Alcohol abuse in pregnant women: effects on the fetus and newborn, mode of action and maternal treatment

Biomarkers of Affective Dysregulation Associated with In Utero Exposure to EtOH

INTRODUCTION

Children with fetal alcohol spectrum disorders (FASD) exhibit behavioral and affective dysregulation, including hyperactivity and depression. The mechanisms are not known, but they could conceivably be due to postnatal social or environmental factors. However, we postulate that, more likely, the affective dysregulation is associated with the effects of EtOH exposure on the development of fetal serotonergic (5-HT) and/or dopaminergic (DA) pathways, i.e., pathways that in postnatal life are believed to regulate mood. Many women who use alcohol (ethanol, EtOH) during pregnancy suffer from depression and take selective serotonin reuptake inhibitors (SSRIs), which might influence these monoaminergic pathways in the fetus. Alternatively, monoaminergic pathway abnormalities might reflect a direct effect of EtOH on the fetal brain. To distinguish between these possibilities, we measured their expressions in fetal brains and in fetal brain-derived exosomes (FB-Es) isolated from the mothers' blood. We hypothesized that maternal use of EtOH and/or SSRIs during pregnancy would be associated with impaired fetal neural development, detectable as abnormal levels of monoaminergic and apoptotic biomarkers in FB-Es.

METHODS

Fetal brain tissues and maternal blood were collected at 9-23 weeks of pregnancy. EtOH groups were compared with unexposed controls matched for gestational age (GA). The expression of 84 genes associated with the DA and 5-HT pathways was analyzed by quantitative reverse transcription polymerase chain reaction (qRT-PCR) on microarrays. FB-Es also were assayed for serotonin transporter protein (SERT) and brain-derived neurotrophic factor (BDNF) by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Six EtOH-exposed human fetal brain samples were compared to SSRI- or polydrug-exposed samples and to unexposed controls. EtOH exposure was associated with significant upregulation of DA receptor D3 and 5-HT receptor HTR2C, while HTR3A was downregulated. Monoamine oxidase A (MAOA), MAOB, the serine/threonine kinase AKT3, and caspase-3 were upregulated, while mitogen-activated protein kinase 1 (MAPK1) and AKT2 were downregulated. ETOH was associated with significant upregulation of the DA transporter gene, while SERT was downregulated. There were significant correlations between EtOH exposure and (a) caspase-3 activation, (b) reduced SERT protein levels, and (c) reduced BDNF levels. SSRI exposure independently increased caspase-3 activity and downregulated SERT and BDNF. Early exposure to EtOH and SSRI together was associated synergistically with a significant upregulation of caspase-3 and a significant downregulation of SERT and BDNF. Reduced SERT and BDNF levels were strongly correlated with a reduction in eye diameter, a somatic manifestation of FASD.

CONCLUSIONS

Maternal use of EtOH and SSRI during pregnancy each was associated with changes in fetal brain monoamine pathways, consistent with potential mechanisms for the affective dysregulation associated with FASD.

In utero and childhood exposure to alcohol and old age mortality: Evidence from the temperance movement in the US

Previous research suggests the relevance of in-utero insults and early-life circumstances for a wide array of life cycle outcomes. This research note joins this strand of studies by exploring the long-run mortality effects of in-utero and early-life exposure to alcohol accessibility. In so doing, we take advantage of the prohibition movement during the early part of the twentieth century that generated quasi-natural reductions in alcohol consumption. We use Social Security Administration Death Master Files linked to the full-count 1940 census and compare the longevity of male individuals exposed to the prohibition during in-utero and early childhood (1900-1930) as a result of statewide and federal alcohol ban to those wet counties after the law change to before. The results suggest an intent-to-treat effect of 0.17 years higher longevity as a result of prohibition. A back-of-an-envelope calculation suggests a minimum treatment-on-treated effect of 1.7 years impact. Furthermore, we show that these effects are not driven by other county-level demographic and socioeconomic changes, endogenous selection of births, and preexisting trends in the outcome. Our findings contribute to the growing body of research that explores the in-utero and childhood circumstances on long-term health outcomes.

Exploring behavioral phenotypes in a mouse model of fetal alcohol spectrum disorders

Fetal alcohol spectrum disorders are one of the leading causes of developmental abnormalities worldwide. Maternal consumption of alcohol during pregnancy leads to a diverse range of cognitive and neurobehavioral deficits. Although moderate-to-heavy levels of prenatal alcohol exposure (PAE) have been associated with adverse offspring outcomes, there is limited data on the consequences of chronic low-level PAE. Here, we use a model of maternal voluntary alcohol consumption throughout gestation in a mouse model to investigate the effects of PAE on behavioral phenotypes during late adolescence and early adulthood in male and female offspring. Body composition was measured by dual-energy X-ray absorptiometry. Baseline behaviors, including feeding, drinking, and movement, were examined by performing home cage monitoring studies. The impact of PAE on motor function, motor skill learning, hyperactivity, acoustic reactivity, and sensorimotor gating was investigated by performing a battery of behavioral tests. PAE was found to be associated with altered body composition. No differences in overall movement, food, or water consumption were observed between control and PAE mice. Although PAE offspring of both sexes exhibited deficits in motor skill learning, no differences were observed in basic motor skills such as grip strength and motor coordination. PAE females exhibited a hyperactive phenotype in a novel environment. PAE mice exhibited increased reactivity to acoustic stimuli, and PAE females showed disrupted short-term habituation. Sensorimotor gating was not altered in PAE mice. Collectively, our data show that chronic low-level exposure to alcohol in utero results in behavioral impairments.

Intention to Engage in Alcohol Use during Pregnancy: The Role of Attitudes and Prototypes

Background: There is no known risk-free level of alcohol use in pregnancy. Despite this, many still believe that occasional drinking is safe. To-date, there is limited evidence of the influences on women's decisions about low to moderate alcohol use in pregnancy. The aim of this study was to explore alcohol use intentions during pregnancy, using variables from the theory of planned behavior, the prototype/willingness model and personality variables. The study also investigated whether priming participants with exposure to prototypes describing different alcohol use behaviors had an impact on intentions.Methods: Participants, 746 women aged 20 to 45 years, were randomized to be prompted to think of one of two different "types" of behaviors, i.e., small level of alcohol use in pregnancy and ambiguous level of alcohol use in pregnancy. They then completed measures of theoretical variables, impulsivity, venturesomeness, and self-efficacy. Participants then answered whether they intended to use alcohol during a future pregnancy.Results: Over half of the variance in intentions to consume alcohol while pregnant were predicted by the final model (R2= .527, F (1, 438) = 13.201, p < .001). Positive attitudes toward alcohol use in pregnancy, from the theory of planned behavior, were the most significant predictor of intentions and intentions did not differ between groups according to prototype exposure.Conclusions: Future research should aim to explore the efficacy of interventions to reduce low to moderate alcohol use in pregnancy that utilize both the theory of planned behavior and prototype/willingness model to target determinants of intentions.

Alcohol use and associated factors among pregnant women during the mid-pandemic of COVID-19 at Debre Tabor Comprehensive Specialized Hospital, South Gondar Zone, Ethiopia

Objective

The aim of this study was to assess the proportion of alcohol use and associated factors among pregnant women attending antenatal care during the mid-pandemic of COVID-19 at Debre Tabor Comprehensive Specialized Hospital from May 1-30, 2021.

Methods

A hospital-based, cross-sectional study was conducted on 612 pregnant women attending a prenatal clinic. Data were entered into EpiData version 3.1 statistical software and then exported to Statistical Package for Social Science version 25 for analysis. A binary logistic regression model was used to predict the association between alcohol use and the independent variable. p = 0.05 variables were considered statistically significant associated factors.

Results

The prevalence of alcohol consumption by pregnant women was 26.3%: residence (Adjusted Odd Ratio (AOR) = 4.08, 95% confidence interval: 2.23, 7.48), antenatal care follow-up before the survey (AOR = 2.69, 95% confidence interval: 1.37, 5.26), unplanned pregnancy (AOR = 3.28, 95% confidence interval: 1.88, 5.70), partner alcohol use (AOR = 6.88, 95% confidence interval: 3.92, 12.06), and knowledge toward effect of alcohol on the fetus (AOR = 2.26, 95% confidence interval: 1.17, 4.33).

Conclusions

The magnitude of alcohol use during pregnancy was high and this might be related to the pandemic. Antenatal care follow-up before the survey, unplanned pregnancy, partner alcohol use, and knowledge were found to be statistically significant associated factors.

Spatial distribution and determinants of alcohol consumption among pregnant women in Ethiopia: Spatial and multilevel analysis

BACKGROUND

Alcohol consumption during pregnancy is a known contributor to teratogen and causes a range of effects on pregnancy and birth outcomes. This study aimed to investigate the spatial variation and determinants of alcohol consumption among pregnant women in Ethiopia.

METHODS

A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 1,135 pregnant women were included in the analysis. ArcGIS version 10.7 software was used to explore the spatial distribution of alcohol consumption, and SaTScan version 9.6 was employed to identify the significant spatial clusters of alcohol consumption. A mixed multi-level logistic regression analysis was employed to identify the determinant factors of alcohol consumption during pregnancy.

