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Henderson EM, Tappin D, Young D, Favretto D, Mactier H. Assessing maternal alcohol consumption in pregnancy: comparison of confidential postnatal maternal interview and measurement of alcohol biomarkers in meconium. Arch Dis Child 2023:archdischild-2022-325028. [PMID: 36997296 DOI: 10.1136/archdischild-2022-325028] [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: 10/18/2022] [Accepted: 03/10/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Knowledge of alcohol consumption in pregnancy is important for early identification of children with fetal alcohol spectrum disorder. We investigated whether alcohol biomarkers fatty acid ethyl esters (FAEEs) and ethyl glucuronide (EtG) in meconium are predicted by maternal or newborn demographics and/or correlate with confidential early postnatal self-report of alcohol consumption in pregnancy. DESIGN Anonymised, observational population-based study. SETTING Inner-city maternity unit, Glasgow, UK. PATIENTS Singleton mother/infant dyads delivering every fourth day. INTERVENTIONS Mother: confidential postnatal interview. Baby: meconium sample for FAEEs and EtG. RESULTS 840/908 mothers consented. 370 (46.4%) reported alcohol consumption in pregnancy, generally of modest amount; for 114 (13.6%) this was after 20 weeks' gestation. Alcohol consumption in later pregnancy was more commonly reported by older (31.3 vs 29.5 years) women of white British ethnicity (p<0.05); their babies were on average 118 g heavier (p=0.032). FAEEs were identified in all meconium samples; concentration was ≥600 ng/g in 39.6%. EtG concentration was ≥30 ng/g in 14.5%. Neither biomarker was associated with maternal age, body mass index or socioeconomic status but when EtG was ≥30 ng/g, the mother was less likely to identify as white British (71.3% vs 81.8%, p=0.028). Sensitivities of FAEEs ≥600 ng/g and EtG ≥30 ng/g were 43.1% and 11.6%, respectively for postnatal self-report of alcohol use in later pregnancy (specificities 60.6% and 84.8%). CONCLUSIONS FAEEs and EtG measured in meconium have low sensitivity and specificity for self-reported alcohol consumption after 20 weeks' gestation in an unselected Scottish population.
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Affiliation(s)
- Elizabeth Ma Henderson
- Paediatric Intensive Care, Royal Hospital for Children, Glasgow, UK
- Neonatology, Princess Royal Maternity, Glasgow, UK
| | - David Tappin
- Department of Child Health, College of Medical, Vetinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Young
- Mathematics & Statistics, University of Strathclyde, Glasgow, UK
| | - Donata Favretto
- Department of Health Science, University of Florence, Forensic Toxicology Division, Florence, Italy
| | - Helen Mactier
- Department of Child Health, College of Medical, Vetinary and Life Sciences, University of Glasgow, Glasgow, UK
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Henderson EMA, Tappin D, Young D, Favretto D, Mactier H. Assessing maternal alcohol consumption in pregnancy: does phosphatidylethanol measured from day 5 newborn blood spot cards have any value? An observational, population-based study. Arch Dis Child 2023; 108:36-41. [PMID: 36288922 DOI: 10.1136/archdischild-2022-324394] [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: 05/15/2022] [Accepted: 09/30/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Prenatal alcohol exposure (PAE) places children at risk of fetal alcohol spectrum disorder (FASD) but ascertainment of PAE is problematic. Early intervention for children at risk of FASD may help mitigate long-term difficulties. Phosphatidylethanol (PEth), a metabolite of alcohol, is incorporated into red cell membranes and can be measured in dried blood spot (DBS) cards. In the UK, DBS samples are collected on day 5 for routine newborn screening. We sought to examine if PEth measured from DBS correlates with postnatal maternal self-report of alcohol consumption in pregnancy. DESIGN Observational population-based study. Comparison of infant PEth concentration and self-report of maternal alcohol use during pregnancy. SETTING Large maternity unit in Glasgow, Scotland. PARTICIPANTS All singleton mother-infant dyads delivered during each fourth consecutive 24-hour period. INTERVENTIONS Mother: direct, confidential, immediate postnatal interview by a single researcher examining alcohol use during pregnancy. Infant: one extra DBS collected coincident with routine newborn screening if bleeding continued. RESULTS 92.5% of eligible mothers agreed to participate. 510 DBS were obtained of which 502 were successfully analysed. 216 (43%) samples contained PEth at a concentration of ≥8 ng/mL and 148 (29.5%) at ≥20 ng/mL. The sensitivity of PEth ≥8 ng/mL and ≥20 ng/mL in identifying women who self-reported modest alcohol use after 36 weeks' gestation was 50% and 36.4%, respectively. CONCLUSION PEth measured from DBS obtained on day 5 of life does not reliably identify modest PAE after 36 weeks' gestation from maternal self-report.
