Search

Prenatal alcohol exposure (PAE) is linked to miscarriage, stillbirth, preterm birth, sudden infant death syndrome, and fetal alcohol spectrum disorders (FASD). (1) Although PAE is the sole necessary cause of [...]

To the Editor: Fetal alcohol syndrome (FAS) is characterized by a range of structural birth defects, including facial dysmorphia, central nervous system growth deficits (microcephaly), and prenatal/postnatal growth restriction, which [...]

Introduction Estimates of prenatal alcohol use among American Indian and Alaska Native (AI/AN) women are limited. This study sought to characterize pre-pregnancy and prenatal alcohol use among AI/AN women in the Pregnancy Risk Assessment Monitoring System (PRAMS) dataset, evaluate variation in alcohol use by state and rural/urban residence, and evaluate associations between potential risk factors and prenatal alcohol use among AI/AN and non-Hispanic white (NHW) women. Methods We pooled PRAMS data from five states (Alaska, New Mexico, Oklahoma, South Dakota and Washington) from 2015 to 2017. We estimated the prevalence of pre-pregnancy and pregnancy risk factors, and alcohol use by race and examined alcohol use by state and rural/urban residence among AI/AN women. We conducted bivariate and multivariable logistic regression modelling to estimate the association between each risk factor of interest and the odds of prenatal alcohol use for AI/AN and NHW women. Results AI/AN women were less likely to report pre-pregnancy alcohol use compared to NHW women (56% vs. 76%, p < 0.0001). Among women who reported drinking pre-pregnancy, AI/AN women were more likely than NHW women to report drinking 1 or more drinks during pregnancy (4.3% vs. 2.4, p = 0.0049). For AI/AN women, older age and experiencing homelessness (aOR = 2.76; 95% CI 1.16-6.55) increased odds of prenatal alcohol use. For NHW women, having a college education (aOR = 4.06; 95% CI 1.19-13.88) and urban residence (aOR = 1.88; 95% CI 1.40-2.53) increased odds of prenatal alcohol use. Conclusions Factors associated with prenatal alcohol use differ between AI/AN women and NHW women, suggesting the need for tailored interventions., Author(s): Luciana E. Hebert [sup.1] , Michelle C. Sarche [sup.2] Author Affiliations: (1) grid.30064.31, 0000 0001 2157 6568, Institute for Research and Education Advancing Community Health (IREACH), Washington State University, [...]

Adequate thiamin levels are crucial for optimal health through maintenance of homeostasis and viability of metabolic enzymes, which require thiamine as a co-factor. Thiamin deficiency occurs during pregnancy when the dietary intake is inadequate or excessive alcohol is consumed. Thiamin deficiency leads to brain dysfunction because thiamin is involved in the synthesis of myelin and neurotransmitters (e.g., acetylcholine, [gamma]-aminobutyric acid, glutamate), and its deficiency increases oxidative stress by decreasing the production of reducing agents. Thiamin deficiency also leads to neural membrane dysfunction, because thiamin is a structural component of mitochondrial and synaptosomal membranes. Similarly, in-utero exposure to alcohol leads to fetal brain dysfunction, resulting in negative effects such as fetal alcohol spectrum disorder (FASD). Thiamin deficiency and prenatal exposure to alcohol could act synergistically to produce negative effects on fetal development; however, this area of research is currently under-studied. This minireview summarizes the evidence for the potential role of thiamin deficiency in fetal brain development, with or without prenatal exposure to alcohol. Such evidence may influence the development of new nutritional strategies for preventing or mitigating the symptoms of FASD. Key words: thiamin, brain, fetus, alcohol, fetal alcohol spectrum disorder. Des niveaux adequats de thiamine sont essentiels a une sante optimale en maintenant l'homeostasie et la viabilite des enzymes metaboliques qui utilisent la thiamine comme cofacteur. La deficience en thiamine durant la grossesse survient lorsque l'apport par la diete est insuffisant ou qu'une quantite excessive d'alcool est consommee. La deficience en thiamine mene a une dysfonction cerebrale a cause de son implication dans la synthese de la myeline et des neurotransmetteurs (p.ex. l'acetylcholine, l'acide 32 [gamma]-aminobutyrique, le glutamate) et elle accroit le stress oxydant en diminuant la production d'agents reducteurs. La deficience mene aussi au dysfonctionnement de la membrane neurale car la thiamine est une composante structurale des membranes mitochondriales et synaptiques. De la meme facon, l'exposition a l'alcool in utero provoque une dysfonction du cerveau foetal qui resulte en des effets indesirables tels les troubles du spectre de l'alcoolisation foetale (TSAF). Les consequences indesirables de la deficience en thiamine et de l'exposition prenatale a l'alcool pourraient resulter de leur action synergique sur le developpement foetal, mais ce domaine de recherche est sous-etudie. Cette synthese resume les preuves du role potentiel de la deficience en thiamine dans le developpement du cerveau foetal avec ou sans exposition prenatale a l'alcool. De telles preuves pourraient influencer le developpement de nouvelles strategies nutritionnelles pour prevenir ou attenuer les symptomes des TSAF. [Traduit par la Redaction] Mots-cles: thiamine, cerveau, foetus, alcool, troubles du spectre de l'alcoolisation foetale., Introduction Maternal abuse of alcohol and its effect on the developing fetus has been widely studied for several decades. Prenatal alcohol consumption is associated with fetal alcohol spectrum disorder (FASD), [...]

