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Ornoy A, Echefu B, Becker M. Valproic Acid in Pregnancy Revisited: Neurobehavioral, Biochemical and Molecular Changes Affecting the Embryo and Fetus in Humans and in Animals: A Narrative Review. Int J Mol Sci 2023; 25:390. [PMID: 38203562 PMCID: PMC10779436 DOI: 10.3390/ijms25010390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Valproic acid (VPA) is a very effective anticonvulsant and mood stabilizer with relatively few side effects. Being an epigenetic modulator, it undergoes clinical trials for the treatment of advanced prostatic and breast cancer. However, in pregnancy, it seems to be the most teratogenic antiepileptic drug. Among the proven effects are congenital malformations in about 10%. The more common congenital malformations are neural tube defects, cardiac anomalies, urogenital malformations including hypospadias, skeletal malformations and orofacial clefts. These effects are dose related; daily doses below 600 mg have a limited teratogenic potential. VPA, when added to other anti-seizure medications, increases the malformations rate. It induces malformations even when taken for indications other than epilepsy, adding to the data that epilepsy is not responsible for the teratogenic effects. VPA increases the rate of neurodevelopmental problems causing reduced cognitive abilities and language impairment. It also increases the prevalence of specific neurodevelopmental syndromes like autism (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). High doses of folic acid administered prior to and during pregnancy might alleviate some of the teratogenic effect of VPA and other AEDs. Several teratogenic mechanisms are proposed for VPA, but the most important mechanisms seem to be its effects on the metabolism of folate, SAMe and histones, thus affecting DNA methylation. VPA crosses the human placenta and was found at higher concentrations in fetal blood. Its concentrations in milk are low, therefore nursing is permitted. Animal studies generally recapitulate human data.
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Affiliation(s)
- Asher Ornoy
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (B.E.); (M.B.)
- Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 9112102, Israel
| | - Boniface Echefu
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (B.E.); (M.B.)
| | - Maria Becker
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (B.E.); (M.B.)
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Cohen-Eliraz L, Ornoy A, Ein-Mor E, Bar-Nitsan M, Pilowsky Peleg T, Calderon-Margalit R. Prenatal exposure to phthalates and emotional/behavioral development in young children. Neurotoxicology 2023; 98:39-47. [PMID: 37536470 DOI: 10.1016/j.neuro.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Endocrine disrupting chemicals (EDCs) such as phthalates, found in our daily environment, are nowadays suggested to be associated with adverse outcomes. Prenatal exposure was found associated with neurodevelopmental complications such as behavioral difficulties in school age children. AIM To explore the association between intrauterine exposure to phthalates and emotional/behavioral development of 24 months old toddlers. METHODS Women were recruited at 11-18 weeks of gestation and provided spot urine samples, analyzed for phthalate metabolites (DEHP, DiNP, MBzBP). Offspring were examined at 24 months of age, using standard maternal report, regarding developmental and behavioral problems (CBCL, ASQ-3, HOME questionnaires) (N = 158). To explore the associations between metabolite levels and developmental outcomes, multivariate GLM analysis (General Linear Model) was used according to tertiles and developmental scores on each developmental outcome. RESULTS Associations of Di-(2-ethylhexyl) phthalate (DEHP) maternal exposure with behavioral-developmental outcomes were found only in boys. Compared with boys with lower DEHP maternal exposure, boys with high DEHP maternal exposure had lower developmental score in personal social abilities in the ASQ-3 questionnaire (50.68 + 8.06 and 44.14 + 11.02, high and low DEHP, respectively, p = 0.03), and more internalizing problems (for example, emotionally reactive score in high and low DEHP: 53.77 + 7.41 and 50.50 + 1.19, respectively, p = 0.029; anxious or depressed score: 53.38 + 5.01 and 50.75 + 1.34, respectively, p = 0.009; and somatic complaints scores 64.03 + 10.1 and 55.84 + 7.84, respectively, p = 0.003), and externalizing problems (49.28 + 8.59 and 43.33 + 9.11, respectively, p = 0.039). No differences were found in the development and behavior problems between high and low DEHP maternal exposure level in girls. CONCLUSION Maternal DEHP metabolite concentrations measured in first trimester urine was associated with children's emotional/behavioral developmental problems in 24-months old boys, supporting accumulating evidence of DEHP as a potentially harming chemical and call for environmental attention.
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Affiliation(s)
- Liron Cohen-Eliraz
- Psychology Department Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Asher Ornoy
- Department of Medical Neurobiology Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eliana Ein-Mor
- Hadassah-Hebrew University, Braun School of Public Health, P.O. Box 12272, Jerusalem 91120, Israel
| | - Moriah Bar-Nitsan
- Psychology Department Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tammy Pilowsky Peleg
- Psychology Department Hebrew University of Jerusalem, Jerusalem, Israel; The Neuropsychological Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ronit Calderon-Margalit
- Hadassah-Hebrew University, Braun School of Public Health, P.O. Box 12272, Jerusalem 91120, Israel
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Ornoy A, Miller RK. Yolk sac development, function and role in rodent pregnancy. Birth Defects Res 2023; 115:1243-1254. [PMID: 36949669 DOI: 10.1002/bdr2.2172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
During the early phases of embryonic development, the yolk sac serves as an initial placenta in many animal species. While in some, this role subsides around the end of active organogenesis, it continues to have important functions in rodents, alongside the chorio-allantoic placenta. The yolk sac is the initial site of hematopoiesis in many animal species including primates. Cells of epiblastic origin form blood islands that are the forerunners of hematopoietic cells and of the primitive endothelial cells that form the vitelline circulation. The yolk sac is also a major route of embryonic and fetal nutrition apparently as long as it functions. In mammals and especially rodents, macro and micronutrients are absorbed by active pinocytosis into the visceral yolk sac, degraded and the degradation products (i.e., amino acids) are then transferred to the embryo. Interference with the yolk sac function may directly reflect on embryonic growth and development, inducing congenital malformations or in extreme damage, causing embryonic and fetal death. In rodents, many agents were found to damage the yolk sac (i.e., anti-yolk sac antibodies or toxic substances interfering with yolk sac pinocytosis) subsequently affecting the embryo/fetus. Often, the damage to the yolk sac is transient while embryonic damage persists. In humans, decreased yolk sac diameter was associated with diabetic pregnancies and increased diameter was associated with pregnancy loss. In addition, culture of rat yolk sacs in serum obtained from pregnant diabetic women or from women with autoimmune diseases induced severe damage to the visceral yolk sac epithelium and embryonic malformations. It can be concluded that as a result of the crucial role of the yolk sac in the well-being of the early embryo, any damage to its normal function may severely and irreversibly affect further development of the embryo/fetus.
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Affiliation(s)
- Asher Ornoy
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University and Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Richard K Miller
- School of Medicine and Dentistry, Departments of Obstetrics/Gynecology, of Pediatrics, of Pathology and of Environmental Medicine, University of Rochester, Rochester, New York, 14642, USA
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Becker M, Gorobets D, Shmerkin E, Weinstein-Fudim L, Pinhasov A, Ornoy A. Prenatal SAMe Treatment Changes via Epigenetic Mechanism/s USVs in Young Mice and Hippocampal Monoamines Turnover at Adulthood in a Mouse Model of Social Hierarchy and Depression. Int J Mol Sci 2023; 24:10721. [PMID: 37445911 PMCID: PMC10361211 DOI: 10.3390/ijms241310721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
The role of hippocampal monoamines and their related genes in the etiology and pathogenesis of depression-like behavior, particularly in impaired sociability traits and the meaning of changes in USVs emitted by pups, remains unknown. We assessed the effects of prenatal administration of S-adenosyl-methionine (SAMe) in Sub mice that exhibit depressive-like behavior on serotonergic, dopaminergic and noradrenergic metabolism and the activity of related genes in the hippocampus (HPC) in adulthood in comparison to saline-treated control Sub mice. During postnatal days 4 and 8, we recorded and analyzed the stress-induced USVs emitted by the pups and tried to understand how the changes in the USVs' calls may be related to the changes in the monoamines and the activity of related genes. The recordings of the USVs showed that SAMe induced a reduction in the emitted flat and one-frequency step-up call numbers in PND4 pups, whereas step-down type calls were significantly increased by SAMe in PND8 pups. The reduction in the number of calls induced by SAMe following separation from the mothers implies a reduction in anxiety, which is an additional sign of decreased depressive-like behavior. Prenatal SAMe increased the concentrations of serotonin in the HPC in both male and female mice without any change in the levels of 5HIAA. It also decreased the level of the dopamine metabolite DOPAC in females. There were no changes in the levels of norepinephrine and metabolites. Several changes in the expression of genes associated with monoamine metabolism were also induced by prenatal SAMe. The molecular and biochemical data obtained from the HPC studies are generally in accordance with our previously obtained data from the prefrontal cortex of similarly treated Sub mice on postnatal day 90. The changes in both monoamines and their gene expression observed 2-3 months after SAMe treatment are associated with the previously recorded behavioral improvement and seem to demonstrate that SAMe is effective via an epigenetic mechanism.
