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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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
PURPOSE Although abstinence is recommended in pregnancy, many pregnancies are exposed to alcohol. Observational studies of the effects of low to moderate prenatal alcohol exposure (PAE) and neurodevelopmental outcomes have yielded inconsistent results, with some studies finding an increased risk of adverse neurobehavioral and cognitive outcomes, and other studies finding no changes or reduced risk of the same outcomes. The purpose of this narrative review is to summarize these inconsistencies and apply a methodological framework to discuss how different parameters contribute to the findings. The authors also provide recommendations on how to advance future research in this area. SEARCH METHODS The PubMed, Web of Science, and Embase databases were searched, along with reference lists of selected systematic reviews and meta-analyses. Search terms used were (infant or child or children or adolescent or offspring) AND (low or light or mild or moderate or low-to-moderate) AND (drinking or alcohol or drinks) AND (pregnancy or prenatal or fetal) AND (neurodevelopment or behavioral or psychological or cognitive or developmental) NOT (mice or rat or fish or animal) NOT (meta-analysis or review). Peer-reviewed original research studies were included if they analyzed associations between an exposure defined and characterized as low/light or moderate PAE with offspring neurodevelopmental outcomes. Animal studies, studies that did not provide clear cutoff points to classify PAE categories, studies lacking an abstinence control group, and studies that did not present a multivariable-adjusted measure of association were excluded. SEARCH RESULTS The searches identified 2,422 papers, with 36 papers meeting eligibility criteria. These studies were carried out across nine countries and included samples ranging from approximately 500 to 40,000 participants. Cognitive, academic, socioemotional, and behavioral outcomes were assessed from infancy through age 19. DISCUSSION AND CONCLUSION When the findings from the selected articles were summarized by geographic region, exposure definition, or neurodevelopmental outcome, no consistent observations or patterns emerged between low to moderate PAE and offspring outcomes. Although some studies found positive (i.e., beneficial) associations between low to moderate PAE and outcomes (primarily outcomes related to cognition) and others found negative (i.e., detrimental) associations (primarily for behavioral outcomes), most findings were null (i.e., showed no effect of PAE). The heterogeneity in study results is likely due to methodological issues, including residual confounding, effect measure modification, and exposure misclassification that make synthesis of studies difficult. Alternative study designs, including longitudinal trajectory analysis, sibling design, negative controls, and instrumental variable analyses, may reduce biases and are discussed. To date, the consequences of light to moderate levels of PAE on neurodevelopment remain unresolved; studies that advance methodological rigor will be important contributions to the field.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Shana Hayes
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Erin Delker
- Department of Pediatrics, University of California San Diego, La Jolla, California
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2
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Young SL, Steane SE, Kent NL, Reid N, Gallo LA, Moritz KM. Prevalence and Patterns of Prenatal Alcohol Exposure in Australian Cohort and Cross-Sectional Studies: A Systematic Review of Data Collection Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13144. [PMID: 36293721 PMCID: PMC9603223 DOI: 10.3390/ijerph192013144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
This study sought to determine data collection approaches in Australian cohort studies and explore the potential impact on reported prenatal alcohol exposure (PAE) prevalence and patterns. Inclusion criteria were that studies related to a general Australian antenatal population where PAE was assessed and reported. Studies were excluded if they were not peer reviewed, examined the prevalence of PAE in pregnancies complicated by alcohol-use disorders, or were published in a language other than English. A systematic search of five electronic databases (PubMed, Embase, CINAHL, Web of Science, and Scopus) was conducted. Risk of bias was assessed using the Effective Public Health Practice Project quality assessment tool. Results were synthesised using MetaXL. Data from 16 separate birth cohorts (n = 78 articles) were included. Included cohorts were either general cohorts that included alcohol as a variable or alcohol-focused cohorts that were designed with a primary focus on PAE. PAE prevalence was estimated as 48% (95% CI: 38 to 57%). When subgroup analysis was performed, estimates of PAE prevalence when self-administered surveys and interviews were used for data collection were 53% (95% CI: 41% to 64%) and 43% (95% CI: 28% to 59%), respectively. Use of trained assessors was an influencing factor of the prevalence estimates when data were collected via interview. Alcohol-focused studies reported higher prevalence of PAE, regardless of method of survey administration. Where interviewer training is not possible, self-administered questionnaires will likely provide the most reliable PAE estimates. No funding sources are relevant to mention. Review was registered with PROSPERO (CRD42020204853).
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Affiliation(s)
- Sophia L. Young
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Sarah E. Steane
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Nykola L. Kent
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Linda A. Gallo
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Petrie, QLD 4502, Australia
| | - Karen M. Moritz
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
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3
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Kar P, Reynolds JE, Gibbard WB, McMorris C, Tortorelli C, Lebel C. Trajectories of brain white matter development in young children with prenatal alcohol exposure. Hum Brain Mapp 2022; 43:4145-4157. [PMID: 35596624 PMCID: PMC9374879 DOI: 10.1002/hbm.25944] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/08/2022] [Accepted: 04/16/2022] [Indexed: 12/22/2022] Open
Abstract
Prenatal alcohol exposure (PAE) is associated with alterations to brain white matter microstructure. Previous studies of PAE have demonstrated different findings in young children compared to older children and adolescents, suggesting altered developmental trajectories and highlighting the need for longitudinal research. 122 datasets in 54 children with PAE (27 males) and 196 datasets in 89 children without PAE (45 males) were included in this analysis. Children underwent diffusion tensor imaging between 2 and 8 years of age, returning approximately every 6 months. Mean fractional anisotropy (FA) and mean diffusivity (MD) were obtained for 10 major brain white matter tracts and examined for age-related changes using linear mixed effects models with age, sex, group (PAE vs. control) and an age-by-group interaction. Children with PAE had slower decreases of MD over time in the genu of the corpus callosum, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus. No significant age-by-group interactions were noted for FA. These findings show slower white matter development in young children with PAE than in unexposed controls. This connects previous cross-sectional findings of lower MD in young children with PAE to findings of higher MD in older children and adolescents with PAE, and further helps to understand brain development in children with PAE. This deviation from typical development trajectories may reflect altered brain plasticity, which has implications for cognitive and behavioral learning in children with PAE.
