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CORK Bibliography: Fetal Alcohol Syndrome/Fetal Alcohol Effects

55 citations. January 2009 to present

Prepared: September 2011

Aliyu MH; Lynch O; Belogolovkin V; Zoorob R; Salihu HM. Maternal alcohol use and medically indicated vs. spontaneous preterm birth outcomes: A population-based study. European Journal of Public Health 20(5): 582-587, 2010. (36 refs.)

Background: The aetiology of preterm birth remains poorly understood. The purpose of this study is to investigate if an association exists between prenatal alcohol consumption and preterm birth and to determine if such an association differs by subcategories of preterm birth. Methods: We employed vital statistics data from the state of Missouri covering the period 1989-2005 (n = 1 221 677 singleton records). The outcome of interest was preterm birth, subclassified into medically indicated and spontaneous phenotypes. Multivariate logistic regression was used to generate adjusted odds ratios, with non-drinking mothers as the referent category. Results: Prenatal alcohol use was associated with elevated risk for preterm birth. The strength of association was more prominent for spontaneous preterm delivery {adjusted odds ratio (AOR) [95% confidence interval (CI)] = 1.34 (1.28-1.41)} than for medically indicated preterm birth [AOR (95% CI) = 1.16 (1.05-1.28)]. The overall risk for drinking-related spontaneous preterm birth increased with incremental rise in the number of drinks consumed per week (P for trend < 0.01). Conclusions: Prenatal alcohol use is a risk factor for preterm delivery, and especially for spontaneous preterm birth. These findings enhance our understanding of the aetiology of preterm birth and could be utilized in the development of appropriate prevention strategies that will assist in decreasing perinatal mortality and morbidity associated with preterm delivery.

Anderson K; Nisenblat V; Norman R. Lifestyle factors in people seeking infertility treatment - A review. (review). Australian & New Zealand Journal of Obstetrics & Gynaecology 50(1): 8-20, 2010. (159 refs.)

Background: Clinical infertility is a prevalent problem with significant financial and psychosocial costs. Modifiable lifestyle factors exist that may affect a person's time to conception and their chance of having a healthy, live birth. However, no guideline delineates what preconception advice should be offered to people presenting for infertility treatment. Aim: The aim of this article is to review the literature regarding modifiable lifestyle factors in people seeking infertility treatment. Results: A person's time to pregnancy and their chance of having a healthy, live birth may be affected by factors such as weight, vitamin and iodine intake, alcohol and caffeine consumption, smoking, substance abuse, stress, environmental pollutants, vaccinations and oxidative stress. Conclusions: Advice on modifiable lifestyle factors should be given to people presenting for infertility treatment to help them make positive changes that may improve their chances of pregnancy and delivering a healthy, live baby. Developing a guideline for this would be a prudent step towards helping clinicians to implement this aspect of preconception care.

Aros S; Mills JL; Iniguez G; Avila A; Conley MR; Troendle J et al. Effects of prenatal ethanol exposure on postnatal growth and the insulin-like growth factor axis. Hormone Research in Paediatrics 75(3): 166-173, 2011. (42 refs.)

Aims:To study the effect of in-utero alcohol exposure on the insulin-like growth factor axis (IGF) and leptin during infancy and childhood, considering that exposed children may exhibit pre- and postnatal growth retardation. Methods: We prospectively identified heavily drinking pregnant women who consumed on average 4 or more drinks of ethanol per day (>= 48 g/day) and assessed growth in 69 of their offspring and an unexposed control group of 83 children, measuring serum IGF-I (radioimmunoassay), IGF-II (immunoradiometric assay, IRMA), insulin-like growth factor-binding protein 3 (IGFBP-3) (IRMA) and leptin (IRMA) at 1 month and 1, 2, 3, 4, and 5 years of age. Results: IGF-II levels increased with age in both groups, but the rate of increase was significantly higher in exposed children, and levels were significantly higher in ethanol-exposed children at 3, 4, and 5 years of age. In exposed children, IGF-I levels were higher at 3 and 4 years and leptin levels were significantly lower at 1 and 2 years. Exposed subjects showed a much lower correlation between IGF-I and growth parameters than unexposed subjects. Conclusion: Exposure to ethanol during pregnancy increases IGF-I and IGF-II and decreases leptin during early childhood. The increase in serum IGF-II concentrations in ethanol-exposed children suggests that this hormone should be explored as a potential marker for prenatal alcohol exposure.

