detailed interviews about alcohol consumptions throughout pregnancy. Infants were assessed with the Bayley Scales of Infant Development - Third edition (Bayley) at 12-months of age. RESULTS Alcohol use during pregnancy was reported by 65.7% of mothers and 84.1% of partners. Using multiple methods to adjust for confounding factors, no evidence for impaired cognitive ability associated with alcohol use by mothers or their partners was observed. Children born to women who drank low-levels of alcohol had slightly higher Bayley cognitive scores than those born to abstaining women. There was some evidence for an interaction between sociodemographic factors and prenatal alcohol exposure on infant cognitive outcomes. CONCLUSION This finding corroborates existing evidence to suggest there are no detrimental effects to infant cognitive development at 12-months of age following low-level prenatal alcohol exposure. Future prospective studies involving families of a broad range of backgrounds would be informative to clarify interaction between alcohol exposure and environmental factors on developmental outcomes.
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Affiliation(s)
- Clare McCormack
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia; Department of Psychiatry, Columbia University Medical Center, 622 West 168th St., New York, NY 10032, USA.
| | - Delyse Hutchinson
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia; Centre for Social and Early Emotional Development, Deakin University, 221 Burwood Hwy., Burwood, VIC 3125, Australia; Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd., Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital, 50 Flemington Rd., Parkville, VIC 3052, Australia
| | - Lucy Burns
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia
| | - George Youssef
- Centre for Social and Early Emotional Development, Deakin University, 221 Burwood Hwy., Burwood, VIC 3125, Australia; Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd., Parkville, VIC 3052, Australia
| | - Judy Wilson
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia
| | - Elizabeth Elliott
- Paediatrics and Child Health, University of Sydney, NSW 2006, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Kent St., Bentley, Perth 6102, Australia
| | - Jake Najman
- Queensland Alcohol and Drug Research Education Centre, University of Queensland, Brisbane, St. Lucia, QLD 4072, Australia
| | - Sue Jacobs
- Dept of Obstetrics, Royal Prince Alfred Hospital,Missenden Rd., Camperdown, NSW 2050, Australia
| | - Larissa Rossen
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia
| | - Craig Olsson
- Centre for Social and Early Emotional Development, Deakin University, 221 Burwood Hwy., Burwood, VIC 3125, Australia; Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd., Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital, 50 Flemington Rd., Parkville, VIC 3052, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia
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Hutchinson D, Wilson J, Allsop S, Elliott E, Najman J, Burns L, Bartu A, Jacobs S, Honan I, McCormack C, Rossen L, Fiedler H, Stone C, Khor S, Ryan J, J Youssef G, A Olsson C, P Mattick R. Cohort Profile: The Triple B Pregnancy Cohort Study: A longitudinal study of the relationship between alcohol, tobacco and other substance use during pregnancy and the health and well-being of Australian children and families. Int J Epidemiol 2018; 47:26-27m. [PMID: 29087498 DOI: 10.1093/ije/dyx126] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Delyse Hutchinson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
- Deakin University, Centre for Social and Early Emotional Development, Geelong, VIC, Australia
- Murdoch Children's Research Institute
- Department of Paediatrics, Royal Children's Hospital, Melbourne University, Melbourne, VIC, Australia
| | - Judy Wilson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Elizabeth Elliott
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Jake Najman
- Queensland Alcohol and Drug Research and Education Centre and Schools of Public Health and Social Science, University of Queensland, Brisbane, QLD, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Anne Bartu
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
| | - Sue Jacobs
- Department of Obstetrics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ingrid Honan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Clare McCormack
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Larissa Rossen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Hannah Fiedler
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Chiara Stone
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Khor
- Deakin University, Centre for Social and Early Emotional Development, Geelong, VIC, Australia
| | - Joanne Ryan
- Murdoch Children's Research Institute
- Department of Paediatrics, Royal Children's Hospital, Melbourne University, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - George J Youssef
- Deakin University, Centre for Social and Early Emotional Development, Geelong, VIC, Australia
- Murdoch Children's Research Institute
- Department of Paediatrics, Royal Children's Hospital, Melbourne University, Melbourne, VIC, Australia
| | - Craig A Olsson
- Deakin University, Centre for Social and Early Emotional Development, Geelong, VIC, Australia
- Murdoch Children's Research Institute
- Department of Paediatrics, Royal Children's Hospital, Melbourne University, Melbourne, VIC, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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Mamluk L, Edwards HB, Savović J, Leach V, Jones T, Moore THM, Ijaz S, Lewis SJ, Donovan JL, Lawlor D, Smith GD, Fraser A, Zuccolo L. Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently 'safe' levels of alcohol during pregnancy? A systematic review and meta-analyses. BMJ Open 2017; 7:e015410. [PMID: 28775124 PMCID: PMC5642770 DOI: 10.1136/bmjopen-2016-015410] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To determine the effects of low-to-moderate levels of maternal alcohol consumption in pregnancy on pregnancy and longer-term offspring outcomes. SEARCH STRATEGY Medline, Embase, Web of Science and Psychinfo from inception to 11 July 2016. SELECTION CRITERIA Prospective observational studies, negative control and quasiexperimental studies of pregnant women estimating effects of light drinking in pregnancy (≤32 g/week) versus abstaining. Pregnancy outcomes such as birth weight and features of fetal alcohol syndrome were examined. DATA COLLECTION AND ANALYSIS One reviewer extracted data and another checked extracted data. Random effects meta-analyses were performed where applicable, and a narrative summary of findings was carried out otherwise. MAIN RESULTS 24 cohort and two quasiexperimental studies were included. With the exception of birth size and gestational age, there was insufficient data to meta-analyse or make robust conclusions. Odds of small for gestational age (SGA) and preterm birth were higher for babies whose mothers consumed up to 32 g/week versus none, but estimates for preterm birth were also compatible with no association: summary OR 1.08, 95% CI (1.02 to 1.14), I2 0%, (seven studies, all estimates were adjusted) OR 1.10, 95% CI (0.95 to 1.28), I2 60%, (nine studies, includes one unadjusted estimates), respectively. The earliest time points of exposure were used in the analysis. CONCLUSION Evidence of the effects of drinking ≤32 g/week in pregnancy is sparse. As there was some evidence that even light prenatal alcohol consumption is associated with being SGA and preterm delivery, guidance could advise abstention as a precautionary principle but should explain the paucity of evidence.