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Affiliation(s)
- Preeti Kar
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Jess E Reynolds
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - William Ben Gibbard
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Carly McMorris
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | | | - Catherine Lebel
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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4
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Kippin NR, Leitão S, Watkins R, Finlay‐Jones A. Oral and written communication skills of adolescents with prenatal alcohol exposure (PAE) compared with those with no/low PAE: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:694-718. [PMID: 34137136 PMCID: PMC9292204 DOI: 10.1111/1460-6984.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/21/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) is associated with growth deficits and neurodevelopmental impairment including foetal alcohol spectrum disorder (FASD). Difficulties with oral and written communication skills are common among children with PAE; however, less is known about how communication skills of adolescents who have PAE compare with those who do not. Adolescence is a critical time for development, supporting the transition into adulthood, but it is considered a high-risk period for those with FASD. AIMS We conducted a systematic review to synthesize evidence regarding oral and written communication skills of adolescents with PAE or FASD and how they compare with those with no PAE. METHODS & PROCEDURES A comprehensive search strategy used seven databases: Cochrane Library, Cinahl, Embase, Medline, PsycInfo, Eric and Web of Science. Included studies reported on at least one outcome related to oral and written communication for a PAE (or FASD) group as well as a no/low PAE group, both with age ranges of 10-24 years. Quality assessment was undertaken. MAIN CONTRIBUTION Communication skills most often assessed in the seven studies included in this review were semantic knowledge, semantic processing, and verbal learning and memory. These communication skills, in addition to reading and spelling, were commonly weaker among adolescents with PAE compared with those with no/low PAE. However, the findings were inconsistent across studies, and studies differed in their methodologies. CONCLUSIONS & IMPLICATIONS Our results emphasize that for adolescents with PAE, communication skills in both oral and written modalities should be comprehensively understood in assessment and when planning interventions. A key limitation of the existing literature is that comparison groups often include some participants with a low level of PAE, and that PAE definitions used to allocate participants to groups differ across studies. WHAT THIS PAPER ADDS What is already known on the subject PAE and FASD are associated with deficits in oral and written communication skills. Studies to date have mostly focused on children with a FASD diagnosis as well as combined groups of children and adolescents with FASD or PAE. There is a gap in what is known about oral and written communication skills of adolescents, specifically, who have PAE or FASD. This has implications for the provision of assessment and supports during a period of increased social and academic demands. What this study adds to existing knowledge This review provides systematic identification, assessment and synthesis of the current literature related to oral and written communication skills of adolescents with PAE compared with those with no/low PAE. The review revealed a small knowledge base with inconsistent methodologies and findings across studies. However, the findings overall highlight that adolescents with PAE have weaker skills in oral and written language than those with no/low PAE. Results are discussed in relation to education, social and emotional well-being, and forensic contexts. What are the potential or actual clinical implications of this work? Findings emphasize that for adolescents with PAE, comprehensive assessment of both oral and written communication skills, through both standardized and functional tasks, should be undertaken. Speech-language pathologists have a key role in assessment with individuals who have PAE.
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Affiliation(s)
- Natalie R. Kippin
- Telethon Kids InstitutePerth Children's HospitalPerthWAAustralia
- Curtin School of Allied HealthCurtin UniversityPerthWAAustralia
| | - Suze Leitão
- Telethon Kids InstitutePerth Children's HospitalPerthWAAustralia
- Curtin School of Allied HealthCurtin UniversityPerthWAAustralia
| | - Rochelle Watkins
- Telethon Kids InstitutePerth Children's HospitalPerthWAAustralia
| | - Amy Finlay‐Jones
- Telethon Kids InstitutePerth Children's HospitalPerthWAAustralia
- School of PsychologyCurtin UniversityPerthWAAustralia
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Pyman P, Collins SE, Muggli E, Testa R, Anderson PJ. Cognitive and Behavioural Attention in Children with Low-Moderate and Heavy Doses of Prenatal Alcohol Exposure: a Systematic Review and Meta-analysis. Neuropsychol Rev 2021; 31:610-627. [PMID: 33656703 DOI: 10.1007/s11065-021-09490-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/18/2021] [Indexed: 01/02/2023]
Abstract
Attention problems are thought to be a hallmark feature of prenatal alcohol exposure (PAE). Despite decades of research however, these findings have never been pooled to assess the association between PAE and the different domains of attention functioning. This systematic review and meta-analysis aimed to examine the relationships between low-moderate, binge and heavy PAE with domains of attention functioning (encode, focus, shift, sustain and behavioural) in children. Thirteen studies compared children with PAE to abstinent controls. A significant adverse effect of any PAE on shifting attention (Cohen's d = -0.61), and a trend towards an adverse effect of heavy PAE on encoding attention (Cohen's d = -0.79) were identified. Compared to controls, there were trends showing that low-moderate PAE (odds ratio = 1.21) was associated with greater odds of behavioural attention problems. Remaining analyses were limited by insufficient studies or were non-significant. In summary, a vulnerability of higher-level attention skills to PAE was found. Urgent investigation into the effects of low to moderate PAE is needed given the prevalence of this drinking pattern, trends towards behavioural attention problems, the lack of comprehensive and high-quality research and the known impacts of attention difficulties on academic and social development in children.
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Affiliation(s)
- Philippa Pyman
- Monash University, Turner Institute for Brain and Mental Health, Melbourne, VIC, Australia. .,Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Simonne E Collins
- Monash University, Turner Institute for Brain and Mental Health, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Evelyne Muggli
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Renee Testa
- Department of Mental Health, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter J Anderson
- Monash University, Turner Institute for Brain and Mental Health, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Römer P, Mathes B, Reinelt T, Stoyanova P, Petermann F, Zierul C. Systematic review showed that low and moderate prenatal alcohol and nicotine exposure affected early child development. Acta Paediatr 2020; 109:2491-2501. [PMID: 32603488 DOI: 10.1111/apa.15453] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
AIM We systematically reviewed the literature on the influence of low and moderate amounts of prenatal alcohol and nicotine exposure on early child development. This paper also suggests possible directions for future research in order to tackle the controversial findings identified. METHODS The PubMed and Web of Science electronic databases were searched together with the reference lists of the selected papers. Empirical studies were included if they focused on the effects of low or moderate exposure, reported outcomes on child development within the first 2 years of life and were published in English between January 2009 and December 2019. The eligibility of the included studies was based on three authors reading the full text. RESULTS The final sample comprised 17 papers. Of these, 13 focused on the effects of prenatal alcohol exposure and they reported decreased sensory sensibility, smaller body sizes and increased cognitive capacities. The other four looked at prenatal nicotine exposure, and they primarily found impairments in children's orienting, communication and motor skills. CONCLUSION Any amount of prenatal alcohol and nicotine exposure appeared to risk healthy child development. There were many reasons for consumption and numerous effects on the child, but representative data from interdisciplinary research were missing.