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Affiliation(s)
- Maria Becker
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Denis Gorobets
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Elena Shmerkin
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Liza Weinstein-Fudim
- Department of Medical Neurobiology Hebrew, University Hadassah Medical School, Jerusalem 9112102, Israel
| | - Albert Pinhasov
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Asher Ornoy
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
- Department of Medical Neurobiology Hebrew, University Hadassah Medical School, Jerusalem 9112102, Israel
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Bromley RL, Bickle Graz M, Bluett-Duncan M, Chambers C, Damkier P, Dietrich K, Dolk H, Grant K, Mattson S, Meador KJ, Nordeng H, Oberlander TF, Ornoy A, Revet A, Richardson J, Rovet J, Schuler-Faccini L, Smearman E, Simms V, Vorhees C, Wide K, Wood A, Yates L, Ystrom E, Supraja TA, Adams J. Expert consensus on neurodevelopmental outcomes in pregnancy pharmacovigilance studies. Front Pharmacol 2023; 14:1094698. [PMID: 37332344 PMCID: PMC10270323 DOI: 10.3389/fphar.2023.1094698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Background: Exposure in utero to certain medications can disrupt processes of fetal development, including brain development, leading to a continuum of neurodevelopmental difficulties. Recognizing the deficiency of neurodevelopmental investigations within pregnancy pharmacovigilance, an international Neurodevelopmental Expert Working Group was convened to achieve consensus regarding the core neurodevelopmental outcomes, optimization of methodological approaches and barriers to conducting pregnancy pharmacovigilance studies with neurodevelopmental outcomes. Methods: A modified Delphi study was undertaken based on stakeholder and expert input. Stakeholders (patient, pharmaceutical, academic and regulatory) were invited to define topics, pertaining to neurodevelopmental investigations in medication-exposed pregnancies. Experts were identified for their experience regarding neurodevelopmental outcomes following medicinal, substances of misuse or environmental exposures in utero. Two questionnaire rounds and a virtual discussion meeting were used to explore expert opinion on the topics identified by the stakeholders. Results: Twenty-five experts, from 13 countries and professionally diverse backgrounds took part in the development of 11 recommendations. The recommendations focus on the importance of neurodevelopment as a core feature of pregnancy pharmacovigilance, the timing of study initiation and a core set of distinct but interrelated neurodevelopmental skills or diagnoses which require investigation. Studies should start in infancy with an extended period of investigation into adolescence, with more frequent sampling during rapid periods of development. Additionally, recommendations are made regarding optimal approach to neurodevelopmental outcome measurement, comparator groups, exposure factors, a core set of confounding and mediating variables, attrition, reporting of results and the required improvements in funding for potential later emerging effects. Different study designs will be required depending on the specific neurodevelopmental outcome type under investigation and whether the medicine in question is newly approved or already in widespread use. Conclusion: An improved focus on neurodevelopmental outcomes is required within pregnancy pharmacovigilance. These expert recommendations should be met across a complementary set of studies which converge to form a comprehensive set of evidence regarding neurodevelopmental outcomes in pregnancy pharmacovigilance.
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Affiliation(s)
- R. L. Bromley
- Division of Neuroscience, Faculty of Medicine, School of Biological Sciences, Biology and Health, University of Manchester, Manchester, United Kingdom
- Royal Manchester Children’s Hospital, Manchester Academic Sciences Park, Manchester, United Kingdom
| | - M. Bickle Graz
- Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - M. Bluett-Duncan
- Division of Neuroscience, Faculty of Medicine, School of Biological Sciences, Biology and Health, University of Manchester, Manchester, United Kingdom
| | - C. Chambers
- Division of Environmental Science and Health, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA, United States
| | - P. Damkier
- Department of Clinical Pharmacology, Odense University Hospital, Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K. Dietrich
- Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - H. Dolk
- Maternal, Fetal and Infant Research Unit, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - K. Grant
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
| | - S. Mattson
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, United States
| | - K. J. Meador
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - H. Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - T. F. Oberlander
- Department Pediatrics and School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - A. Ornoy
- Hebrew University Hadassah Medical School, Adelson School of Medicine, Ariel University, Jerusalem, Israel
| | - A. Revet
- INSERM University of Toulouse 3, Toulouse, France
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
| | - J. Richardson
- UK Teratology Information Service, Newcastle, United Kingdom
| | - J. Rovet
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - L. Schuler-Faccini
- Genetics Department, Hospital de Clinicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - E. Smearman
- Department of Surgery, Emory University, Atlanta, GA, United States
| | - V. Simms
- School of Psychology, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - C. Vorhees
- Department of Pediatrics, Division of Neurology, University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - K. Wide
- Department of Pediatrics, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A. Wood
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - L. Yates
- Northern Genetics Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
- KRISP, University of KwaZulu-Natal, Durban, South Africa
| | - E. Ystrom
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - T. A. Supraja
- National Institute of Mental Health and Neurosciences NIMHANS, Bangalore, Karnataka, India
| | - J. Adams
- Department of Psychology, University of Massachusetts Boston, Boston, MA, United States
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Lapidot Y, Maya M, Reshef L, Cohen D, Ornoy A, Gophna U, Muhsen K. Relationships of the gut microbiome with cognitive development among healthy school-age children. Front Pediatr 2023; 11:1198792. [PMID: 37274812 PMCID: PMC10235814 DOI: 10.3389/fped.2023.1198792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/05/2023] [Indexed: 06/07/2023] Open
Abstract
Background The gut microbiome might play a role in neurodevelopment, however, evidence remains elusive. We aimed to examine the relationship between the intestinal microbiome and cognitive development of school-age children. Methods This cross-sectional study included healthy Israeli Arab children from different socioeconomic status (SES). The microbiome was characterized in fecal samples by implementing 16S rRNA gene sequencing. Cognitive function was measured using Stanford-Binet test, yielding full-scale Intelligence Quotient (FSIQ) score. Sociodemographics and anthropometric and hemoglobin measurements were obtained. Multivariate models were implemented to assess adjusted associations between the gut microbiome and FSIQ score, while controlling for age, sex, SES, physical growth, and hemoglobin levels. Results Overall, 165 children (41.2% females) aged 6-9 years were enrolled. SES score was strongly related to both FSIQ score and the gut microbiome. Measures of α-diversity were significantly associated with FSIQ score, demonstrating a more diverse, even, and rich microbiome with increased FSIQ score. Significant differences in fecal bacterial composition were found; FSIQ score explained the highest variance in bacterial β-diversity, followed by SES score. Several taxonomic differences were significantly associated with FSIQ score, including Prevotella, Dialister, Sutterella, Ruminococcus callidus, and Bacteroides uniformis. Conclusions We demonstrated significant independent associations between the gut microbiome and cognitive development in school-age children.
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Affiliation(s)
- Yelena Lapidot
- Department of Epidemiology and Preventive Medicine, School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maayan Maya
- Department of Epidemiology and Preventive Medicine, School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leah Reshef
- The Shmunis School of Biomedicine and Cancer Research, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Medical Neurobiology, The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Uri Gophna
- The Shmunis School of Biomedicine and Cancer Research, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kassem E, Na’amnih W, Shapira M, Ornoy A, Muhsen K. Comparison between School-Age Children with and without Obesity in Nutritional and Inflammation Biomarkers. J Clin Med 2022; 11:jcm11236973. [PMID: 36498548 PMCID: PMC9739253 DOI: 10.3390/jcm11236973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Childhood obesity is a major health problem. We examined differences between children with obesity and normal weight in nutritional and inflammation biomarkers. A cross-sectional study was conducted among healthy children aged 10-12 years from Arab villages in Israel. Parents were interviewed regarding sociodemographic and children's health status. Body weight and height measurements were performed and weight categories were defined using the 2007 WHO growth curves. Blood samples were tested for complete blood count, levels of iron, ferritin, lipids, uric acid, and C-reactive protein (CRP). Overall, 146 children (59.0% males, mean age = 11.3 [SD = 0.5]) were enrolled. In total 43.8%, 14.1% and 42.3% of the participants had normal weight, overweight and obesity, respectively. A multivariable logistic regression model showed that children with overweight and obesity had lower iron, and HDL-C levels than children with normal weight. Levels of CRP, uric acid, LDL-C and lymphocytes were higher among children with overweight and obesity. In conclusion, our findings highlight the worse metabolic and nutritional status in overweight and obese children. Such markers play a role in metabolic syndrome, thus suggesting that metabolic syndrome might start in childhood.
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Affiliation(s)
- Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera 3810101, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Wasef Na’amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maanit Shapira
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
- Laboratory Division, Hillel Yaffe Medical Center, Hadera 3810101, Israel
| | - Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel 4077625, Israel
- Laboratory of Teratology, Department of Medical Neurobiology, The Hebrew University Hadassah Medical School, Jerusalem 9112002, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-6405945
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Na'amnih W, Akawi A, Abu-Moch A, Cohen R, Dror G, Kassem E, Muhsen K, Ornoy A. Associations of early-life exposures and socioeconomic status with cognitive development at preadolescence. Pediatr Neonatol 2022; 64:192-200. [PMID: 36357285 DOI: 10.1016/j.pedneo.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/30/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The long-term relations of socioeconomic status (SES) and early-life exposures with cognitive development at preadolescence are not fully understood, especially in low SES populations. We examined associations of SES and early-life exposures including feeding practices, physical growth and infections with cognitive development among preadolescents from underprivileged communities. METHODS A prospective study was conducted among 146 healthy children from two relatively low SES Arab villages in Israel, who were recruited at age 1-9 weeks and followed until age 18 months. Information was obtained on their feeding practices, health status and growth indicators. Cognitive development at age 10-12 years was assessed using the Wechsler Intelligence Scale, including the full-scale intelligence quotient (FSIQ) and scores of four cognitive domains. Multiple linear regression models were performed. RESULTS Nearly all the children (98%) were breastfed in infancy. Bivariate correlations were found of SES, growth indices and rates of diarrheal and respiratory illnesses in infancy, but not of feeding practices, with cognitive scores. In multivariable models, SES was positively (p < 0.001) associated with all the cognitive domains (beta coefficient ranges 4.3 to 8.2). Birthweight was positively associated with FSIQ (p = 0.039) and the perceptual reasoning index (p = 0.002). Weight for age Z score at age 10-14 months was positively associated with the verbal comprehension index (p = 0.003). The rate of respiratory illnesses was negatively associated with the perceptual reasoning index (p = 0.05). CONCLUSION SES is strongly associated with cognitive development even in relatively low SES communities. Birthweight, weight indicators and respiratory illness in infancy might affect cognitive development through preadolescence.