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Affiliation(s)
- Loubaba Mamluk
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Hannah B Edwards
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Jelena Savović
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Verity Leach
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Timothy Jones
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Theresa H M Moore
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Sharea Ijaz
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Sarah J Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Debbie Lawlor
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Luisa Zuccolo
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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26
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Taylor CM, Kordas K, Golding J, Emond AM. WITHDRAWN: Data relating to prenatal lead exposure and child IQ at 4 and 8 years old in the Avon Longitudinal Study of Parents and Children. Data Brief 2017. [DOI: 10.1016/j.dib.2017.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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27
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Data relating to prenatal lead exposure and child IQ at 4 and 8 years old in the Avon Longitudinal Study of Parents and Children. Neurotoxicology 2017; 62:224-230. [PMID: 28765090 PMCID: PMC5630198 DOI: 10.1016/j.neuro.2017.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 11/24/2022]
Abstract
As part of the Avon Longitudinal Study of Parents and Children (ALSPAC), measures of child IQ were collected by trained psychologists. The Wechsler Pre-school and Primary Scale of Intelligence – Revised UK edition (WPPSI) was used at age 4 years in a subsample of children enrolled in ALSPAC (the Children in Focus cohort), chosen at random from the last 6 months of ALSPAC births (about 10% of the participants). At age 8 years all children enrolled in the main cohort were invited to complete a short form of the Wechsler Intelligence Scale for Children (WISC)-III UK. Prenatal blood lead (B-Pb) concentrations were measured by inductively-couple plasma mass spectrometry in samples from women at a median gestation age of 11 weeks. Child blood lead was measured by atomic absorption spectrometry in samples from children attending the Children in Focus clinic at age 30 months. Maternal reports at 32 weeks’ gestation were used to generate data on a range of potential confounders. The data were used to determine the associations between prenatal exposure to lead and child IQ at 4 and 8 years. The effect of child B-Pb at 3 years as a moderator of these associations was tested. (For results, please see doi:10.1016/j.neuro.2017.07.003 Taylor et al., (2017)).
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Sanou AS, Diallo AH, Holding P, Nankabirwa V, Engebretsen IMS, Ndeezi G, Tumwine JK, Meda N, Tylleskar T, Kashala-Abotnes E. Maternal alcohol consumption during pregnancy and child's cognitive performance at 6-8 years of age in rural Burkina Faso: an observational study. PeerJ 2017; 5:e3507. [PMID: 28674660 PMCID: PMC5494175 DOI: 10.7717/peerj.3507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/06/2017] [Indexed: 01/06/2023] Open
Abstract
Background In Burkina Faso, it is not uncommon for mothers to drink alcohol, even during pregnancy. We aimed to study the association between maternal alcohol consumption during pregnancy and the child’s cognitive performance using the Kaufman Assessment Battery for Children, 2nd edition (KABC-II) and the Children’s Category Test Level 1 (CCT-1) in rural Burkina Faso. Methods We conducted a follow-up study of a community cluster-randomised Exclusive breastfeeding trial, and re-enrolled the children in rural Burkina Faso. A total of 518 children (268 boys and 250 girls) aged 6–8 years were assessed using the KABC-II and the CCT-1. We examined the effect size difference using Cohen’s d and conducted a linear regression analysis to examine the association. Results Self-reported alcohol consumption during pregnancy was 18.5% (96/518). Children whose mothers reported alcohol consumption during pregnancy performed significantly poorly for memory and spatial abilities tests from small effect size difference for ‘Atlantis’ (0.27) and ‘Triangle’ (0.29) to moderate effect size difference for ‘Number recall’ (0.72) compared to children whose mothers did not consume alcohol during pregnancy; the exposed children scored significantly higher errors with a small effect size (0.37) at problem solving (CCT-1) test compared to unexposed children. At unstandardized and standardized multivariable analysis, children whose mothers reported alcohol consumption during pregnancy performed significantly poorer for memory-‘Atlantis’ (p = 0.03) and ‘Number recall’ (p = 0.0001), and spatial ability tests-‘Triangle’ (p = 0.03); they scored significantly higher errors at problem solving CCT-1 test (p = 0.002); all the results were adjusted for age, sex, schooling, stunting, father’s education, mother’s employment and the promotion of exclusive breastfeeding. No statistical association was found for visual abilities-‘Conceptual Thinking’, ‘Face recognition’, ‘Story completion’, and reasoning tests-‘Rover’, ‘Block counting’, and ‘Pattern Reasoning’. Conclusion Maternal alcohol consumption during pregnancy is associated with poorer cognitive performance for memory, spatial ability, and problem solving tests in the offspring in rural Burkina Faso. Futures studies needs to assess in more detail the maternal alcohol consumption patterns in Burkina Faso and possible preventive strategies.
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Affiliation(s)
- Anselme Simeon Sanou
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye Hama Diallo
- Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso.,Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Victoria Nankabirwa
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Epidemiology & Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.,Centre for Intervention Science in Maternal and Child Health (CISMAC), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ingunn Marie S Engebretsen
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Nicolas Meda
- Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso.,Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Thorkild Tylleskar
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Esperance Kashala-Abotnes
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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29
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Lee E, Sutton RM, Hartley BL. From scientific article to press release to media coverage: advocating alcohol abstinence and democratising risk in a story about alcohol and pregnancy. HEALTH RISK & SOCIETY 2016; 18:247-269. [PMID: 28367068 PMCID: PMC5351785 DOI: 10.1080/13698575.2016.1229758] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/05/2016] [Indexed: 10/31/2022]
Abstract
In this article, we follow the approach taken by Riesch and Spiegalhalter in "Careless pork costs lives': Risk stories from science to press release to media' published in this journal, and offer an assessment of one example of a 'risk story'. Using content and thematic qualitative analysis, we consider how the findings of an article 'Fetal Alcohol Exposure and IQ at Age 8: Evidence from a Population-Based Birth-Cohort Study' were framed in the article itself, the associated press release, and the subsequent extensive media coverage. We contextualise this consideration of a risk story by discussing a body of work that critically engages with the development and global proliferation of efforts to advocate for alcohol abstinence to pregnant (and pre-pregnant) women. This work considers the 'democratisation' of risk, a term used to draw attention to the expansion of the definition of the problem of drinking in pregnancy to include any drinking and all women. We show here how this risk story contributed a new dimension to the democratisation of risk through claims that were made about uncertainty and certainty. A central argument we make concerns the contribution of the researchers themselves (not just lobby groups or journalists) to this outcome. We conclude that the democratisation of risk was advanced in this case not simply through journalists exaggerating and misrepresenting research findings, but that communication to the press and the initial interpretation of findings played their part. We suggest that this risk story raises concerns about the accuracy of reporting of research findings, and about the communication of unwarrantedly worrying messages to pregnant women about drinking alcohol.