RESULTS

The result showed that the prevalence of alcohol consumption during pregnancy was 22.49% (with a 95% CI: 18.18 to 26.17). The spatial analysis showed that the spatial distribution of alcohol consumption significantly varied across the country [Global Moran's I value = 0.30 (P<0.001)]. The SaTScan analysis identified two most likely clusters with high rates of alcohol consumption such as northwest Ethiopia (Log-Likelihood Ratio (LLR) = 155.56, p<0.001) and central Ethiopia (LLR = 19.27, p<0.01). Never in union, divorced and/ widowed [Adjusted odds ratio (AOR) = 2.56; 95% CI: 1.07, 10.14], attended primary school [AOR = 0.45; 95% CI: 0.27, 0.95], having two or more lifetime sexual partners [AOR = 2.59; 95% CI: 1.11, 6.18], living in rural [AOR = 1.52; 95% CI: 1.12, 2.93] and higher community media exposure [AOR = 0.54; 95% CI: 0.28, 0.97] were the factors associated with alcohol consumption.

CONCLUSION

Alcohol consumption during pregnancy in Ethiopia was high. The spatial distribution of alcohol consumption was significantly varied across the country. Therefore, public health interventions targeting areas with high alcohol consumption are needed for drinking cessation and to prevent poor pregnancy outcomes related to alcohol use.

Molecular Markers in Maternal Blood Exosomes Allow Early Detection of Fetal Alcohol Spectrum Disorders

Prenatal alcohol exposure can cause developmental abnormalities (fetal alcohol spectrum disorders; FASD), including small eyes, face and brain, and neurobehavioral deficits. These cannot be detected early in pregnancy with available imaging techniques. Early diagnosis could facilitate development of therapeutic interventions. Banked human fetal brains and eyes at 9−22 weeks’ gestation were paired with maternal blood samples, analyzed for morphometry, protein, and RNA expression, and apoptotic signaling. Alcohol (EtOH)-exposed (maternal self-report) fetuses were compared with unexposed controls matched for fetal age, sex, and maternal race. Fetal brain-derived exosomes (FB-E) were isolated from maternal blood and analyzed for protein, RNA, and apoptotic markers. EtOH use by mothers, assessed by self-report, was associated with reduced fetal eye diameter, brain size, and markers of synaptogenesis. Brain caspase-3 activity was increased. The reduction in eye and brain sizes were highly correlated with amount of EtOH intake and caspase-3 activity. Levels of several biomarkers in FB-E, most strikingly myelin basic protein (MBP; r > 0.9), correlated highly with morphological abnormalities. Reduction in FB-E MBP levels was highly correlated with EtOH exposure (p < 1.0 × 10−10). Although the morphological features of FAS appear long before they can be detected by live imaging, FB-E in the mother’s blood may contain markers, particularly MBP, that predict FASD.

Prevalence and Patterns of Prenatal Alcohol Exposure in Australian Cohort and Cross-Sectional Studies: A Systematic Review of Data Collection Approaches

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).

Could Alcohol Abuse and Dependence on Junk Foods Inducing Obesity and/or Illicit Drug Use Represent Danger to Liver in Young People with Altered Psychological/Relational Spheres or Emotional Problems?

Recent data show that young people, mainly due to the pressure of some risk factors or due to disrupted interpersonal relationships, utilise greater reward value and display greater sensitivity to the reinforcing properties of “pleasurable stimuli”, specifically in those situations in which an enhanced dopamine release is present. Alcoholic beverages, foods rich in sugar and fat, and illicit drug use are pleasurable feelings associated with rewards. Research shows that there is a link between substance abuse and obesity in brain functioning. Still, alcohol excess is central in leading to obesity and obesity-related morbidities, such as hepatic steatosis, mainly when associated with illicit drug dependence and negative eating behaviours in young people. It is ascertained that long-term drinking causes mental damage, similarly to drug abuse, but also affects liver function. Indeed, beyond the pharmacokinetic interactions of alcohol with drugs, occurring in the liver due to the same metabolic enzymes, there are also pharmacodynamic interactions of both substances in the CNS. To complicate matters, an important noxious effect of junk foods consists of inducing obesity and obesity-related NAFLD. In this review, we focus on some key mechanisms underlying the impact of these addictions on the liver, as well as those on the CNS.

Association between Parent-Reported Executive Functions and Self-Reported Emotional Problems among Adolescent Offspring of Fathers with Alcohol-Dependence

Objectives  To compare the executive functions in adolescents of fathers with alcohol dependence (AOFADs) with a control group of adolescents without a paternal history of alcohol dependence and examine the association between executive functioning problems and behavioral and emotional problems.

Materials and Methods  The study included 39 AOFADs and 45 adolescent offspring of fathers without a history of alcohol-use disorders, who were matched for age and sex. They were assessed using standardized measures of executive functions and emotional and behavioral problems.

Statistical Analysis  A comparison was made between the two groups about the parental report of adolescents' executive functions and adolescents' self-reported emotional and behavioral problems. ANCOVA was performed to understand the covariance of educational and socio-economic status on executive functions. Correlation between executive functions, emotional and behavioral problems, and the duration of father's alcohol dependence was examined with Spearman's rho.

Results  AOFAD group showed significant impairment on all subdomains of executive functions and emotional and behavioral disturbances ( p  < 0.01) but not on the prosocial behavioral dimension ( p  < 0.01). The group differences were independent of child's education and family income. Executive functional impairments positively correlated with psychopathology ( p  < 0.01). Problems with executive functions and psychopathology correlated with the duration of the father's alcohol dependence.

Conclusions  AOFADs are at risk for executive function impairments which in turn are strongly associated with emotional and behavioral problems. The association is independent of child's education and family economic status. The duration of alcohol dependence in fathers is associated with these problems. It has implications for targeted interventions for both adolescents and families.

Tella intake among pregnant and lactating mothers: may it affect child growth?

Alcohol abuse among women is a public health importance that may impair prenatal and postnatal growth. Tella is among the most common homemade alcoholic beverages in rural Ethiopia, but little is known about the magnitude of tella intake during pregnancy and lactation or its effects on child growth. The present study investigated associations between maternal tella intake and the growth of their children. A cross-sectional mixed-methods study was conducted with mothers (n 228) and their 12–36-month-old children and with key informants (n 12). Tella intake during most recent pregnancy and lactation was estimated retrospectively by glasses per drinking event and frequency of events. Nearly 80 % of mothers had consumed some amount of tella during their most recent pregnancy and lactation. Furthermore, 72 % of children had tasted or drunk tella at some time during their life. Stunting was 42 % and was significantly associated with maternal tella consumption at least every other day during pregnancy (adjusted odds ratio (AOR) 4⋅97, 95 % confidence interval (CI) 2⋅20, 11⋅25), male sex (AOR 2⋅31, 95 % CI 1⋅27, 4⋅19), two or more under-5-year-old children in the household (AOR 3⋅52, 95 % CI 1⋅49, 8⋅33) and family size >5 (AOR 1⋅84, 95 % CI 1⋅01, 3⋅36). Underweight was 24⋅6 % and was associated with the child drinking tella with their mother (AOR 4⋅23, 95 % CI 1⋅99, 8⋅97), being male (AOR 3⋅73, 95 % CI 1⋅73, 7⋅94), having ≥3 diarrhoeal episodes in the last 3 months (AOR 11⋅83, 95 % CI 4⋅22, 33⋅14) and being in the older age group (AOR 2⋅98, 95 % CI 1⋅09, 8⋅13). The associations between tella intake and child growth suggest the need to mitigate the effects of tella on child anthropometry.

Gapdh Shows Altered Gene Expression in Alcohol Models

Background and objectives. Though glyceraldehyde-3-phosphate dehydrogenase (Gapdh) is one of the most commonly used housekeeping genes for comparison of gene expression data, studies have revealed that Gapdh expression is not constant at different developmental stages, and is modulated by many factors including ethanol. In view of this, in the present study, we investigated the effect of ethanol on Gapdh stability and expression levels in different model systems.

Methods. Evaluation of Gapdh stability was determined by comparison with three commonly used housekeeping genes in alcohol-exposed and control mouse blastocysts, embryos, and placentas (ActB, Hsp90ab1, and Atp5b), and in alcohol-dependent and healthy humans (ACTB, ATP5B, and HSPCB), and was ranked by the software program RefFinder. To detect the Gapdh expression patterns as a target gene, qRT-PCR analysis was applied.

Results. The order of expression stabilities obtained by the RefFinder ranked Gapdh as the most unstable reference gene in studied groups. The study of the expression dynamics of Gapdh showed significant upregulation in ethanol-exposed mouse blastocysts and embryos (FC = 1.56, p = 0.05 and FC = 6.0, p = 0.01) and downregulation in placentas (FC = 0.60, p = 0.01).

Conclusions. Our results revealed that the expression of Gapdh can vary in different model systems under ethanol exposure and imply the need for caution when using it as an internal control. This is the first report for statistically significant change in Gapdh expression after ethanol exposure during preimplantation mouse development.