Alcohol consumption during pregnancy places the fetus at risk for permanent physical, cognitive, and behavioral impairments, collectively termed fetal alcohol spectrum disorder (FASD). However, prenatal alcohol exposure (PAE) outcomes vary widely, and growing evidence suggests that maternal nutrition is a modifying factor. Certain nutrients, such as iron, may modulate FASD outcomes. Untreated gestational iron deficiency (ID) causes persistent neurodevelopmental deficits in the offspring that affect many of the same domains damaged by PAE. Although chronic alcohol consumption enhances iron uptake and elevates liver iron stores in adult alcoholics, alcohol-abusing premenopausal women often have low iron reserves due to menstruation, childbirth, and poor diet. Recent investigations show that low iron reserves during pregnancy are strongly associated with a worsening of several hallmark features in FASD including reduced growth and impaired associative learning. This review discusses recent clinical and animal model findings that maternal ID worsens fetal outcomes in response to PAE. It also discusses underlying mechanisms by which PAE disrupts maternal and fetal iron homeostasis. We suggest that alcoholexposed ID pregnancies contribute to the severe end of the FASD spectrum. Key words: fetal alcohol spectrum disorder, gestational iron deficiency, hepcidin, neurodevelopment, maternal/fetal nutrition. La consommation d'alcool durant la grossesse met le foetus a risque de deficits physiques, cognitifs et comportementaux permanents, appeles collectivement les troubles du spectre de l'alcoolisation foetale (TSAF). Toutefois, les consequences d'une exposition prenatale a l'alcool (EPA) varient grandement, et de plus en plus de donnees suggerent que la nutrition maternelle serait un facteur de modification. Certains nutriments comme le fer peuvent moduler les consequences des TSAF. Une deficience en fer (DF) durant la gestation provoque des deficits neurodeveloppementaux persistants chez la progeniture qui peuvent affecter plusieurs des domaines endommages par l'EPA. Meme si la consommation chronique d'alcool augmente la captation de fer et eleve les reserves de fer dans le foie des adultes alcooliques, les femmes pre-menopausees qui abusent d'alcool ont souvent de faibles reserves en fer a cause des menstruations, de l'accouchement et d'une alimentation deficiente. Des recherches recentes montrent que de faibles reserves en fer durant la grossesse sont fortement associees a une aggravation de plusieurs des marques distinctives des TSAF, dont une croissance reduite et un apprentissage associatif deficient. Cet article de synthese discute des resultats recents obtenus de modeles cliniques et animaux qui indiquent que la DF maternelle aggrave les consequences de l'EPA pour le foetus. Il discute aussi des mecanismes sous-jacents par lesquels l'EPA perturbe l'homeostasie maternelle et foetale du fer. Les auteurs suggerent que l'exposition a l'alcool et la deficience en fer durant la grossesse contribuent a l'extremite la plus grave du spectre des TSAF. [Traduit par la Redaction] Mots-cles : troubles du spectre de l'alcoolisation foetale, deficience gestationnelle en fer, hepcidine, neurodeveloppement, nutrition foetale et maternelle., Maternal nutrition and fetal alcohol spectrum disorder (FASD) Prenatal alcohol exposure (PAE) negatively affects embryonic and fetal development. Hallmark PAE characteristics include specific facial dysmorphology, growth restriction, restricted brain growth, [...]