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Affiliation(s)
- Pia Römer
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Birgit Mathes
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Tilman Reinelt
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Polina Stoyanova
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Franz Petermann
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Claudia Zierul
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
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A Case for Early Screening: Prenatal Alcohol Risk Exposure Predicts Risk for Early Childhood Communication Delays. J Dev Behav Pediatr 2020; 41:559-564. [PMID: 32412992 DOI: 10.1097/dbp.0000000000000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Studies have confirmed the detrimental effects of prenatal alcohol exposure on language development in children. Little is known about the ability of prenatal alcohol risk (PAR) screening measures to predict language or other neurodevelopmental delays in young children, however. The intent of this study is to identify whether PAR predicts communication development in children at 12, 24, and 36 months of age. METHOD Data from 772 women and their children who participated in the All Our Families pregnancy cohort were analyzed. Respondents completed the T-ACE, a validated screening tool for detecting PAR. Communication development in children was measured through the Ages and Stages Questionnaire, Third Edition. Logistic regression was used to generate odds ratios and 95% confidence intervals. RESULTS A positive screen for PAR places a child at risk for communication delay (≤1 SD below mean) by approximately 1.5-fold at 12, 24, and 36 months of age, even after adjustment for demographic variables. Follow-up analysis revealed a significant difference in the prevalence of risk for communication delays between 12 and 24 months and between 24 and 36 months in both low- and high-risk drinking groups, with 24-month-old children showing the greatest risk for delay. CONCLUSION The results of this study suggest that screening for PAR in expectant mothers may identify a group of young children at increased risk for communication delays. This research carries clinical implications and provides support for PAR screening in informing early childhood developmental screening efforts.
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8
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Birth and early developmental screening outcomes associated with cannabis exposure during pregnancy. J Perinatol 2020; 40:473-480. [PMID: 31911642 PMCID: PMC7047636 DOI: 10.1038/s41372-019-0576-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/29/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare birth and early developmental screening outcomes for infants with and without in utero cannabis exposures. STUDY DESIGN Observational cohort of women receiving prenatal care within a large health system, live birth between October 1, 2015 and December 1, 2017, and at least one infant visit. Cannabis exposure was through routine urine toxicology screen. Preterm birth, small for gestational age (SGA) birth, birth defects, and early developmental screening outcomes were assessed from birth and electronic health record data. RESULTS Of 3435 women, 283 (8.2%) had a positive urine toxicology screen. In utero cannabis exposure was associated with SGA birth, adjusted rate ratio (aRR) 1.69 (95% confidence interval [CI]: 1.22-2.34). Abnormal 12-month developmental screens occurred in 9.1% of infants with in utero cannabis exposure vs. 3.6% of those with negative maternal screens, aRR 1.90 (95% CI: 0.92-3.91). Additional birth outcomes were not associated with in utero cannabis exposure. CONCLUSIONS Exposure to cannabis during pregnancy may adversely impact fetal growth.
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Hendricks G, Malcolm-Smith S, Stein DJ, Zar HJ, Wedderburn CJ, Nhapi RT, Chivese T, Adnams CM, Donald KA. Prenatal alcohol exposure is associated with early motor, but not language development in a South African cohort. Acta Neuropsychiatr 2020; 32:1-8. [PMID: 31902391 PMCID: PMC7282868 DOI: 10.1017/neu.2019.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the association of prenatal alcohol exposure (PAE) and early neurodevelopment in the first 2 years of life, adjusting for maternal socio-demographic and psychosocial factors, in the Drakenstein Child Health Study (DCHS), a South African birth cohort study. METHODS The DCHS comprises a population-based birth cohort of 1143 children, of which a subsample completed the Bayley Scales of Infant Development-III (BSID-III) at 6 (n = 260) and 24 months of age (n = 734). A subset of alcohol-exposed and -unexposed children was included in this analysis at age 6 (n = 52 exposed; n = 104 unexposed) and 24 months (n = 92 exposed; n = 184 unexposed). Multiple hierarchical regression was used to explore the associations of PAE with motor and language development. RESULTS PAE was significantly associated with decreased gross motor [odds ratio (OR) = 0.16, 95% confidence interval (CI) = 0.06-0.44, p = 0.001] or fine motor (OR = 0.16, 95% CI = 0.06-0.46, p = 0.001) functioning after adjusting for maternal socio-demographic and psychosocial factors at 6 months of age only. No significant effects were found in either receptive or expressive communication and cognitive outcomes at either time points. CONCLUSION PAE has potentially important consequences for motor development in the first 2 years of life, a period during which the most rapid growth and maturation occur. These findings highlight the importance of identifying high-risk families in order to provide preventive interventions, particularly in antenatal clinics and early intervention services.
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Affiliation(s)
- Gaironeesa Hendricks
- Department of Psychiatry and Mental Health, and SAMRC Unit on Risk and Resilience, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Susan Malcolm-Smith
- Department of Psychology, Applied Cognitive Science and Experimental Neuropsychology Team, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, and SAMRC Unit on Risk and Resilience, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- SAMRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Catherine J. Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Raymond T. Nhapi
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Tawanda Chivese
- Department of Population Health, College of Medicine, Qatar University, Doha, Qatar
| | - Colleen M. Adnams
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kirsten A. Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Subramoney S, Eastman E, Adnams C, Stein DJ, Donald KA. The Early Developmental Outcomes of Prenatal Alcohol Exposure: A Review. Front Neurol 2018; 9:1108. [PMID: 30619064 PMCID: PMC6305542 DOI: 10.3389/fneur.2018.01108] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/04/2018] [Indexed: 02/05/2023] Open
Abstract
Aim: This paper systematically reviews the literature on the effects of prenatal alcohol exposure on early child development from birth to 5 years with the aim to synthesize the developmental outcomes associated with prenatal alcohol exposure, and inform further research to improve our knowledge of the manifestations of prenatal alcohol exposure. Methods: Electronic databases (MEDLINE, Psych INFO, and Psych ARTICLES) were searched to find papers on the developmental outcomes of prenatal alcohol exposure in neonates, infants and toddlers and pre-school aged children. Studies were selected based on participants self-reporting alcohol consumption during pregnancy (either prospectively or retrospectively) and/or children being diagnosed with FASD based on a standardized assessment that includes a dysmorphology examination. The search was limited to peer-reviewed, English language studies involving human subjects, up to 5.5 years old. Results: Out of the 1,684 titles screened, a total of 71 papers were identified as relevant and included in this review. The majority of studies were prospective longitudinal studies. A range of assessment modalities (or tools) was used to determine neurodevelopmental outcomes of prenatal exposure to alcohol in the age group under review, the most frequently described being the Bayley Scales of Infant and Toddler Development (BSID) (n = 19). Studies varied in terms of the dose, frequency, and timing of alcohol consumption during pregnancy and methodology used to assess alcohol consumption. Findings demonstrate extensive evidence for poor global developmental outcomes in children prenatally exposed to alcohol, particularly with moderate to severe levels of prenatal alcohol exposure. Conclusion: The outcomes related to lower levels of prenatal alcohol exposure as well as outcomes in specific developmental domains, are poorly understood. Further research should aim to clarify the more subtle or less easily measurable manifestations of prenatal alcohol exposure on early development when the potential for greatest impact of interventions is highest.