The Universal and Primary Prevention of Foetal Alcohol Spectrum Disorders (FASD): A Systematic Review

Foetal alcohol spectrum disorder (FASD) comprises multiple neurodevelopmental disorders caused by alcohol consumption during pregnancy. With a global prevalence rate of 7.7 per 1000 population, FASD is a leading cause of prenatal developmental disorders. The extent of physical, mental, and social consequences for individuals with FASD can be vast and negatively affect their social environment, daily life, school, relationships, and work. As treatment for FASD is labour- and cost-intensive, with no cure available, prevention is key in reducing FASD prevalence rates. As most systematic reviews conducted so far have focused on specific FASD risk groups, we investigated the effectiveness of universal FASD prevention and primary preventive strategies. We identified a total of 567 potentially pertinent records through PubMed, Cochrane Library, EBSCO, PubPsych, and DAHTA published from 2010 to May 2020, of which 10 studies were included in this systematic review. Results showed a substantial heterogeneity in the studies’ quality, although all preventive measures, except one, proved effective in both increasing knowledge and awareness of FASD, as well as decreasing the risk of an alcohol exposed pregnancy. Limiting factors such as small sample sizes and a lack of behavioural change testing require further studies to support existing evidence for FASD prevention and its implementation, as well as detecting the best course of action for FASD prevention when creating and implementing prevention and intervention approaches.

Fast-track referral for health interventions during pregnancy: study protocol of a randomised pragmatic experimental study to reduce low birth weight in Portugal (STOP LBW)

INTRODUCTION

Low birth weight (LBW) is associated with a wide range of short-term and long-term consequences and is related to maternal psychosocial and behavioural determinants. The objective of this study is to estimate the effect of implementing fast-track referral for early intervention on psychosocial and behavioural risk factors-smoking, alcohol consumption, depression and physical violence-in reducing the incidence of LBW.

METHODS AND ANALYSIS

Parallel superiority pragmatic clinical trial randomised by clusters. Primary healthcare units (PHCU) located in Portugal will be randomised (1:1) to intervention or control groups. Pregnant women over 18 years of age attending these PHCU will be eligible to the study. Risk factors will be assessed through face-to-face interviews. In the intervention group, women who report at least one risk factor will have immediate access to referral services. The comparison group will be the local standard of care for these risk factors. We will use intention-to-treat analyses to compare intervention and control groups. We estimated a sample size of 2832 pregnant women to detect a 30% reduction in the incidence rate of LBW between the control and intervention groups. Secondary outcomes are the reduction of preterm births, reduction of the four risk factors and acceptance of the intervention.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of the Public Health Institute of the University of Porto (no CE20140). The findings will be disseminated to the public, the funders, health professionals, health managers and other researchers.

TRIAL REGISTRATION NUMBER

NCT04866277.

SAMe, Choline, and Valproic Acid as Possible Epigenetic Drugs: Their Effects in Pregnancy with a Special Emphasis on Animal Studies

In this review, we discuss the functions and main effects on pregnancy outcomes of three agents that have the ability to induce epigenetic modifications: valproic acid (VPA), a well-known teratogen that is a histone deacetylase inhibitor; S-adenosylmethionine (SAMe), the most effective methyl donor; and choline, an important micronutrient involved in the one methyl group cycle and in the synthesis of SAMe. Our aim was to describe the possible effects of these compounds when administered during pregnancy on the developing embryo and fetus or, if administered postnatally, their effects on the developing child. These substances are able to modify gene expression and possibly alleviate neurobehavioral changes in disturbances that have epigenetic origins, such as autism spectrum disorder (ASD), depression, Rett syndrome, and fetal alcohol spectrum disorder (FASD). Valproic acid and SAMe are antagonistic epigenetic modulators whether administered in utero or postnatally. However, VPA is a major human teratogen and, whenever possible, should not be used by pregnant women. Most currently relevant data come from experimental animal studies that aimed to explore the possibility of using these substances as epigenetic modifiers and possible therapeutic agents. In experimental animals, each of these substances was able to alleviate the severity of several well-known diseases by inducing changes in the expression of affected genes or by other yet unknown mechanisms. We believe that additional studies are needed to further explore the possibility of using these substances, and similar compounds, for the treatment of ”epigenetic human diseases”.

Assessment of BMP responses in an in vitro model of acute ethanol toxicity

The assay presented here was designed to assess the immediate effects of ethanol (EtOH) exposure on intracellular signaling activated by BMPs (Bone Morphogenetic Proteins). Previous reports of the relationship between EtOH exposure and BMP-dependent signaling have primarily assessed the expression of individual BMPs, changes in BMP target genes or effects on the phosphorylation level of key downstream mediators after days or weeks of in vivo EtOH exposure. What happens to BMP-stimulated signaling immediately following exposure to EtOH remains largely unexplored. Here, the early events of BMP-evoked intracellular signaling were examined in an in vitro model of acute EtOH toxicity. The BMP/Ethanol Stimulation Assay involved first stimulating cultured cells with recombinant BMPs. BMP-evoked intracellular signaling was then allowed to develop for 30 minutes. Next, the cells were exposed to a range of EtOH concentrations for an additional 30 minutes. Finally, the cultures were processed for Western blot analysis or immunofluorescent labeling.

This short-term assay:

• Permits investigation of EtOH exposure during the initial signaling events downstream of BMP receptor activation

• Enables assessment of how the presence of BMPs might protect against cellular injury caused by toxic EtOH levels

Infants of Mothers with Cocaine Use: Review of Clinical and Medico-Legal Aspects

Illicit drug use is a global problem that also affects pregnant women. Substance use and alcohol abuse during pregnancy may have various harmful consequences for both mothers and foetuses. Intrauterine exposure to illicit substances can be investigated through maternal reports and toxicological tests on mothers’ and/or newborns’ samples. While the negative effects of alcohol and opioid use on pregnancy, the foetus, and/or newborn are well established, the effects of cocaine use remain controversial. We performed a review of the literature to evaluate the current state of knowledge of the effects of intrauterine cocaine exposure on newborns’ and children’s long-term development and to highlight possible implications for health professionals dealing with women who use cocaine during pregnancy. Although intrauterine cocaine exposure has been associated with reduced infant measurements, no specific amount of cocaine use exerting such effects has been determined, and no long-term effects have been confirmed. The evidence of cocaine use during pregnancy justifies a clinical and social takeover of the mother and newborn without assuming that there will certainly be long-term damage related to intrauterine cocaine exposure, but also considering other possible associated factors.

Oligodendrocyte pathology in fetal alcohol spectrum disorders

The pathology of fetal alcohol syndrome and the less severe fetal alcohol spectrum disorders includes brain dysmyelination. Recent studies have shed light on the molecular mechanisms underlying these white matter abnormalities. Rodent models of fetal alcohol syndrome and human studies have shown suppressed oligodendrocyte differentiation and apoptosis of oligodendrocyte precursor cells. Ethanol exposure led to reduced expression of myelin basic protein and delayed myelin basic protein expression in rat and mouse models of fetal alcohol syndrome and in human histopathological specimens. Several studies have reported increased expression of many chemokines in dysmyelinating disorders in central nervous system, including multiple sclerosis and fetal alcohol syndrome. Acute ethanol exposure reduced levels of the neuroprotective insulin-like growth factor-1 in fetal and maternal sheep and in human fetal brain tissues, while ethanol increased the expression of tumor necrosis factor α in mouse and human neurons. White matter lesions have been induced in the developing sheep brain by alcohol exposure in early gestation. Rat fetal alcohol syndrome models have shown reduced axon diameters, with thinner myelin sheaths, as well as reduced numbers of oligodendrocytes, which were also morphologically aberrant oligodendrocytes. Expressions of markers for mature myelination, including myelin basic protein, also were reduced. The accumulating knowledge concerning the mechanisms of ethanol-induced dysmyelination could lead to the development of strategies to prevent dysmyelination in children exposed to ethanol during fetal development. Future studies using fetal oligodendrocyte- and oligodendrocyte precursor cell-derived exosomes isolated from the mother’s blood may identify biomarkers for fetal alcohol syndrome and even implicate epigenetic changes in early development that affect oligodendrocyte precursor cell and oligodendrocyte function in adulthood. By combining various imaging modalities with molecular studies, it may be possible to determine which fetuses are at risk and to intervene therapeutically early in the pregnancy.

The effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes among pregnant women attending antenatal care at public health facilities in Gondar town, Northwest Ethiopia: a prospective cohort study

BACKGROUND

The teratogenic effect of fetal alcohol exposure may lead to actual and potential problems, instantly after birth, at infancy; or even later, and mental impairment in life. This study aimed to investigate the effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes at Gondar town public health facilities, Northwest Ethiopia.

METHODS

A facility-based prospective cohort study was performed among 1778 pregnant women who were booked for antenatal care in selected public health facilities from 29 October 2019 to 7 May 2020 in Gondar town. We used a two-stage random sampling technique to recruit and include participants in the cohort. Data were collected using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) standardized and pre-tested questionnaire. Multivariable analysis was performed to examine the association between reported prenatal alcohol exposure (non-hazardous and hazardous) and interested adverse birth outcomes using log-binomial regression modeling. The burden of outcomes was reported using the adjusted risk ratio and population-attributable risk (PAR).

RESULTS

A total of 1686 pregnant women were included in the analysis, which revealed that the incidences of low birth weight, preterm, and stillbirth were 12.63% (95% CI: 11.12, 14.31), 6.05% (95% CI: 5.00, 7.29) and 4.27% (95% CI: 3.4, 5.35), respectively. Non-hazardous and hazardous alcohol consumption during pregnancy was significantly associated with low birth weight (ARR = 1.50; 95% CI: 1.31, 1.98) and (ARR = 2.34; 95% CI: 1.66, 3.30), respectively. Hazardous alcohol consumption during pregnancy was also significantly associated with preterm birth (ARR = 2.06; 95% CI: 1.21, 3.52). The adjusted PAR of low birth weight related to non-hazardous and hazardous alcohol drinking during pregnancy was 11.72 and 8.44%, respectively. The adjusted PAR of hazardous alcohol consumption was 6.80% for preterm.

