1
|
Kable JA, Coles CD, Keen CL, Uriu-Adams JY, Jones KL, Yevtushok L, Kulikovsky Y, Zymak-Zakutnya N, Dubchak I, Akhmedzhanova D, Wertelecki W, Chambers CD. The impact of micronutrient supplementation in alcohol-exposed pregnancies on reaction time responses of preschoolers in Ukraine. Alcohol 2022; 99:49-58. [PMID: 34942330 PMCID: PMC8844237 DOI: 10.1016/j.alcohol.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/05/2020] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022]
Abstract
The potential of micronutrients to ameliorate the impact of prenatal alcohol exposure (PAE) on attentional regulation skills was explored in a randomized clinical trial conducted in Ukraine. Women who differed in prenatal alcohol use were recruited during pregnancy and assigned to one of three groups [No study-provided supplements, Multivitamin/Mineral Supplement (MVM), or MVM plus Choline]. Their offspring were seen in the preschool period and a reaction time task was administered. Participants were asked to press a response button as quickly as possible as 30 stimuli from the same category (animals) were presented consecutively and then followed by six stimuli from a novel category (vehicles). Number correct, mean latency of the response over trials, and variability in the latency were analyzed separately by sex. During the initial animal trials, boys whose mothers received MVM during pregnancy had more correct responses and reduced response latency compared to boys whose mothers had no MVM treatment. During vehicle trials, maternal choline supplementation was associated with increased response speed in males without a PAE history. Females receiving supplements did not show the same benefits from micronutrient supplementation and were more adversely impacted by prenatal alcohol exposure. Relationships between maternal levels of choline, betaine, and dimethylglycine (DMG) and task performance were also assessed. Although no effects were found for choline after adjusting for multiple comparisons, lower baseline DMG level was associated with greater accuracy and shorter latency of responses in the initial animal trials and shorter latency in the vehicle trials in female preschoolers. Level of betaine in Trimester 3 was associated with reduced variability in the latency of male responses during the animal trials. Maternal micronutrient supplementation in pregnancy appears to improve preschool reaction time performance, but the effects varied as a function of sex and PAE exposure status.
Collapse
Affiliation(s)
- JA Kable
- Departments of Psychiatry and Behavioral Science, Emory University School of Medicine,,Pediatrics, Emory University School of Medicine
| | - CD Coles
- Departments of Psychiatry and Behavioral Science, Emory University School of Medicine,,Pediatrics, Emory University School of Medicine
| | - CL Keen
- Department of Nutrition, University of California, Davis
| | - JY Uriu-Adams
- Department of Nutrition, University of California, Davis
| | - KL Jones
- Departments of Pediatrics, University of California San Diego,,Family Medicine and Public Health, University of California San Diego
| | - L Yevtushok
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine,,Lviv National Medical University, Lviv, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - Y Kulikovsky
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - N. Zymak-Zakutnya
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - Iryna Dubchak
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - D Akhmedzhanova
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - W Wertelecki
- Departments of Pediatrics, University of California San Diego,,OMNI-Net Ukraine Birth Defects Program
| | - CD Chambers
- Departments of Pediatrics, University of California San Diego,,Family Medicine and Public Health, University of California San Diego
| | | |
Collapse
|
2
|
Sowell K, Uriu-Adams J, Van de Water J, Chambers C, Coles C, Kable J, Yevtushok L, Zymak-Zakutnya N, Wertelecki W, Keen C. Implications of altered maternal cytokine concentrations on infant outcomes in children with prenatal alcohol exposure. Alcohol 2018; 68:49-58. [PMID: 29453023 DOI: 10.1016/j.alcohol.2017.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 12/16/2022]
Abstract