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Affiliation(s)
- Elizabeth M A Henderson
- Neonatology, Princess Royal Maternity, Glasgow, UK .,Paediatric Intensive Care, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - David Tappin
- Department of Child Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Young
- Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Donata Favretto
- Department of Health Science, University of Florence, Forensic Toxicology Division, Florence, Italy
| | - Helen Mactier
- Neonatology, Princess Royal Maternity, Glasgow, UK.,Department of Child Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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3
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Arkell R, Lee E. Using meconium to establish prenatal alcohol exposure in the UK: ethical, legal and social considerations. JOURNAL OF MEDICAL ETHICS 2022; 49:medethics-2022-108170. [PMID: 35868663 DOI: 10.1136/jme-2022-108170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
An expanding policy framework aimed at monitoring alcohol consumption during pregnancy has emerged. The primary justification is prevention of harm from what is termed 'prenatal alcohol exposure' (PAE), by enabling more extensive diagnosis of the disability labelled fetal alcohol spectrum disorder (FASD). Here we focus on proposals to include biomarkers as a PAE 'screening tool', specifically those found in meconium (the first newborn excrement), which are discussed as an 'objective' measure of PAE.We ask the overarching question, 'Can routine screening of meconium to establish PAE be ethically or legally justified', and we answer, 'No'. To reach this conclusion, we discuss three areas. First, we consider the reasons why meconium screening should not be deemed 'typical' within the scope of accepted screening tools. We argue that given the aim and necessary timing of the screen, it cannot achieve what it promises. Second, we outline why patient autonomy and consent are not properly accounted for and cannot be reconciled with the 'routinisation' of the proposed 'screening'. Last, we outline why the benefit of such a screen is not clear, focusing on the significance of trust in healthcare professionals (HCP) for the best interests of the future child and pregnant woman.While recognising the adverse effects of heavy alcohol consumption during pregnancy, we emphasise the case for robust ethical, legal and social considerations and the central need for trust between HCP and patients in maternity care. We conclude the permissibility of meconium screening has not been proven, and it is not justified.
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Affiliation(s)
- Rachel Arkell
- Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, Stratford-upon-Avon, UK
| | - Ellie Lee
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
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Tappin D, Mackay D, Reynolds L, Fitzgerald N. Minimizing sample bias due to stigmatized behaviours: the representativeness of participants in a cohort study of alcohol in pregnancy. BMC Med Res Methodol 2022; 22:138. [PMID: 35562676 PMCID: PMC9107203 DOI: 10.1186/s12874-022-01629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 04/29/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Stigmatized behaviours are often underreported, especially in pregnancy, making them challenging to address. The Alcohol and Child Development Study (ACDS) seeks to inform prevention of foetal alcohol harm, linking self-report as well as a maternal blood alcohol biomarker with child developmental outcomes. Samples were requested using passive, generic consent. The success of this approach at minimizing bias is presented comparing characteristics of women who provided samples to those who did not. METHODS All pregnant women in the study city were sent a Patient Information Sheet (PIS) with their first NHS obstetric appointment letter. The PIS informed them that the NHS would like to take an extra blood sample for research purposes, unless they opted out. Neither the women nor the midwives were informed that the samples might be tested for an alcohol biomarker. This paper examines the extent to which women who provided the extra sample were representative of women where no sample was provided, in terms of routinely collected information: age; body mass index; area-based deprivation; previous pregnancies, abortions and caesarians; smoking status and carbon monoxide level; self-reported alcohol use, gestation and birth weight of their baby. Chi-square and Mann-Whitney U tests were used to compare groups. RESULTS 3436 (85%) of the 4049 pregnant women who attended their appointment provided the extra sample. Women who did not were significantly younger (p < 0.001), more materially deprived (p < 0.001), and less likely to be considered for intervention based on self-reported alcohol use (p < 0.001). There were no significant differences between the two groups on other routine data. CONCLUSIONS The use of passive consent without disclosure of the specific research focus resulted in a high level of sample provision. There was no evidence that study blinding was breached, and women who provided a sample were more likely to report alcohol consumption. Passive consent to draw additional blood for research purposes at routine antenatal venipuncture reduced sampling bias compared to asking women to give blood for an alcohol study. This methodology may be useful for other stigmatised behaviours.