CONCLUSIONS

Our findings suggest that there is an increasing risk of adverse birth outcomes, particularly preterm delivery and low birth weight, with increasing levels of alcohol intake. This result showed that the prevention of maternal alcohol use during pregnancy has the potential to reduce low birth weight and preterm birth. Hence, screening women for alcohol use during antenatal care visits and providing advice with rigorous follow-up of women who used alcohol may save the fetus from the potential risks of adverse birth outcomes.

Risk Factors of Stillbirth Among Women Who Gave Birth in Amhara Region Referral Hospitals, Ethiopia, in 2019: A Case-Control Study

Background

Worldwide, 2.6 million stillbirths occur annually and more than three-quarters of them are recorded in South Asia and Sub-Saharan Africa. Thus, the aim of this study was to identify risk factors of stillbirth among women who gave birth in Amhara region referral hospitals found in northwest and northcentral, Ethiopia in 2019.

Methods

A multi-center institution-based unmatched case-control study was conducted among 456 mothers who gave birth in Amhara region referral hospitals from October 1 to December 30, 2019. Consecutive and simple random sampling was used to select the cases and controls, respectively. A semi-structured, interviewer-administered questionnaire and patient chart reviews were used to collect the data. Epidemiological (Epi) data version 4.4.2.1 and Statistical Package for the Social Sciences (SPSS) version 25.0 were used for data entry and analysis, respectively. Binary logistic regression was employed. An adjusted odds ratio with a 95% confidence interval was used to declare statistically significant variables on the basis of p-value<0.05 in the multivariable binary logistic regression model.

Results

Alcohol drinking (adjusted odds ratio (AOR)=3.02, 95% confidence interval (CI)=1.24–7.35), antepartum hemorrhage (AOR=5.74, 95% CI=2.67–12.33), premature rupture of membrane (AOR=2.21, 95% CI=1.09–4.44), meconium-stained amniotic fluid (AOR=8.18, 95% CI=4.29–15.60), non-use of partograph for labor follow-up (AOR=3.89, 95% CI=2.12–7.17), induction of labor (AOR=2.12, 95% CI=1.09–4.11), previous history of stillbirth (AOR=2.15, 95% CI=1.08–4.26), and birthweight less than 2,500 grams (AOR=7.36, 95% CI=3.43–15.81) increase the odds of stillbirth.

Conclusion

Stillbirth was higher among women who drank alcohol during their pregnancy, experienced antepartum hemorrhage, premature rupture of membrane, meconium-stained amniotic fluid, induction of labor, labor not followed by partograph, previous history of stillbirth, and birthweight less than 2,500 grams. As such, education to stop alcohol drinking during pregnancy, monitoring the progress of labor with partograph, and improving the quality of care for mothers and newborns at the time of pregnancy and childbirth will contribute to preventing stillbirth.

Predictors of alcohol use during pregnancy in Australian women

INTRODUCTION

This paper aimed to document alcohol use during pregnancy and determine predictors of ongoing use, including knowledge and agreement with national alcohol guideline recommendations.

METHODS

Pregnant women (n = 1179) attending public antenatal services in a Local Health District in NSW, Australia, were surveyed about their alcohol use before pregnancy and after pregnancy recognition, and awareness of, and agreement with, national alcohol guidelines and health-related statements. Respondent characteristics, drinking behaviour and predictors of ongoing drinking during pregnancy were assessed.

RESULTS

Most women consumed alcohol before pregnancy (79.3%) but the majority (82.0%) stopped following pregnancy recognition. Half the ongoing drinkers only drank on special occasions. Most (63.6%) women were aware of the national guidelines: 78.1% knew the recommendation that consuming no alcohol in pregnancy is safest, 4.6% thought some alcohol was safe and 17.3% were unsure. Predictors [OR (95%CI)] of ongoing drinking were older age [1.11 (1.07, 1.15)]; medium [2.42 (1.46, 4.00)] or high-risk drinking pre-pregnancy [3.93 (2.35, 6.56)]; and agreement that: avoiding alcohol in pregnancy is safest [0.05 (0.006, 0.47)]; avoiding alcohol is important for baby's health [0.14 (0.06, 0.31)] and pregnancy is a good time to change alcohol use for mother's health [0.29 (0.13, 0.63)].

DISCUSSION AND CONCLUSIONS

Results emphasise the importance of asking about special occasion drinking, the link between pre-pregnancy drinking and ongoing drinking during pregnancy, and the need to understand why women disagree with the national guideline. To ensure guidelines have their intended benefit, interventions to promote behaviour change relating to alcohol consumption during pregnancy are warranted.

Pregnancy and Binge Drinking: An Intersectionality Theory Perspective Using Veteran Status and Racial/Ethnic Identity

OBJECTIVES

Alcohol use during pregnancy is a critical public health issue that results in several adverse outcomes for both mother and child. While the prevalence of and consequences of binge drinking among pregnant women is well-documented in the literature, little is known about the intersectional effect of racial/ethnic identity and veteran status. The purpose of this study was to examine the prevalence of binge drinking among pregnant women using the intersectionality of racial/ethnic identity and veteran status.

METHODS

This study utilized combined data from the 2016, 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a telephone survey that collects health-related risk behaviors, chronic health conditions and use of preventative services among U.S residents. Generalized linear mixed models were used to examine the prevalence of binge drinking using the interaction between race/ethnicity and veteran status.

RESULTS

Overall binge drinking prevalence was 3.60% among the sample of 6101 pregnant women. Binge drinking prevalence was the highest among racial/ethnic minority veterans at 17.42%, compared to 5.34% among white veterans, 4.05% among non-veteran racial/ethnic minorities and 3% among non-veteran whites, supporting the theory of intersectionality.

CONCLUSIONS

Intersectionality Theory suggests that the stressors from membership in two vulnerable groups may lead to increased disparities. The results of this study highlight the unique experience of being a veteran and identifying as a member of a racial/ethnic minority group. This calls for a need to customize preventative measures that address the combined impact of both racial/ethnic minority group status and veteran status.

Substance use among women who are pregnant: Examining treatment completion by race and ethnicity

Substance use during pregnancy is a critical public health issue that affects both the mother and the fetus. While research has assessed racial differences in treatment completion among women who are pregnant for specific types of substances, few studies have evaluated treatment completion for a variety of substances. As such, the purpose of this study was to examine racial differences in substance use treatment completion among women who are pregnant. The study derived data from the 2017 Treatment Episode Data-Discharges (TEDS-D) of the Substance Abuse and Mental Health Services Administration (SAMHSA). TEDS-D documents annual discharges from publicly funded substance use treatment programs in the United States, collected by each state and aggregated by SAMHSA. The study used Chi square tests for bivariate analyses and used logistic regression models to predict treatment completion by race and ethnicity. After accounting for other explanatory factors, Black and Hispanic women who were pregnant were significantly less likely to complete treatment compared to Whites. These differences were evident even after examining the interaction between race and substance of use. The study found no differences between Indigenous and Other race women who were pregnant and Whites. Results indicate the need to examine cultural, historical, and systemic factors that could affect lower treatment completion among Black and Hispanic women who are pregnant. Interventions should, therefore, move beyond the impact of socioeconomic factors and focus on the role of social support, external responsibilities, and the criminalizing of substance use during pregnancy.

Does early ethanol exposure increase seeking-like behavior in zebrafish?

Fetal alcohol spectrum disorder (FASD) is the most common cause of birth defects. The severe variations are in fetal alcohol syndrome (FAS) but the most frequent cases are alcohol-related neurodevelopmental disorder (ARND), which is of a difficult diagnosis. ARND characteristics include impaired social behavior, anxiety and depression prevalence, cognitive deficits, and an increased chance for drug addiction. Here, we aimed to test whether early alcohol exposure leads to later alcohol preference. We hypothesize that early alcohol exposure increases the reinforcing effects on later experiences, raising the chance of addiction in adult life. Lately, the zebrafish has been a valuable model on alcohol research, allowing embryonic exposure and the study of the ontogenetic effects. For this, embryos were exposed to three different alcohol treatments: 0.0%, 0.25% and 0.5%, for 2 hr, at 24-hr post-fertilization. Then we evaluated the effects of embryonic alcohol exposure on conditioned place preference in two developmental stage: fry (10 days post-fertilization (dpf)) and young (90 dpf) zebrafish. Results show that control fish presented alcohol associative learning, which means, changes in place preference due to alcohol exposure, at both ontogenetic phases. However, zebrafish exposed to 0.25 and 0.5% alcohol during embryogenesis did not show conditioning response at any evaluated stage. These results suggest perception and cognitive deficits due to embryonic alcohol exposure that can alter alcohol responsiveness throughout a lifetime. Although low alcohol doses do not provoke malformation, it has been shown to induce several neurological and behavioral changes that are termed as Alcohol-Related Neurodevelopmental Disorders. These results may contribute to future investigations on how embryonic exposure affects the neurocircuitry related to perception and associative learning processing.