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Affiliation(s)
- Ellie Lee
- School of Social Policy, Sociology and Social Research, University of Kent , Canterbury , UK
| | | | - Bonny L Hartley
- Department of Psychology, Social Work and Counselling, University of Greenwich , London , UK
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30
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Ruiz JDC, Quackenboss JJ, Tulve NS. Contributions of a Child's Built, Natural, and Social Environments to Their General Cognitive Ability: A Systematic Scoping Review. PLoS One 2016; 11:e0147741. [PMID: 26840411 PMCID: PMC4739499 DOI: 10.1371/journal.pone.0147741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/09/2015] [Indexed: 12/24/2022] Open
Abstract
The etiology of a child’s cognitive ability is complex, with research suggesting that it is not attributed to a single determinant or even a defined period of exposure. Rather, cognitive development is the product of cumulative interactions with the environment, both negative and positive, over the life course. The aim of this systematic scoping review was to collate evidence associated with children’s cognitive health, including inherent factors as well as chemical and non-chemical stressors from the built, natural, and social environments. Three databases were used to identify recent epidemiological studies (2003–2013) that examined exposure factors associated with general cognitive ability in children. Over 100 factors were evaluated from 258 eligible studies. We found that recent literature mainly assessed the hypothesized negative effects of either inherent factors or chemical exposures present in the physical environment. Prenatal growth, sleep health, lead and water pollutants showed consistent negative effects. Of the few studies that examined social stressors, results consistently showed cognitive development to be influenced by both positive and negative social interactions at home, in school or the community. Among behavioral factors related to diet and lifestyle choices of the mother, breastfeeding was the most studied, showing consistent positive associations with cognitive ability. There were mostly inconsistent results for both chemical and non-chemical stressors. The majority of studies utilized traditional exposure assessments, evaluating chemical and non-chemical stressors separately. Collective evidence from a limited number of studies revealed that cumulative exposure assessment that incorporates multiple chemical and non-chemical stressors over the life course may unravel the variability in effect on cognitive development and help explain the inconsistencies across studies. Future research examining the interactions of multiple stressors within a child’s total environment, depicting a more real-world exposure, will aid in understanding the cumulative effects associated with a child’s ability to learn.
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Affiliation(s)
- Jazmin Del Carmen Ruiz
- Oak Ridge Institute for Science and Education, Research Participation Program, Oak Ridge, TN, United States of America
- Human Exposure and Atmospheric Sciences Division, National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, Durham, NC, United States of America
- * E-mail: ;
| | - James J. Quackenboss
- Human Exposure and Atmospheric Sciences Division, National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Las Vegas, NV, United States of America
| | - Nicolle S. Tulve
- Human Exposure and Atmospheric Sciences Division, National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, Durham, NC, United States of America
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31
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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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Abstract
Alcohol use disorders (AUDs) are less prevalent in pregnant women than in nonpregnant women, but these disorders can create a host of clinical challenges when encountered. Unfortunately, little evidence is available to guide clinical decision making in this population. Drinking alcohol during pregnancy can have negative consequences on both fetus and mother, but it remains controversial as to the volume of alcohol consumption that correlates with these consequences. Likewise, little evidence is available to support the use of particular pharmacologic interventions for AUDs during pregnancy or to guide the management of alcohol detoxification in pregnant women. The use of benzodiazepines (the mainstay of most alcohol detoxification protocols) in pregnant women is controversial. Nevertheless, despite the lack of robust data to guide management of AUDs in pregnancy, clinicians need to make management decisions when confronted with these challenging situations. In that context, this article reviews the epidemiology of AUDs in pregnancy and the pharmacologic management of both AUDs and alcohol withdrawal in pregnant women, with the goal of informing clinicians about what is known about managing these co-occurring conditions.
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Affiliation(s)
- Jeffrey DeVido
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA
- McLean Hospital, Division of Alcohol and Drug Abuse, Harvard Medical School, Belmont, MA
| | - Olivera Bogunovic
- McLean Hospital, Division of Alcohol and Drug Abuse, Harvard Medical School, Belmont, MA
| | - Roger D. Weiss
- McLean Hospital, Division of Alcohol and Drug Abuse, Harvard Medical School, Belmont, MA
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Hill AJ, Drever N, Yin H, Tamayo E, Saade G, Bytautiene E. The role of NADPH oxidase in a mouse model of fetal alcohol syndrome. Am J Obstet Gynecol 2014; 210:466.e1-5. [PMID: 24334207 DOI: 10.1016/j.ajog.2013.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/19/2013] [Accepted: 12/09/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Fetal alcohol syndrome (FAS) is the most common cause of nongenetic mental retardation. Oxidative stress is one of the purported mechanisms. Nicotinamide adenine dinucleotide phosphate oxidase (NOX) is an enzyme involved in the production of reactive oxygen species. Our objective was to evaluate NOX in the fetal brain of a well-validated mouse model of FAS. STUDY DESIGN Timed, pregnant C57BL/6J mice were injected intraperitoneally with 0.03 mL/g of either 25% ethyl alcohol or saline. Fetal brain, liver, and placenta were harvested on gestational day 18. The unit of analysis was the litter; tissue from 6-8 litters in the alcohol and control group was isolated. Evaluation of messenger ribonucleic acid (mRNA) expression of NOX subunits (DUOX1, DUOX2, NOX1, NOX2, NOX3, NOX4, NOXA1, NOXO1, RAC1, p22phox, and p67phox) was performed using quantitative real-time polymerase chain reaction; alcohol vs placebo groups were compared using a Student t test or a Mann-Whitney test (P < .05). RESULTS Alcohol exposed fetal brains showed significant up-regulation in subunits DUOX2 (1.61 ± 0.28 vs 0.84 ± 0.09; P = .03), NOXA1 (1.75 ± 0.27 vs 1.09 ± 0.06; P = .04), and NOXO1 (1.59 ± 0.10 vs 1.28 ± 0.05; P = .02). Differences in mRNA expression in the placenta were not significant; p67phox was significantly up-regulated in alcohol-exposed livers. CONCLUSION Various NOX subunits are up-regulated in fetal brains exposed to alcohol. This effect was not observed in the fetal liver or placenta. Given the available evidence, the NOX system may be involved in the causation of FAS through the generation of reactive oxygen species and may be a potential target for preventative treatment in FAS.