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Affiliation(s)
- Sivenesi Subramoney
- Division of Developmental Pediatrics, Department of Pediatrics, and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Emma Eastman
- Division of Developmental Pediatrics, Department of Pediatrics, and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Colleen Adnams
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Kirsten A. Donald
- Division of Developmental Pediatrics, Department of Pediatrics, and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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11
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Sylvestre A, Desmarais C, Meyer F, Bairati I, Leblond J. Prediction of the outcome of children who had a language delay at age 2 when they are aged 4: Still a challenge. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:731-744. [PMID: 28766373 DOI: 10.1080/17549507.2017.1355411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/05/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This study investigated the role that variables related to children and their environment play in the prediction of outcomes at 4 years of age for children with a language delay at 2 years. METHOD A longitudinal study was undertaken where 64 children (45 boys, 19 girls; mean age = 53.3 months; SD = 4.4) with language delay at age 2 years were re-evaluated at age 4 years. Three developmental trajectories were analysed. RESULT The early stages of grammar, as estimated by mean length of utterance at 3.5 years, are an important prognosis factor of subsequent language impairment (LI). Children who are exposed to several risk factors simultaneously are more likely to have a language delay (LD) or a LI, but the profile of LD children is more akin to that of the typically developing (TD) children. Children with LI tend to have profiles with a greater number of risk factors. CONCLUSION The results of this study encourage different intervention approaches depending on the child's language profile at 2 years, due to differing language prognosis. The results also point to the need to assess the child's environment. Future studies with large diverse population samples may give more precise information on potential risk factors and their cumulative effect.
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Affiliation(s)
- Audette Sylvestre
- a Département de Réadaptation, Programme de Maîtrise en Orthophonie , Université Laval , Québec , Canada
- b Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Université Laval , Québec , Canada
| | - Chantal Desmarais
- a Département de Réadaptation, Programme de Maîtrise en Orthophonie , Université Laval , Québec , Canada
- b Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Université Laval , Québec , Canada
| | - François Meyer
- c Département de Médecine Sociale et Préventive , Université Laval , Québec , Canada
- d Centre de Recherche L'Hôtel-Dieu-de-Québec, Université Laval , Québec , Canada
| | - Isabelle Bairati
- e Département de chirurgie , Université Laval , Québec , Canada , and
- f Direction de Santé Publique de la Capitale-Nationale , Québec , Canada
| | - Jean Leblond
- b Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Université Laval , Québec , Canada
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12
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Sundelin-Wahlsten V, Hallberg G, Helander A. Higher alcohol consumption in early pregnancy or low-to-moderate drinking during pregnancy may affect children's behaviour and development at one year and six months. Acta Paediatr 2017; 106:446-453. [PMID: 27859634 DOI: 10.1111/apa.13664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 10/01/2016] [Accepted: 11/07/2016] [Indexed: 02/01/2023]
Abstract
AIM It is unclear whether low-to-moderate alcohol consumption during pregnancy affects child development. This study examined the effects that a mother's self-reported alcohol consumption had on her pregnancy and her child's birth, behaviour and development. METHODS We asked 291 Swedish women to report their alcohol consumption before and during pregnancy using the Alcohol Use Disorders Identification Test (AUDIT); provide data on their pregnancy, labour and neonatal period; and complete a child behaviour and development questionnaire when their child was one year and six months of age. The mothers were separated into four subgroups based on their AUDIT scores. RESULTS There were no group differences in gestational length, but children were shorter at birth if their mother drank during pregnancy. Mothers with the highest alcohol consumption before pregnancy were generally younger and more likely to smoke, have unplanned pregnancies and have children who displayed behavioural problems than controls who reported abstinence before and during pregnancy. Mothers who drank more during pregnancy than before were more likely to have had abortions and unplanned pregnancies and less likely to breastfeed for more than six months. CONCLUSION Our results suggested that low-to-moderate alcohol consumption during pregnancy may negatively influence a child's development and behaviour in several ways.
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Affiliation(s)
- Viveka Sundelin-Wahlsten
- Unit of Child and Adolescent Psychiatry; Department of Neuroscience; Uppsala University; Uppsala Sweden
| | - Gunilla Hallberg
- Unit of Obstetrics and Gynecology; Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Anders Helander
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
- Karolinska University Laboratory Huddinge; Stockholm Sweden
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13
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du Plooy CP, Malcolm-Smith S, Adnams CM, Stein DJ, Donald KA. The Effects of Prenatal Alcohol Exposure on Episodic Memory Functioning: A Systematic Review: Table 1. Arch Clin Neuropsychol 2016; 31:710-726. [DOI: 10.1093/arclin/acw067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 01/04/2023] Open
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14
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Wallace IF, Berkman ND, Watson LR, Coyne-Beasley T, Wood CT, Cullen K, Lohr KN. Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review. Pediatrics 2015; 136:e448-62. [PMID: 26152671 DOI: 10.1542/peds.2014-3889] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES No recommendation exists for or against routine use of brief, formal screening instruments in primary care to detect speech and language delay in children through 5 years of age. This review aimed to update the evidence on screening and treating children for speech and language since the 2006 US Preventive Services Task Force systematic review. METHODS Medline, the Cochrane Library, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and reference lists. We included studies reporting diagnostic accuracy of screening tools and randomized controlled trials reporting benefits and harms of treatment of speech and language. Two independent reviewers extracted data, checked accuracy, and assigned quality ratings using predefined criteria. RESULTS We found no evidence for the impact of screening on speech and language outcomes. In 23 studies evaluating the accuracy of screening tools, sensitivity ranged between 50% and 94%, and specificity ranged between 45% and 96%. Twelve treatment studies improved various outcomes in language, articulation, and stuttering; little evidence emerged for interventions improving other outcomes or for adverse effects of treatment. Risk factors associated with speech and language delay were male gender, family history, and low parental education. A limitation of this review is the lack of well-designed, well-conducted studies addressing whether screening for speech and language delay or disorders improves outcomes. CONCLUSIONS Several screening tools can accurately identify children for diagnostic evaluations and interventions, but evidence is inadequate regarding applicability in primary care settings. Some treatments for young children identified with speech and language delays and disorders may be effective.