Noninvasive screening for congenital heart defects using a serum metabolomics approach

OBJECTIVE

Heart anomalies represent nearly one-third of all congenital anomalies. They are currently diagnosed using ultrasound. However, there is a strong need for a more accurate and less operator-dependent screening method. Here we report a metabolomics characterization of maternal serum in order to describe a metabolomic fingerprint representative of heart congenital anomalies.

METHODS

Metabolomic profiles were obtained from serum of 350 mothers (280 controls and 70 cases). Nine classification models were built and optimized. An ensemble model was built based on the results from the individual models.

RESULTS

The ensemble machine learning model correctly classified all cases and controls. Malonic, 3-hydroxybutyric and methyl glutaric acid, urea, androstenedione, fructose, tocopherol, leucine, and putrescine were determined as the most relevant metabolites in class separation.

CONCLUSION

The metabolomic signature of second trimester maternal serum from pregnancies affected by a fetal heart anomaly is quantifiably different from that of a normal pregnancy. Maternal serum metabolomics is a promising tool for the accurate and sensitive screening of such congenital defects. Moreover, the revelation of the associated metabolites and their respective biochemical pathways allows a better understanding of the overall pathophysiology of affected pregnancies.

Ethanol-mediated alterations in oligodendrocyte differentiation in the developing brain

INTRODUCTION

Alterations of white matter integrity and subsequent white matter structural deficits are consistent findings in Fetal Alcohol Syndrome (FAS), but knowledge regarding the molecular mechanisms underlying these abnormalities is incomplete. Experimental rodent models of FAS have shown dysregulation of cytokine expression leading to apoptosis of oligodendrocyte precursor cells (OPCs) and altered oligodendrocyte (OL) differentiation, but whether this is representative of human FAS pathogenesis has not been determined.

METHODS

Fetal brain tissue (12.2-21.4 weeks gestation) from subjects undergoing elective termination of pregnancy was collected according to an IRB-approved protocol. Ethanol (EtOH) exposure status was classified based on a detailed face-to-face questionnaire adapted from the National Institute on Alcohol Abuse and Alcoholism Prenatal Alcohol and Sudden Infant Death Syndrome and Stillbirth (PASS) study. Twenty EtOH-exposed fetuses were compared with 20 gestational age matched controls. Cytokine and OPC marker mRNA expression was quantified by Real-Time Polymerase chain reaction (qRT-PCR). Patterns of protein expression of OPC markers and active Capase-3 were studied by Fluorescence Activated Cell Sorting (FACS).

RESULTS

EtOH exposure was associated with reduced markers of cell viability, OPC differentiation, and OL maturation, while early OL differentiation markers were unchanged or increased. Expression of mRNAs for proteins specific to more mature forms of OL lineage (platelet-derived growth factor α (PDGFRα) and myelin basic protein (MBP) was lower in the EtOH group than in controls. Expression of the multifunctional growth and differentiation-promoting growth factor IGF-1, which is essential for normal development, also was reduced. Reductions were not observed for markers of early stages of OL differentiation, including Nuclear transcription factor NK-2 homeobox locus 2 (Nkx2.2). Expression of mRNAs for the proinflammatory cytokine, tumor necrosis factor-α (TNFα), and several proinflammatory chemokines was higher in the EtOH group compared to controls, including: Growth regulated protein alpha/chemokine (C-X-C motif) ligand 1 (GRO-α/CXCL1), Interleukin 8/chemokine (C-X-C motif) ligand 8 (IL8/CXCL8), Chemokine (C-X-C motif) ligand 6/Granulocyte chemotactic protein 2 (CXCL16/GCP2), epithelial-derived neutrophil-activating protein 78/chemokine (C-X-C motif) ligand 5 (ENA-78/CXCL5), monocyte chemoattractant protein-1 (MCP-1). EtOH exposure also was associated with an increase in the proportion of cells expressing markers of early stage OPCs, such as A2B5 and NG2. Finally, apoptosis (measured by caspase-3 activation) was increased substantially in the EtOH group compared to controls.

CONCLUSION

Prenatal EtOH exposure is associated with excessive OL apoptosis and/or delayed OL maturation in human fetal brain. This is accompanied by markedly dysregulated expression of several chemokines and cytokines, in a pattern predictive of increased OL cytotoxicity and reduced OL differentiation. These findings are consistent with findings in animal models of FAS.

Ethanol binge drinking during pregnancy and its effects on salivary glands of offspring rats: oxidative stress, morphometric changes and salivary function impairments

OBJECTIVES

To investigate the biochemical and morphological effects of ethanol (EtOH) binge drinking during pregnancy on parotid glands (PG), submandibular glands (SMG), and saliva of offspring rats.

METHODS

Pregnant Wistar rats (n = 8) were exposed to EtOH consumption (3 g/kg/day - 20 % w/v) for three consecutive days. The saliva of 40-day-old offspring rats was collected to determine amylase activity and total protein concentration. PG and SMG were collected to performe oxidative biochemistry, morphometric and immunohistochemistry analyses (Student's t-test, p < .05).

RESULTS

EtOH consumption during pregnancy significantly decreased the total protein concentration and decreased amylase activity. In the PG, the EtOH group showed increased lipid peroxidation and decreased antioxidant capacity against peroxyl. In the SMG, the EtOH group showed increased lipid peroxidation and NOx metabolite levels. PG exposed to EtOH showed a decrease of acini, ducts, and total parenchymal area. SMG exposed to EtOH showed an increase in the total stromal area. The expression of CK-19 and Vimentin were found not different between groups.

CONCLUSIONS

For the first time, a three-day EtOH binge-drinking protocol during pregnancy is associated with oxidative stress and morphometric alterations in the salivary glands of offspring rats and with the functional reduction of the main salivary enzyme (amylase).

CLINICAL RELEVANCE

EtOH consumption during pregnancy altered the morphology and physiology of the salivary glands of offspring rats.

Fetal alcohol and maternal stress modify the expression of proteins controlling postnatal development of the male rat hippocampus

Background: Developing brains can partially get over prenatal alcohol exposure-related detrimental conditions by activating some mechanisms involved in survival. Objectives: This study aimed to shed light on the molecular correlates of compensatory mechanisms by examining temporal profiles in the expression of proteins controlling postnatal development in the rat hippocampus prenatally exposed to intubation stress/ethanol. Methods: Male pups were randomly assigned to age subgroups (n = 21/age) which were sacrificed on postnatal day (PD)1, PD10, PD30, and PD60. Ethanol (6 g/kg/day) were intragastrically intubated to the dams throughout 7-21 gestation days. The expression of neurogenesis and angiogenesis markers, extracellular matrix proteins, and growth-promoting ligands were examined by western blot. Results: The most rapid increase in the index of neuronal maturation was noted between PD10-PD30 (p < .05). Prenatal stress caused a decrease of neurogenesis markers at birth and an increase of their expressions at PD10 and PD30 to reach control levels (p < .001). The impact of fetal-alcohol was observed as a decrease in the expression of synaptic plasticity protein versican at birth (p < .001), an increase in the synaptic repulsion protein ephrin-B2 at PD10 (p < .001), and a decrease in the maturation of BDNF at PD30 (p < .001) with a decrease in the mature neuron markers at PD30 (p < .001) and PD60 (p = .005) which were compensated with upregulation of angiogenesis and increasing brevican expression, a neuronal maturation protein (p < .001). Conclusion: These data provide in vivo evidence for the potential therapeutic factors related to neurogenesis, angiogenesis, and neurite remodeling which may tolerate the alcohol/stress dependent teratogenicity in the developing hippocampus.

Recalled maternal lifestyle behaviors associated with anti-müllerian hormone of adult female offspring

Anti-müllerian hormone (AMH) is an established marker of ovarian reserve that decreases with age. Though the pool of ovarian follicles is established during fetal development, impacts of in utero exposures on AMH are uncertain. Thus, we sought to evaluate associations of in utero exposures with AMH of adult daughters with a prospective cohort study of adult daughters at university medical centers. Women noted their mother's reported use of diethylstilbestrol (DES), vitamins, tobacco, alcohol, and caffeine during pregnancy, and their mother's occupation during pregnancy. All participants were reproductive age women (18-40 years) enrolled in the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial. Serum AMH concentrations were measured at baseline prior to conception and categorized using clinical guidelines. Multinomial regression models estimated associations between each exposure and high (>3.5 ng/mL) and low (<1.0 ng/mL) versus normal AMH (1.0-3.5 ng/mL), adjusting for participant's age, mother's age, mother's history of fertility treatment, and mother's use of vitamins. In 1202 women with available data, maternal caffeine use was associated with an increased risk of low AMH, compared to normal (relative risk [RR] 1.90, 95 % confidence interval [CI] 1.09, 3.30). Vitamins were associated with an increased risk of high AMH compared to normal (RR 1.93, 95 % CI 1.24, 3.00). Other exposures were not associated with AMH concentrations in offspring. Maternal caffeine and vitamin use during pregnancy may be associated with ovarian reserve in adult offspring, highlighting the potential importance of pregnancy lifestyle on the reproductive health of daughters.

