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Keating O, Brown RH, Kuenssberg R, Driscoll S, McDougall S, O'Rourke S. The international prevalence of prenatal alcohol use obtained via meconium biomarkers: A systematic literature review. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1657-1676. [PMID: 39085191 DOI: 10.1111/acer.15410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/27/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024]
Abstract
Fetal alcohol exposure is a growing public health concern. However, ascertaining its true extent remains challenging as maternal self-reports may lack validity. Increasingly, interest has turned to more objective measures of prenatal alcohol use (PAU) of which one, meconium, is recognized as a valuable tool. This review assesses both the international prevalence of PAU obtained using meconium biomarkers in general maternity populations and, when feasible, the level of agreement between meconium biomarkers and self-reported PAU. A systematic literature search for studies reporting the prevalence of PAU, as determined by meconium biomarker testing, was conducted using multiple electronic databases from 1990 to 2023. Seventeen studies were identified for inclusion and evaluated for methodological quality. Using fatty acid ethyl esters (FAEEs) meconium biomarkers, PAU prevalence varied from 2.4% to 44%. Rates based on EtG (ethyl glucuronide) analysis ranged from 0% to 16.3%, and EtS (ethyl sulfate) analysis from 7.8% to 16.7%. Studies were of moderate quality with high heterogeneity. Prevalence rates based on self-report data ranged from 0% to 46.4%. When reported, none of the reviewed studies identified agreement between meconium-based and self-report-based PAU prevalence rates. Using both self-reports to detect early pregnancy alcohol use, and meconium biomarkers to detect the occurrence of alcohol use later in pregnancy, may provide a more complete picture of PAU prevalence. Furthermore, research is warranted to develop stringent guidance on the ascertainment, storage, analysis, and reporting required in this field.
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Affiliation(s)
- Orlagh Keating
- Health in Social Sciences Department, University of Edinburgh, Edinburgh, UK
- Paediatric Psychology and Liaison Service, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, UK
| | - Ruth H Brown
- Health in Social Sciences Department, University of Edinburgh, Edinburgh, UK
| | | | - Sarah Driscoll
- Health in Social Sciences Department, University of Edinburgh, Edinburgh, UK
| | - Stewart McDougall
- Health in Social Sciences Department, University of Edinburgh, Edinburgh, UK
| | - Suzanne O'Rourke
- Health in Social Sciences Department, University of Edinburgh, Edinburgh, UK
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Koren G, Cohen R. Quantifying fetal alcohol exposure by meconium fatty acid ethyl esters (FAEE); association with adverse fetal outcomes and population estimates of fetal alcohol exposure. Drug Metab Rev 2019; 51:524-532. [PMID: 31595802 DOI: 10.1080/03602532.2019.1671859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Fetal Alcohol Spectrum Disorder (FASD) describes the wide range of adverse physical, behavioral and cognitive effects resulting from ethanol exposure during embryonic and fetal development. Identification of children suffering from FASD is often difficult, as abuse of ethanol during pregnancy is a heavily stigmatized behavior that receives little prenatal screening attention in routine care. Over the last 3 decades, measurement of the ethanol metabolites fatty acid ethyl esters (FAEE) has emerged as a useful tool to detect in the neonatal period fetal alcohol exposure starting from mid gestation. This review aims at updating clinicians and researchers on the validity and utility of this biological marker in two aspects: The association with adverse fetal outcomes and in generating population estimates of fetal alcohol exposure.
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Affiliation(s)
- Gideon Koren
- Motherisk Israel Program, Division of Clinical Pharmacology, Shamir Hospital, Zrifin, Israel.,Adelson Faculty of Medicine, Ariel University, Ariel, Israel.,Department of Physiology/Pharmacology, Western University, Ontario, Canada
| | - Rana Cohen
- Motherisk Israel Program, Division of Clinical Pharmacology, Shamir Hospital, Zrifin, Israel
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Prevalence of Fetal Alcohol Exposure by Analysis of Meconium Fatty Acid Ethyl Esters; A National Canadian Study. Sci Rep 2019; 9:2298. [PMID: 30783158 PMCID: PMC6381181 DOI: 10.1038/s41598-019-38856-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/09/2019] [Indexed: 01/02/2023] Open
Abstract
Our study aimed to estimate the prevalence of heavy fetal alcohol exposure through the analysis of meconium FAEEs as an objective biomarker of fetal exposure. We conducted a study on meconium samples collected nationwide through the Maternal-Infant Research on Environmental Chemicals (MIREC) Study Group. FAEE in meconium was quantified by an established headspace solid-phase microextraction coupled with gas chromatography-mass spectrometry (SPME GC-MS). Out of 1315 samples collected in 10 Canadian obstetric units coast to coast between 2008-2011, the estimated prevalence of positive meconium FAEE ranged between 1.16% and 2.40%, translating into at least 1800 new cases of FASD in Canada each year. Positive maternal self- reports of heavy alcohol use were tenfold lower (0.24%). Use of meconium FAEE revealed tenfold more cases of heavy exposure to maternal drinking than did maternal reports. The use of objective measures of maternal alcohol exposure is critical in accurately estimating risks and in monitoring effective prevention of FASD.