Bailey BA; Sokol RJ. Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. Alcohol Research & Health 34(1): 86-91, 2011. (39 refs.)

In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposures and conditions. Consequently, attributing poor birth outcomes to prenatal alcohol exposure is a complicated and ongoing task, requiring continued attention to validated methodology and to identifying specific biological mechanisms.

Bakhireva LN; Young BN; Dalen J; Phelan ST; Rayburn WF. Periconceptional binge drinking and acculturation among pregnant Latinas in New Mexico. Alcohol 43(6): 475-481, 2009. (38 refs.)

Binge drinking during pregnancy might lead to the development of Fetal Alcohol Spectrum Disorders in the offspring. Latinas are often considered a low-risk group for alcohol abuse, although recent reports indicate that the prevalence of alcohol consumption in this group is increasing due to changing cultural norms. The predictors of alcohol consumption during pregnancy among Latinas are largely unknown. We explored predictors of periconceptional drinking among Latinas (n = 155) recruited into an ongoing cohort study at the University of New Mexico. Women were interviewed by a bilingual trained interviewer about any episodes of binge drinking (>= 4 drinks/occasion) a month around their last menstrual period (LMP) and were administered a TWEAK questionnaire. Sociodemographic, lifestyle, and reproductive health characteristics were also ascertained. Predictors of binge drinking were identified by Chi-square test and logistic regression in univariate and multivariable analyses, respectively. Backward selection procedure was used to identify covariates that were independently associated with binge drinking in the final model. The mean age of participants was 27.0 +/- 5.8 years and 69% were foreign born. In the entire sample, 17.4% of pregnant Latinas admitted at least one binge-drinking episode in the month around their LMP. Results of multivariate analysis indicate that Latinas born in the United States have a much greater risk of binge drinking in the periconceptional period (odds ratio [OR] = 3.2; 95% confidence interval [CI]: 1.2, 8.9) compared with foreign-born Latinas. Similarly, Latinas who primarily speak English at home were at much greater risk (OR = 3.6; 95% CI: 1.3, 10.5) compared with primarily Spanish-speaking women. No other variables were identified as significant predictors in multivariable models. Our results indicate that more acculturated Latinas are at much greater risk of binge drinking before conception and in early pregnancy compared with less acculturated Latinas. Culturally sensitive interventions should be developed to address risky alcohol consumption among Latinas of reproductive age.

Bakker R; Pluimgraaff LE; Steegers EAP; Raat H; Tiemeier H; Hofman A et al. Associations of light and moderate maternal alcohol consumption with fetal growth characteristics in different periods of pregnancy: The Generation R Study. International Journal of Epidemiology 39(3): 777-789, 2010. (41 refs.)

Methods This study was based on 7333 pregnant women participating in a population-based cohort study. Alcohol consumption habits and fetal growth were assessed in early (gestational age < 17.9 weeks), mid- (gestational age 18-24.9 weeks) and late pregnancy (gestational age >= 25 weeks). We assessed the effects of different categories of alcohol consumption (no; less than one drink per week; one to three drinks per week; four to six drinks per week; one drink per day and two to three drinks per day) on repeatedly measured fetal head circumference, abdominal circumference and femur length. Results In total, 37% of all mothers continued alcohol consumption during pregnancy, of whom the majority used less than three drinks per week. We observed no differences in growth rates of fetal head circumference, abdominal circumference or femur length between mothers with and without continued alcohol consumption during pregnancy. Compared with mothers without alcohol consumption, mothers with continued alcohol consumption during pregnancy had an increased fetal weight gain [difference 0.61 g (95% confidence interval: 0.18, 1.04) per week]. Cross-sectional analyses in mid- and late pregnancy showed no consistent associations between the number of alcoholic consumptions and fetal growth characteristics. All analyses were adjusted for potential confounders. Conclusions: Light-to-moderate maternal alcohol consumption during pregnancy does not adversely affect fetal growth characteristics. Further studies are needed to assess whether moderate alcohol consumption during pregnancy influences organ growth and function in postnatal life.