Early life predictors of development of blood pressure from childhood to adulthood: Evidence from a 30-year longitudinal birth cohort study

BACKGROUND AND AIMS

The early life predictors of changes in the blood pressures of offspring between childhood and young adulthood have not been well defined. Thus, this study aimed to determine the life course association of offspring's blood pressure with prenatal and early infancy lifestyle, and other factors taking advantage of a large community-based, longitudinal study of a birth cohort in Australia - the MUSP study.

METHODS

The systolic and diastolic blood pressure (SBP, DBP) was measured for 3793, 3782, 2628 and 1780 offspring of the Australian longitudinal cohort study at 5, 14, 21 and 30 years of their age, respectively. Individual PP and mean arterial pressure (MAP) was equated, and Generalized Estimating Equations with time (age) and predictor interaction modelling were performed.

RESULTS

Blood pressures of the offspring increased significantly between 5 and 30 years. Early life factors such as pre-pregnancy overweight/obesity, and hypertensive disorder in pregnancy were significantly positively associated, and duration of gestation and pre-pregnancy thinness of the mothers negatively associated with this life course increase in the offspring's blood pressure. Rapid increase in body weight from birth to 5 years had a strong association with increasing blood pressures components throughout their life course.

CONCLUSIONS

Several maternal pre-pregnancy and pregnancy factors along with the early life growth characteristics of offspring are important predictors of increase in blood pressure of the offspring from their childhood to adulthood.

The Protective Role of Prenatal Alpha Lipoic Acid Supplementation against Pancreatic Oxidative Damage in Offspring of Valproic Acid-Treated Rats: Histological and Molecular Study

Background: Sodium valproate (VPA) is an antiepileptic drug (AED) licensed for epilepsy and used during pregnancy in various indications. Alpha-lipoic acid (ALA) is a natural compound inducing endogenous antioxidant production. Our study aimed to investigate the effect of prenatal administration of VPA on the pancreas of rat offspring and assess the potential protective role of ALA co-administration during pregnancy. Methods: Twenty-eight pregnant female albino rats were divided into four groups: group I (negative control), group II (positive control, ALA treated), group III (VPA-treated), and group IV (VPA-ALA-treated). The pancreases of the rat offspring were removed at the fourth week postpartum and prepared for histological, immune-histochemical, morphometric, molecular, and oxidative stress marker studies. Results: In group III, there were pyknotic nuclei, vacuolated cytoplasm with ballooning of acinar, α, and β cells of the pancreas. Ultrastructural degeneration of cytoplasmic organelles was detected. Additionally, there was a significant increase in oxidative stress, a decrease in insulin-positive cell percentage, and an increase in glucagon positive cells in comparison to control groups. Moreover, VPA increased the gene expression of an apoptotic marker, caspase-3, with a decrease in anti-apoptotic Bcl2 and nuclear factor erythroid 2-related factor 2 (Nrf2) transcriptional factor. Conversely, ALA improved oxidative stress and apoptosis in group VI, and a consequent improvement of the histological and ultrastructure picture was detected. Conclusion: ALA co-administration with VPA significantly improved the oxidative stress condition, histological and morphometric picture of the pancreas, and restored normal expression of related genes, including Nrf2, caspase-3, and Bcl-2. Administration of α-lipoic acid has a protective effect against VPA-induced pancreatic oxidative damage via its cytoprotective antioxidant effect.

Maternal lifestyle characteristics and Wilms tumor risk in the offspring: A systematic review and meta-analysis

BACKGROUND

Little is known about the etiology of childhood Wilms tumor (WT) and potentially modifiable maternal risk factors, in particular.

METHODS

Unpublished data derived from the hospital-based, case-control study of the Greek Nationwide Registry for Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST) were included in an ad hoc conducted systematic literature review and meta-analyses examining the association between modifiable maternal lifestyle risk factors and WT. Eligible data were meta-analysed in separate strands regarding the associations of WT with (a) maternal folic acid and/or vitamins supplementation, (b) alcohol consumption and (c) smoking during pregnancy. The quality of eligible studies was evaluated using the Newcastle-Ottawa Scale.

RESULTS

Effect estimates from 72 cases and 72 age- and sex-matched controls contributed by NARECHEM-ST were meta-analysed together with those of another 17, mainly medium size, studies of ecological, case-control and cohort design. Maternal intake of folic acid and/or other vitamins supplements during pregnancy was inversely associated with WT risk (6 studies, OR: 0.78; 95 %CI: 0.69-0.89, I2 = 5.4 %); of similar size was the association for folic acid intake alone (4 studies, OR: 0.79; 95 %CI: 0.69-0.91, I2 = 0.0 %), derived mainly from ecological studies. In the Greek study a positive association (OR: 5.31; 95 %CI: 2.00-14.10) was found for mothers who consumed alcohol only before pregnancy vs. never drinkers whereas in the meta-analysis of the four homogeneous studies examining the effect of alcohol consumption during pregnancy the respective overall result showed an OR: 1.60 (4 studies, 95 %CI: 1.28-2.01, I2 = 0.0 %). Lastly, no association was seen with maternal smoking during pregnancy (14 studies, OR: 0.93; 95 %CI: 0.80-1.09, I2 = 0.0 %).

CONCLUSIONS

In the largest to-date meta-analysis, there was an inverse association of maternal folic acid or vitamins supplementation with WT risk in the offspring, derived mainly from ecological studies. The association with maternal alcohol consumption found in our study needs to be further explored whereas no association with maternal smoking was detected. Given the proven benefits for other health conditions, recommendations regarding folic acid supplementation as well as smoking and alcohol cessation should apply. The maternal alcohol consumption associations, however, should be further explored given the inherent limitations in the assessment of exposures of the published studies.

Murine Models for the Study of Fetal Alcohol Spectrum Disorders: An Overview

Prenatal alcohol exposure is associated to different physical, behavioral, cognitive, and neurological impairments collectively known as fetal alcohol spectrum disorder. The underlying mechanisms of ethanol toxicity are not completely understood. Experimental studies during human pregnancy to identify new diagnostic biomarkers are difficult to carry out beyond genetic or epigenetic analyses in biological matrices. Therefore, animal models are a useful tool to study the teratogenic effects of alcohol on the central nervous system and analyze the benefits of promising therapies. Animal models of alcohol spectrum disorder allow the analysis of key variables such as amount, timing and frequency of ethanol consumption to describe the harmful effects of prenatal alcohol exposure. In this review, we aim to synthetize neurodevelopmental disabilities in rodent fetal alcohol spectrum disorder phenotypes, considering facial dysmorphology and fetal growth restriction. We examine the different neurodevelopmental stages based on the most consistently implicated epigenetic mechanisms, cell types and molecular pathways, and assess the advantages and disadvantages of murine models in the study of fetal alcohol spectrum disorder, the different routes of alcohol administration, and alcohol consumption patterns applied to rodents. Finally, we analyze a wide range of phenotypic features to identify fetal alcohol spectrum disorder phenotypes in murine models, exploring facial dysmorphology, neurodevelopmental deficits, and growth restriction, as well as the methodologies used to evaluate behavioral and anatomical alterations produced by prenatal alcohol exposure in rodents.

24-Epibrassinolide protects against ethanol-induced behavioural teratogenesis in zebrafish embryo

Embryonic studies have demonstrated the neurotoxic, teratogenic, and neurobehavioral toxicity of ethanol (EtOH). Although multiple mechanisms may contribute to these effects, oxidative stress has been described as the major damage pathway. In this regard, natural antioxidants have the potential to counteract oxidative stress-induced cellular damage. Therefore, the present study aimed to investigate the potential protective role of 24-epibrassinolide (24-EPI), a natural brassinosteroid with proved antioxidant properties, in EtOH-induced teratogenic effects during early zebrafish development. Embryos (~2 h post-fertilization - hpf) were exposed to 1 % EtOH, co-exposed to 24-EPI (0.01, 0.1 and 1 μM) and to 24-EPI alone (1 μM) for 24 h. Following exposure, biochemical evaluations were made at 26 hpf, developmental analysis was made throughout the embryo-larval period, and behavioural responses were evaluated at 120 hpf. Exposure to 1 % EtOH caused an increase in the number of malformations, which were diminished by 24-EPI. In addition, EtOH induced an accumulation of GSSG and consequent reduction of GSH:GSSG ratio, indicating the involvement of oxidative mechanisms in the EtOH-induced effects. These were reverted by 24-EPI as proved by the GSSG levels and GSH:GSSG ratio that returned to control values. Furthermore, exposure to EtOH resulted in behavioural deficits at 120 hpf as observed by the disrupted response to an aversive stimulus, suggesting the involvement of neurotoxic mechanisms. 24-EPI restored the behavioural deficits observed in a dose-dependent manner. The absence of effects in the embryos exposed solely to 24-EPI showed its safety during the exposure period. In conclusion, EtOH caused developmental teratogenicity and behavioural toxicity by inducing glutathione changes, which were prevented by 24-EPI.