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Affiliation(s)
- Wasef Na'amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6139001, Israel
| | - Ashraf Akawi
- Child Development Center, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ahmad Abu-Moch
- Child Development Center, Hillel Yaffe Medical Center, Hadera, Israel
| | - Rinat Cohen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University Ramat Aviv, Tel Aviv, Israel
| | - Gal Dror
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6139001, Israel
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6139001, Israel.
| | - Asher Ornoy
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel and the Hebrew University Hadassah Medical School, Jerusalem, Israel
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Becker M, Abaev K, Pinhasov A, Ornoy A. S-Adenosyl-Methionine alleviates sociability aversion and reduces changes in gene expression in a mouse model of social hierarchy. Behav Brain Res 2022; 427:113866. [DOI: 10.1016/j.bbr.2022.113866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 02/06/2023]
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Ornoy A, Koren G. Neurotropic Drugs in Pregnancy and Lactation from the Point of View of the Clinical Teratologist. Curr Neuropharmacol 2021; 19:1792-1793. [PMID: 34814813 PMCID: PMC9185794 DOI: 10.2174/1570159x1911211115145019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Asher Ornoy
- Adelson School of Medicine Ariel University Ariel 40700 and Hebrew University Hadassah Medical School Jerusalem, Israel
| | - Gideon Koren
- Adelson School of Medicine Ariel University Ariel, Israel 40700 and Motherisk, Israel
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Tal-Saban M, Ornoy A, Parush S. Participation of soldiers with DCD in the military. Military Psychology 2021. [DOI: 10.1080/08995605.2021.1968288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Miri Tal-Saban
- School of Occupational Therapy, Hebrew University, Jerusalem, Israel
| | - Asher Ornoy
- Department of Medical Neurobiology, Laboratory of Teratology,Hebrew University, Hadassah Medical School, Jerusalem, Israel
| | - Shula Parush
- School of Occupational Therapy, Hebrew University, Jerusalem, Israel
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12
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Lapidot Y, Reshef L, Goldsmith R, Na’amnih W, Kassem E, Ornoy A, Gophna U, Muhsen K. The Associations between Diet and Socioeconomic Disparities and the Intestinal Microbiome in Preadolescence. Nutrients 2021; 13:2645. [PMID: 34444813 PMCID: PMC8398108 DOI: 10.3390/nu13082645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
The intestinal microbiome continues to shift and develop throughout youth and could play a pivotal role in health and wellbeing throughout adulthood. Environmental and interpersonal determinants are strong mediators of the intestinal microbiome during the rapid growth period of preadolescence. We aim to delineate associations between the gut microbiome composition, body mass index (BMI), dietary intake and socioeconomic status (SES) in a cohort of ethnically homogenous preadolescents. This cohort included 139 Arab children aged 10-12 years, from varying socioeconomic strata. Dietary intake was assessed using the 24-h recall method. The intestinal microbiome was analyzed using 16S rRNA gene amplicon sequencing. Microbial composition was associated with SES, showing an overrepresentation of Prevotella and Eubacterium in children with lower SES. Higher BMI was associated with lower microbial diversity and altered taxonomic composition, including higher levels of Collinsella, especially among participants from lower SES. Intake of polyunsaturated fatty acids was the strongest predictor of bacterial alterations, including an independent association with Lachnobacterium and Lactobacillus. This study demonstrates that the intestinal microbiome in preadolescents is associated with socioeconomic determinants, BMI and dietary intake, specifically with higher consumption of polyunsaturated fatty acids. Thus, tailored interventions during these crucial years have the potential to improve health disparities throughout the lifespan.
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Affiliation(s)
- Yelena Lapidot
- Department of Epidemiology and Preventive Medicine, School of Public Health, The Sackler Faculty, Tel Aviv University, Ramat Aviv, Tel Aviv 6139001, Israel; (Y.L.); (W.N.)
| | - Leah Reshef
- The Shmunis School of Biomedicine and Cancer Research Faculty of Life Sciences, Tel Aviv University, Tel Aviv 6139001, Israel; (L.R.); (U.G.)
| | | | - Wasef Na’amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, The Sackler Faculty, Tel Aviv University, Ramat Aviv, Tel Aviv 6139001, Israel; (Y.L.); (W.N.)
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera 3810101, Israel;
| | - Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel 4077625, Israel;
- Laboratory of Teratology, Department of Medical Neurobiology, The Hebrew University Hadassah Medical School, Jerusalem 9112002, Israel
| | - Uri Gophna
- The Shmunis School of Biomedicine and Cancer Research Faculty of Life Sciences, Tel Aviv University, Tel Aviv 6139001, Israel; (L.R.); (U.G.)
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, The Sackler Faculty, Tel Aviv University, Ramat Aviv, Tel Aviv 6139001, Israel; (Y.L.); (W.N.)
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13
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Muhsen K, Na’amnih W, Goldsmith R, Maya M, Zeidan N, Kassem E, Ornoy A. Associations of Feeding Practices in Early Life and Dietary Intake at School Age with Obesity in 10- to 12-Year-Old Arab Children. Nutrients 2021; 13:nu13062106. [PMID: 34205416 PMCID: PMC8234619 DOI: 10.3390/nu13062106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Understanding the role in pediatric obesity of early life feeding practices and dietary intake at school age is essential for early prevention. The study aimed to examine associations of early life feeding practices, environmental and health-related exposures, and dietary intake at school age as determinants of obesity in children aged 10–12 years. In an earlier study of 233 healthy infants in two Arab towns in northern Israel, neonatal history, feeding practices, and health information were obtained up to age 18 months. This follow-up study assessed dietary intake and anthropometric measurements at age 10–12 years using the 24 h recall method. Overall, 174 children participated in this study. Almost all (98%) the children were breastfed. The prevalence of obesity at school age was 42%. A multivariable model adjusted for energy intake and socioeconomic status showed positive associations of total fat intake and of weight-for-height z score, but not feeding practices in infancy, with obesity. Higher gestational age at birth was associated with lower odds of obesity at age 10–12 years. In conclusion, in a population with near universal breastfeeding, gestational age at birth, weight indicators but not feeding practices in infancy, and total fat intake at school age were associated with increased likelihood of obesity.
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Affiliation(s)
- Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel; (W.N.); (M.M.)
- Correspondence: ; Tel.: +972-3-6405945; Fax: +972-3-6409868
| | - Wasef Na’amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel; (W.N.); (M.M.)
| | | | - Maayan Maya
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel; (W.N.); (M.M.)
| | - Nuha Zeidan
- Clalit Health Service, Diet and Nutrition Unit, P.O. Box 789, Arara 30026, Israel;
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera 38100, Israel;
| | - Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, The Hebrew University Hadassah Medical School, Jerusalem 9112002, Israel
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
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14
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Rimawi I, Ornoy A, Yanai J. Paternal and/or maternal preconception-induced neurobehavioral teratogenicity in animal and human models. Brain Res Bull 2021; 174:103-121. [PMID: 34087361 DOI: 10.1016/j.brainresbull.2021.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/06/2021] [Accepted: 05/28/2021] [Indexed: 01/15/2023]
Abstract
Prenatal insult exposure effects on the offspring, have and are still considered the main interest of most teratological studies, while paternal and maternal preconception effects have received relatively little interest. Once thought to be a myth, paternal exposure to insults leading to numerous detrimental effects in the offspring, has been confirmed on several occasions and is gaining increased attention. These effects could be demonstrated molecularly, biochemically and/or behaviorally. Different epigenetic mechanisms have been proposed for these effects to occur, including DNA methylation, histone modification and sperm RNA transmission. Paternal insult exposure has been shown to cause several neurobehavioral and developmental defects in the offspring. Findings on parental insult exposure effects on the progeny will be discussed in this review, with the main focus being on neurobehavioral effects after parental preconceptional exposure. The exposure to the insults induced long-lasting, mostly marked, defects. A few pioneering, prevention and reversal studies were published. Interestingly, most studies were conducted on paternal exposure and, at the present state of this field, on animal models. Clinical translation remains the subsequent challenge.
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Affiliation(s)
- Issam Rimawi
- The Ross Laboratory for Studies in Neural Birth Defects, Department of Medical Neurobiology, Institute for Medical Research - Israel-Canada and The Hebrew University-Hadassah Medical School, Box 12272, 91120, Jerusalem, Israel
| | - Asher Ornoy
- Adelson School of Medicine, Ariel University, Israel; Laboratory of Teratology, department of Medical Neurobiology, Institute for Medical Research - Israel-Canada and The Hebrew University-Hadassah Medical School, Box 12272, 91120 Jerusalem, Israel
| | - Joseph Yanai
- The Ross Laboratory for Studies in Neural Birth Defects, Department of Medical Neurobiology, Institute for Medical Research - Israel-Canada and The Hebrew University-Hadassah Medical School, Box 12272, 91120, Jerusalem, Israel; Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, 27710, USA.