Excessive alcohol consumption has been shown to increase serum plasma levels of numerous immune cytokines. Maternal immune activation and elevated cytokines have been implicated in certain neurological disorders (e.g., autism and schizophrenia) in the offspring. We investigated the hypothesis that elevated cytokines during pregnancy are a risk factor in women who gave birth to a child with Fetal Alcohol Spectrum Disorder (FASD) or a child with neurobehavioral impairment, regardless of prenatal alcohol exposure. Moderate to heavy alcohol-exposed (AE) (N = 149) and low or no alcohol-exposed (LNA) (N = 92) women were recruited into the study during mid pregnancy (mean of 19.8 ± 5.8 weeks' gestation) in two regions of Ukraine: Khmelnytsky and Rivne. Maternal blood samples were obtained at enrollment into the study at early to mid-pregnancy and during a third-trimester follow-up visit and analyzed for plasma cytokines. Children were examined at 6 and/or 12 months of age and were classified as having FASD if their mothers reported alcohol use and if they had at least one standardized score (Bayley Scales of Infant Development II Mental Development Index [MDI], or Psychomotor Development Index [PDI]) below 85 with the presence or absence of physical features of FASD. In multivariate analyses of maternal cytokine levels in relation to infant MDI and PDI scores in the entire sample, increases in the ratio of TNF-α/IL-10 and IL-6/IL-10 were negatively associated with PDI scores at 6 months (p = 0.020 and p = 0.036, respectively) and 12 months (p = 0.043 and p = 0.029, respectively), and with MDI scores at 12 months (p = 0.013 and p = 0.050, respectively). A reduction in the odds ratio of having an FASD child was observed with increasing levels of IL-1β, IL-2, IL-4, IL-6, and IL-10 in early to mid-pregnancy and IL-1β and IL-10 during late pregnancy. However, women that failed to increase IL-10 levels in the third trimester in order to maintain the balance of pro- and anti-inflammatory cytokines had an elevated risk of having an FASD child, specifically a significant increase in the odds ratio of FASD with every one-unit log increase in late pregnancy TNF-α/IL-10 levels (aOR: 1.654, CI: 1.096-2.495, p = 0.017). These data support the concept that disruptions in the balance between pro- and anti-inflammatory cytokines may contribute to neurobehavioral impairment and alter the risk of FASD.
Collapse
|
3
|
Kable JA, Coles CD, Keen CL, Uriu-Adams JY, Jones KL, Yevtushok L, Kulikovsky Y, Wertelecki W, Pedersen TL, Chambers CD. The impact of micronutrient supplementation in alcohol-exposed pregnancies on information processing skills in Ukrainian infants. Alcohol 2015; 49:647-56. [PMID: 26493109 PMCID: PMC4636447 DOI: 10.1016/j.alcohol.2015.08.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 12/24/2022]
Abstract
The potential of micronutrients to ameliorate the impact of prenatal alcohol exposure (PAE) was explored in a clinical trial conducted in Ukraine. Cardiac orienting responses (ORs) during a habituation/dishabituation learning paradigm were obtained from 6 to 12 month-olds to assess neurophysiological encoding and memory. Women who differed in prenatal alcohol use were recruited during pregnancy and assigned to a group (No study-provided supplements, multivitamin/mineral supplement, or multivitamin/mineral supplement plus choline supplement). Heart rate was collected for 30 s prior to stimulus onset and 12 s post-stimulus onset. Difference values (∆HR) for the first 3 trials of each condition were aggregated for analysis. Gestational blood samples were collected to assess maternal nutritional status and changes as a function of the intervention. Choline supplementation resulted in a greater ∆HR on the visual habituation trials for all infants and for the infants with no PAE on the dishabituation trials. The latency of the response was reduced in both conditions for all infants whose mothers received choline supplementation. Change in gestational choline level was positively related to ∆HR during habituation trials and levels of one choline metabolite, dimethylglycine (DMG), predicted ∆HR during habituation trials and latency of responses. A trend was found between DMG and ∆HR on the dishabituation trials and latency of the response. Supplementation did not affect ORs to auditory stimuli. Choline supplementation when administered together with routinely recommended multivitamin/mineral prenatal supplements during pregnancy may provide a beneficial impact to basic learning mechanisms involved in encoding and memory of environmental events in alcohol-exposed pregnancies as well as non- or low alcohol-exposed pregnancies. Changes in maternal nutrient status suggested that one mechanism by which choline supplementation may positively impact brain development is through prevention of fetal alcohol-related depletion of DMG, a metabolic nutrient that can protect against overproduction of glycine, during critical periods of neurogenesis.