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Affiliation(s)
- Alexandria J Hill
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX
| | - Nathan Drever
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX
| | - Huaizhi Yin
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX
| | - Esther Tamayo
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX
| | - George Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX
| | - Egle Bytautiene
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX
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Bliddal M, Olsen J, Støvring H, Eriksen HLF, Kesmodel US, Sørensen TIA, Nøhr EA. Maternal pre-pregnancy BMI and intelligence quotient (IQ) in 5-year-old children: a cohort based study. PLoS One 2014; 9:e94498. [PMID: 24727836 PMCID: PMC3984139 DOI: 10.1371/journal.pone.0094498] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An association between maternal pre-pregnancy BMI and childhood intelligence quotient (IQ) has repeatedly been found but it is unknown if this association is causal or due to confounding caused by genetic or social factors. METHODS We used a cohort of 1,783 mothers and their 5-year-old children sampled from the Danish National Birth Cohort. The children participated between 2003 and 2008 in a neuropsychological assessment of cognitive ability including IQ tests taken by both the mother and the child. Linear regression analyses were used to estimate the associations between parental BMI and child IQ adjusted for a comprehensive set of potential confounders. Child IQ was assessed with the Wechsler Primary and Preschool Scales of Intelligence--Revised (WPPSI-R). RESULTS The crude association between maternal BMI and child IQ showed that BMI was adversely associated with child IQ with a reduction in IQ of -0.40 point for each one unit increase in BMI. This association was attenuated after adjustment for social factors and maternal IQ to a value of -0.27 (-0.50 to -0.03). After mutual adjustment for the father's BMI and all other factors except maternal IQ, the association between paternal BMI and child IQ yielded a regression coefficient of -0.26 (-0.59 to 0.07), which was comparable to that seen for maternal BMI (-0.20 (-0.44 to 0.04)). CONCLUSION Although maternal pre-pregnancy BMI was inversely associated with the IQ of her child, the similar association with paternal BMI suggests that it is not a specific pregnancy related adiposity effect.
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Affiliation(s)
- Mette Bliddal
- Department of Gynaecology and Obstetrics, Odense University Hospital, and Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | - Jørn Olsen
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Henrik Støvring
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
| | - Hanne-Lise F. Eriksen
- Center of Functionally Integrative Neuroscience, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik S. Kesmodel
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Thorkild I. A. Sørensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals – Part of Copenhagen University Hospital, Copenhagen, Denmark
| | - Ellen A. Nøhr
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
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Prenatal exposure to binge pattern of alcohol consumption: mental health and learning outcomes at age 11. Eur Child Adolesc Psychiatry 2014; 23:891-9. [PMID: 25209690 PMCID: PMC4186965 DOI: 10.1007/s00787-014-0599-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 08/07/2014] [Indexed: 12/17/2022]
Abstract
The objective of the study is to investigate whether episodic binge pattern of alcohol consumption during pregnancy is independently associated with child mental health and academic outcomes. Using data from the prospective, population-based Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated the associations between binge patterns of alcohol consumption during pregnancy (≥4 drinks per day) and child mental health [as rated by both parent (n = 4,610) and teacher (n = 4,274)] and academic outcomes [based on examination results (n = 6,939)] at age 11 years. After adjusting for prenatal and postnatal risk factors, binge pattern of alcohol consumption (≥4 drinks in a day on at least one occasion) during pregnancy was associated with higher levels of mental health problems (especially hyperactivity/inattention) in girls at age 11 years, according to parental report. After disentangling binge-pattern and daily drinking, binge-pattern drinking was independently associated with teacher-rated hyperactivity/inattention and lower academic scores in both genders. Episodic drinking involving ≥4 drinks per day during pregnancy may increase risk for child mental health problems and lower academic attainment even if daily average levels of alcohol consumption are low. Episodic binge pattern of drinking appears to be a risk factor for these outcomes, especially hyperactivity and inattention problems, in the absence of daily drinking.
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Eriksen HLF, Kesmodel US, Underbjerg M, Kilburn TR, Bertrand J, Mortensen EL. Predictors of intelligence at the age of 5: family, pregnancy and birth characteristics, postnatal influences, and postnatal growth. PLoS One 2013; 8:e79200. [PMID: 24236109 PMCID: PMC3827334 DOI: 10.1371/journal.pone.0079200] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 09/20/2013] [Indexed: 11/27/2022] Open
Abstract
Parental education and maternal intelligence are well-known predictors of child IQ. However, the literature regarding other factors that may contribute to individual differences in IQ is inconclusive. The aim of this study was to examine the contribution of a number of variables whose predictive status remain unclarified, in a sample of basically healthy children with a low rate of pre- and postnatal complications. 1,782 5-year-old children sampled from the Danish National Birth Cohort (2003–2007) were assessed with a short form of the Wechsler Preschool and Primary Scale of Intelligence – Revised. Information on parental characteristics, pregnancy and birth factors, postnatal influences, and postnatal growth was collected during pregnancy and at follow-up. A model including study design variables and child’s sex explained 7% of the variance in IQ, while parental education and maternal IQ increased the explained variance to 24%. Other predictors were parity, maternal BMI, birth weight, breastfeeding, and the child’s head circumference and height at follow-up. These variables, however, only increased the explained variance to 29%. The results suggest that parental education and maternal IQ are major predictors of IQ and should be included routinely in studies of cognitive development. Obstetrical and postnatal factors also predict IQ, but their contribution may be of comparatively limited magnitude.