Bay B; Kesmodel US. Prenatal alcohol exposure: A systematic review of the effects on child motor function. (review). Acta Obstetricia et Gynecologica Scandinavica 90(3): 210-226, 2011. (55 refs.)

Objective. To systematically review the available evidence on the effects of prenatal alcohol exposure on motor function in humans. Design. Systematic review. Population. Pregnant women and their offspring. Methods. The search strategy included Medline, Embase, The Cochrane Library and Scopus. The authors read titles and abstracts, and the articles that met the predefined criteria for inclusion were obtained and the full text read. The articles were assessed for quality using the Newcastle-Ottawa Quality Assessment Scale. Main outcome measures. Motor function measured on standardized or validated tests. Results. The search resulted in 311 titles and abstracts, of which 39 were found relevant for inclusion. The findings of this review suggest a negative effect when the maternal consumption exceeded a certain level. Of all studies reporting a maternal intake of more than four drinks/day, only one study showed no effect on motor function, and of all studies reporting intake levels of less than 10 drinks/week, only one study showed deficit on the children's motor function. Conclusions. While it appears consistent that high daily alcohol intake is associated with deficits in gross and fine motor function, and low weekly intake is not associated with such deficits, the issue of binge drinking is unsettled.

Boyles AL; DeRoo LA; Lie RT; Taylor JA; Jugessur A; Murray JC et al. Maternal alcohol consumption, alcohol metabolism genes, and the risk of oral clefts: A population-based case-control study in Norway, 1996-2001. American Journal of Epidemiology 172(8): 924-931, 2010. (36 refs.)

Heavy maternal alcohol consumption during early pregnancy increases the risk of oral clefts, but little is known about how genetic variation in alcohol metabolism affects this association. Variants in the alcohol dehydrogenase 1C (ADH1C) gene may modify the association between alcohol and clefts. In a population-based case-control study carried out in Norway (1996-2001), the authors examined the association between maternal alcohol consumption and risk of oral clefts according to mother and infant ADH1C haplotypes encoding fast or slow alcohol-metabolizing phenotypes. Subjects were 483 infants with oral cleft malformations and 503 control infants and their mothers, randomly selected from all other livebirths taking place during the same period. Mothers who consumed 5 or more alcoholic drinks per sitting during the first trimester of pregnancy had an elevated risk of oral cleft in their offspring (odds ratio (OR) = 2.6, 95% confidence interval (CI): 1.4, 4.7). This increased risk was evident only in mothers or children who carried the ADH1C haplotype associated with reduced alcohol metabolism (OR= 3.0, 95% CI: 1.4, 6.8). There was no evidence of alcohol-related risk when both mother and infant carried only the rapid-metabolism ADH1C variant (OR = 0.9, 95% CI: 0.2, 4.1). The teratogenic effect of alcohol may depend on the genetic capacity of the mother and fetus to metabolize alcohol.

Burden MJ; Westerlund A; Muckle G; Dodge N; Dewailly E; Nelson CA et al. The effects of maternal binge drinking during pregnancy on neural correlates of response inhibition and memory in childhood. Alcoholism: Clinical and Experimental Research 35(1): 69-82, 2011. (63 refs.)

Background: Although an extensive literature has documented a broad range of cognitive performance deficits in children with prenatal alcohol exposure, little is known about how the neurophysiological processes underlying these deficits may be affected. Event-related potentials (ERPs), which reflect task-specific changes in brain electrical activity, provide a method for examining multiple constituents of cognitive processing at the neural level. Methods: We recorded ERPs in 217 children from Inuit communities in Arctic Quebec (M age = 11.3 years) during 2 different tasks-Go/No-go response inhibition and continuous recognition memory. Children were classified as either alcohol-exposed (ALC) or controls (CON) depending on whether the mother reported binge drinking during pregnancy. Results: Both groups performed comparably in terms of accuracy and reaction time on the tasks, and both tasks elicited the expected effects on ERPs when responses were compared across conditions. However, the ALC group showed slower P2 latencies on Go/No-go, suggesting an altered neurophysiological response associated with initial visual processing of the stimuli. On the memory task, the ALC group showed reduced FN400 amplitude to New items, known as the familiarity effect, and reduced amplitude for the late positive component, possibly reflecting impairment in memory retrieval. Conclusions: These findings show that, even in tasks in which alcohol-exposed children exhibit behavioral performance that is comparable to controls, fetal alcohol exposure is associated with altered neurophysiological processing of response inhibition and recognition memory. The data suggest that fetal alcohol exposure is associated with reduced efficiency in the initial extracting of the meaning of a stimulus, reduced allocation of attention to the task, and poorer conscious, explicit recognition memory processing.