OBJECTIVE. The 4-Digit Diagnostic Code for fetal alcohol spectrum disorders and the Hoyme fetal alcohol spectrum disorders diagnostic guidelines differ markedly. The performances of the 2 diagnostic systems were compared. METHODS. The fetal alcohol syndrome diagnostic criteria from the 4-Digit Code and Hoyme guidelines were applied to 952 patients who had received an interdisciplinary, fetal alcohol spectrum disorders, diagnostic evaluation at the University of Washington with the 4-Digit Diagnostic Code and 16 children with confirmed absence of prenatal alcohol exposure. RESULTS. The prevalence of fetal alcohol syndrome was 3.7% with the 4-Digit Code and 4.1% with the Hoyme guidelines. Although the prevalences were similar, the patients identified were not. Only 17 individuals met the fetal alcohol syndrome criteria for both systems. An extraordinary number of patients (35%) met the Hoyme criteria for the fetal alcohol syndrome facial phenotype, but only 39 of those 330 patients met the Hoyme criteria for fetal alcohol syndrome. Even some children with no alcohol exposure (25%) had the Hoyme fetal alcohol syndrome face. The specificities of the Hoyme fetal alcohol syndrome face for the Hoyme fetal alcohol syndrome diagnosis and prenatal alcohol exposure were low in these populations. CONCLUSIONS. Without a specific facial phenotype, a valid diagnosis of fetal alcohol syndrome cannot be rendered for patients with prenatal alcohol exposure, because a causal link between their outcomes and exposure cannot be established, and a valid diagnosis of fetal alcohol syndrome cannot be rendered for patients with unknown alcohol exposure, because the face cannot serve as a valid proxy measure for alcohol exposure. Diagnostic guidelines must confirm the specificity of their fetal alcohol syndrome facial criteria to validate their diagnostic criteria. Key Words diagnostic methods, fetal alcohol syndrome, fetal alcohol spectrum disorders, evaluation, guidelines Abbreviations FASD--fetal alcohol spectrum disorders FAS--fetal alcohol syndrome OFC--occipital frontal circumference PFL--palpebral fissure length IOM--Institute of Medicine CDC--Centers for Disease Control and Prevention ARND--alcohol-related neurodevelopmental disorder ARBD--alcohol-related birth defects CNS--central nervous system DPN--Diagnostic and Prevention Network CI--confidence interval, FETAL ALCOHOL SPECTRUM disorders (FASD) is a general term used to describe the full spectrum of adverse outcomes observed among individuals with prenatal alcohol exposure. Fetal alcohol syndrome (FAS) and [...]

Objective: Factors associated with alcohol consumption during pregnancy and with fetal alcohol syndrome (FAS) births were examined as part of a larger epidemiologic study of FAS in a community in the Western Cape Province of South Africa. Method: Using retrospective case-control methodology, 31 mothers who had given birth to FAS children 6 to 9 years previously were compared with 31 matched controls on a variety of demographic, socioeconomic, drinking, family and maternity variables. Descriptive analyses were utilized to determine major differential characteristics between the two groups. Results: In this community with a very high rate of FAS and rather uniform low socioeconomic status, the two groups were found to be comparable with respect to age, annual income, ethnic background, age of initiation of regular drinking, age at birth of the index child, gravidity and parity. However, mothers of FAS children reported initiating drinking at an earlier age, as well as reporting higher rates of heavy alcohol consumption in their extended family, current use of alcohol, drinking before and during pregnancy, and smoking of tobacco (percentage who smoke) during each trimester of the pregnancy. Mothers of FAS children had lower educational attainment and reported lower religiosity than control mothers. Conclusions: This study in South Africa draws upon the experience of mothers of 31 children with FAS to confirm many of the same high-risk variables identified in maternal risk studies in the United States and Europe. Some factors associated with less maternal alcohol abuse in this high-risk population were also identified, which may be helpful for implementing prevention in this region as well as in other developing countries., SINCE THE FIRST recognition and documentation of fetal alcohol syndrome (FAS) as a distinct birth defect (Jones and Smith, 1973), the search for unique maternal characteristics, risk factors and protective [...]