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Affiliation(s)
| | - Ulrik Schiøler Kesmodel
- Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Underbjerg
- Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark
- Children’s Neurocenter at Vejlefjord Rehabilitation Center, Stouby, Denmark
| | - Tina Røndrup Kilburn
- Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jacquelyn Bertrand
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Ageing, University of Copenhagen, Copenhagen, Denmark
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Alati R, Davey Smith G, Lewis SJ, Sayal K, Draper ES, Golding J, Fraser R, Gray R. Effect of prenatal alcohol exposure on childhood academic outcomes: contrasting maternal and paternal associations in the ALSPAC study. PLoS One 2013; 8:e74844. [PMID: 24130672 PMCID: PMC3794033 DOI: 10.1371/journal.pone.0074844] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/07/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The impact of low-to-moderate levels of alcohol consumption during pregnancy on child cognitive outcomes has been of recent concern. This study has tested the hypothesis that low-to-moderate maternal alcohol use in pregnancy is associated with lower school test scores at age 11 in the offspring via intrauterine mechanisms. METHODS We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a birth cohort study based in the South West of England. Analyses were conducted on 7062 participants who had complete data on: maternal and paternal patterns of alcohol use in the first trimester and at 18 weeks' gestation, child's academic outcomes measured at age 11, gender, maternal age, parity, marital status, ethnicity, household crowding, home ownership status and parental education. We contrasted the association of mother's alcohol consumption during pregnancy with child's National Curriculum Key Stage 2 (KS2) test scores with the association for father's alcohol consumption (during the time the mother was pregnant) with child's National Curriculum Key Stage 2 (KS2) test scores. We used multivariate linear regression to estimate mean differences and 95% confidence intervals [CI] in KS2 scores across the exposure categories and computed f statistics to compare maternal and paternal associations. FINDINGS AND CONCLUSIONS Drinking up to 1 unit of alcohol a day during pregnancy was not associated with lower test scores. However, frequent prenatal consumption of 4 units (equivalent to 32 grams of alcohol) on each single drinking occasion was associated with reduced educational attainment [Mean change in offspring KS2 score was -0.68 (-1.03, -0.33) for maternal alcohol categories compared to 0.27 (0.07, 0.46) for paternal alcohol categories]. Frequent consumption of 4 units of alcohol during pregnancy may adversely affect childhood academic outcomes via intrauterine mechanisms.
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Affiliation(s)
- Rosa Alati
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Sarah J. Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Kapil Sayal
- Developmental Psychiatry, University of Nottingham, Nottingham, United Kingdom
| | - Elizabeth S. Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Jean Golding
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Robert Fraser
- Reproductive and Developmental Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Ron Gray
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
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Learning disorder and blood concentration of heavy metals in the United Arab Emirates. Asian J Psychiatr 2013; 6:394-400. [PMID: 24011686 DOI: 10.1016/j.ajp.2013.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 03/31/2013] [Accepted: 04/12/2013] [Indexed: 11/23/2022]
Abstract
Children are frequently exposed to toxic metals in the environment, and their developing central nervous system is particularly vulnerable to their effects. This study examined the blood level of heavy metals in children with learning disorder (LD) as compared to children without LD in the United Arab Emirates (UAE). Significantly high blood concentrations of seven heavy metals were found in children with LD. Further analysis using forward stepwise logistic regression showed that molybdenum levels and family history of developmental problems were the best predictors of LD. Our findings suggest the need for monitoring for toxic metals in the environment.
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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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Kelly Y, Iacovou M, Quigley MA, Gray R, Wolke D, Kelly J, Sacker A. Light drinking versus abstinence in pregnancy - behavioural and cognitive outcomes in 7-year-old children: a longitudinal cohort study. BJOG 2013; 120:1340-7. [PMID: 23590126 PMCID: PMC4296342 DOI: 10.1111/1471-0528.12246] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether light drinking in pregnancy is linked to unfavourable developmental outcomes in children. DESIGN Prospective population-based cohort. SETTING UK. POPULATION Ten thousand five hundred and thirty-four 7-year-olds. METHODS Quasi-experimental using propensity score matching (PSM) to compare children born to light (up to 2 units per week) and non-drinkers. MAIN OUTCOME MEASURES Behavioural difficulties rated by parents and teachers; cognitive test scores for reading, maths and spatial skills. RESULTS Ordinary least squares (OLS) regression and PSM analyses are presented. For behavioural difficulties, unadjusted estimates for percentage standard deviation (SD) score differences ranged from 2 to 14%. On adjustment for potential confounders, differences were attenuated, with a loss of statistical significance, except for teacher-rated boys' difficulties. For boys, parent-rated behavioural difficulties: unadjusted, -11.5; OLS, -4.3; PSM, -6.8; teacher-rated behavioural difficulties: unadjusted, -13.9; OLS, -9.6; PSM, -10.8. For girls, parent-rated behavioural difficulties: unadjusted, -9.6; OLS, -2.9; PSM, -4.5; teacher-rated behavioural difficulties: unadjusted, -2.4; OLS, 4.9; PSM, 3.9. For cognitive test scores, unadjusted estimates for differences ranged between 12 and 21% of an SD score for reading, maths and spatial skills. After adjustment for potential confounders, estimates were reduced, but remained statistically significantly different for reading and for spatial skills in boys. For boys, reading: unadjusted, 20.9; OLS, 8.3; PSM, 7.3; maths: unadjusted, 14.7; OLS, 5.0; PSM, 6.5; spatial skills: unadjusted, 16.2; OLS, 7.6; PSM, 8.1. For girls, reading: unadjusted, 11.6; OLS, -0.3; PSM, -0.5; maths: unadjusted, 12.9; OLS, 4.3; PSM, 3.9; spatial skills: unadjusted, 16.2; OLS, 7.7; PSM, 6.4. CONCLUSION The findings suggest that light drinking during pregnancy is not linked to developmental problems in mid-childhood. These findings support current UK Department of Health guidelines on drinking during pregnancy.