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Affiliation(s)
- David Tappin
- grid.8756.c0000 0001 2193 314XSection of Child Health, College of Medical, Veterinary & Life Sciences, Wolfson Medical School Building, University of Glasgow, 31, Shawhill Road, Glasgow, Scotland G41 3RW UK
| | - Daniel Mackay
- grid.8756.c0000 0001 2193 314XInstitute of Health and Wellbeing, Public Health, University of Glasgow, 1 Lilybank Gardens, Glasgow, Scotland G12 8RZ UK
| | - Lucy Reynolds
- grid.413301.40000 0001 0523 9342NHS Greater Glasgow & Clyde Health Board, Community Child Health, Children’s Services, Woodside Health and Care Centre, 891 Garscube Road, Glasgow, G20 7ER UK
| | - Niamh Fitzgerald
- grid.11918.300000 0001 2248 4331Institute for Social Marketing & Health, Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA UK ,SPECTRUM Consortium, Edinburgh, UK
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Muggli E, Halliday J, Elliott EJ, Penington A, Thompson D, Spittle AJ, Forster D, Lewis S, Hearps S, Anderson PJ. Cohort profile: early school years follow-up of the Asking Questions about Alcohol in Pregnancy Longitudinal Study in Melbourne, Australia (AQUA at 6). BMJ Open 2022; 12:e054706. [PMID: 35039298 PMCID: PMC8765013 DOI: 10.1136/bmjopen-2021-054706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The Asking Questions about Alcohol in Pregnancy (AQUA) study, established in 2011, is a prebirth cohort of 1570 mother and child pairs designed to assess the effects of low to moderate prenatal alcohol exposure and sporadic binge drinking on long-term child development. Women attending general antenatal clinics in public hospitals in Melbourne, Australia, were recruited in their first trimester, followed up three times during pregnancy and at 12 and 24 months postpartum. The current follow-up of the 6-8-year-old children aims to strengthen our understanding of the relationship between these levels of prenatal alcohol exposure and neuropsychological functioning, facial dysmorphology, brain structure and function. PARTICIPANTS Between June 2018 and April 2021, 802 of the 1342 eligible AQUA study families completed a parent-report questionnaire (60%). Restrictions associated with COVID-19 pandemic disrupted recruitment, but early school-age neuropsychological assessments were undertaken with 696 children (52%), and 482 (36%) craniofacial images were collected. A preplanned, exposure-representative subset of 146 children completed a brain MRI. An existing biobank was extended through collection of 427 (32%) child buccal swabs. FINDINGS TO DATE Over half (59%) of mothers consumed some alcohol during pregnancy, with one in five reporting at least one binge-drinking episode prior to pregnancy recognition. Children's craniofacial shape was examined at 12 months of age, and low to moderate prenatal alcohol exposure was associated with subtle midface changes. At 2 years of age, formal developmental assessments showed no evidence that cognitive, language or motor outcome was associated with any of exposure level. FUTURE PLANS We will investigate the relationship between prenatal alcohol exposure and specific aspects of neurodevelopment at 6-8 years, including craniofacial shape, brain structure and function. The contribution of genetics and epigenetics to individual variation in outcomes will be examined in conjunction with national and international collaborations.
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Affiliation(s)
- Evelyne Muggli
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Halliday
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Reproductive Epidemiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Elizabeth J Elliott
- Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Anthony Penington
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Plastic and Maxillofacial Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Deanne Thompson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia Jane Spittle
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Della Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Sharon Lewis
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Reproductive Epidemiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
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Schölin L, Mukherjee RAS, Aiton N, Blackburn C, Brown S, Flemming KM, Gard PR, Howlett H, Plant M, Price AD, Shields J, Smith LA, Suttie M, Zammitt DC, Cook PA. Fetal alcohol spectrum disorders: an overview of current evidence and activities in the UK. Arch Dis Child 2021; 106:636-640. [PMID: 33441316 DOI: 10.1136/archdischild-2020-320435] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/03/2022]
Abstract
Estimates for the UK suggest that alcohol consumption during pregnancy and prevalence of fetal alcohol spectrum disorder (FASD)-the most common neurodevelopmental condition-are high. Considering the significant health and social impacts of FASD, there is a public health imperative to prioritise prevention, interventions and support. In this article, we outline the current state of play regarding FASD knowledge and research in the UK, which is characterised by a lack of evidence, a lack of dedicated funding and services, and consequently little policy formulation and strategic direction. We highlight progress made to date, as well as current knowledge and service gaps to propose a way forward for UK research.