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Affiliation(s)
- Ina F Wallace
- RTI International, Research Triangle Park, North Carolina; and
| | - Nancy D Berkman
- RTI International, Research Triangle Park, North Carolina; and
| | | | - Tamera Coyne-Beasley
- Departments of Pediatrics, and Internal Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | | | - Kathleen N Lohr
- RTI International, Research Triangle Park, North Carolina; and
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15
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Niclasen J, Andersen AMN, Strandberg-Larsen K, Teasdale TW. Is alcohol binge drinking in early and late pregnancy associated with behavioural and emotional development at age 7 years? Eur Child Adolesc Psychiatry 2014; 23:1175-80. [PMID: 24390718 DOI: 10.1007/s00787-013-0511-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/22/2013] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to investigate associations of maternal binge drinking in early and late pregnancy with child behavioural and emotional development at age seven. It was hypothesised that late exposure is associated with more negative outcomes than early exposure. Differences were expected on the continuous outcome measures, but not on above cutoff scale scores. Data were derived from the Danish National Birth Cohort. Three exposure groups were defined according to binge drinking from three interviews regarding binge episodes in early, middle and late pregnancy. A 'no binge' group included women with no binge episodes reported in any of the interviews, the 'early bingers' reported episodes in the first interview only, and the 'late bingers' in the last part of pregnancy only. The outcome measure was the Strengths and Difficulties Questionnaire (SDQ) used as continuous externalising/internalising scores and above cutoff hyperactivity/inattention, conduct, emotional and peer problems scores. Only women with full information concerning binge drinking from the three interviews, together with full-scale SDQ information on their children at age seven and being term-born, were included in the study (N = 37,315). After adjustment for maternal education, psychiatric diagnoses, age and smoking, children exposed to binge drinking in early and late pregnancy had significantly higher mean externalizing scores at age seven than unexposed children, an effect albeit much less for early binge drinking (relative change in mean 1.02, CI 1.00-1.05) than for late binge drinking (relative change in mean 1.21, CI 1.04-1.42). No associations were observed for any of the above cutoff outcomes. Exposure to binge drinking in early and late pregnancy is associated with elevated externalising scores, particularly so in late pregnancy. No increased risk for any of the above cutoff scale scores was observed.
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Affiliation(s)
- Janni Niclasen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K, Denmark,
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16
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Watkins RE, Elliott EJ, Wilkins A, Latimer J, Halliday J, Fitzpatrick JP, Mutch RC, O'Leary CM, Burns L, McKenzie A, Jones HM, Payne JM, D'Antoine H, Miers S, Russell E, Hayes L, Carter M, Bower C. Fetal alcohol spectrum disorder: development of consensus referral criteria for specialist diagnostic assessment in Australia. BMC Pediatr 2014; 14:178. [PMID: 25005425 PMCID: PMC4123492 DOI: 10.1186/1471-2431-14-178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is known to be under-recognised in Australia. The use of standard methods to identify when to refer individuals who may have FASD for specialist assessment could help improve the identification of this disorder. The purpose of this study was to develop referral criteria for use in Australia. METHOD An online survey about FASD screening and diagnosis in Australia, which included 23 statements describing criteria for referral for fetal alcohol syndrome (FAS) and FASD based on published recommendations for referral in North America, was sent to 139 health professionals who had expertise or involvement in FASD screening or diagnosis. Survey findings and published criteria for referral were subsequently reviewed by a panel of 14 investigators at a consensus development workshop where criteria for referral were developed. RESULTS Among the 139 health professionals who were sent the survey, 103 (74%) responded, and 90 (65%) responded to the statements on criteria for referral. Over 80% of respondents agreed that referral for specialist evaluation should occur when there is evidence of significant prenatal alcohol exposure, defined as 7 or more standard drinks per week and at least 3 standard drinks on any one day, and more than 70% agreed with 13 of the 16 statements that described criteria for referral other than prenatal alcohol exposure. Workshop participants recommended five independent criteria for referral: confirmed significant prenatal alcohol exposure; microcephaly and confirmed prenatal alcohol exposure; 2 or more significant central nervous system (CNS) abnormalities and confirmed prenatal alcohol exposure; 3 characteristic FAS facial anomalies; and 1 characteristic FAS facial anomaly, growth deficit and 1 or more CNS abnormalities. CONCLUSION Referral criteria recommended for use in Australia are similar to those recommended in North America. There is a need to develop resources to raise awareness of these criteria among health professionals and evaluate their feasibility, acceptability and capacity to improve the identification of FASD in Australia.
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Affiliation(s)
- Rochelle E Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
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Kodituwakku P, Kodituwakku E. Cognitive and Behavioral Profiles of Children with Fetal Alcohol Spectrum Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2014. [DOI: 10.1007/s40474-014-0022-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Peyre H, Bernard JY, Forhan A, Charles MA, De Agostini M, Heude B, Ramus F. Predicting changes in language skills between 2 and 3 years in the EDEN mother-child cohort. PeerJ 2014; 2:e335. [PMID: 24749012 PMCID: PMC3976115 DOI: 10.7717/peerj.335] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/16/2014] [Indexed: 11/20/2022] Open
Abstract
Objective. To examine the factors predicting changes in language skills between 2 and 3 years. Methods. By using longitudinal data concerning 1002 children from the EDEN study, linear regression was used to predict 3-year language performance from 2-year language performance and the risk factors associated with language delays. Logistic regressions were performed to examine two change trajectories: children who fall below the 10th percentile of language skills between 2 and 3 years (declining trajectory), and those who rose above the 10th percentile (resilient trajectory). Results. The final linear model accounted for 43% of the variance in 3-year language scores, with 2-year language scores accounting for 22%. Exposure to alcohol during pregnancy, earlier birth term, lower level of parental education and lower frequency of maternal stimulation were associated with the declining trajectory. Breastfeeding was associated with the resilient trajectory. Conclusions. This study provides a better understanding of the natural history of early language delays by identifying biological and social factors that predict changes in language skills between the ages of 2 and 3 years.