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Choate P, Badry D. Stigma as a dominant discourse in fetal alcohol spectrum disorder. ADVANCES IN DUAL DIAGNOSIS 2019. [DOI: 10.1108/add-05-2018-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to conduct a scoping review of the literature to explore the many ways stigma affects people with FASD and to highlight the disciplines and places where discourse on FASD and stigma is taking place.Design/methodology/approachSearches were conducted in PubMed, ERIC, Family & Society Studies Worldwide, Families Studies Abstracts and Google Scholar between 2008 and 2018. Search terms focused on stigma, shame and the connection to FASD with a view to looking across social and medical science literature.FindingsSearches identified 39 full text manuscripts, 13 of which were included in the scoping review. Stigma toward people with FASD exists in multiple professional forums across disciplines. The relationship between mother’s use of alcohol and the lasting impact on the child is a focus in the articles identified from a public health perspective. The review showed there was limited cross-disciplinary discussion evident. In total 13 articles were selected for inclusion in this review.Research limitations/implicationsNegative discourses predominate with little attention being paid to possible areas of success as well as cases of lower FASD impacts. There is a significant void in work focusing on positive outcomes for people with FASD. Such discourse would support a better understanding of pathways to more positive outcomes.Originality/valueThis paper highlights the issue of FASD and stigma through identification of relevant literature and expands the conversation to offer insights into the challenging terrain that individuals with FASD must navigate. The issue of stigma is not linked only to individuals with FASD but also their support systems. It is critical to recognize the multiple attributions of stigma to FASD in order to effectively take up conversations across and between disciplines to promote new discourses focused on de-stigmatization.
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Lee HS, Kim YH, Kwak HS, Han JY, Jo SJ, Lee HK. Association of Fatty Acid Ethyl Esters in Meconium of Neonates with Growth Deficits at Birth: a Prospective, Single-Centre Cohort Study. J Korean Med Sci 2018; 33:e318. [PMID: 30534030 PMCID: PMC6281955 DOI: 10.3346/jkms.2018.33.e318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/30/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In this prospective cohort study, we investigated the association between fatty acid ethyl esters (FAEEs) in meconium as biomarkers of prenatal ethanol exposure and growth deficits, as birth outcomes, that constitute several of the key cardinal features of fetal alcohol syndrome. METHODS A total of 157 meconium samples were collected from enrolled infants within 24 hours of birth, and nine FAEEs were quantified using liquid chromatography/tandem mass spectrometry. The relationships between cumulative concentrations of nine species of FAEEs in meconium and birth parameters of growth (age-sex-specific centiles of head circumference [HC], weight, and length) and respective and combined birth outcomes of growth deficits (HC ≤ 10th centile, weight ≤ 10th centile, and length ≤ 10th centile) were determined. RESULTS Multivariate logistic regression analysis demonstrated that higher cumulative concentrations of meconium FAEEs correlated with elevated risks for HC and length, both, 10th percentile or less (adjusted odds ratio [aOR], 2.94; 95% confidence interval [CI], 1.12-7.74; P = 0.029) and HC and weight and length, all of them, 10th percentile or less (aOR, 3.27; 95% CI, 1.12-9.59; P = 0.031). CONCLUSION The elevated cumulative FAEEs in meconium were associated with combined growth deficits at birth, specifically HC and length, both, 10th percentile or less, which might be correlated with detrimental alcohol effects on fetal brain and bone development, suggesting a plausible alcohol-specific pattern of intrauterine growth restriction.