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Affiliation(s)
- Lisa Schölin
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Raja A S Mukherjee
- Fetal Alcohol Syndrome Specialist Behaviour Clinic, Surrey and Borders Partnership NHS Foundation Trust, Surrey, UK
| | - Neil Aiton
- One Stop Clinic, Royal Sussex County Hospital, Brighton, Brighton and Hove, UK
| | - Carolyn Blackburn
- Centre for the Study of Practice and Culture in Education, Birmingham City University, Birmingham, West Midlands, UK
| | - Sarah Brown
- Fetal Alcohol Advisory and Support Team, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - Kate M Flemming
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
- Liverpool Centre for Alcohol Research, Liverpool, UK
| | - Paul R Gard
- School of Pharmacy and Biomolecular Science, University of Brighton, Brighton, East Sussex, UK
| | - Helen Howlett
- Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Moira Plant
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Alan D Price
- School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Jennifer Shields
- Fetal Alcohol Advisory and Support Team, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - Lesley A Smith
- Institute of Clinical and Applied Health Research, University of Hull, Hull, Kingston upon Hull, UK
| | - Michael Suttie
- Nuffield Department of Women's and Reproductive Health, Oxford University, Oxford, Oxfordshire, UK
| | - David C Zammitt
- Fetal Alcohol Advisory and Support Team, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - Penny A Cook
- School of Health Sciences, University of Salford, Salford, UK
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7
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Maurage P, Bollen Z, Masson N, D'Hondt F. A review of studies exploring fetal alcohol spectrum disorders through eye tracking measures. Prog Neuropsychopharmacol Biol Psychiatry 2020; 103:109980. [PMID: 32470497 DOI: 10.1016/j.pnpbp.2020.109980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/10/2020] [Accepted: 05/20/2020] [Indexed: 01/20/2023]
Abstract
The widespread cognitive and cerebral consequences of prenatal alcohol exposure have been established during the last decades, through the exploration of fetal alcohol spectrum disorders (FASD) using neuropsychological and neuroscience tools. This research field has recently benefited from the emergence of innovative measures, among which eye tracking, allowing a precise measure of the eye movements indexing a large range of cognitive functions. We propose a comprehensive review, based on PRISMA guidelines, of the eye tracking studies performed in populations with FASD. Studies were selected from the PsycINFO, PubMed and Scopus databases, and were evaluated through a standardized methodological quality assessment. Studies were classified according to the eye tracking indexes recorded (saccade characteristics, initial fixation, number of fixations, dwell time, gaze pattern) and the process measured (perception, memory, executive functions). Eye tracking data showed that FASD are mostly associated with impaired ocular perceptive/motor abilities (i.e., altered eye movements, centrally for saccade initiation), lower accuracy as well as increased error rates in saccadic eye movements involving working memory abilities, and reduced inhibitory control on saccades. After identifying the main limitations presented by the reviewed studies, we propose guidelines for future research, underlining the need to increase the standardization of diagnosis and evaluation tools, and to improve the methodological quality of eye tracking measures.
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Affiliation(s)
- Pierre Maurage
- Louvain for Experimental Psychopathology Research Group, Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Zoé Bollen
- Louvain for Experimental Psychopathology Research Group, Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Nicolas Masson
- Numerical Cognition Group, Psychological Sciences Research Institute and Neuroscience Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, Lille, France; CHU Lille, Clinique de Psychiatrie, Unité CURE, Lille, France; Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France.
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8
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Symons M, Carter M, Oscar J, Pearson G, Bruce K, Newett K, Fitzpatrick JP. A reduction in reported alcohol use in pregnancy in Australian Aboriginal communities: a prevention campaign showing promise. Aust N Z J Public Health 2020; 44:284-290. [PMID: 32628358 DOI: 10.1111/1753-6405.13012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Aboriginal leaders in remote Western Australian communities with high rates of prenatal alcohol exposure invited researchers to evaluate the community-led Marulu foetal alcohol spectrum disorder (FASD) Prevention Strategy initiated in 2010. METHODS The proportion of women reporting alcohol use during pregnancy to midwives was compared between 2008, 2010 and 2015. Initial midwife appointments were calculated by weeks of gestation. The proportions of women reporting alcohol use by age at birth were compared. RESULTS Alcohol use reduced significantly from 2010 (61.0%) to 2015 (31.9%) with first-trimester use reducing significantly from 2008 (45.1%) to 2015 (21.6%). Across all years, 40.8% reported alcohol use during pregnancy and 14.8% reported use in both first and third trimesters. Most women attended the midwife in the first trimester. There was a significant relationship between increased maternal age and third-trimester alcohol use. CONCLUSIONS The reduction in reported prenatal alcohol exposure in an Aboriginal community setting during a period of prevention activities provides initial evidence for a community-led strategy that might be applicable to similar communities. Implications for public health: The reductions in alcohol use reduce the risk of children being born with FASD in an area with high prevalence, with possible resultant reductions in associated health, economic and societal costs.