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15
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Ornoy A, Becker M, Weinstein-Fudim L, Ergaz Z. Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review. Int J Mol Sci 2021; 22:ijms22062965. [PMID: 33803995 PMCID: PMC7999044 DOI: 10.3390/ijms22062965] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/28/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
In spite of the huge progress in the treatment of diabetes mellitus, we are still in the situation that both pregestational (PGDM) and gestational diabetes (GDM) impose an additional risk to the embryo, fetus, and course of pregnancy. PGDM may increase the rate of congenital malformations, especially cardiac, nervous system, musculoskeletal system, and limbs. PGDM may interfere with fetal growth, often causing macrosomia, but in the presence of severe maternal complications, especially nephropathy, it may inhibit fetal growth. PGDM may also induce a variety of perinatal complications such as stillbirth and perinatal death, cardiomyopathy, respiratory morbidity, and perinatal asphyxia. GDM that generally develops in the second half of pregnancy induces similar but generally less severe complications. Their severity is higher with earlier onset of GDM and inversely correlated with the degree of glycemic control. Early initiation of GDM might even cause some increase in the rate of congenital malformations. Both PGDM and GDM may cause various motor and behavioral neurodevelopmental problems, including an increased incidence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Most complications are reduced in incidence and severity with the improvement in diabetic control. Mechanisms of diabetic-induced damage in pregnancy are related to maternal and fetal hyperglycemia, enhanced oxidative stress, epigenetic changes, and other, less defined, pathogenic mechanisms.
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Affiliation(s)
- Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
- Correspondence: ; Tel.: +972-(2)-675-8329
| | - Maria Becker
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
- Medical Center, Hadassah Hebrew University, Mount Scopus, Jerusalem 91240, Israel
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16
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Koren G, Ornoy A. Institutionalized Children and the Risk of Fetal Alcohol Spectrum Disorder (FASD); A Primer for Clinicians, Adoption Staff and Parents. Glob Pediatr Health 2021; 8:2333794X21989556. [PMID: 33644259 PMCID: PMC7890725 DOI: 10.1177/2333794x21989556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/22/2020] [Accepted: 12/31/2020] [Indexed: 12/05/2022] Open
Abstract
Objectives: Our objective was to estimate the likelihood of abnormal development among institutionalized children, addressing either the risk in general, or the risk for fetal alcohol spectrum disorder (FASD). Methods: Narrative review of studies measuring developmental effects of these populations. We identified all systematic reviews and meta analyses dealing with the associations between institutionalization of children and their neurodevelopment in general, or between institunalization of children and their likelihood of suffering from FASD. Results: a) In a published meta-analysis the mean IQ/DQ was 84 among institutionalized children, as compared to 104 among children raised in families. Favorable caregiver-child ratios appeared to have a protective effect, whereas longer stays in institutions had a detrimental effect on IQ/DQ. b) A further meta- analysis has shown a positive impact of adoption on children’s cognitive development with adopted children’s displaying remarkably normal cognitive competence as compared to their non-adopted peers. c) The overall pooled prevalence was 6% (60 per 1,000, 95% CI 38-85) for full blown fetal alcohol syndrome (FAS), and 16.9% (95% CI 109-238 per 1,000) for the whole range of FASD. d) The estimated prevalence of FASD was 10-40 fold higher than the 7.7 per 1000 in the general population. Conclusions: A large proportion of adopted institutionalized children may not follow a normal developmental trajectory. If not afflicted by FASD, there is a positive impact of adoption on children’s cognitive development and in general they are comparable to their non- adopted peers.
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Affiliation(s)
- Gideon Koren
- Adelson faculty of medicine, Ariel University, Ariel, Israel.,Motherisk Israel, Clinical Pharmacology Unit, Shamir Hospital, Zrifin, Israel
| | - Asher Ornoy
- Motherisk Israel, Clinical Pharmacology Unit, Shamir Hospital, Zrifin, Israel.,Hebrew University Hadassah Medical School
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17
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Becker M, Pinhasov A, Ornoy A. Animal Models of Depression: What Can They Teach Us about the Human Disease? Diagnostics (Basel) 2021; 11:123. [PMID: 33466814 PMCID: PMC7830961 DOI: 10.3390/diagnostics11010123] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/28/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022] Open
Abstract
Depression is apparently the most common psychiatric disease among the mood disorders affecting about 10% of the adult population. The etiology and pathogenesis of depression are still poorly understood. Hence, as for most human diseases, animal models can help us understand the pathogenesis of depression and, more importantly, may facilitate the search for therapy. In this review we first describe the more common tests used for the evaluation of depressive-like symptoms in rodents. Then we describe different models of depression and discuss their strengths and weaknesses. These models can be divided into several categories: genetic models, models induced by mental acute and chronic stressful situations caused by environmental manipulations (i.e., learned helplessness in rats/mice), models induced by changes in brain neuro-transmitters or by specific brain injuries and models induced by pharmacological tools. In spite of the fact that none of the models completely resembles human depression, most animal models are relevant since they mimic many of the features observed in the human situation and may serve as a powerful tool for the study of the etiology, pathogenesis and treatment of depression, especially since only few patients respond to acute treatment. Relevance increases by the fact that human depression also has different facets and many possible etiologies and therapies.
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Affiliation(s)
- Maria Becker
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Albert Pinhasov
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
- Hebrew University Hadassah Medical School, Jerusalem 9112102, Israel
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18
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Ornoy A, Koren G. The Effects of Drugs used for the Treatment of Attention Deficit Hyperactivity Disorder (ADHD) on Pregnancy Outcome and Breast-feeding: A Critical Review. Curr Neuropharmacol 2020; 19:1794-1804. [PMID: 33245274 PMCID: PMC9185785 DOI: 10.2174/1570159x18666201127164000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/21/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral condition found in 5-10% of school-age children and in 2-5% of adults. Stimulants affecting the dopaminergic, noradrenergic and/or serotonergic systems are commonly used for treatment in children and adults, including women of childbearing age. The data on the effects of stimulants (methylphenidate and amphetamines) in pregnancy are generally reassuring, but methylphenidate might slightly increase the rate of cardiac malformations and of spontaneous abortions, while amphetamines might slightly increase the risk for premature birth, low birth weight and other pregnancy complications. Bupropion, a dopamine and norepinephrine reuptake inhibitor, when used as an antidepressant, appears to be safe in pregnancy. The data on the use of atomoxetine, guanfacine and clonidine in pregnancy are scarce. Importantly, there are practically no data on the long-term neurodevelopmental effects of most of these drugs. The published data on the development of children born to methamphetamine-abusing women may be misleading since these women generally use other drugs, including alcohol, and the home environment where the child is raised may not be optimal. The treating physician should judge the need for treatment during pregnancy in relation to the severity of the clinical symptoms. If needed, methylphenidate is preferred over amphetamines because breast feeding is possible. If one uses non-stimulant medications, bupropion seems to be the preferred drug.
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Affiliation(s)
- Asher Ornoy
- Hebrew University Hadassah Medical School, Jerusalem, Israel
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19
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Frcpc Facmt GKM, Ornoy A. Gestational Exposure to Serotonin Reuptake Inhibitors and Pregnancy Outcome ; Exploring the Role of Bias and Confounders. Curr Neuropharmacol 2020; 19:2227-2232. [PMID: 33059578 PMCID: PMC9185759 DOI: 10.2174/1570159x18666201015161105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/20/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022] Open
Abstract
There is no other example in human teratology where, after more than 40 epidemiological studies, repeated meta analyses and thousands of pregnancies, the fetal safety or risk of an agent has not been verified and settled. The objectives of the present review was to identify and discuss sources of bias that may lead clinicians and scientists to believe that SRI cause malformation or other adverse outcomes, where, in fact, they may not. The present study highlights sources of bias which may explain why children exposed in utero to SRI exhibit higher rates of congenital malformations, mostly cardiovascular and other complications. It appears that pregnant women treated for depression and anxiety are distinctively different from healthy women in numerous covariates which may confound pregnancy outcome. Acknowledging and adjusting for these sources of bias is critical before one selects to withhold therapy for moderate or severe cases of depression and anxiety in pregnancy.
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20
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Koren G, Barer Y, Ornoy A. Fetal Safety of Methylphenidate - A Systematic Review and Meta Analysis. Reprod Toxicol 2020. [DOI: 10.1016/j.reprotox.2020.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Kozhuhov A, Tfilin M, Turgeman G, Ornoy A, Yanai J, Abookasis D. Implementation of a six-around-one optical probe based on diffuse light spectroscopy for study of cerebral properties in a murine mouse model of autism spectrum disorder. Appl Opt 2020; 59:6809-6816. [PMID: 32788771 DOI: 10.1364/ao.396681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 05/28/2023]
Abstract
Light reflectance spectroscopy (LRS) is a multispectral technique, sensitive to the absorption and scattering properties of biological molecules in tissues. It is used as a noninvasive tool to extract quantitative physiological information from human tissues and organs. A near-infrared LRS based on a single optical probe was used to monitor changes in optical and hemodynamic parameters in a mouse model of autism. A murine model of autism induced by developmental exposure to valproic acid (VPA) was used. Since autism could be attributed to neuroanatomical changes, we hypothesize that these changes can be detected using the LRS because spectral properties depend on both molecular composition and structural changes. The fiber-optic probe in the setup consisted of seven small optical fibers: six fibers for illumination placed in a circular manner around a central single collection fiber. Overall, measurements demonstrate changes in diffused reflectance spectra, cerebral optical tissue properties (absorption and scattering), and chromophore levels. Furthermore, we were able to identify differences between male and female groups. Finally, the effectiveness of S-Adenosylmethionine as a drug therapy was studied and found to improve the hemodynamic outcome. For the first time, to the best of our knowledge, the LRS is utilized to study variations in brain parameters in the VPA autism model mice through an intact scalp.