Alcohol consumption before pregnancy causes detrimental fetal development and maternal metabolic disorders

Alcohol consumption before or during pregnancy poses serious health risks to the fetus; however, the underlying mechanisms involved remain obscure. Here, we investigated whether ethanol consumption before pregnancy affects maternal or fetal health and whether pharmacological inhibition of CYP2E1, a major ethanol oxidation enzyme, by 4-methylpyrazole (4-MP) has therapeutic effects. We found that ethanol consumption (5%) 2 weeks before pregnancy resulted in a decrease in the number of viable fetuses and abnormal fetal development, and these effects were accompanied by impaired maternal glucose homeostasis and hepatic steatosis during pregnancy. Neonates of ethanol-fed mice had postnatal macrosomia and significantly decreased growth rates during the lactation period. However, treatment with 4-MP, a CYP2E1 inhibitor, markedly ameliorated the reduction in insulin action and glucose disposal responsiveness in the livers of ethanol-fed mice. Blockage of CYP2E1 significantly reduced the alteration in hepatic lipid deposition, fatty acid oxidation, mitochondrial energy status, and macrophage infiltration observed in ethanol-fed mice. Finally, there was a positive correlation between postnatal macrosomia or growth retardation and increased inflammatory responses. Collectively, our study suggests that even moderate ethanol intake may be detrimental to fetal development and may cause growth retardation through maternal metabolic disorders.

Anxious Behavior of Adult CD1 Mice Perinatally Exposed to Low Concentrations of Ethanol Correlates With Morphological Changes in Cingulate Cortex and Amygdala

Perinatal ethanol (EtOH) exposure is associated with high incidence of behavioral disorders such as depression and anxiety. The cerebral areas related with these consequences involve the corticolimbic system, in particular the prefrontal cortex, hippocampus, amygdala, and cingulate cortex, although the latter has not been thoroughly studied yet. Different animal models of prenatal or perinatal EtOH exposure have reported morphofunctional alterations in the central nervous system, which could explain behavioral disorders along life; these results focus on youth and adolescents and are still controversial. In the light of these inconclusive results, the aim of this work was to analyze adult behavior in CD1 mice perinatally exposed to low concentrations of EtOH (PEE) during gestation and lactation, and describe the morphology of the cingulate cortex and amygdala with a view to establishing structure/function/behavior correlations. Primiparous CD1 female mice were exposed to EtOH 6% v/v for 20 days prior to mating and continued drinking EtOH 6% v/v during pregnancy and lactation. After weaning, male pups were fed food and water ad libitum until 77 days of age, when behavioral and morphological studies were performed. Mouse behavior was analyzed through light–dark box and open field tests. Parameters related to anxious behavior and locomotor activity revealed anxiogenic behavior in PEE mice. After behavioral studies, mice were perfused and neurons, axons, serotonin transporter, 5HT, CB1 receptor (CB1R) and 5HT1A receptor (5HT1AR) were studied by immunofluorescence and immunohistochemistry in brain sections containing cingulate cortex and amygdala. Cingulate cortex and amygdala cytoarchitecture were preserved in adult PEE mice, although a smaller number of neurons was detected in the amygdala. Cingulate cortex axons demonstrated disorganized radial distribution and reduced area. Serotonergic and endocannabinoid systems, both involved in anxious behavior, showed differential expression. Serotonergic afferents were lower in both brain areas of PEE animals, while 5HT1AR expression was lower in the cingulate cortex and higher in the amygdala. The expression of CB1R was lower only in the amygdala. In sum, EtOH exposure during early brain development induces morphological changes in structures of the limbic system and its neuromodulation, which persist into adulthood and may be responsible for anxious behavior.

Gender Differences in the Outcome of Offspring Prenatally Exposed to Drugs of Abuse

Despite great efforts to warn pregnant women that drugs of abuse impact development of the embryo and the fetus, the use of legal and illegal drugs by childbearing women is still a major public health concern. In parallel with well-established teratogenic effects elicited by some drugs of abuse, epidemiological studies show that certain psychoactive substances do not induce birth defects but lead to subtle neurobehavioral alterations in the offspring that manifest as early as during infancy. Although gender differences in offspring susceptibility have not been fully investigated, a number of longitudinal studies indicate that male and female progeny exposed in utero to drugs of abuse show different vulnerabilities to deleterious effects of these substances in cognitive, executive, and behavioral domains. Here, we briefly review the existing literature focusing on gender differences in the neurobehavioral consequences of maternal exposure to drugs of abuse. Overall, the data strongly indicate that male exposed progeny are more susceptible than female to dysfunctions in cognitive processing and emotional regulation. However, insights into the mechanisms determining this natural phenomenon are not currently available. Our analysis prompts future investigations to implement clinical studies including the influence of gender/sex as a biological variable in the outcome of offspring prenatally exposed to drugs of abuse.

Prevalence of alcohol use in late pregnancy

BACKGROUND

Prenatal alcohol exposure (PAE) can result in detrimental developmental complications. The objective of this study was to estimate the most recent PAE prevalence data for the state of West Virginia (WV) and associated factors.

METHOD

In all, 1830 newborn residual dried blood spots (DBS) in the WV Newborn Screening Repository were analyzed for phosphatidylethanol (PETH). Data were matched with Project WATCH data (94% match, N = 1729).

RESULTS

The prevalence of late pregnancy PAE was 8.10% (95%CI: 6.81, 9.38) for all births, 7.61% (95%CI: 6.26, 8.97) for WV residents only, and ranged from 2.27 to 17.11% by region. The significant factors associated with PAE included smoking (OR: 2.03, 95% CI: 1.40, 2.94), preterm births (OR: 1.88; 95% CI: 1.23, 2.89), birth weight of ≤2000 g vs. >3000 g (OR: 2.62, 95%CI: 1.19, 5.79), no exclusive breastfeeding intention (OR: 1.45, 95% CI: 1.02, 2.04), and not exclusively breastfeeding before discharge (OR: 1.61; 95% CI: 1.09, 2.38).

CONCLUSION

The prevalence of PAE is higher than previously shown for the state. Accurate and timely estimates are vital to inform public health workers, policymakers, researchers, and clinicians to develop and promote effective prevention strategies to lower PAE prevalence and provide targeted interventions and treatment services for infants affected by PAE.

Food and nutrient intake and adherence to dietary recommendations during pregnancy: a Nordic mother-child population-based cohort

Background

A woman's food intake during pregnancy has important implications not only for herself but also for the future health and well-being of her child. Suboptimal dietary quality has been consistently reported in many high-income countries, reflecting poor adherence to dietary guidelines.

Objective

This study aimed to explore the intake of food and nutrients in a cohort of pregnant women in Norway and their adherence to Nordic Nutrition Recommendations (NNR) and Norwegian food-based guidelines (NFG).

Design

We investigated the dietary intake in 1,674 pregnant women from the mother-child birth cohort, PreventADALL, recruited at approximately 18-week gestational age. Dietary intake was assessed by an electronic validated food frequency questionnaire (PrevFFQ) in the first half of pregnancy.

Results

Total fat intake was within the recommended intake (RI) range in most women; however, the contribution of saturated fatty acids to the total energy intake was above RI in the majority (85.2%) of women. Carbohydrate intake was below RI in 43.9% of the women, and 69.5% exceeded the RI of salt. Intakes of fiber, vegetables, and fish were high in a large part of the population. Many women had a high probability of inadequate intakes of the following key micronutrients during pregnancy: folate (54.4%), iron (49.6%), calcium (36.2%), vitamin D (28.7%), iodine (24.4%), and selenium (41.3%). A total of 22.8% women reported an alcohol intake of >1 g/day, and 4.4% reported an alcohol intake of >10 g/day. Women with higher educational levels showed a tendency towards healthier eating habits, except for higher intakes of alcohol and coffee, compared to women with lower educational level.

Discussion

Excessive saturated fat intake and limited intake of many important micronutrients during pregnancy were common, potentially increasing the risk for adverse pregnancy and birth outcomes.

Conclusions

This study highlights the need for improved nutritional guidance to pregnant women across all educational levels.

A review of factors associated with patterns of drinking during pregnancy

Purpose

The purpose of this paper is to identify factors associated with drinking patterns during pregnancy.

Design/methodology/approach

A rapid evidence assessment was undertaken, scanning multiple databases for studies examining factors associated with alcohol consumption in pregnancy. Studies were included if they stratified data according to quantity of alcohol consumed and identified relevant associated factors. Drinking patterns were classified as light/moderate and heavy/binge.

Findings

In total, 15 studies were included (N=7 light/moderate; N=15 heavy/binge drinking). Factors associated with alcohol consumption during pregnancy included: smoking, age, SES, marital status, pre-pregnancy substance use and parity. While few studies reported an association between heavy/binge drinking and maternal mental health, none of the studies included explored the association between mental health and light/moderate drinking.

Research limitations/implications

Relatively few studies have looked at the association between psychological characteristics of women and their drinking patterns. There is a lack of articles examining light/moderate drinking in pregnancy compared to heavy/binge drinking. Moreover, there is marked variation in how alcohol use is measured. Further studies are needed to increase understanding of the association between psychological factors and patterns of drinking during pregnancy, and how health professionals might support women in this context.

Originality/value

The authors expand on previous work by examining two different patterns of alcohol consumption in pregnancy, rather than alcohol use simply as an isolated concept. The two groups were found to differ in a number of demographic and social factors. This information could be used to aid healthcare professionals in targeting specific interventions to those women most at risk.