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Affiliation(s)
- Martyn Symons
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia.,National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, Telethon Kids Institute, Perth, Western Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia
| | - Glenn Pearson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
| | - Kaashifah Bruce
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
| | | | - James P Fitzpatrick
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia.,School of Psychological Sciences, The University of Western Australia, Perth, Western Australia
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Jussila H, Pajulo M, Ekholm E. A Novel 4D Ultrasound Parenting Intervention for Substance Using Pregnant Women in Finland: Participation in Obstetric Care, Fetal Drug Exposure, and Perinatal Outcomes in a Randomized Controlled Trial. Matern Child Health J 2020; 24:90-100. [PMID: 31250239 PMCID: PMC6957471 DOI: 10.1007/s10995-019-02773-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives The aim of the study was to explore the effect of a new prenatal intervention on participation in obstetric care, fetal drug exposure, and perinatal outcomes among substance using pregnant women in Finland. Methods The participants were 90 women referred to a hospital obstetric outpatient clinic due to current or recent substance use. The intervention group (n = 46) was offered three interactive ultrasounds at 24, 30 and 34 gestational weeks and a pregnancy diary accompanied by three prenatal infant mental health consultations. The intervention elements were designed to enhance parental mentalization and prenatal attachment. A randomized control group (n = 44) design was used. All participants were offered treatment-as-usual in the obstetric tertiary setting. Medical record data and meconium toxicology were analyzed. Results The retention rate in the whole sample was 89%. Retention was higher in the intervention group (96% vs. 82%, p < 0.05), of which 74% attended all three ultrasound sessions. However, the pregnant women in the intervention group participated less often in all the scheduled obstetric standard care visits (59% vs. 83%, p = 0.02). Fetal drug exposure and perinatal outcomes were similar in both groups. Within the whole sample, 13% of the neonates were preterm, 12% small for gestational age and 7% had exposure to drugs. Conclusions for Practice Retention in the intervention was very good. Watching the fetus with parenting focus seemed to motivate these high-risk women. Interestingly, the pregnant women in the intervention group tended to prefer the intervention sessions to the routine care. Clinical implications of this finding are discussed. Trial Registry The trial registration number in ClinicalTrials.gov: NCT03413631.
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Affiliation(s)
- Heidi Jussila
- Doctoral Programme of Clinical Investigation, Department of Child Psychiatry, University of Turku, 20014 Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521 Turku, Finland
| | - Marjukka Pajulo
- Department of Child Psychiatry and The FinnBrain, University of Turku, 20014 Turku, Finland
| | - Eeva Ekholm
- Department of Obstetrics and Gynecology, Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521 Turku, Finland
- Department of Obstetrics and Gynecology, University of Turku, 20014 Turku, Finland
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10
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Berrigan P, Andrew G, Reynolds JN, Zwicker JD. The cost-effectiveness of screening tools used in the diagnosis of fetal alcohol spectrum disorder: a modelled analysis. BMC Public Health 2019; 19:1746. [PMID: 31881876 PMCID: PMC6935188 DOI: 10.1186/s12889-019-8110-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure. Though diagnosis may help improve patient outcomes, the diagnostic process can be costly. Subsequently, screening children suspected of FASD prior to diagnostic testing has been suggested, to avoid administering testing to children who are unlikely to receive a diagnosis. The present study set out to assess the cost-effectiveness of currently recommended FASD screening tools. METHODS The screenings tools evaluated were chosen from Children's Healthcare Canada's National Screening Toolkit for Children and Youth Identified and Potentially Affected by FASD and include meconium testing of fatty acid ethyl esters (meconium testing) and the neurobehavioral screening tool (NST). An economic model was constructed to assess cost-effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of findings. Costs reflect 2017 Canadian dollars and the perspective is the public healthcare system. RESULTS Both screening tools evaluated resulted in reduced costs and fewer diagnosed years of life than a no screening strategy in which all children suspected of FASD receive diagnostic testing. The model predicts that screening newborns with meconium testing results in a reduced cost of $89,186 per 100 individuals screened and 38 fewer diagnosed years of life by age 18, corresponding to an incremental cost-effectiveness ratio (ICER) of $2359. Screening children with the NST resulted in a reduced cost of $183,895 per 100 individuals screened and 77 fewer diagnosed years of life by age 18, corresponding to an ICER of $2390. CONCLUSION Findings suggest that screening is associated with less use of healthcare recourses but also fewer years of life with an FASD diagnosis over a no screening strategy. Since diagnosis can be key to children receiving timely and appropriate health and educational services, cost-savings must be weighed against the fewer years of life with a diagnosis associated with screening.
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Affiliation(s)
- Patrick Berrigan
- School of Public Policy, University of Calgary, 906 8th Avenue SW, 5th Floor, Calgary, Alberta, T2P 1H9, Canada.
| | - Gail Andrew
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 5th Floor, 11405 - 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.,Glenrose FASD Clinic, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta, T5G 0B7, Canada
| | - James N Reynolds
- Department of Biomedical and Molecular Sciences, Queen's University, Botterell Hall, Room 563, 18 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906 8th Avenue SW, 5th Floor, Calgary, Alberta, T2P 1H9, Canada.,Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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11
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Schölin L, Fitzgerald N. The conversation matters: a qualitative study exploring the implementation of alcohol screening and brief interventions in antenatal care in Scotland. BMC Pregnancy Childbirth 2019; 19:316. [PMID: 31481011 PMCID: PMC6724251 DOI: 10.1186/s12884-019-2431-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022] Open
Abstract
Background Alcohol screening and brief intervention (SBI) in antenatal care is internationally recommended to prevent harm caused by alcohol exposure during pregnancy. There is, however, limited understanding of how SBI is implemented within antenatal care; particularly the approach taken by midwives. This study aimed to explore the implementation of a national antenatal SBI programme in Scotland. Methods Qualitative interviews were conducted with antenatal SBI implementation leaders (N = 8) in eight Scottish health boards. Interviews were analysed thematically and using the ‘practical, robust implementation and sustainability model’ (PRISM) to understand differences in implementation across health boards and perceived setting-specific barriers and challenges. Results In several health boards, where reported maternal alcohol use was lower than expected, implementation leaders sought to optimize enquires about women’s alcohol use to facilitate honest disclosure. Strategies focused on having positive conversations, exploring pre-pregnancy drinking habits, and building a trusting relationship between pregnant women and midwives. Women’s responses were encouraging and disclosure rates appeared improved, though with some unexpected variation over time. Adapting the intervention to the local context was also considered important. Conclusions This is the first study to explore implementation leaders’ experiences of antenatal SBI delivery and identify possible changes in disclosure rates arising from the approach taken. In contrast with current antenatal alcohol screening recommendations, a conversational approach was advocated to enhance the accuracy and honesty of reporting. This may enable provision of support to more women to prevent Fetal Alcohol Spectrum Disorders (FASD) and will therefore be of international interest.