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Affiliation(s)
- Hugo Peyre
- Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Supérieure, CNRS, EHESS , Paris , France ; Hôpital Robert Debré, Service de Psychopathologie de l'Enfant et de l'Adolescent, APHP , Paris , France
| | - Jonathan Y Bernard
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), Epidemiology of Diabetes and Renal Diseases Lifelong Approach Team , Villejuif , France ; University Paris-Sud, UMRS , Villejuif , France
| | - Anne Forhan
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), Epidemiology of Diabetes and Renal Diseases Lifelong Approach Team , Villejuif , France ; University Paris-Sud, UMRS , Villejuif , France
| | - Marie-Aline Charles
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), Epidemiology of Diabetes and Renal Diseases Lifelong Approach Team , Villejuif , France ; University Paris-Sud, UMRS , Villejuif , France
| | - Maria De Agostini
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), Epidemiology of Diabetes and Renal Diseases Lifelong Approach Team , Villejuif , France ; University Paris-Sud, UMRS , Villejuif , France
| | - Barbara Heude
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), Epidemiology of Diabetes and Renal Diseases Lifelong Approach Team , Villejuif , France ; University Paris-Sud, UMRS , Villejuif , France
| | - Franck Ramus
- Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Supérieure, CNRS, EHESS , Paris , France
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O'Keeffe LM, Greene RA, Kearney PM. The effect of moderate gestational alcohol consumption during pregnancy on speech and language outcomes in children: a systematic review. Syst Rev 2014; 3:1. [PMID: 24383422 PMCID: PMC3892059 DOI: 10.1186/2046-4053-3-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 12/05/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Consensus has not been reached on safe alcohol consumption recommendations during pregnancy. The National Institutes for Care and Health Excellence (NICE) in the UK suggest that one to two drinks not more than twice per week is safe. However, the speech and language effects of even low levels of alcohol use among offspring are unknown. The aim of this study was to review systematically the evidence on studies of the effect of low to moderate levels of alcohol consumption during pregnancy (up to 70 grams of alcohol per week) compared to abstinence on speech and language outcomes in children. METHODS Using medical subject headings, PubMed, Web of knowledge, Scopus, Embase, Cinahl and the Cochrane Library were searched from their inception up to March 2012. Case control and cohort studies were included. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality. RESULTS A total of 1,397 titles and abstracts were reviewed of which 51 full texts were retrieved. Three cohort studies totaling 10,642 women met the inclusion criteria. All three studies, (United States (2) and Australia (1)) indicated that language was not impaired as a result of low to moderate alcohol consumption during pregnancy. Two studies were judged to be of low quality based on a six-item bias classification tool. Due to heterogeneity, results could not be meta-analyzed. CONCLUSION Studies included in this review do not provide sufficient evidence to confirm or refute an association between low to moderate alcohol use during pregnancy and speech and language outcomes in children. High quality, population based studies are required to establish the safety of low to moderate levels of alcohol use such as those set out by the NICE guidelines in the UK.
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Affiliation(s)
- Linda M O'Keeffe
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland.
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20
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Glass L, Ware AL, Mattson SN. Neurobehavioral, neurologic, and neuroimaging characteristics of fetal alcohol spectrum disorders. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:435-462. [PMID: 25307589 DOI: 10.1016/b978-0-444-62619-6.00025-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Alcohol consumption during pregnancy can have deleterious consequences for the fetus, including changes in central nervous system development leading to permanent neurologic alterations and cognitive and behavioral deficits. Individuals affected by prenatal alcohol exposure, including those with and without fetal alcohol syndrome, are identified under the umbrella of fetal alcohol spectrum disorders (FASD). While studies of humans and animal models confirm that even low to moderate levels of exposure can have detrimental effects, critical doses of such exposure have yet to be specified and the most clinically significant and consistent consequences occur following heavy exposure. These consequences are pervasive, devastating, and can result in long-term dysfunction. This chapter summarizes the neurobehavioral, neurologic, and neuroimaging characteristics of FASD, focusing primarily on clinical research of individuals with histories of heavy prenatal alcohol exposure, although studies of lower levels of exposure, particularly prospective, longitudinal studies, will be discussed where relevant.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Ashley L Ware
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Sarah N Mattson
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA.
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21
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McBride N. Alcohol use during pregnancy: considerations for Australian policy. SOCIAL WORK IN PUBLIC HEALTH 2014; 29:540-548. [PMID: 25144696 DOI: 10.1080/19371918.2014.890150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 01/29/2014] [Indexed: 06/03/2023]
Abstract
Although there is an extensive recorded history of concerns related to alcohol exposed pregnancies and possible outcomes of fetal alcohol spectrum disorder in recent scientific literature, Australia has only recently begun to accurately or systematically diagnose and record these conditions, or to provide comprehensive, coordinated, policy-guided funding, prevention, and treatment. This article discusses some considerations that can guide policy development within the Australian context including the social context and determinates of alcohol consumption during pregnancy and the need to consider the issue as one that goes beyond the decision making of individual women. The article also identifies the contribution of research to guide evidence-based policy development, including emerging evidence of epigenetics, and systematic reviews for prevention. Other policy considerations include costs, and the possibility of the prevention paradox applying to this field, with its associated impact on costs and focus of prevention.