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Affiliation(s)
- Hyun-Seung Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Hee Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho-Seok Kwak
- Department of Bioanalytical Mass Spectrometry, Sunin Bio Corporation, Seoul, Korea
| | - Jung-Yeol Han
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Centre, Dankook University College of Medicine, Seoul, Korea
| | - Sun-Jin Jo
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Kook Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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English LL, Mugyenyi G, Nightingale I, Kiwanuka G, Ngonzi J, Grunau BE, MacLeod S, Koren G, Delano K, Kabakyenga J, Wiens MO. Prevalence of Ethanol Use Among Pregnant Women in Southwestern Uganda. Matern Child Health J 2017; 20:2209-15. [PMID: 27299903 DOI: 10.1007/s10995-016-2025-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction The prevalence of ethanol use in many Sub-Saharan African countries is high, but little research exists on use during pregnancy. The objective of this study was to assess the prevalence and predictors of ethanol use among pregnant women in Southwestern Uganda. Methods This descriptive, cross-sectional study was conducted in the maternity ward at Mbarara Regional Referral Hospital (MRRH). All pregnant women giving birth at MRRH between September 23, 2013 and November 23, 2013 were eligible for enrollment. The primary outcome was the proportion of women with ethanol use during pregnancy as determined by self-report. Secondary outcomes included the proportion with positive fatty acid ethyl ester (FAEE) results (indicating ethanol use) and positive TWEAK questionnaire results (indicating possible problem drinking). Predictors of ethanol use were assessed and stratified by patterns of ethanol intake. Results Overall, 505 mother-child dyads enrolled in the study. The proportion of women who reported any ethanol use during pregnancy was 16 % (n = 81, 95 % CI 13-19 %) and the prevalence of heavy drinking 6.3 % (n = 32, 95 % CI 3.8-7.9 %). The strongest predictor of use during pregnancy was pre-pregnancy use, with maternal education as a protective factor. Few neonates (n = 11, 2 %) tested positive for FAEE > 2.00 nmol/g in meconium. The TWEAK questionnaire captured 75 % of women who reported moderate/heavy drinking and aligned more with self-reported ethanol use than meconium results. Conclusions The substantial prevalence and clear predictors of ethanol use suggest that legislative action and educational interventions to increase awareness of potential harms could assist in efforts to decrease use during pregnancy in Southwestern Uganda.
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Affiliation(s)
- L L English
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - G Mugyenyi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - I Nightingale
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, Canada
| | - G Kiwanuka
- Department of Biochemistry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - J Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - B E Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - S MacLeod
- Child and Family Research Institute, BC Children's Hospital, Vancouver, Canada
| | - G Koren
- Motherisk, Toronto Hospital for Sick Children, Toronto, Canada
| | - K Delano
- Motherisk, Toronto Hospital for Sick Children, Toronto, Canada
| | - J Kabakyenga
- Institute for Maternal Child Heath, Mbarara University of Science and Technology, Mbarara, Uganda
| | - M O Wiens
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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The Detection of Fetal Alcohol Exposure by FAEEs Meconium Analysis. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0102-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hoyme HE, Kalberg WO, Elliott AJ, Blankenship J, Buckley D, Marais AS, Manning MA, Robinson LK, Adam MP, Abdul-Rahman O, Jewett T, Coles CD, Chambers C, Jones KL, Adnams CM, Shah PE, Riley EP, Charness ME, Warren KR, May PA. Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders. Pediatrics 2016; 138:peds.2015-4256. [PMID: 27464676 PMCID: PMC4960726 DOI: 10.1542/peds.2015-4256] [Citation(s) in RCA: 472] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/24/2022] Open
Abstract
The adverse effects of prenatal alcohol exposure constitute a continuum of disabilities (fetal alcohol spectrum disorders [FASD]). In 1996, the Institute of Medicine established diagnostic categories delineating the spectrum but not specifying clinical criteria by which diagnoses could be assigned. In 2005, the authors published practical guidelines operationalizing the Institute of Medicine categories, allowing for standardization of FASD diagnoses in clinical settings. The purpose of the current report is to present updated diagnostic guidelines based on a thorough review of the literature and the authors' combined expertise based on the evaluation of >10 000 children for potential FASD in clinical settings and in epidemiologic studies in conjunction with National Institute on Alcohol Abuse and Alcoholism-funded studies, the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, and the Collaboration on FASD Prevalence. The guidelines were formulated through conference calls and meetings held at National Institute on Alcohol Abuse and Alcoholism offices in Rockville, MD. Specific areas addressed include the following: precise definition of documented prenatal alcohol exposure; neurobehavioral criteria for diagnosis of fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder; revised diagnostic criteria for alcohol-related birth defects; an updated comprehensive research dysmorphology scoring system; and a new lip/philtrum guide for the white population, incorporating a 45-degree view. The guidelines reflect consensus among a large and experienced cadre of FASD investigators in the fields of dysmorphology, epidemiology, neurology, psychology, developmental/behavioral pediatrics, and educational diagnostics. Their improved clarity and specificity will guide clinicians in accurate diagnosis of infants and children prenatally exposed to alcohol.