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22
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Abstract
This narrative review presents the emerging published evidence on the existence
of a phenotypic behavior in children with fetal alcohol spectrum behavior. Such
a phenotype, exhibiting high sensitivity, specificity, and predictive values,
may assist clinicians and families in identifying children who often miss some
of the information needed for full diagnosis, but who may benefit from these
screening tools in mobilizing help to these youngsters and their families.
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Affiliation(s)
- Gideon Koren
- Ariel University, Ariel, Israel.,Motherisk Israel Program, Tel Aviv, Israel
| | - Asher Ornoy
- Ariel University, Ariel, Israel.,Hebrew University, Jerusalem, Israel
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23
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Koren G, Barer Y, Ornoy A. Fetal safety of methylphenidate-A scoping review and meta analysis. Reprod Toxicol 2020; 93:230-234. [PMID: 32169555 DOI: 10.1016/j.reprotox.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/27/2020] [Accepted: 03/06/2020] [Indexed: 11/26/2022]
Abstract
While for decades attention deficit hyperactivity disorder (ADHD) was regarded as mostly a pediatric condition, it is apparent that many adults continue to be afflicted by this condition, and presently an estimated 30 %-40 % of patients continue with ADHD symptomatology into adulthood. With more adults using stimulants for ADHD, there is evidence of increased numbers using ADHD medications in pregnancy. Till recently the reports on ADHD medication safety have been sparse with insufficient power to address fetal safety. Methylphenidate has been a first line treatment for ADHD, with relatively large numbers of usage. We conducted a scoping review and meta-analysis of observational cohort studies that compared malformation rates among offspring exposed to methylphenidate during early pregnancy, to the rates in the general population. Meta- analysis of 4 cohort studies with almost 3000 women exposed to methylphenidate only, and almost 3 million unexposed controls, yielded an OR of 1.26(95 % confidence interval 1.05-1.51) for major malformations, and 1.59 (95 % confidence interval 1.02-2.49) for cardiac malformations. In conclusion, methylphenidate exposure in early pregnancy is associated with a small but significant increased risk for major malformations, which can be attributed mostly to increased risk of cardiac malformations. It may be advisable to consider fetal echocardiography in pregnant women using methylphenidate during pregnancy.
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Affiliation(s)
- Gideon Koren
- From Adelson School of Medicine, Ariel University, Israel; Motherisk Israel Program, Israel.
| | | | - Asher Ornoy
- From Adelson School of Medicine, Ariel University, Israel; Hebrew University Hadassah Medical School, Israel
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24
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Blumenfeld O, Ben-Pazi H, Ornoy A, Josef A, Shohat T. Prevalence of cerebral palsy with Gross Motor Function Classification System levels IV and V in children in Israel: a cross-cultural comparison. Childs Nerv Syst 2020; 36:411-416. [PMID: 31292758 DOI: 10.1007/s00381-019-04262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Cerebral palsy is the most common physical disability in childhood. Our aim was to study the prevalence of wheelchair-dependent cerebral palsy (equivalent to gross motor function classification system level IV/V) among Jewish and Arab children in Israel and to investigate differences between the children of the two population groups. METHODS Children diagnosed with cerebral palsy born in the years 2005-2006 were located through the Israel National Insurance Institute database. Demographic and clinical data were retrieved from children's records. RESULTS Overall prevalence in Israel was 0.8 (0.7-0.9) per 1000 live births. The prevalence was significantly higher among Arabs (1.2:1000) than Jews (0.6:1000; OR = 1.6, 95% CI 1.2-2.1, p = 0.001) and was highest among Arabs in the South (Bedouins) (2.8:1000). Consanguinity among parents and low socioeconomic status were significantly more common among Arab children with wheelchair- dependent cerebral palsy compared with Jews. Higher rates of children with cerebral palsy following term pregnancy were found in Arabs. Extreme preterm births, very low birth weight, and emergent cesarean section were more common among Jews compared with Arabs. CONCLUSIONS This study revealed population group differences of cerebral palsy with Gross Motor Function Classification System levels IV and V. Higher rates of cerebral palsy, especially following term pregnancy in the Arab population, may be attributed to consanguinity and genetic factors. There is a need to tailor services to underserved population based on etiology: preterm births and genetic causes for the Jewish and Arab populations, respectively.
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Affiliation(s)
- Orit Blumenfeld
- Israel Center for Disease Control, Israel Ministry of Health, Jerusalem, Israel.
| | - Hilla Ben-Pazi
- Pediatric Neurology, Shaare Zedek Medical Center, Shmuel Bait 6, 91031, Jerusalem, Israel
| | - Asher Ornoy
- Department of Child Development, Ministry of Health, Jerusalem, Israel
- Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Adina Josef
- Department of Child Development, Ministry of Health, Jerusalem, Israel
| | - Tamy Shohat
- Israel Center for Disease Control, Israel Ministry of Health, Jerusalem, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Abstract
Abstract
Background
Most studies on the association between the mental health of mothers and the development of their offspring have focused on maternal depression, but only a few have investigated the association between maternal anxiety and child development. We aimed to compare the associations between maternal depression and anxiety symptoms 6-8 weeks postpartum and infant development at 1 year.
Methods
We conducted a longitudinal study of 396 mother-child dyads. The mothers were recruited after birth in 3 different hospitals in Israel in 2017 and were followed for one year. Mothers were assessed by completing the General Anxiety Disorder-7 (GAD-7) questionnaire and the Edinburgh Postnatal Depression Scale (EPDS) 6-8 weeks postpartum. Child development was assessed by the Ages & Stages Questionnaires (ASQ-3) at 12 months. Multivariate linear regressions were used to explore the relationship between the EPDS and GAD-7 scores and child development, all as continuous variables, adjusting for maternal education, parity, and gender.
Results
Depressive symptoms postpartum were only associated with poor personal-social skills (β=-0.5, 95% CI: -0.91, -0.08). Increasing maternal anxiety was associated with poorer development in communication skills (β =-0.48, 95% CI: -0.93, -0.04), personal-social skills (β =-1.02, 95% CI: -1.58, -0.46), solving problems skills (β =-0.7, 95% CI: -1.27, -0.14) and fine motor skills (β =-0.46, 95% CI: -0.9, -0.02). Neither anxiety nor depressive symptoms were associated with gross motor skills. Controlling for quality of attachment, the associations of depression and anxiety with development were no longer significant, suggesting mediation.
Conclusions
Postpartum anxiety was a stronger predictor of low developmental scores than depression, and associations were probably mediated by impaired attachment. Identifying and supporting mothers experiencing anxiety after birth may mitigate the risk of developmental delays in children.
Key messages
Maternal anxiety was found to be a significant risk factor for developmental delay at 1 year of age. The association between maternal anxiety and child development was probably mediated by attachment.
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Affiliation(s)
- S Gete
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - R Calderon-Margalit
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - I Grotto
- Public Health, Ministry of Health, Jerusalem, Israel
| | - A Ornoy
- School of Medicine-IMRIC-Medical Neurobiology, Hebrew University-Hadassah, Jerusalem, Israel
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Ornoy A, Spivak A. Cost effectiveness of optimal treatment of ADHD in Israel: a suggestion for national policy. Health Econ Rev 2019; 9:24. [PMID: 31289954 PMCID: PMC6734254 DOI: 10.1186/s13561-019-0240-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/26/2019] [Indexed: 05/23/2023]
Abstract
OBJECTIVES There are well known behavioral complications of ADHD at adulthood such as learning difficulties resulting in lower education attainments; increased rate of car and other accidents; substance abuse; misconduct and imprisonment. These complications can be prevented or alleviated by effective treatment. In this study we calculated the economic burden of ADHD among adults in Israel and the cost of diagnosing and treating ADHD from childhood to adulthood. We then obtained the cost-benefit ratio of the treatment. METHODS The data were calculated using accepted estimations of prevalence and cost for the Israeli population assuming a prevalence of 4% among adults which is based on the ADHD prevalence among school age children. RESULTS The estimated cost per person with ADHD due to lower education attainment, higher involvement in crime and car accidents and more drug abuse is 289,969 USD and the estimated cost for optimal treatment is 41,667 USD. Hence, the benefit cost ratio is 7.02 and, assuming only 50% success of treatment, it is 3.51, still a very high cost benefit ratio. CONCLUSIONS Since early diagnosis and appropriate treatment of ADHD is very effective in reducing the various symptoms and complications at adulthood thus enabling a better education and higher income, it seems important to diagnose and offer comprehensive treatment to children with ADHD. Moreover, it seems equally important to continue treatment at adulthood.