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Affiliation(s)
- Nyanda McBride
- a National Drug Research Institute, Health Sciences, Curtin University , Perth , Australia
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22
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Niclasen J. Drinking or not drinking in pregnancy: the multiplicity of confounding influences. Alcohol Alcohol 2013; 49:349-55. [PMID: 24105631 DOI: 10.1093/alcalc/agt141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Studies investigating associations between prenatal exposure to low-moderate doses of alcohol and mental health development in childhood are inconsistent. The aim of the present study was to compare women who drink and who do not drink alcohol in pregnancy on a number of potential confounding variables, and to investigate whether any latent variables could be identified among these. METHODS Data were obtained from the Danish National Birth Cohort. EXPOSURE cumulated alcohol intake in full pregnancy (n = 63,464). The women were subdivided into intake groups 0, >0-10, >10-30, >30-90 and >90 units of alcohol in full pregnancy. Hereafter, the abstainers were subdivided into an all-time and a pregnancy-abstaining group, and the high intakers (>90) were subdivided into a high (>90-180) and a very high (>180) intake group. OUTCOME self-reported and register-based information on socio-demographic and lifestyle factors, and latent variables from an exploratory factor analysis. RESULTS Significant differences were observed between the intake groups on virtually all parameters. Significant differences were observed between the abstaining groups and the high-intake groups. The exploratory factor analyses identified a number of latent variables between the potential confounding variables. CONCLUSION Differences on confounding factors may in part explain the lack of consistency in the literature investigating prenatal exposure to low-moderate doses of alcohol and mental health development. It is cautiously concluded that the failure to control for these factors introduces residual and/or unmeasured confounding into the analyses, and thus masks the potential (small) effect of being exposed to low doses of alcohol in pregnancy. It is recommended that future studies control for factor scores rather than for the observed variables as is practice today.
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O'Leary CM, Taylor C, Zubrick SR, Kurinczuk JJ, Bower C. Prenatal alcohol exposure and educational achievement in children aged 8-9 years. Pediatrics 2013; 132:e468-75. [PMID: 23837182 DOI: 10.1542/peds.2012-3002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study examines the relationships between the dose, pattern, and timing of prenatal alcohol exposure and achievement in reading, writing, spelling, and numeracy in children aged 8 to 9 years. METHODS Data from a randomly selected, population-based birth cohort of infants born to non-Indigenous women in Western Australia between 1995 and 1997 (n = 4714) (Randomly Ascertained Sample of Children born in Australia's Largest State Study cohort) were linked to the Western Australian Midwives' Notification System and the Western Australian Literacy and Numeracy Assessment statewide education testing program. The records for 86% (n = 4056) of the cohort were successfully linked with education records when the children were aged 8 to 9 years. The associations between prenatal alcohol exposure and achievement of national benchmarks in school numeracy, reading, spelling, and writing tests and nonattendance for the tests was examined. Logistic regression was used to generate adjusted odds ratios (aOR) and 95% confidence intervals (CI), adjusting for potential confounding factors. The referent group included children of mothers who previously drank alcohol but who abstained during pregnancy. RESULTS Children were twice as likely not to achieve the benchmark for reading after heavy prenatal alcohol exposure during the first trimester (aOR 2.26; 95% CI 1.10-4.65) and for writing when exposed to occasional binge drinking in late pregnancy (aOR 2.35; 95% CI 1.04-5.43). Low-moderate prenatal alcohol exposure was not associated with academic underachievement. CONCLUSIONS The type of learning problems expressed depends on the dose, pattern, and timing of prenatal alcohol exposure.
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Affiliation(s)
- Colleen M O'Leary
- Centre for Population Health Research, Curtin University, Perth, Australia.
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Filgueiras A, Pires P, Maissonette S, Landeira-Fernandez J. Psychometric properties of the Brazilian-adapted version of the Ages and Stages Questionnaire in public child daycare centers. Early Hum Dev 2013; 89:561-76. [PMID: 23507472 DOI: 10.1016/j.earlhumdev.2013.02.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 11/03/2012] [Accepted: 02/12/2013] [Indexed: 11/17/2022]
Abstract
Well-designed screening assessment instruments that can evaluate child development in public daycare centers represent an important resource to help improve the quality of these programs, as an early detection method for early developmental delay. The Ages and Stages Questionnaire, 3rd edition (ASQ-3), comprises a series of 21 questionnaires designed to screen developmental performance in the domains of communication, gross motor skills, fine motor skills, problem solving, and personal-social ability in children aged 2 to 66 months. The purpose of the present work was to translate and adapt all of the ASQ-3 questionnaires for use in Brazilian public child daycare centers and to explore their psychometric characteristics with both Classical Test Theory and Rating Scale analyses from the Rasch model family. A total of 18 Ages & Stages Questionnaires - Brazilian translation (ASQ-BR) questionnaires administered at intervals from 6 to 60 months of age were analyzed based on primary caregiver evaluations of 45,640 children distributed in 468 public daycare centers in the city of Rio de Janeiro. The results indicated that most of the ASQ-BR questionnaires had adequate internal consistency. Exploratory factor analyses yielded a one-factor solution for each domain of all of the ASQ-BR questionnaires. The only exception was the personal-social domain in some of the questionnaires. Item Response Theory based on Rating Scale analysis (infit and outfit mean squares statistics) indicated that only 44 of 540 items showed misfit problems. In summary, the ASQ-BR questionnaires are psychometrically sound developmental screening instruments that can be easily administered by primary caregivers.
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Abstract
PURPOSE OF REVIEW This article addresses the question of 'best treatment options', which clinicians face when treating pregnant women with alcohol and opioid dependence. RECENT FINDINGS Studies show that alcohol consumption is associated with fetal abnormalities and long-term cognitive problems depending on the amount consumed, drinking pattern, and time of gestation. Screening and evaluation of specific interventions are important to reduce alcohol consumption during pregnancy and associated problems in infants. Opioid detoxification is only recommended beyond the first trimester and only in those pregnant women who refuse opioid maintenance therapy. Methadone is the most established treatment of pregnant opioid-dependent women, though recent results indicate some advantages of buprenorphine, slow-release oral methadone and diamorphine compared with methadone. SUMMARY Benzodiazepines seem to be the most recommendable option for managing alcohol withdrawal, and psychosocial interventions succeed in reducing alcohol consumption or in maintaining abstinence in alcohol-dependent pregnant women. Regarding opioid dependence, current results suggest that factors like the health status of the mother, the need for additional medications (e.g. treatment for HIV), comorbid drug dependence, and concurrent drug use need to be considered in order to find the 'best opioid substitute'.