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Affiliation(s)
- Lisa Schölin
- School of Health in Social Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Niamh Fitzgerald
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, UK.
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Brown JM, Bland R, Jonsson E, Greenshaw AJ. The Standardization of Diagnostic Criteria for Fetal Alcohol Spectrum Disorder (FASD): Implications for Research, Clinical Practice and Population Health. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:169-176. [PMID: 29788774 PMCID: PMC6405816 DOI: 10.1177/0706743718777398] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Fetal Alcohol Spectrum Disorder (FASD) is a preventable disorder caused by maternal alcohol consumption and marked by a range of physical and mental disabilities. Although recognized by the scientific and medical community as a clinical disorder, no internationally standardized diagnostic tool yet exists for FASD. METHODS AND RESULTS This review seeks to analyse the discrepancies in existing diagnostic tools for FASD, and the repercussions these differences have on research, public health, and government policy. CONCLUSIONS Disagreement on the adoption of a standardised tool is reflective of existing gaps in research on the conditions and factors that influence fetal vulnerability to damage from exposure. This discordance has led to variability in research findings, inconsistencies in government messaging, and misdiagnoses or missed diagnoses. The objective measurement of the timing and level of prenatal alcohol exposure is key to bridging these gaps; however, there is conflicting or limited evidence to support the use of existing measures.
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Affiliation(s)
- Jasmine M Brown
- 1 Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Roger Bland
- 1 Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Egon Jonsson
- 1 Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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13
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McQuire C, Mukherjee R, Hurt L, Higgins A, Greene G, Farewell D, Kemp A, Paranjothy S. Screening prevalence of fetal alcohol spectrum disorders in a region of the United Kingdom: A population-based birth-cohort study. Prev Med 2019; 118:344-351. [PMID: 30503408 PMCID: PMC6344226 DOI: 10.1016/j.ypmed.2018.10.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/13/2018] [Accepted: 10/19/2018] [Indexed: 12/30/2022]
Abstract
Fetal alcohol spectrum disorders (FASDs) are lifelong disabilities caused by prenatal alcohol exposure. Prenatal alcohol use is common in the UK, but FASD prevalence was unknown. Prevalence estimates are essential for informing FASD prevention, identification and support. We applied novel screening algorithms to existing data to estimate the screening prevalence of FASD. Data were from a population-based cohort study (ALSPAC), which recruited pregnant women with expected delivery dates between 1991 and 1992 from the Bristol area of the UK. We evaluated different missing data strategies by comparing results from complete case, single imputation (which assumed that missing data indicated no exposure and no impairment), and multiple imputation methods. 6.0% of children screened positive for FASD in the analysis that used the single imputation method (total N = 13,495), 7.2% in complete case analysis (total N = 223) and 17.0% in the analysis with multiply imputed data (total N = 13,495). A positive FASD screen was more common among children of lower socioeconomic status and children from unplanned pregnancies. Our analyses showed that the complete case and single imputation methods that are commonly used in FASD prevalence studies are likely to underestimate FASD prevalence. Although not equivalent to a formal diagnosis, these screening prevalence estimates suggest that FASD is likely to be a significant public health concern in the UK. Given current patterns of alcohol consumption and recent changes in prenatal guidance, active case ascertainment studies are urgently needed to further clarify the current epidemiology of FASD in the general population of the UK.