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Affiliation(s)
- Y Kelly
- Department of Epidemiology and Public Health, University College LondonLondon, UK
| | - M Iacovou
- Institute for Social and Economic Research (ISER), University of EssexColchester, UK
| | - MA Quigley
- National Perinatal Epidemiology Unit, University of OxfordHeadington, Oxford, UK
| | - R Gray
- National Perinatal Epidemiology Unit, University of OxfordHeadington, Oxford, UK
| | - D Wolke
- Department of Psychology and Health Sciences Research Institute, Warwick Medical School, The University of WarwickCoventry, UK
| | - J Kelly
- Department of Epidemiology and Public Health, University College LondonLondon, UK
| | - A Sacker
- Department of Epidemiology and Public Health, University College LondonLondon, UK
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Flak AL, Su S, Bertrand J, Denny CH, Kesmodel US, Cogswell ME. The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis. Alcohol Clin Exp Res 2013; 38:214-26. [PMID: 23905882 DOI: 10.1111/acer.12214] [Citation(s) in RCA: 227] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 05/15/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The objective of this review is to evaluate the literature on the association between mild, moderate, and binge prenatal alcohol exposure and child neurodevelopment. METHODS Meta-analysis with systematic searches of MEDLINE (1970 through August 2012), EMBASE (1988 through August 2012), and PsycINFO(®) (1970 through August 2012) and examination of selected references. RESULTS From 1,593 articles, we identified 34 presenting data from cohort studies that met our inclusion criteria. Information on study population, outcomes, measurement instruments, timing and quantification of alcohol exposure, covariates, and results was abstracted. Outcomes included academic performance, attention, behavior, cognition, language skills, memory, and visual and motor development. The quality of each article was assessed by 2 researchers using the Newcastle-Ottawa Scale. Based on 8 studies of 10,000 children aged 6 months through 14 years, we observed a significant detrimental association between any binge prenatal alcohol exposure and child cognition (Cohen's d [a standardized mean difference score] -0.13; 95% confidence interval [CI], -0.21, -0.05). Based on 3 high-quality studies of 11,900 children aged 9 months to 5 years, we observed a statistically significant detrimental association between moderate prenatal alcohol exposure and child behavior (Cohen's d -0.15; 95% CI, -0.28, -0.03). We observed a significant, albeit small, positive association between mild-to-moderate prenatal alcohol exposure and child cognition (Cohen's d 0.04; 95% CI, 0.00, 0.08), but the association was not significant after post hoc exclusion of 1 large study that assessed mild consumption nor was it significant when including only studies that assessed moderate alcohol consumption. None of the other completed meta-analyses resulted in statistically significant associations between mild, moderate, or binge prenatal alcohol exposure and child neuropsychological outcomes. CONCLUSIONS Our findings support previous findings suggesting the detrimental effects of prenatal binge drinking on child cognition. Prenatal alcohol exposure at levels less than daily drinking might be detrimentally associated with child behavior. The results of this review highlight the importance of abstaining from binge drinking during pregnancy and provide evidence that there is no known safe amount of alcohol to consume while pregnant.
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Affiliation(s)
- Audrey L Flak
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Humphriss R, Hall A, May M, Zuccolo L, Macleod J. Prenatal alcohol exposure and childhood balance ability: findings from a UK birth cohort study. BMJ Open 2013; 3:bmjopen-2013-002718. [PMID: 23794556 PMCID: PMC3686236 DOI: 10.1136/bmjopen-2013-002718] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the association of prenatal alcohol exposure with balance in10-year-old children. DESIGN Population-based prospective longitudinal study. SETTING Former Avon region of UK (Southwest England). PARTICIPANTS 6915 children from the Avon Longitudinal Study of Parents and Children who had a balance assessment at age 10 and had data on maternal alcohol consumption. OUTCOME MEASURES 3 composite balance scores: dynamic balance (beam-walking), static balance eyes open, static balance eyes closed (heel-to-toe balance on a beam and standing on one leg, eyes open or closed). RESULTS Most mothers (95.5%) consumed no-to-moderate amounts (3-7 glasses/week) of alcohol during pregnancy. Higher total-alcohol consumption was associated with maternal-social advantage, whereas binge drinking (≥4 units/day) and abstinence were associated with maternal social disadvantage. No evidence was found of an adverse effect of maternal-alcohol consumption on childhood balance. Higher maternal-alcohol use during pregnancy was generally associated with better offspring outcomes, with some specific effects appearing strong (static balance eyes open and moderate total alcohol exposure at 18 weeks, adjusted OR 1.23 (95% CI 1.01 to 1.49); static balance eyes closed and moderate total alcohol exposure at 18 weeks, adjusted OR 1.25 (95% CI 1.06 to 1.48). Similar results were found for both paternal and postnatal maternal alcohol exposure. A Mendelian-randomization approach was used to estimate the association between maternal genotype and offspring balance using the non-synonymous variant rs1229984*A (ADH1B) to proxy for lower maternal alcohol consumption; no strong associations were found between this genotype/proxy and offspring balance. CONCLUSIONS No evidence was found to indicate that moderate maternal alcohol consumption in this population sample had an adverse effect on offspring balance at age 10. An apparent beneficial effect of higher total maternal alcohol consumption on offspring balance appeared likely to reflect residual confounding.
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Affiliation(s)
- Rachel Humphriss
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Amanda Hall
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Centre for Hearing and Balance Studies, University of Bristol, Bristol, UK
| | - Margaret May
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Luisa Zuccolo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Macleod
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Hutchinson D, Moore EA, Breen C, Burns L, Mattick RP. Alcohol use in pregnancy: prevalence and predictors in the Longitudinal Study of Australian Children. Drug Alcohol Rev 2013; 32:475-82. [PMID: 23675867 DOI: 10.1111/dar.12027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 12/18/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS This study aimed to estimate the prevalence and describe the patterns of alcohol use during pregnancy among Australian mothers. The study also aimed to examine the characteristics associated with alcohol use in pregnancy. DESIGN AND METHODS Data comprised two representative samples of families (infant cohort = 5107 parents of 0- to 1-year-olds; child cohort = 4983 parents of 4- to 5-year-olds) from the 2005 Longitudinal Study of Australian Children. RESULTS Alcohol use in pregnancy was reported by 37.6% of mothers of infants aged 0-1 years and 27.6% of mothers of children aged 4-5 years. The majority of women reported low level/occasional use of alcohol but, when extrapolated to population level, this equates to 131,250 children in these two age groups exposed to alcohol in utero, with over 1000 children exposed to alcohol most days and an estimated 671 infants exposed to three or more drinks per occasion. Among mothers of infants, alcohol use in pregnancy was associated with increasing maternal age, higher education, greater economic advantage and fewer physical health problems in pregnancy. Among mothers of children, maternal drinking in pregnancy was associated with increasing maternal age and smoking in pregnancy. DISCUSSION AND CONCLUSIONS Alcohol use during pregnancy is common with around one-third of all mothers reporting use. Most women reported only occasional use, and among those who were asked, consumed one standard drink on average per occasion. Significant numbers were exposed to three or more drinks on one occasion or to alcohol most days while in utero. National guidelines recommend abstinence as no 'safe' threshold has been determined. Public health campaigns are needed to educate pregnant women regarding national guidelines.