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Affiliation(s)
- Asher Ornoy
- Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Avia Spivak
- Department of Economics, Ben Gurion University, Beersheba, Israel
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Shilo D, Blumenfeld A, Haze A, Sharon S, Goren K, Hanhan S, Gruenbaum-Cohen Y, Ornoy A, Deutsch D. Tuftelin's involvement in embryonic development. J Exp Zool B Mol Dev Evol 2019; 332:125-135. [PMID: 31045321 DOI: 10.1002/jez.b.22855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/16/2019] [Accepted: 03/20/2019] [Indexed: 01/20/2023]
Abstract
Little is known about tuftelin expression in the developing embryo, previously it was thought to play a role in tooth enamel mineralization. In this study we show tuftelin's spatio-temporal expression in mineralizing and nonmineralizing tissues of the craniofacial complex in the developing mouse embryo. Embryos aged E10.5-E18.5 and newborns aged P3 were used in this study. Polymerase chain reaction (PCR), Real-time PCR, sequencing, and in-situ hybridization were used to detect and quantify messenger RNA (mRNA) expression in different developmental stages. We applied indirect immunohistochemistry and western-blot analyses to investigate protein expression. Two tuftelin mRNA transcripts and a single 64KDa protein were detected throughout embryonic development. Tuftelin was detected in tissues which develop from different embryonic origins; ectoderm, ectomesenchyme, and mesoderm. Tuftelin mRNA and protein were expressed already at E10.5, before the initiation of tooth formation and earlier than previously described. The expression pattern of tuftelin mRNA and protein exhibits dynamic spatio-temporal changes in various tissues. Tuftelin is expressed in neuronal tissues, thus fitting with its described correlation to nerve growth factor. A shift between cytoplasmatic and perinuclear/nuclear expression implies a possible role in regulation of transcription. Recent studies showed tuftelin is induced under hypoxic conditions in-vitro and in-vivo, through the hypoxia-inducible factor 1-α pathway. These results led to the hypothesis that tuftelin is involved in adaptation to hypoxic conditions. The fact that much of mammalian embryogenesis occurs at O 2 concentrations of 1-5%, raises the possibility that tuftelin expression throughout development is due to its role in the adaptive mechanisms in response to hypoxia.
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Affiliation(s)
- Dekel Shilo
- Dental Research Laboratory, Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Anat Blumenfeld
- Dental Research Laboratory, Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Amir Haze
- Dental Research Laboratory, Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Shay Sharon
- Dental Research Laboratory, Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Koby Goren
- Dental Research Laboratory, Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Salem Hanhan
- Dental Research Laboratory, Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Yael Gruenbaum-Cohen
- Dental Research Laboratory, Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, The Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Dan Deutsch
- Dental Research Laboratory, Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
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Ornoy A, Weinstein-Fudim L, Ergaz Z. Prevention or Amelioration of Autism-Like Symptoms in Animal Models: Will it Bring Us Closer to Treating Human ASD? Int J Mol Sci 2019; 20:ijms20051074. [PMID: 30832249 PMCID: PMC6429371 DOI: 10.3390/ijms20051074] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/23/2019] [Indexed: 11/17/2022] Open
Abstract
Since the first animal model of valproic acid (VPA) induced autistic-like behavior, many genetic and non-genetic experimental animal models for Autism Spectrum Disorder (ASD) have been described. The more common non-genetic animal models induce ASD in rats and mice by infection/inflammation or the prenatal or early postnatal administration of VPA. Through the establishment of these models, attempts have been made to ameliorate or even prevent ASD-like symptoms. Some of the genetic models have been successfully treated by genetic manipulations or the manipulation of neurotransmission. Different antioxidants have been used (i.e., astaxanthin, green tea, piperine) to reduce brain oxidative stress in VPA-induced ASD models. Agents affecting brain neurotransmitters (donepezil, agmatine, agomelatine, memantine, oxytocin) also successfully reduced ASD-like symptoms. However, complete prevention of the development of symptoms was achieved only rarely. In our recent study, we treated mouse offspring exposed on postnatal day four to VPA with S-adenosine methionine (SAM) for three days, and prevented ASD-like behavior, brain oxidative stress, and the changes in gene expression induced by VPA. In this review, we describe, in addition to our data, the existing literature on the prevention/amelioration of ASD-like symptoms. We also discuss the possible mechanisms underlying some of these phenomena. Finally, we describe some of the clinical trials in children with ASD that were carried out as a result of data from animal studies, especially those with polyunsaturated fatty acids (PUFAs).
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Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 9112001, Israel.
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 9112001, Israel.
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 9112001, Israel.
- Neonatology Department, Hadassah Hebrew University Medical Center, Jerusalem 9112001, Israel.
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Howdeshell KL, Ornoy A. Depression and Its Treatment During Pregnancy: Overview and Highlights. Birth Defects Res 2019; 109:877-878. [PMID: 28714609 DOI: 10.1002/bdr2.1080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/07/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Kembra L Howdeshell
- Office of Health Assessment and Translation, National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
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Ornoy A, Weinstein-Fudim L, Tfilin M, Ergaz Z, Yanai J, Szyf M, Turgeman G. S-adenosyl methionine prevents ASD like behaviors triggered by early postnatal valproic acid exposure in very young mice. Neurotoxicol Teratol 2019; 71:64-74. [DOI: 10.1016/j.ntt.2018.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/21/2017] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
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Hellwig K, Geissbuehler Y, Sabidó M, Popescu C, Adamo A, Klinger J, Huppke P, Ornoy A, Korhonen P, Myhr K, Montgomery S, Burkill S. Pregnancy and Infant Outcomes with Interferon Beta: Data from the European Interferon Beta Pregnancy Registry and Population Based Registries in Finland and Sweden. Mult Scler Relat Disord 2018. [DOI: 10.1016/j.msard.2018.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Koren G, Ornoy A. Clinical implications of selective serotonin reuptake inhibitors-selective serotonin norepinephrine reuptake inhibitors pharmacogenetics during pregnancy and lactation. Pharmacogenomics 2018; 19:1139-1145. [DOI: 10.2217/pgs-2018-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Depression occurs during pregnancy in 3.9–12.8% of the women. The different serotonin reuptake inhibitors (SRIs) are metabolized in the liver by CYP450 enzymes. CYP2D6 metabolizes paroxetine, fluoxetine, duloxetine and venlafaxine, while CYP2C19 deactivates citalopram and escitalopram. Polymorphisms in these enzymes change the metabolic clearance and levels of these drugs. Higher metabolism of most SRIs in late pregnancy results in lower maternal levels, which could result in decreased efficacy. Very few studies have addressed the potential interaction between pregnancy-induced increase in 2D6 metabolism and specific genotypes of the women, suggesting that ultra-rapid and extensive metabolizers exhibit lower serum concentrations than the other slower genotypes. Preliminary studies suggest that some genotypes of the serotonin transporter (SLC6A4) promoter are associated and are linked to adverse effects in infants with SRI exposure during pregnancy. Presently, there are no clear clinical implications of SRI pharmacogenetic status in pregnancy and lactation. In late pregnancy, women may exhibit lower steady state concentrations of these drugs, necessitating increased doses but these are presently guided clinically and not through genotyping. Much more work is needed to define whether SRI genotype has clinical implications and predictive value for either mother or offspring.
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Affiliation(s)
- Gideon Koren
- Department of Pediatrics, Morris Kahn-Maccabi Istitute of Research & Innovation, & Tel Aviv University, Israel
| | - Asher Ornoy
- Department of Medical Neurobiology, Laboratory of Teratology, Department of Medical Neurobiology, Hadassah Medical School, Hebrew University, Israel
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Diav-Citrin O, Steinmetz-Shoob S, Shechtman S, Ornoy A. In-utero exposure to metformin for type 2 diabetes or polycystic ovary syndrome: A prospective comparative observational study. Reprod Toxicol 2018; 80:85-91. [DOI: 10.1016/j.reprotox.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/14/2018] [Accepted: 05/26/2018] [Indexed: 12/16/2022]
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Ornoy A, Chambers C, Koren G. Secondary prevention in teratology: Can the consequences of exposure to teratogens be alleviated or attenuated by maternal nutrition? Reprod Toxicol 2018. [DOI: 10.1016/j.reprotox.2018.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ornoy A, Koren G, Yanai J. Is post exposure prevention of teratogenic damage possible: Studies on diabetes, valproic acid, alcohol and anti folates in pregnancy: Animal studies with reflection to human. Reprod Toxicol 2018; 80:92-104. [DOI: 10.1016/j.reprotox.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/06/2018] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
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Ergaz Z, Weinstein-Fudim L, Ornoy A. High sucrose low copper diet in pregnant diabetic rats induces transient oxidative stress, hypoxia, and apoptosis in the offspring's liver. Birth Defects Res 2018; 110:1001-1015. [PMID: 29851303 DOI: 10.1002/bdr2.1341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/05/2018] [Accepted: 03/19/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hyperglycemia-related oxidative stress and hypoxia are important mechanisms responsible for diabetes-induced embryopathy and other complications. High sucrose low copper diet (HSD), but not regular diet (RD), induces type 2 diabetes in the inbred Cohen diabetic sensitive (CDs) rats but not in the Sabra control rats. We recently demonstrated long-term changes of DNA methylation and gene expression in various groups of genes, including genes involved in oxidant-antioxidant activity in the liver of 2-4-week-old CDs offspring of diabetic dams. We now studied the postnatal effects of diabetes and/or HSD on several liver metabolic parameters in these offspring. METHODS we studied lipid peroxidation, activity of the antioxidants enzymes superoxide dismutase (SOD) and Catalase (CAT). By immunohistochemistry: protein oxidation by nitrotyrosine staining, hypoxia inducing factor1α (HIF1α), apoptosis [caspase 3, bcl-2-like protein (BAX)], proliferation [proliferating cell nuclear antigen (PCNA)] and NF-κB. RESULTS In the Sabra rats fed HSD only few, early and transitional changes were observed in lipid peroxidation, SOD and CAT activity. In the CDs fed HSD more significant changes in lipid and protein oxidation, HIF1α, apoptosis and proliferation were observed, persisting for longer. CONCLUSIONS The changes in the Sabra rats HSD were attributed to the pro-oxidant effects of the diet and those in the diabetic CDs to the HSD and maternal diabetes. In light of the DNA methylation changes in the liver of the CDs HSD, we presume that changes in gene expression are responsible for our findings, and that similar changes may lead to the metabolic syndrome at adulthood.