Collapse
Affiliation(s)
- J A Kable
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, USA; Department of Pediatrics, Emory University School of Medicine, USA.
| | - C D Coles
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, USA; Department of Pediatrics, Emory University School of Medicine, USA
| | - C L Keen
- Department of Nutrition, University of California, Davis, USA
| | - J Y Uriu-Adams
- Department of Nutrition, University of California, Davis, USA
| | - K L Jones
- Department of Pediatrics, University of California, San Diego, USA
| | - L Yevtushok
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne Province, Ukraine
| | - Y Kulikovsky
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne Province, Ukraine
| | - W Wertelecki
- Department of Pediatrics, University of California, San Diego, USA; Department of Medical Genetics, University of South Alabama, USA
| | - T L Pedersen
- United States Department of Agriculture, Agricultural Research Service (ARS), Western Human Nutrition Research Center, Davis, CA, USA
| | - C D Chambers
- Department of Pediatrics, University of California, San Diego, USA; Department of Family Medicine and Public Health, University of California, San Diego, USA
| |
Collapse
|
4
|
Jones KL, Hoyme HE, Robinson L, DelCampo M, Manning M, Chambers C, Yevtushok L, Zymak-Zakutnya N, Wertelecki W, Jones KL, Keen CL, Uriu-Adams JY, Coles C, Yevtushok L, Zymak-Zakutnya N, Wertelecki W, Keen CL, Uriu-Adams JY, Kable JA, Jones KL, Chambers CD, Kable J, Coles C, Chambers C, Keen C, Uriu-Adams J, Jones K, Yevtushok L, Wertelecki W. S21 * TOWARD A BETTER UNDERSTANDING OF THE SPECTRUM OF FETAL ALCOHOL SPECTRUM DISORDERS AND THE ROLE OF MATERNAL NUTRITION IN MODIFYING FETAL RISK. Alcohol Alcohol 2013. [DOI: 10.1093/alcalc/agt092] [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: 11/15/2022] Open
|
5
|
Kfir M, Yevtushok L, Onishchenko S, Wertelecki W, Bakhireva L, Chambers CD, Jones KL, Hull AD. Can prenatal ultrasound detect the effects of in-utero alcohol exposure? A pilot study. Ultrasound Obstet Gynecol 2009; 33:683-9. [PMID: 19444822 PMCID: PMC3746738 DOI: 10.1002/uog.6379] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES The aim of this pilot study was to explore possible ultrasound parameters for the early detection of alcohol-mediated fetal somatic and central nervous system (CNS) maldevelopment. Maternal alcohol ingestion during pregnancy may lead to fetal alcohol spectrum disorders (FASD), which encompass a broad range of structural abnormalities including growth impairment, specific craniofacial features and CNS abnormalities. Early detection of fetuses at risk of FASD would support earlier interventions. METHODS We performed a longitudinal prospective pilot study from 2004 to 2006 at two sites in Ukraine. A sample of pregnant women who reported consuming moderate-to-heavy amounts of alcohol participated in a comprehensive maternal interview, and received ultrasound evaluation of fetal growth and specific fetal brain measurements during the second and third trimesters. These measurements were compared with those collected from a group of pregnant women who consumed little-to-no alcohol during pregnancy, and who were recruited and followed in the same manner. RESULTS From 6745 screened women, 84 moderate-to-heavy alcohol users and 82 comparison women were identified and ultrasound examinations performed. After controlling for maternal smoking, alcohol-exposed fetuses had shorter mean femur length, caval-calvarial distance and frontothalamic measurements in the second trimester (P < 0.05), and alcohol-exposed fetuses also had shorter frontothalamic distance measurements in the third trimester relative to comparison fetuses (P < 0.05). In addition, after controlling for maternal smoking, both mean orbital diameter and biparietal diameter measurements were significantly smaller on average in the alcohol-exposed group in the third trimester relative to comparison fetuses (P < 0.05). CONCLUSIONS Significant differences in selected somatic and brain measurements were noted between alcohol-exposed and comparison fetuses, suggesting these markers may be further explored for clinical utility in prenatal identification of affected children. Further study correlating these findings with alcohol-related physical features of the newborn and subsequent comparisons of neuro-developmental outcomes will help define potential uses of prenatal ultrasound for intervention and prevention of FASD.
Collapse
Affiliation(s)
- M Kfir
- Department of Reproductive Medicine, University of California San Diego, La Jolla, CA 92103-8433, USA
| | | | | | | | | | | | | | | |
Collapse
|