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Affiliation(s)
- Delyse Hutchinson
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Fraser A, Macdonald-Wallis C, Tilling K, Boyd A, Golding J, Davey Smith G, Henderson J, Macleod J, Molloy L, Ness A, Ring S, Nelson SM, Lawlor DA. Cohort Profile: the Avon Longitudinal Study of Parents and Children: ALSPAC mothers cohort. Int J Epidemiol 2013; 42:97-110. [PMID: 22507742 PMCID: PMC3600619 DOI: 10.1093/ije/dys066] [Citation(s) in RCA: 1640] [Impact Index Per Article: 149.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2012] [Indexed: 11/23/2022] Open
Abstract
Summary The Avon Longitudinal Study of Children and Parents (ALSPAC) was established to understand how genetic and environmental characteristics influence health and development in parents and children. All pregnant women resident in a defined area in the South West of England, with an expected date of delivery between 1st April 1991 and 31st December 1992, were eligible and 13761 women (contributing 13867 pregnancies) were recruited. These women have been followed over the last 19-22 years and have completed up to 20 questionnaires, have had detailed data abstracted from their medical records and have information on any cancer diagnoses and deaths through record linkage. A follow-up assessment was completed 17-18 years postnatal at which anthropometry, blood pressure, fat, lean and bone mass and carotid intima media thickness were assessed, and a fasting blood sample taken. The second follow-up clinic, which additionally measures cognitive function, physical capability, physical activity (with accelerometer) and wrist bone architecture, is underway and two further assessments with similar measurements will take place over the next 5 years. There is a detailed biobank that includes DNA, with genome-wide data available on >10000, stored serum and plasma taken repeatedly since pregnancy and other samples; a wide range of data on completed biospecimen assays are available. Details of how to access these data are provided in this cohort profile.
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Affiliation(s)
- Abigail Fraser
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - Corrie Macdonald-Wallis
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - Kate Tilling
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - Andy Boyd
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - Jean Golding
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - George Davey Smith
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - John Henderson
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - John Macleod
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - Lynn Molloy
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - Andy Ness
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - Susan Ring
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - Scott M Nelson
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
| | - Debbie A Lawlor
- MRC Centre for Causal Analyses in Translational
Epidemiology, University of Bristol, UK, School of Social and Community
Medicine, University of Bristol, UK, School of Oral and Dental Sciences,
University of Bristol, University of Bristol, Bristol, UK and School of
Medicine, University of Glasgow, UK
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Effects of tobacco smoking in pregnancy on offspring intelligence at the age of 5. J Pregnancy 2012; 2012:945196. [PMID: 23316364 PMCID: PMC3539404 DOI: 10.1155/2012/945196] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 11/22/2012] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to examine the effects of tobacco smoking in pregnancy on children's IQ at the age of 5. A prospective follow-up study was conducted on 1,782 women, and their offspring were sampled from the Danish National Birth Cohort. At 5 years of age, the children were tested with the Wechsler Preschool and Primary Scale of Intelligence-Revised. Parental education, maternal IQ, maternal alcohol consumption in pregnancy, the sex and age of the child, and tester were considered core confounders, but the full model also controlled for prenatal paternal smoking, maternal age and Bodymass Mass Index, parity, family/home environment, postnatal parental smoking, breast feeding, the child's health status, and indicators for hearing and vision impairments.
Unadjusted analyses showed a statistically significant decrement of 4 points on full-scale IQ (FSIQ) associated with smoking 10+ cigarettes per day compared to nonsmoking. After adjustment for potential confounders, no significant effects of prenatal exposure to tobacco smoking were found. Considering the indisputable teratogenic effects of tobacco smoking, these findings should be interpreted with caution. Still, the results may indicate that previous studies that failed to control for important confounders, particularly maternal intelligence, may be subject to substantial residual confounding.
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Lewis SJ, Zuccolo L, Davey Smith G, Macleod J, Rodriguez S, Draper ES, Barrow M, Alati R, Sayal K, Ring S, Golding J, Gray R. Fetal alcohol exposure and IQ at age 8: evidence from a population-based birth-cohort study. PLoS One 2012; 7:e49407. [PMID: 23166662 PMCID: PMC3498109 DOI: 10.1371/journal.pone.0049407] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/09/2012] [Indexed: 01/02/2023] Open
Abstract
Background Observational studies have generated conflicting evidence on the effects of moderate maternal alcohol consumption during pregnancy on offspring cognition mainly reflecting problems of confounding. Among mothers who drink during pregnancy fetal alcohol exposure is influenced not only by mother’s intake but also by genetic variants carried by both the mother and the fetus. Associations between children’s cognitive function and both maternal and child genotype at these loci can shed light on the effects of maternal alcohol consumption on offspring cognitive development. Methods We used a large population based study of women recruited during pregnancy to determine whether genetic variants in alcohol metabolising genes in this cohort of women and their children were related to the child’s cognitive score (measured by the Weschler Intelligence Scale) at age 8. Findings We found that four genetic variants in alcohol metabolising genes in 4167 children were strongly related to lower IQ at age 8, as was a risk allele score based on these 4 variants. This effect was only seen amongst the offspring of mothers who were moderate drinkers (1–6 units alcohol per week during pregnancy (per allele effect estimates were −1.80 (95% CI = −2.63 to −0.97) p = 0.00002, with no effect among children whose mothers abstained during pregnancy (0.16 (95%CI = −1.05 to 1.36) p = 0.80), p-value for interaction = 0.009). A further genetic variant associated with alcohol metabolism in mothers was associated with their child’s IQ, but again only among mothers who drank during pregnancy.