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Affiliation(s)
- Zivanit Ergaz
- Neonatology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
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Koren G, Ornoy A, Berkovitch M. Hyperemesis gravidarum-Is it a cause of abnormal fetal brain development? Reprod Toxicol 2018; 79:84-88. [PMID: 29913206 DOI: 10.1016/j.reprotox.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 05/20/2018] [Accepted: 06/14/2018] [Indexed: 12/27/2022]
Abstract
Hyperemesis gravidarum (HG) is characterized by severe gestational nausea and vomiting, leading to dehydration, electrolyte imbalance and nutritional deficits. HG adversely affects the health and wellbeing of the woman. However, the detrimental impact of HG on fetal brain development has not been addressed. We evaluate herein the emerging evidence suggesting that HG interferes with human brain development, and discuss putative mechanisms. Evidence emerges from prospective developmental studies in offspring exposed in utero to HG, from studies of pregnancy outcome after in utero exposure to famine, as well as evidence on specific nutritional deficiencies affecting fetal brain development.
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Affiliation(s)
- Gideon Koren
- Motherisk Israel, Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Zerifin; Maccabi Institute for Research and Innovation, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel; Westen University, ON, Canada; The Hebrew University, Israel.
| | - Asher Ornoy
- Westen University, ON, Canada; The Hebrew University, Israel
| | - Matitiahu Berkovitch
- Motherisk Israel, Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Zerifin; Sackler Faculty of Medicine, Tel Aviv University, Israel; The Hebrew University, Israel
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Ornoy A, Ergaz Z. Parvovirus B19 infection during pregnancy and risks to the fetus. Birth Defects Res 2018; 109:311-323. [PMID: 28398685 DOI: 10.1002/bdra.23588] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/02/2016] [Accepted: 09/14/2016] [Indexed: 01/30/2023]
Abstract
Parvovirus B19 infects 1 to 5% of pregnant women, generally with normal pregnancy outcomes. During epidemics, the rate of infection is higher. Major congenital anomalies among offspring of infected mothers are rare, as the virus does not appear to be a significant teratogen. However, parvovirus B19 infection may cause significant fetal damage, and in rare cases, brain anomalies and neurodevelopmental insults, especially if infection occurs in the first 20 weeks of pregnancy. Parvovirus B19 is also an important cause of fetal loss, especially in the second half of pregnancy when spontaneous fetal loss from other causes is relatively rare. Parvovirus B19 infection may affect many fetal organs and can cause severe anemia, following fetal erythroid progenitor cells infection and apoptosis, especially in fetuses, that have shortened half-life of erythrocytes. Severe anemia may cause high output cardiac failure and nonimmune hydrops fetalis. In addition, parvovirus B19 may directly infect myocardial cells and produce myocarditis that further aggravates the cardiac failure. Intrauterine fetal transfusion is commonly used for the treatment of severe fetal anemia with survival rates of 75 to 90% and significant reduction of fetal morbidity. Only 66 cases were evaluated neurodevelopmentally, of which 10 (16%) had slight or severe neurodevelopmental problems. Because parvovirus B19 infection can cause severe fetal morbidity and mortality, it should be part of the routine work-up of pregnant women who have been exposed to the virus or of pregnancies with suspected fetal hydrops. Assessment for maternal infection during pregnancy is especially important during epidemics, when sero-conversion rates are high. Birth Defects Research 109:311-323, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel.,Department of Neonatology, Hadassah University Hospital Mount Scopus, Jerusalem, Israel
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Ornoy A, Rivkin D, Barlev L. [CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD): ACCESSIBILITY AND AVAILABILITY OF SERVICES IN ISRAEL]. Harefuah 2018; 157:219-224. [PMID: 29688638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among children ranges from 8% -12% and is more common in males. Most ADHD children suffer from related disorders such as learning disabilities and behavioral problems. Treatment with stimulants improves the learning and social abilities of most children and the addition of non-pharmaceutical treatments induces further improvement. OBJECTIVES Our previous study, four years ago, screened 1,129 1st and 2nd grade children in Jerusalem and identified 105 with high risk for ADHD. Currently we evaluated the contribution of the screening and the availability and utilization of services for these children. METHODS Interviews were conducted with 85 parents of identified children, now in 5th and 6th grades (response rate 81%) and 12 education and health professionals. Research tools consisted of a structured questionnaire for parents completed by phone and semi-structured interviews with professionals. RESULTS A total of 87% of parents reported that they were aware of the child's attention difficulties before the screening; 68% reported that the screening had encouraged them to pursue diagnosis. Only 49% of the children were diagnosed by the HMO's and 51% privately. Waiting time at HMO's was 3 times that of private services. Only 52% of the ADHD children received pharmacological treatment, most of them also received "supportive treatment". CONCLUSIONS HMO's do not provide sufficient services to ADHD children and parents have to seek help privately. HMO's should find the way to make better use of the services of psychiatrists and pediatricians permitted to diagnose and treat such children and furthermore, they must improve services and public awareness of ADHD.
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Affiliation(s)
- Asher Ornoy
- Hebrew University Hadassah Medical School and Myers JDC Brookdale Institute
| | - Dori Rivkin
- Hebrew University Hadassah Medical School and Myers JDC Brookdale Institute
| | - Lital Barlev
- Hebrew University Hadassah Medical School and Myers JDC Brookdale Institute
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Tal-Saban M, Ornoy A, Parush S. Success in Adults With Probable Developmental Coordination Disorder Using Structural Equation Modeling. Am J Occup Ther 2018; 72:7202205010p1-7202205010p8. [DOI: 10.5014/ajot.2018.022012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. The aim of this study was to conduct a broad in-depth examination of the relationship between developmental coordination disorder (DCD) and use of executive strategies, daily life activities, emotional state, and internal factors attributed to success.
METHOD. We used a large randomized cohort of young adults. Structural equation modeling was performed to test both the direct effects and the mediated effects of the independent variable (probable DCD) on dependent variables (executive functions, academic and nonacademic activities, emotional state, and attribution to success).
RESULTS. Probable DCD had a direct and significant effect on all variables. Motor coordination impairments directly affected daily function in nonacademic and academic abilities and resulted in decreased use of executive strategies. Likewise, all the indirect effects hypothesized in the model were found to be significant.
CONCLUSION. The model revealed the direct and indirect influences of probable DCD on a range of functions, with far-reaching clinical implications.
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Affiliation(s)
- Miri Tal-Saban
- Miri Tal-Saban, PhD, is Lecturer and Researcher, School of Occupational Therapy, Hebrew University Hadassah Medical School, Jerusalem, Israel;
| | - Asher Ornoy
- Asher Ornoy, MD, is Professor of Anatomy, Embryology and Teratology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Shula Parush
- Shula Parush, PhD, is School Chair and Director of Graduate Studies, School of Occupational Therapy, Hebrew University Hadassah Medical School, Jerusalem, Israel
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Ornoy A, Koren G. Selective serotonin reuptake inhibitor use in pregnant women; pharmacogenetics, drug-drug interactions and adverse effects. Expert Opin Drug Metab Toxicol 2018; 14:247-259. [PMID: 29345153 DOI: 10.1080/17425255.2018.1430139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Possible negative effects of selective serotonin reuptake inhibitors (SSRIs) in pregnancy relate to congenital anomalies, negative perinatal events and neurodevelopmental outcome. Many studies are confounded by the underlying maternal disease and by pharmacogenetic and pharmacokinetic differences of these drugs. Areas covered: The possible interactions of SSRIs and serotonin and norepinephrine reuptake inhibitors with other drugs and the known effects of SSRIs on congenital anomalies, perinatal and neurodevelopmental outcome. Expert opinion: SSRIs should be given with caution when combined with other drugs that are metabolized by cytochrome P450 enzymes. SSRIs apparently increase the rate of severe cardiac malformations, induce neonatal adaptation problems in up to 30% of the offspring, increase the rate of persistent pulmonary hypertension of the newborn and possibly slightly increase the rate of prematurity and low birth weight. Most neurodevelopmental follow up studies did not find significant cognitive impairments except some transient gross motor delay, slight impairment of language abilities and possibly behavioral changes. The literature on the possible association of SSRIs with autism spectrum disorder is inconsistent; if an association exists, it is apparently throughout pregnancy. The risk associated with treatment discontinuation seems to outweigh the risk of treatment, as severe maternal depression may negatively affect the child's development. If needed, treatment should continue in pregnancy with the minimal effective dose.