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Affiliation(s)
- H. Eugene Hoyme
- Sanford Research and Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota;,Center for Applied Genetics and Genomic Medicine and Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona
| | - Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Amy J. Elliott
- Sanford Research and Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - Jason Blankenship
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Anna-Susan Marais
- Stellenbosch University Faculty of Medicine and Health Sciences, Stellenbosch, South Africa
| | - Melanie A. Manning
- Departments of Pathology and Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Luther K. Robinson
- Department of Pediatrics, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Margaret P. Adam
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Omar Abdul-Rahman
- Department of Pediatrics, University of Mississippi School of Medicine, Jackson, Mississippi
| | - Tamison Jewett
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Claire D. Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Christina Chambers
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California
| | - Kenneth L. Jones
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California
| | - Colleen M. Adnams
- Department of Psychiatry and Mental Health, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Prachi E. Shah
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Edward P. Riley
- Department of Psychology, San Diego State University, San Diego, California
| | - Michael E. Charness
- VA Boston Healthcare System, Department of Neurology, Harvard Medical School, and Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Kenneth R. Warren
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland; and
| | - Philip A. May
- Sanford Research and Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota;,Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico;,Department of Nutrition, Gillings School of Global Public Health, Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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May PA, Baete A, Russo J, Elliott AJ, Blankenship J, Kalberg WO, Buckley D, Brooks M, Hasken J, Abdul-Rahman O, Adam MP, Robinson LK, Manning M, Hoyme HE. Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics 2014; 134:855-66. [PMID: 25349310 PMCID: PMC4210790 DOI: 10.1542/peds.2013-3319] [Citation(s) in RCA: 393] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To determine the prevalence and characteristics of fetal alcohol spectrum disorders (FASD) among first grade students (6- to 7-year-olds) in a representative Midwestern US community. METHODS From a consented sample of 70.5% of all first graders enrolled in public and private schools, an oversample of small children (≤ 25th percentile on height, weight, and head circumference) and randomly selected control candidates were examined for physical growth, development, dysmorphology, cognition, and behavior. The children's mothers were interviewed for maternal risk. RESULTS Total dysmorphology scores differentiate significantly fetal alcohol syndrome (FAS) and partial FAS (PFAS) from one another and from unexposed controls. Alcohol-related neurodevelopmental disorder (ARND) is not as clearly differentiated from controls. Children who had FASD performed, on average, significantly worse on 7 cognitive and behavioral tests and measures. The most predictive maternal risk variables in this community are late recognition of pregnancy, quantity of alcoholic drinks consumed 3 months before pregnancy, and quantity of drinking reported for the index child's father. From the final multidisciplinary case findings, 3 techniques were used to estimate prevalence. FAS in this community likely ranges from 6 to 9 per 1000 children (midpoint, 7.5), PFAS from 11 to 17 per 1000 children (midpoint, 14), and the total rate of FASD is estimated at 24 to 48 per 1000 children, or 2.4% to 4.8% (midpoint, 3.6%). CONCLUSIONS Children who have FASD are more prevalent among first graders in this Midwestern city than predicted by previous, popular estimates.
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Affiliation(s)
- Philip A. May
- Department of Nutrition, Gillings School of Global Public Health, Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;,Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico;,Department of Pediatrics, Sanford School of Medicine, The University of South Dakota, Sioux Falls, South Dakota
| | - Amy Baete
- Sanford Research, Sioux Falls, South Dakota
| | | | - Amy J. Elliott
- Sanford Research, Sioux Falls, South Dakota;,Department of Pediatrics, Sanford School of Medicine, The University of South Dakota, Sioux Falls, South Dakota
| | - Jason Blankenship
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Marita Brooks
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Julie Hasken
- Department of Nutrition, Gillings School of Global Public Health, Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Omar Abdul-Rahman
- Department of Pediatrics, University of Mississippi, Jackson, Mississippi
| | - Margaret P. Adam
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Luther K. Robinson
- Dysmorphology and Clinical Genetics, State University of New York at Buffalo, Buffalo, New York
| | - Melanie Manning
- Departments of Pathology and Pediatrics, Stanford University, Stanford, California; and
| | - H. Eugene Hoyme
- Sanford Research, Sioux Falls, South Dakota;,Department of Pediatrics, Sanford School of Medicine, The University of South Dakota, Sioux Falls, South Dakota
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