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Affiliation(s)
- Cheryl McQuire
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK.
| | - Raja Mukherjee
- Surrey and Borders Partnership NHS Foundation Trust, Redhill, UK
| | - Lisa Hurt
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Giles Greene
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Alison Kemp
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Symons M, Pedruzzi RA, Bruce K, Milne E. A systematic review of prevention interventions to reduce prenatal alcohol exposure and fetal alcohol spectrum disorder in indigenous communities. BMC Public Health 2018; 18:1227. [PMID: 30390661 PMCID: PMC6215602 DOI: 10.1186/s12889-018-6139-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/22/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a preventable, lifelong neurodevelopmental disorder caused by prenatal alcohol exposure. FASD negatively impacts individual Indigenous communities around the world. Although many prevention interventions have been developed and implemented, they have not been adequately evaluated. This systematic review updates the evidence for the effectiveness of FASD prevention interventions in Indigenous/Aboriginal populations internationally, and in specific populations in North America and New Zealand, and offers recommendations for future work. METHOD The MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO, SocINDEX, and Informit databases were searched from inception to 22/08/2017 for all prevention and intervention papers published in peer-reviewed scientific journals, with results, targeting prenatal alcohol exposure and FASD in Indigenous populations. This review was limited to studies published in English and excluded interventions focusing on the workforce. All steps were completed independently by two reviewers with discrepancies resolved via consensus with the senior author. RESULTS There was significant heterogeneity in the ten included studies. Populations targeted included non-pregnant women of child-bearing age, pregnant women, school children and the general public. Study designs included one randomised controlled trial, five cohort studies with pre-post design, one cross-sectional study with different pre- and post-intervention groups, and four studies collected post-intervention data. Studies assessed changes in knowledge, and/or changes in risk for prenatal alcohol exposure including self-reported alcohol consumption, use of birth control or a combination of both. One study was conducted in Australia and nine in the US. The methodological quality of all studies was rated as 'Poor' using the systematic review assessment tools developed by The National Heart, Lung and Blood Institute. Studies were subject to substantial bias due to issues such as high loss to follow-up, lack of control groups and the reliance on self-report measures to assess the main outcome. CONCLUSION Overall, there is little evidence that previous interventions aiming to reduce the risk of prenatal alcohol exposure or FASD in Indigenous populations have been effective. Future intervention studies should address the cultural factors and historical context that are fundamental to successful work with Indigenous populations, and be designed, implemented and evaluated using rigorous methods. This systematic review was registered with PROSPERO, CRD42018086212.
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Affiliation(s)
- Martyn Symons
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Perth, WA 6872 Australia
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, Perth, Australia
| | - Rebecca Anne Pedruzzi
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Perth, WA 6872 Australia
| | - Kaashifah Bruce
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Perth, WA 6872 Australia
| | - Elizabeth Milne
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Perth, WA 6872 Australia
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15
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Abernethy C, McCall KE, Cooper G, Favretto D, Vaiano F, Bertol E, Mactier H. Determining the pattern and prevalence of alcohol consumption in pregnancy by measuring biomarkers in meconium. Arch Dis Child Fetal Neonatal Ed 2018; 103:F216-F220. [PMID: 28676561 DOI: 10.1136/archdischild-2016-311686] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 04/24/2017] [Accepted: 05/26/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the feasibility of determining the pattern and prevalence of alcohol consumption in pregnancy by measuring ethanol biomarkers in meconium. DESIGN Population-based observational study. SETTING Inner-city maternity unit in Scotland, UK. POPULATION Random sample of singleton infants delivered after 36 completed weeks' gestation. METHODS Fatty acid ethyl esters (FAEEs) and ethyl glucuronide (EtG) in meconium were measured by liquid chromatography-mass spectroscopy. Samples were frozen at -20°C before analysis. Results were compared anonymously with demographic data including maternal age, parity, smoking, ethnicity and postcode and with infant gestation, birth weight and head circumference. Written informed consent was obtained from all subjects. RESULTS 235 samples of meconium were analysed (70% of eligible babies). Only four (1%) of mothers declined to participate. FAAEs were detected in all, including four samples below the limit of quantification (10 ng/g). 98 (42%) samples had FAEE concentrations >600 ng/g. EtG was detectable in 93 (40%) samples; in 35 (15%) EtG concentration was >30 ng/g. No mother reported heavy alcohol consumption in pregnancy. FAAE concentration correlated with EtG (Pearson's coefficient; p<0.001). There was no association between either biomarker and maternal age, parity, smoking, ethnicity or postcode, or infant gestation, birth weight or head circumference. CONCLUSION Measurement of ethanol biomarkers in meconium is a feasible tool for determining the pattern and prevalence of alcohol consumption in pregnancy. Data suggest that at least 15% of pregnant women in the west of Scotland are consuming significant quantities of alcohol during latter pregnancy.