Burns L; Black E; Powers JR; Loxton D; Elliott E; Shakeshaft A et al. Geographic and maternal characteristics associated with alcohol use in pregnancy. Alcoholism: Clinical and Experimental Research 35(7): 1230-1237, 2011. (42 refs.)

Background: To date, no studies have used population-level data to investigate whether maternal location of residence (metropolitan vs. regional/remote populations) is associated with alcohol use in pregnancy. This information has important implications for appropriate service provision. Methods: Information on all live births in New South Wales Australia was linked to records of alcohol-related admissions for mothers of these births over a 6-year period (2000 to 2006). Cases were women who had at least 1 alcohol-related hospital admission during pregnancy or at birth. Controls were women who had at least 1 live birth over that same time period but no alcohol-related hospital admissions during that time. Admissions were considered to be alcohol-related based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) code. Demographic, obstetric, and neonatal variables were compared. Results: A total of 417,464 singleton birth records were analyzed, 488 of which were coded positive for at least 1 alcohol-related ICD-10-AM diagnosis. Characteristics associated with alcohol-related admissions in pregnancy were residence in a remote/very remote area, being Australian-born, having had a previous pregnancy, smoking in the current pregnancy, and presenting late to antenatal care. Alcohol-exposed pregnancies were associated with a range of poor obstetric and neonatal outcomes, with no geographic differences noted. However, women in regional/remote areas were less likely to attend specialist obstetric hospitals. Conclusions: This study shows the need for standardized screening programs for alcohol use in pregnancy and where problematic use is detected, for clear clinical guidelines on management and referral.

Cavazos-Rehg PA; Krauss MJ; Spitznagel EL; Schootman M; Cottler LB; Bierut LJ. Substance use and the risk for sexual intercourse with and without a history of teenage pregnancy among adolescent females. Journal of Studies on Alcohol and Drugs 72(2): 194-198, 2011. (24 refs.)

Objective: The present study examined the associations between initiation and intensity of substance use and with sexual experience with and without a history of teenage pregnancy. Method: Participants: were high school females (weighted n = 3,451) who participated in the 1999-2003 Youth Risk Behavior Surveillance System, a cross-sectional, nationally representative survey. Multinomial multivariable logistic regression was used to assess the likelihood of being sexually experienced (but never pregnant) and teenage pregnancy (reference group: never had sexual intercourse) as a function of age at substance use initiation (i.e., age 12 or younger, 13-14 years of age, and age 15 or older) and intensity of substance use (i.e., nonuser, experimental/new or nondaily, nonexperimental/daily user) for alcohol, cigarettes, and marijuana, while controlling for race/ethnicity, metropolitan location, symptoms of depression, and illegal drug availability at school. Results: A major finding of our study is that substance use behaviors across each substance (alcohol, cigarettes, and marijuana) independently contributed to an increased risk in sexual intercourse experience with and without a history of teenage pregnancy (vs. nonsexually experienced females). A dose-response relationship was also observed between an increased likelihood of a teenage pregnancy and marijuana behaviors. Furthermore, the risk for teenage pregnancy was compounded for daily cigarette smokers who initiated use at age 12 or younger. Conclusions: Screening substance use behaviors can help to identify girls who may benefit from pregnancy prevention strategies. Targeting cigarette and marijuana behaviors as early as age 12 or younger may provide an added benefit. Prevention strategies should also consider the role of race above and beyond substance use behaviors.

Cheng DA; Kettinger L; Uduhiri K; Hurt L. Alcohol consumption during pregnancy: Prevalence and provider assessment. Obstetrics and Gynecology 117(2, Part 1): 212-217, 2011. (19 refs.)