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Roberts SCM, Avalos LA, Sinkford D, Foster DG. Alcohol, tobacco and drug use as reasons for abortion. Alcohol Alcohol 2012; 47:640-8. [PMID: 22917755 DOI: 10.1093/alcalc/ags095] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS Concern about the effects of alcohol and drug use during pregnancy is intertwined with debates about abortion. There is concern that alcohol abstinence recommendations lead women using low levels of alcohol to terminate otherwise wanted pregnancies. This study examines how women describe alcohol, tobacco and/or drug use (ATOD) as reasons for deciding to have abortions and assesses the differences between women reporting and not reporting ATOD as reasons for deciding to have an abortion. METHODS Data come from the UCSF Turnaway Study which recruited 956 women seeking an abortion at one of 30 US clinics between 2008 and 2010. Mixed methods were used and data were analyzed through thematic coding and logistic regression. RESULTS Nearly 5% reported ATOD as a reason for abortion. Women worried that their ATOD had affected their baby's health and that their or their partner's ATOD would influence parenting. Most women (84%) who reported alcohol as a reason binge drank or had an alcohol-problem symptom in the month before discovering their pregnancy. Sixty-one percent who reported drugs as a reason used drugs, with 88% using more than once/week. Although two-thirds smoked tobacco, no woman reported tobacco alone as a reason. Ninety-eight percent of women reporting ATOD as a reason had unintended pregnancies. CONCLUSION Women reporting ATOD as a reason drink at levels exceeding a low threshold and do not appear to be terminating otherwise wanted pregnancies. Thus, findings are inconsistent with hypotheses that abstinence recommendations and punitive policies lead women using low levels of alcohol or using drugs to terminate otherwise wanted pregnancies.
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Affiliation(s)
- Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA 94612, USA.
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O'LEARY COLLEENM, BOWER CAROL. Guidelines for pregnancy: What's an acceptable risk, and how is the evidence (finally) shaping up? Drug Alcohol Rev 2011; 31:170-83. [DOI: 10.1111/j.1465-3362.2011.00331.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Predicting language development at age 18 months: data from the Norwegian Mother and Child Cohort Study. J Dev Behav Pediatr 2011; 32:375-83. [PMID: 21546853 DOI: 10.1097/dbp.0b013e31821bd1dd] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study investigated predictors of delayed language development at 18 months of age in a large population cohort of Norwegian toddlers. METHODS Data were analyzed on 42,107 toddlers. Language outcome at age 18 months was measured using a standard parent report instrument, the Ages and Stages Questionnaire, communication scale. Confirmatory factor analysis was conducted on the Ages and Stages Questionnaire items. A theoretically derived set of child, family, and environmental risk factors were used to predict delayed language development at age 18 months using Generalized Estimating Equation. RESULTS A number of child factors, including being a boy, low birth weight or gestational age, or a multiple birth child were all significantly associated with low scores on the language outcome at age 18 months. Maternal distress/depression and low maternal education, having older siblings, or a non-Norwegian language background also predicted low scores on the language outcome at age 18 months. Overall, estimated variance in language outcome explained by the model was 4% to 7%. CONCLUSIONS A combination of early neurobiological and genetic factors (e.g., male gender, birth weight, and prematurity) and concurrent family variables (e.g., maternal distress/depression) were associated with slower language development at age 18 months. This finding replicated previous research conducted on slightly older language-delayed 2 year olds but also detected the importance of factors related to family resources for the first time in this younger age group. Despite this finding, most of the variability in language performance in this cohort of 18 month olds remained unexplained by the comprehensive set of purported risk factors.
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Mattson SN, Crocker N, Nguyen TT. Fetal alcohol spectrum disorders: neuropsychological and behavioral features. Neuropsychol Rev 2011; 21:81-101. [PMID: 21503685 DOI: 10.1007/s11065-011-9167-9] [Citation(s) in RCA: 388] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 04/03/2011] [Indexed: 01/11/2023]
Abstract
Heavy prenatal alcohol exposure can cause alterations to the developing brain. The resulting neurobehavioral deficits seen following this exposure are wide-ranging and potentially devastating and, therefore, are of significant concern to individuals, families, communities, and society. These effects occur on a continuum, and qualitatively similar neuropsychological and behavioral features are seen across the spectrum of effect. The term fetal alcohol spectrum disorders (FASD) has been used to emphasize the continuous nature of the outcomes of prenatal alcohol exposure, with fetal alcohol syndrome (FAS) representing one point on the spectrum. This paper will provide a comprehensive review of the neuropsychological and behavioral effects of heavy prenatal alcohol exposure, including a discussion of the emerging neurobehavioral profile. Supporting studies of lower levels of exposure, brain-behavior associations, and animal model systems will be included when appropriate.
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Affiliation(s)
- Sarah N Mattson
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA.
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Maloney E, Hutchinson D, Burns L, Mattick RP, Black E. Prevalence and predictors of alcohol use in pregnancy and breastfeeding among Australian women. Birth 2011; 38:3-9. [PMID: 21332768 DOI: 10.1111/j.1523-536x.2010.00445.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous research suggests that alcohol use during pregnancy and breastfeeding has a negative impact on birth and neonatal outcomes. No threshold for this effect has been determined. The aim of this study is to determine the prevalence and correlates of alcohol use in pregnancy and lactation in a large representative sample of Australian women. METHOD Data were used from a large representative sample of Australian women drawn from the 2007 National Drug Strategy Household Survey. A complex sampling framework was used to elicit prevalence estimates for alcohol use during pregnancy and lactation. A logistic regression analysis was used to determine the psychosocial characteristics associated with alcohol use during the perinatal period. RESULTS Alcohol use was reported by 29 percent of women who were pregnant in the past 12 months. In addition, 43 percent of women who were breastfeeding in the past 12 months reported alcohol use, whereas 36 percent of women who were both pregnant and breastfeeding in the past 12 months reported alcohol use. Most women (95%) reported a reduction in the quantity of their alcohol use while pregnant or breastfeeding. Older age was significantly associated with alcohol use in pregnancy, and also with alcohol use while breastfeeding (after controlling for other psychosocial characteristics). Higher educational attainment, and breastfeeding for more weeks in the past 12 months were significantly associated with alcohol use while breastfeeding, after controlling for confounding psychosocial factors. CONCLUSIONS More research is needed to ease uncertainty about "safe" levels of alcohol use during pregnancy and while breastfeeding. A high proportion of the sample reported alcohol use during pregnancy or lactation, despite uniform international government guidelines recommending that no alcohol should be consumed during the prenatal and postnatal periods. These results indicate that public health education campaigns about the risks of alcohol during these periods are needed.
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Affiliation(s)
- Elizabeth Maloney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Current world literature. Curr Opin Obstet Gynecol 2010; 21:541-9. [PMID: 20072097 DOI: 10.1097/gco.0b013e3283339a65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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