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Affiliation(s)
| | - Karen E McCall
- Neonatal Unit, Princess Royal Maternity Hospital, Glasgow, UK
| | - Gail Cooper
- School of Medicine, University of Glasgow, Glasgow, UK
- Department of Forensic Toxicology, Office of Chief Medical Examiner, New York, USA
| | - Donata Favretto
- Forensic Toxicology Division, Department of Health Science, University of Florence, Florence, Italy
| | - Fabio Vaiano
- Forensic Toxicology Division, Department of Health Science, University of Florence, Florence, Italy
| | - Elisabetta Bertol
- Forensic Toxicology Division, Department of Health Science, University of Florence, Florence, Italy
| | - Helen Mactier
- Neonatal Unit, Princess Royal Maternity Hospital, Glasgow, UK
- School of Medicine, University of Glasgow, Glasgow, UK
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Lussier AA, Morin AM, MacIsaac JL, Salmon J, Weinberg J, Reynolds JN, Pavlidis P, Chudley AE, Kobor MS. DNA methylation as a predictor of fetal alcohol spectrum disorder. Clin Epigenetics 2018; 10:5. [PMID: 29344313 PMCID: PMC5767049 DOI: 10.1186/s13148-018-0439-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background Fetal alcohol spectrum disorder (FASD) is a developmental disorder that manifests through a range of cognitive, adaptive, physiological, and neurobiological deficits resulting from prenatal alcohol exposure. Although the North American prevalence is currently estimated at 2-5%, FASD has proven difficult to identify in the absence of the overt physical features characteristic of fetal alcohol syndrome. As interventions may have the greatest impact at an early age, accurate biomarkers are needed to identify children at risk for FASD. Building on our previous work identifying distinct DNA methylation patterns in children and adolescents with FASD, we have attempted to validate these associations in a different clinical cohort and to use our DNA methylation signature to develop a possible epigenetic predictor of FASD. Methods Genome-wide DNA methylation patterns were analyzed using the Illumina HumanMethylation450 array in the buccal epithelial cells of a cohort of 48 individuals aged 3.5-18 (24 FASD cases, 24 controls). The DNA methylation predictor of FASD was built using a stochastic gradient boosting model on our previously published dataset FASD cases and controls (GSE80261). The predictor was tested on the current dataset and an independent dataset of 48 autism spectrum disorder cases and 48 controls (GSE50759). Results We validated findings from our previous study that identified a DNA methylation signature of FASD, replicating the altered DNA methylation levels of 161/648 CpGs in this independent cohort, which may represent a robust signature of FASD in the epigenome. We also generated a predictive model of FASD using machine learning in a subset of our previously published cohort of 179 samples (83 FASD cases, 96 controls), which was tested in this novel cohort of 48 samples and resulted in a moderately accurate predictor of FASD status. Upon testing the algorithm in an independent cohort of individuals with autism spectrum disorder, we did not detect any bias towards autism, sex, age, or ethnicity. Conclusion These findings further support the association of FASD with distinct DNA methylation patterns, while providing a possible entry point towards the development of epigenetic biomarkers of FASD.
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Affiliation(s)
- Alexandre A. Lussier
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia Canada
- Department of Cellular and Physiological Sciences, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia Canada
| | - Alexander M. Morin
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia Canada
| | - Julia L. MacIsaac
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia Canada
| | - Jenny Salmon
- Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba Canada
- Department of Biochemistry and Medical Genetics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba Canada
| | - Joanne Weinberg
- Department of Cellular and Physiological Sciences, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia Canada
| | - James N. Reynolds
- Department of Biomedical and Molecular Sciences, Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario Canada
| | - Paul Pavlidis
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columnbia Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Albert E. Chudley
- Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba Canada
- Department of Biochemistry and Medical Genetics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba Canada
| | - Michael S. Kobor
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia Canada
- Human Early Learning Partnership, University of British Columbia, Vancouver, British Columbia Canada
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Nash A, Davies L. Fetal Alcohol Spectrum Disorders: What Pediatric Providers Need to Know. J Pediatr Health Care 2017; 31:594-606. [PMID: 28838601 DOI: 10.1016/j.pedhc.2017.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
Prenatal alcohol exposure is the cause of fetal alcohol spectrum disorders (FASDs), the prevalence of which is similar to that of other developmental disabilities like Down syndrome and autism. Children, adolescents, and adults who live with the disabilities associated with prenatal alcohol exposure face extraordinary challenges throughout their lives. Pediatric providers need to be able to identify patients with FASD because early recognition and intervention is known to improve life outcomes for affected individuals. The purposes of this continuing education activity are to report what is known about the prevalence of FASDs; to detail the spectrum of problems experienced by affected individuals; and to suggest specific strategies for preventing, identifying, and managing FASDs in clinical practice.
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Faa G, Manchia M, Pintus R, Gerosa C, Marcialis MA, Fanos V. Fetal programming of neuropsychiatric disorders. ACTA ACUST UNITED AC 2016; 108:207-223. [DOI: 10.1002/bdrc.21139] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Gavino Faa
- Division of Pathology, Department of Surgery; University Hospital San Giovanni di Dio; Cagliari Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine; University of Cagliari; Cagliari Italy
- Department of Pharmacology; Dalhousie University; Halifax Nova Scotia Canada
| | - Roberta Pintus
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
| | - Clara Gerosa
- Division of Pathology, Department of Surgery; University Hospital San Giovanni di Dio; Cagliari Italy
| | - Maria Antonietta Marcialis
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
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