OBJECTIVE: To estimate the prevalence of prenatal alcohol consumption and the extent of provider screening and discussion about alcohol use during pregnancy. METHODS: Data were obtained from a stratified random sample of 12,611 mothers from Maryland who delivered live infants during the years 2001-2008 and completed the Maryland Pregnancy Risk Assessment Monitoring System survey. Analyses were conducted using Proc Surveyfreq in SAS 9.2. RESULTS: Nearly 8% (95% confidence interval 7.1-8.4) of mothers from Maryland reported alcohol consumption during the last 3 months of pregnancy. The highest prevalence of late-pregnancy alcohol consumption was reported by mothers who were non-Hispanic white, (10.9%, confidence interval 9.8-11.9), aged 35 years or older (13.4%, confidence interval 12.4-14.4), and college graduates (11.4%, confidence interval 10.2-12.6) (P<.001). Nineteen percent (confidence interval 17.6-21.0) of mothers reported that their prenatal care provider did not ask whether they were drinking alcoholic beverages, and 30% (confidence interval 28.3-30.8) reported that a healthcare provider did not counsel them about the consequences of alcohol use on the child. Reported screening and counseling were least prevalent among mothers who were non-Hispanic white, aged 35 years or older, and college graduates (P<.01). CONCLUSION: Despite the substantial number of women who continue to drink alcohol during pregnancy, healthcare providers do not routinely assess alcohol consumption or counsel all women about its harmful effects. Counseling was least prevalent among the same groups of women with the highest rates for drinking. Provider alcohol assessment, as recommended by the U. S. Surgeon General to prevent alcohol misuse, needs further promotion as a routine part of prenatal care.

Chiodo LM; da Costa DE; Hannigan JH; Covington CY; Sokol RJ; Janisse J et al. The impact of maternal age on the effects of prenatal alcohol exposure on attention. Alcoholism: Clinical and Experimental Research 34(10): 1813-1821, 2010. (76 refs.)

Background: Prenatal exposure to alcohol has a variety of morphologic and neurobehavioral consequences, yet more than 10% of women continue to drink during pregnancy, placing their offspring at risk for fetal alcohol spectrum disorders (FASD). Identification of at-risk pregnancies has been difficult, in part, because the presence and severity of FASD are influenced by factors beyond the pattern of alcohol consumption. Establishing maternal characteristics, such as maternal age, that increase the risk of FASD is critical for targeted pregnancy intervention. Methods: We examined the moderating effect of maternal age on measures of attention in 462 children from a longitudinal cohort born to women with known alcohol consumption levels (absolute ounces of alcohol per day at conception) who were recruited during pregnancy. Analyses examined the impact of binge drinking, as average ounces of absolute alcohol per drinking day. Smoking and use of cocaine, marijuana, and opiates were also assessed. At 7 years of age, the children completed the Continuous Performance Test, and their teachers completed the Achenbach Teacher Report Form. Results: After controlling for covariates, stepwise multiple regression analyses revealed a negative relation between levels of prenatal binge drinking and several measures of attention. The interaction between alcohol consumption and maternal age was also significant, indicating that the impact of maternal binge drinking during pregnancy on attention was greater among children born to older drinking mothers. Conclusion: These findings are consistent with previous findings that children born to older alcohol-using women have more deleterious effects of prenatal alcohol exposure on other neurobehavioral outcomes.

Crozier SR; Robinson SM; Borland SE; Godfrey KM; Cooper C; Inskip HM. Do women change their health behaviours in pregnancy? Findings from the Southampton Women's Survey. Paediatric and Perinatal Epidemiology 23(5): 446-453, 2009. (21 refs.)