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Affiliation(s)
- Sarah J Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
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Eriksen HLF, Mortensen EL, Kilburn T, Underbjerg M, Bertrand J, Støvring H, Wimberley T, Grove J, Kesmodel US. The effects of low to moderate prenatal alcohol exposure in early pregnancy on IQ in 5-year-old children. BJOG 2012; 119:1191-200. [PMID: 22712749 PMCID: PMC4471997 DOI: 10.1111/j.1471-0528.2012.03394.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the effects of low to moderate maternal alcohol consumption during early pregnancy on children's intelligence (IQ) at age 5 years. DESIGN Prospective 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 pregnancy. At 5 years of age, children were tested with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R). Parental education, maternal IQ, maternal smoking in pregnancy, the child's age at testing, gender, and tester were considered core confounding factors, whereas the full model also controlled for maternal binge drinking, age, BMI, parity, home environment, postnatal smoking in the home, health status, and indicators for hearing and vision impairments. MAIN OUTCOME MEASURES The WPPSI-R. RESULTS No differences in test performance were observed between children whose mothers reported consuming between one and four or between five and eight drinks per week at some point during pregnancy, compared with children of mothers who abstained. For women who reported consuming nine or more drinks per week no differences were observed for mean differences; however, the risks of low full-scale IQ (OR 4.6; 95% CI 1.2-18.2) and low verbal IQ (OR 5.9; 95% CI 1.4-24.9) scores, but not low performance IQ score, were increased. CONCLUSIONS Maternal consumption of low to moderate quantities of alcohol during pregnancy was not associated with the mean IQ score of preschool children. Despite these findings, acceptable levels of alcohol use during pregnancy have not yet been established, and conservative advice for women continues to be to avoid alcohol use during pregnancy.
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Affiliation(s)
- H-L Falgreen Eriksen
- Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark
| | - EL Mortensen
- Institute of Public Health and Centre for Healthy Ageing, University of Copenhagen, Copenhagen, Denmark
| | - T Kilburn
- Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark
| | - M Underbjerg
- Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark
- Children’s Neurocentre at Vejlefjord Rehabilitation Centre, Vejle, Denmark
| | - J Bertrand
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - H Støvring
- Department of Public Health, Section of Biostatistics, Aarhus University, Aarhus, Denmark
| | - T Wimberley
- Department of Public Health, Section of Biostatistics, Aarhus University, Aarhus, Denmark
| | - J Grove
- Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Biomedicine, Faculty of Health Sciences and Bioinformatics Research Centre (BiRC), Aarhus University, Aarhus, Denmark
| | - US Kesmodel
- Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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48
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Kesmodel US, Eriksen HLF, Underbjerg M, Kilburn TR, Støvring H, Wimberley T, Mortensen EL. The effect of alcohol binge drinking in early pregnancy on general intelligence in children. BJOG 2012; 119:1222-31. [PMID: 22712770 DOI: 10.1111/j.1471-0528.2012.03395.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine the effects of binge alcohol consumption during early pregnancy, including the number of binge episodes and the timing of binge drinking, on general intelligence in 5-year-old children. DESIGN Follow-up study. SETTING Neuropsychological testing in four Danish cities 2003-2008. POPULATION A cohort of 1617 women and their children sampled from the Danish National Birth Cohort. METHODS Participants were sampled on the basis of maternal alcohol consumption during pregnancy. At 5 years of age the children were tested with six subtests from the Wechsler Preschool and Primary Scale of Intelligence - Revised (WPPSI-R). Parental education, maternal IQ, prenatal maternal smoking, the child's age at testing, the gender of the child, and tester were considered core confounding factors, whereas the full model also controlled for prenatal maternal average alcohol intake, maternal age, maternal pre-pregnancy body mass index (BMI), parity, home environment, postnatal parental smoking, health status, and indicators for hearing and vision impairment. MAIN OUTCOME MEASURE WPPSI-R. RESULTS There were no systematic or significant differences in general intelligence between children of mothers reporting binge drinking and children of mothers with no binge episodes, except that binge drinking in gestational weeks 1-2 significantly reduced the risk of low, full-scale IQ (OR 0.54; 95% CI 0.31-0.96) when adjusted for core confounding factors. The results were otherwise not statistically significantly related to the number of binge episodes (with a maximum of 12) and timing of binge drinking. CONCLUSIONS We found no systematic association between binge drinking during early pregnancy and child intelligence. However, binge drinking reduced the risk of low, full-scale IQ in gestational weeks 1-2. This finding may be explained by residual confounding.
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Affiliation(s)
- U S Kesmodel
- Department of Public Health, Section of Epidemiology, Aarhus University, Denmark.
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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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50
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Skogerbø Å, Kesmodel US, Wimberley T, Støvring H, Bertrand J, Landrø NI, Mortensen EL. The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on executive function in 5-year-old children. BJOG 2012; 119:1201-10. [PMID: 22712874 DOI: 10.1111/j.1471-0528.2012.03397.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the effects of low to moderate maternal alcohol consumption and binge drinking in early pregnancy on children's executive functions at the age of 5 years. 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 drinking patterns during early pregnancy. When the children were 5 years old, the parent and teacher forms of the Behaviour Rating Inventory of Executive Function (BRIEF) were completed by the mothers and a preschool teacher. Parental education, maternal IQ, prenatal maternal smoking, the child's age at testing, and the child's gender were considered core confounding factors. The full model also included maternal binge drinking or low to moderate alcohol consumption, maternal age, parity, maternal marital status, family home environment, postnatal parental smoking, pre-pregnancy maternal body mass index (BMI), and the health status of the child. MAIN OUTCOME MEASURES The BRIEF parent and teacher forms. RESULTS Adjusted for all potential confounding factors, no statistically significant associations between maternal low to moderate average weekly consumption and BRIEF index scores were observed.In adjusted analyses, binge drinking in gestational week 9 or later was significantly associated with elevated Behavioural Regulation Index parent Scores (2.04, 95% CI 0.33–3.76), and with the risk of high scores on the Metacognitive Index assessed by the teacher (OR 2.06, 95% CI 1.01–4.23) [corrected]. CONCLUSIONS This study did not observe significant effects of low to moderate alcohol consumption during pregnancy on executive functioning at the age of 5 years. Furthermore, only weak and no consistent associations between maternal binge drinking and executive functions were observed.
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Affiliation(s)
- Å Skogerbø
- Institute of Public Health, University of Copenhagen, Denmark
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