Environmental & occupational exposure & female reproductive dysfunction

All individuals are exposed to certain chemical, physical, biological, environmental as well as occupational factors. The data pertaining to role of these factors on female reproduction are scanty as compared to male. The available data suggest the adverse effects of certain toxicants, viz., metals such as lead, cadmium and mercury, pesticides such as bis(4-chlorophenyl)-1,1,1-trichloroethane and organic solvent such as benzene, toluene and ionizing radiation on the female reproductive system affecting directly the organ system or impacting in directly through hormonal impairments, molecular alterations, oxidative stress and DNA methylation impairing fertility as well as pregnancy and its outcomes. Thus, there is a need for awareness and prevention programme about the adverse effects of these factors and deterioration of female reproductive health, pregnancy outcome and offspring development as some of these chemicals might affect the developing foetus at very low doses by endocrine disruptive mechanism.

Identifying trajectories of antenatal depression in women and their associations with gestational age and neonatal anthropometry: A prospective cohort study

OBJECTIVE

The present study sought to determine the longitudinal trajectories of antenatal depression and examine their associations with birth outcomes.

METHOD

926 healthy women with uncomplicated singleton pregnancies within 14 weeks of gestation participated in this prospective cohort study. Women completed a sociodemographic and medical questionnaire and the locally-validated Edinburgh Postnatal Depression Scale (EPDS) in their first, second, and third trimesters, and prior to parturition. Gestational age and neonatal weight, length, and head circumference were recorded at birth. Group-based trajectory modelling characterized trajectories of antenatal depression. Analyses of covariance and covariate-adjusted linear regressions identified associations between trajectories and neonatal outcomes.

RESULTS

Four distinct non-fluctuating trajectories of depressive symptoms were identified, with 9% women suffering from probable clinical depression throughout the pregnancy. Women in this persistently-moderate depression trajectory delivered 2.48 days earlier than in other trajectories; a one-point increase in EPDS scores was associated with an adjusted reduction of 5.82 g in birthweight.

CONCLUSIONS

Although meaningful trajectories were identified, no clinically relevant associations between persistently-moderate depressive symptoms with neonatal outcomes were found. The stability of these trajectories, however, suggests the importance of screening for depressive symptoms early in pregnancy to identify women who may benefit from greater formal and informal support.

Alcohol use and associated factors among women attending antenatal care in Southern Ethiopia: a facility based cross sectional study

Objectives

The aim of this study was to assess the prevalence and associated factors of alcohol use among women attending Antenatal Care in Gedeo zone rural health centers (Southern Ethiopia). This was a cross-sectional study conducted among randomly selected 718 pregnant women attending Antenatal Care. Alcohol Use Disorder Identification Test-C was used to assess alcohol consumption. Variables with p-values of < 0.05 in the multivariable logistic regression were considered as having a statistically significant association with alcohol use.

Results

The prevalence of alcohol use among pregnant women attending antenatal care service was 8.1% with 95% CI (6.3–10.0). Unplanned pregnancy [AOR = 2.12, 95% CI (1.20, 3.73)], abortion history [AOR = 2.40, 95% CI (1.16, 4.96)], pre pregnancy alcohol use [AOR 2.17, 95% CI (1.18, 4.00)] and mental distress [AOR = 3.50, 95% CI (1.99, 6.15)] were variables found to have a statistically significant association with alcohol use. This calls a holistic and multi modal approach for the prevention, early identification and intervention of alcohol use during pregnancy. More emphasis should also be given for pregnant women with unplanned pregnancy, history of abortion, pre pregnancy alcohol use and mental distress.

Effects of gestational thiamine-deprivation and/or exposure to ethanol on crucial offspring rat brain enzyme activities

OBJECTIVE

The fetal alcohol spectrum disorder (FASD) is a group of clinical conditions associated with the in utero exposure to ethanol (EtOH). We have recently examined the effects of a moderate maternal exposure to EtOH on crucial brain enzyme activities in offspring rats, and discussed the translational challenges arising when attempting to simulate any of the clinical conditions associated with FASD.

MATERIALS AND METHODS

In this current study, we: (i) address the need for a more consistent and reliable in vivo experimental platform that could simulate milder cases of FASD complicated by simultaneous thiamine-deprivation during gestation and (ii) explore the effects of such a moderate maternal exposure pattern to EtOH and a thiamine-deficient diet (TDD) on crucial enzyme activities in the offspring rat brains.

RESULTS

We demonstrate a significant decrease in the newborn and 21-day-old offspring body and brain weight due to maternal dietary thiamine-deprivation, as well as evidence of crucial brain enzyme activity alterations that in some cases are present in the offspring rat brains long after birth (and the end of the maternal exposure to both EtOH and TDD).

CONCLUSIONS

Our findings provide a preliminary characterization of important neurochemical effects due to maternal exposure to EtOH and TDD during gestation that might affect the offspring rat neurodevelopment, and that characterization should be further explored in a brain region-specific manner level as well as through the parallel examination of changes in the offspring rat brain lipid composition.

Aerobic Physical Exercise as a Neuroprotector Strategy for Ethanol Binge-Drinking Effects in the Hippocampus and Systemic Redox Status in Rats

The heavy and episodic EtOH drinking pattern, equivalent to weekend consumption, characterizes the binge-drinking pattern and promotes a misbalance of encephalic metabolic functions, concurring to neurodegeneration and cerebral dysfunction. And for being a legal drug, it has global public health and social relevance. In this way, we aimed to investigate the effects of physical training, in a treadmill, on the deleterious effects of EtOH on hippocampal functions, related to memory and learning. For this, we used 40 Wistar rats, divided into four groups: Control group, Trained group (trained animals with doses of distilled water), EtOH group (nontrained animals with doses of 3 g/kg/day of EtOH, 20% w/v), and Trained+EtOH group (trained animals exposed to EtOH). The physical exercise was performed by running on a treadmill for 5 days a week for 4 weeks, and all doses of EtOH were administered through intragastric gavage in four repeated cycles of EtOH in binge. After the experimental period, the animals were submitted to the object recognition task and Morris water maze test, and after being euthanized, the blood and hippocampus were collected for Trolox Equivalent Antioxidant Capacity (TEAC), Reduced Glutathione Content (GSH), and Nitrite and Lipid Peroxidation (LPO) level measurements. Our results showed that EtOH caused marked oxidative stress and mnemonic damage, and the physical exercise promoted neuroprotective effects, among them, the modulation of oxidative biochemistry in plasma (by restoring GSH levels) and in the hippocampus (by reducing LPO levels and increasing antioxidant parameters) and cognitive function improvement. Therefore, physical exercise can be an important prophylactic and therapeutic tool in order to ameliorate and even prevent the deleterious effects of EtOH on cognitive functions.

Alcohol Use in Pregnancy

Alcohol exposure during pregnancy results in impaired growth, stillbirth, and fetal alcohol spectrum disorder. Fetal alcohol deficits are lifelong issues with no current treatment or established diagnostic or therapeutic tools to prevent and/or ameliorate some of these adverse outcomes. Despite the recommendation to abstain, almost half of the women consume alcohol in pregnancy in the United States. This review focuses on the trends in prenatal alcohol exposure, implications for maternal and fetal health, and evidence suggesting that preconception and the prenatal period provide a window of opportunity to intervene, mitigate, and ideally curtail the lifetime effects of fetal alcohol spectrum disorder.

What's retinoic acid got to do with it? Retinoic acid regulation of the neural crest in craniofacial and ocular development

Retinoic acid (RA), the active derivative of vitamin A (retinol), is an essential morphogen signaling molecule and major regulator of embryonic development. The dysregulation of RA levels during embryogenesis has been associated with numerous congenital anomalies, including craniofacial, auditory, and ocular defects. These anomalies result from disruptions in the cranial neural crest, a vertebrate-specific transient population of stem cells that contribute to the formation of diverse cell lineages and embryonic structures during development. In this review, we summarize our current knowledge of the RA-mediated regulation of cranial neural crest induction at the edge of the neural tube and the migration of these cells into the craniofacial region. Further, we discuss the role of RA in the regulation of cranial neural crest cells found within the frontonasal process, periocular mesenchyme, and pharyngeal arches, which eventually form the bones and connective tissues of the head and neck and contribute to structures in the anterior segment of the eye. We then review our understanding of the mechanisms underlying congenital craniofacial and ocular diseases caused by either the genetic or toxic disruption of RA signaling. Finally, we discuss the role of RA in maintaining neural crest-derived structures in postembryonic tissues and the implications of these studies in creating new treatments for degenerative craniofacial and ocular diseases.

DNA methylation studies of depression with onset in the peripartum: A critical systematic review

OBJECTIVE

Major depression with peripartum onset (MDP) has been associated with multiple adverse offspring health outcomes. The biological mechanisms underlying this relationship remain unclear, but DNA methylation (DNAm) represents a plausible mechanism for mediating MDP exposures and changes in offspring development, behavior, and health. Advances in DNAm research necessitate reevaluating the MDP-DNAm literature to determine how well past studies conform with current best practices.

METHOD

Five databases were searched to identify studies of prenatal-onset MDP and DNAm. Quality scores were assigned to each article independently by two raters using a novel scale specific for MDP-DNAm research.

RESULTS

Nineteen studies met inclusion criteria. Quality scores ranged from 10 to 17 out of 24 points (M = 12.8; SD = 1.9), with higher scores indicating increased study rigor. Poor covariate reporting was the most significant contributor to lower scores.

CONCLUSION

No longitudinal MDP-DNAm studies exist. Earlier MDP-DNAm studies should be interpreted with caution, and future research must commit to sharing methodology and data to facilitate cross-study comparisons and maximize dataset utility.