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Affiliation(s)
- Asher Ornoy
- a Laboratory of Teratology, Department of Medical Neurobiology , Hebrew University Hadassah Medical School , Jerusalem , Israel
| | - Gideon Koren
- b Morris Kahn- Maccabi Institute of Research and Innovation, and Tel Aviv University , TEl - AVIV , Israel
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Affiliation(s)
- Gideon Koren
- Institute of Research and Innovation, Maccabi Health Services, Israel
| | - Asher Ornoy
- Department of Pediatrics, Hebrew University, Israel
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Ornoy A, Weinstein-Fudim L, Szyf M, Ergaz Z. High sucrose low copper diet in diabetic and non-diabetic pregnant rats induces long-term changes in the offspring epigenome manifested by DNA hypo-methylation of critical developmental genes. Reprod Toxicol 2017. [DOI: 10.1016/j.reprotox.2017.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ornoy A, Koren G. Selective Serotonin Reuptake Inhibitors during Pregnancy: Do We Have Now More Definite Answers Related to Prenatal Exposure? Birth Defects Res 2017; 109:898-908. [DOI: 10.1002/bdr2.1078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/17/2017] [Accepted: 06/06/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School Jerusalem and Maccabi Research Institute and Tel Aviv University; Tel Aviv Israel
| | - Gideon Koren
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School Jerusalem and Maccabi Research Institute and Tel Aviv University; Tel Aviv Israel
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Ornoy A, Weinstein-Fudim L, Ergaz Z. Antidepressants, Antipsychotics, and Mood Stabilizers in Pregnancy: What Do We Know and How Should We Treat Pregnant Women with Depression. Birth Defects Res 2017; 109:933-956. [DOI: 10.1002/bdr2.1079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/02/2017] [Accepted: 06/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School; Jerusalem Israel
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School; Jerusalem Israel
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School; Jerusalem Israel
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Diav-Citrin O, Shechtman S, Zvi N, Finkel-Pekarsky V, Ornoy A. Is it safe to use lamotrigine during pregnancy? A prospective comparative observational study. Birth Defects Res 2017; 109:1196-1203. [DOI: 10.1002/bdr2.1058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/13/2017] [Accepted: 04/24/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Orna Diav-Citrin
- The Israeli Teratology Information Service, Israel Ministry of Health; Jerusalem
- The Hebrew University Hadassah Medical School; Jerusalem Israel
| | - Svetlana Shechtman
- The Israeli Teratology Information Service, Israel Ministry of Health; Jerusalem
| | - Naama Zvi
- The Israeli Teratology Information Service, Israel Ministry of Health; Jerusalem
| | | | - Asher Ornoy
- The Hebrew University Hadassah Medical School; Jerusalem Israel
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Hagai A, Diav-Citrin O, Shechtman S, Ornoy A. Pregnancy outcome after in utero exposure to local anesthetics as part of dental treatment: A prospective comparative cohort study. J Am Dent Assoc 2017; 146:572-580. [PMID: 26227642 DOI: 10.1016/j.adaj.2015.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/29/2015] [Accepted: 04/02/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Dental treatment and use of local anesthetics during pregnancy generally are considered harmless because of lack of evidence of adverse pregnancy effects. Data on the safety of dental treatment and local anesthetics during pregnancy are scant. Dental care is often a reason for concern both among women and their health care providers. The primary objective of this study was to evaluate the rate of major anomalies after exposure to local anesthetics as part of dental care during pregnancy. METHODS The authors performed a prospective, comparative observational study at the Israeli Teratology Information Services between 1999 and 2005. RESULTS The authors followed 210 pregnancies exposed to dental local anesthetics (112 [53%] in the first trimester) and compared them with 794 pregnancies not exposed to teratogens. The rate of major anomalies was not significantly different between the groups (4.8% versus 3.3%, P = .300). There was no difference in the rate of miscarriages, gestational age at delivery, or birth weight. The most common types of dental treatment were endodontic treatment (43%), tooth extraction (31%), and tooth restoration (21%). Most women (63%) were not exposed to additional medications. Approximately one-half (51%) of the women were not exposed to dental radiography, and 44% were exposed to radiation, mostly bite-wing radiography. CONCLUSIONS This study's results suggest that use of dental local anesthetics, as well as dental treatment during pregnancy, do not represent a major teratogenic risk. PRACTICAL IMPLICATIONS There seems to be no reason to prevent pregnant women from receiving dental treatment and local anesthetics during pregnancy.
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Ornoy A, Finkel-Pekarsky V, Peles E, Adelson M, Schreiber S, Ebstein R. Children of opiate addicted mothers have a high rate of ADHD and increased risk alleles associated with ADHD and with opiate addiction: Study of addicted parents and their children. Reprod Toxicol 2016. [DOI: 10.1016/j.reprotox.2016.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Diav-Citrin O, Shechtman S, Arnon J, Wajnberg R, Borisch C, Beck E, Richardson JL, Bozzo P, Nulman I, Ornoy A. Methylphenidate in Pregnancy: A Multicenter, Prospective, Comparative, Observational Study. J Clin Psychiatry 2016; 77:1176-1181. [PMID: 27232650 DOI: 10.4088/jcp.15m10083] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/30/2015] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Methylphenidate is a central nervous system stimulant medicinally used in the treatment of attention-deficit disorder with or without hyperactivity (ADD/ADHD). Data on its use in human pregnancy are limited. The primary objective of the study was to evaluate the risk of major congenital anomalies after pregnancy exposure to methylphenidate for medical indications. METHODS In a prospective, comparative, multicenter observational study performed in 4 participating Teratology Information Services (in Jerusalem, Berlin, Newcastle upon Tyne, and Toronto) between 1996 and 2013, methylphenidate-exposed pregnancies were compared with pregnancies counseled for nonteratogenic exposure (NTE) after matching by maternal age, gestational age, and year at initial contact. RESULTS 382 methylphenidate-exposed pregnancies (89.5% in the first trimester) were followed up. The overall rate of major congenital anomalies was similar between the groups (10/309 = 3.2% [methylphenidate] vs 13/358 = 3.6% [NTE], P = .780). The rates of major congenital anomalies (6/247 = 2.4% [methylphenidate] vs 12/358 = 3.4% [NTE], P = .511) and cardiovascular anomalies (2/247 = 0.8% [methylphenidate] vs 3/358 = 0.8% [NTE], P = .970) were also similar after exclusion of genetic or cytogenetic anomalies and limiting methylphenidate exposure to the period of organogenesis (weeks 4-13 after the last menstrual period). There was a higher rate of miscarriages and elective terminations of pregnancy in the methylphenidate group. Significant predictors for the miscarriages using Cox proportional hazards model were methylphenidate exposure (adjusted hazard ratio [HR] = 1.98; 95% CI, 1.23-3.20; P = .005) and past miscarriage (adjusted HR = 1.35; 95% CI, 1.18-1.55; P < .001). CONCLUSIONS The present study suggests that methylphenidate does not seem to increase the risk for major malformations. Further studies are required to establish its pregnancy safety and its possible association with miscarriages.
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Affiliation(s)
- Orna Diav-Citrin
- The Israeli Teratology Information Service, Israel Ministry of Health, PO Box 1176, Jerusalem, 9446724, Israel. .,The Israeli Teratology Information Service, Jerusalem, Israel Ministry of Health.,The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Svetlana Shechtman
- The Israeli Teratology Information Service, Jerusalem, Israel Ministry of Health
| | - Judy Arnon
- The Israeli Teratology Information Service, Jerusalem, Israel Ministry of Health
| | - Rebecka Wajnberg
- The Israeli Teratology Information Service, Jerusalem, Israel Ministry of Health
| | - Cornelia Borisch
- Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Berlin, Germany
| | - Evelin Beck
- Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Berlin, Germany
| | | | - Pina Bozzo
- The Motherisk Program, The Hospital for Sick Children, Toronto, Canada
| | - Irena Nulman
- The Motherisk Program, The Hospital for Sick Children, Toronto, Canada
| | - Asher Ornoy
- The Israeli Teratology Information Service, Jerusalem, Israel Ministry of Health.,The Hebrew University Hadassah Medical School, Jerusalem, Israel
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Ornoy A, Finkel-Pekarsky V, Peles E, Adelson M, Schreiber S, Ebstein PR. ADHD risk alleles associated with opiate addiction: study of addicted parents and their children. Pediatr Res 2016; 80:228-36. [PMID: 27064247 DOI: 10.1038/pr.2016.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/02/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Polymorphisms in genes such as DAT1, 5HTTLPR, D4DR4, and MAO-A have been linked to attention deficit hyperactivity disorder (ADHD) and susceptibility for opiate addiction. We investigated in opiate-addicted parents and their children the rate of ADHD and genetic markers that could predict susceptibility to ADHD and/or opiate addiction. METHODS We studied 64 heroin-addicted, methadone-maintained parents, and their 94 children who had or had not been exposed prenatally to opiates. DNA extracted from mouthwash was assessed for genetic polymorphism for six polymorphic sites of four different genes. Study subjects also filled a variety of questionnaires assessing the rate of ADHD in the parents and children and the children's intelligence quotient. RESULTS Children of opiate-dependent mothers had a higher rate of ADHD compared to those of the opiate-dependent fathers. Opiate-dependent parents have a high risk of being carriers of most risk alleles examined except DRD4EX3 (allele 7). There was no difference whether the addicted parents had or did not have ADHD. CONCLUSIONS Serotonergic and dopaminergic risk alleles seem to be mainly related to opiate dependence with no effect on the occurrence of ADHD. People carrying those polymorphisms are susceptible to opioid addiction and not necessarily to ADHD.
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Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, Canada Israel Institute of Medical Research, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Victoria Finkel-Pekarsky
- Laboratory of Teratology, Department of Medical Neurobiology, Canada Israel Institute of Medical Research, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Einat Peles
- Adelson clinic for drug abuse treatment & Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miriam Adelson
- Adelson clinic for drug abuse treatment & Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaul Schreiber
- Adelson clinic for drug abuse treatment & Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - P Richard Ebstein
- Department of Psychology, National University of Singapore, Singapore, Singapore
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