Byline: Katherine A. Perham-Hester (1), Bradford D. Gessner (1) Keywords: Alaska; Alaska Native; alcohol drinking; domestic violence; fetal alcohol syndrome; pregnancy; substance use Abstract: Objectives: To examine characteristics related to drinking during pregnancy among a population-based sample of women. Method: We analyzed data related to third-trimester drinking collected from the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS used a population-based, stratified sampling design to survey 9733 of the approximately 44,000 live births to Alaska-resident women during 1991--1994. We defined regular drinking as one or more drinks per week on average during the third trimester. Analyses included bivariate and multivariate associations with any and regular drinking. Results: Of women mailed a survey, 6973 responded and answered the questions related to alcohol consumption. Nine percent reported any drinking during the third trimester and 2.5% were regular third-trimester drinkers. The strongest risk factors for both any and regular third-trimester drinking were older age and marijuana or cocaine use. Other risk factors for any third-trimester drinking included prenatal cigarette smoking, greater education, non-Alaska Native race, the experience of significant life stressors, and residence in a community that did not restrict the sale of alcohol. Other risk factors for regular third-trimester drinking included prenatal cigarette smoking and the experience of domestic violence. Prenatal counseling regarding the effects of alcohol consumption during pregnancy and adequacy of prenatal care were not significantly associated with either outcome variable. Conclusions: Efforts to decrease prenatal alcohol consumption should be directed at older women and should address social determinants of health, such as education, domestic violence, drug use, and the availability of alcohol. In the absence of these efforts, prenatal alcohol education by health care providers may have little impact on pregnancy-related drinking. Author Affiliation: (1) Division of Public Health, Department of Health and Social Services, State of Alaska, Section of Maternal, Child, and Family Health, Anchorage, Alaska Article History: Registration Date: 19/09/2004

Objective: Fetal alcohol syndrome (FAS) and less severe outcomes are typically diagnosed later in childhood, although earlier diagnosis of the effects of exposure would allow intervention in infancy and prevention of associated secondary disabilities. Identification is particularly difficult in such high-risk groups as low-birthweight infants. The goal of this study was to develop methods for early identification of at-risk infants. Method: Three methods (microcephaly, heavy episodic drinking [[is greater than or equal to] 5 drinks/occasion] in pregnancy and a cumulative risk index) identified neonates at risk for those developmental consequences of prenatal exposure that can be measured at 6 and 12 months (i.e., standard scores on Bayley Scales of Infant Development and growth measures). The usefulness of these methods was assessed by comparing those infants selected to an unexposed contrast group, while controlling for potentially confounding factors (e.g., race, socioeconomic status and birthweight). Results: At 6 months, when 70 infants were tested, trends were found for lower language facet scores and lower scores on the Behavioral Regulation Scale; at 12 months, when 134 were tested, alcohol-exposed infants had significantly lower cognitive facet scores (p [is less than] .02) and were more likely to be classified as either mildly or significantly developmentally delayed (p [is less than] .02). Conclusions: It is possible to identify infants at risk for alcohol-related developmental delays using information available in the neonatal period, although it is not usually done. Of the three methods tested, a cumulative risk index based on maternal characteristics was found to be most predictive. (J. Stud. Alcohol 61: 607-616, 2000), EARLY IDENTIFICATION of alcohol-affected infants, both those with fetal alcohol syndrome (FAS) and those less obviously affected, could provide the opportunity for significantly improved services for both mothers and infants. [...]

Prenatal exposure to alcohol is one of the leading causes of mental retardation and preventable birth defects, fetal alcohol syndrome (FAS), a medical term that describes a lifelong, physically and mentally disabling condition in children whose mothers took alcohol while pregnancy. Some of the characteristics of FAS include abnormal features, growth deficiencies, and central nervous system problems.

Cryptorchidism (undescended testes), the most frequently occurring genital malformation in newborn boys, is a risk factor for later testicular cancer and fertility problems. By some reports, incidence has increased in [...]