A woman's life style choices before and during pregnancy have important implications for her unborn child, but information on behaviour can be unreliable when data are collected retrospectively. In particular there are no large longitudinal datasets that include information collected prospectively before pregnancy to allow accurate description of changes in behaviour into pregnancy. The Southampton Women's Survey is a longitudinal study of women in Southampton, UK, characterised when they were not pregnant and again during pregnancy. The objective of the analyses presented here is to describe the degree to which women comply with diet and life style recommendations before and during pregnancy, and changes between these time points. The analyses are based on 1490 women who delivered between 1998 and 2003 and who provided information before pregnancy and at 11 and 34 weeks' gestation. At each time point a trained research nurse ascertained smoking status and assessed food and drink consumption using a food frequency questionnaire. We derived the proportions of women who complied with recommendations not to smoke, to eat five portions of fruit and vegetables per day and to drink no more than four units of alcohol per week and 300 mg of caffeine per day. There was a notable reduction in smoking when women became pregnant: before pregnancy 27% of women smoked, whereas in early pregnancy 15% smoked. Similarly there were significant reductions in alcohol consumption and intake of caffeinated drinks: before pregnancy 54% of women drank more than four units of alcohol per week and 39% had estimated intakes of caffeine in drinks of > 300 mg per day, whereas comparable figures for early pregnancy were 10% and 16% respectively. However, there was little change in fruit and vegetable intake; the percentages of women who did not achieve the recommendation to eat at least five portions of fruit and vegetables per week were 47% before pregnancy and 46% in early pregnancy. Younger women and those with fewer educational qualifications were less likely to comply with public health recommendations. Overall, 81% of women in early pregnancy complied with at least three of the recommendations. Although there is encouraging evidence of changed health behaviours in pregnancy, young women and those with few educational qualifications may particularly benefit from targeted health initiatives.

De Genna NM; Cornelius MD; Donovan JE. Risk factors for young adult substance use among women who were teenage mothers. Addictive Behaviors 34(5): 463-470, 2009. (77 refs.)

Teenage mothers may not "mature out" of substance use during young adulthood, and this non-normative trajectory of use may contribute to negative outcomes for teenage mothers and their offspring. Pregnant teenagers (age range = 12-18 years; 68% Black) were recruited from a prenatal clinic and interviewed about their substance use, and subsequently re-interviewed six and ten years later (n = 292). Consistent with the literature, early tobacco and marijuana use were risk factors for young adult use. Other substance use. peer adolescent use and mental health indicators were more important than race and socioeconomic status (SES) in determining which teenage mothers would use tobacco, engage in binge drinking, and use marijuana as young adults. However, race and SES were significant predictors of quitting tobacco use and marijuana use by the 10-year follow-up. Depression was associated with both persistent tobacco use and marijuana use in teenage mothers. These results illustrate the long-term consequences of teenage childbearing and identify modifiable risk factors for later health risks that should be addressed among younger mothers.

Denny CH; Tsai J; Floyd RL; Green PP. Alcohol use among pregnant and nonpregnant women of childbearing age --- United States, 1991--2005. MMWR. Morbidity and Mortality Weekly Review 58(19): 529-532, 2009. (10 refs.)

Alcohol consumption during pregnancy is a risk factor for poor birth outcomes, including fetal alcohol syndrome, birth defects, and low birth weight. To examine the prevalence of any alcohol use and binge drinking among pregnant women and nonpregnant women of childbearing age in the United States and to characterize the women with these alcohol use behaviors, CDC analyzed 1991--2005 data from Behavioral Risk Factor Surveillance System (BRFSS) surveys. The findings indicated that the prevalence of any alcohol use and binge drinking among pregnant and nonpregnant women of childbearing age did not change substantially from 1991 to 2005. During 2001--2005, the highest percentages of pregnant women reporting any alcohol use were aged 35--44 years (17.7%), college graduates (14.4%), employed (13.7%), and unmarried (13.4%). Greater percentages of pregnant women with at least some college education (11.2%), or a college degree or more (14.4%), reported alcohol use than pregnant women with a high school diploma or less (8.5%) (AORs = 1.4 and 1.9, respectively). A greater percentage of employed pregnant women (13.7%) reported alcohol use than unemployed pregnant women (8.3%, AOR = 1.5), and a greater percentage of unmarried pregnant women (13.4%) reported alcohol use than married pregnant women (10.2%, AOR = 2.2) In addition, a greater percentage of employed pregnant women (2.3%) reported binge drinking, compared with unemployed pregnant women (1.3%, AOR = 1.8), and a greater percentage of unmarried pregnant women (3.6%) reported binge drinking than married pregnant women (1.1%, AOR = 4.4).

Public Domain

D'Onofrio BM. The need for more quasi-experimental studies of alcohol consumption during pregnancy. (editorial). Addiction 104(8): 1278-1279, 2009. (18 refs.)

du Toit MM; Smith M; Odendaal HJ. The role of prenatal alcohol exposure in abruptio placentae. South African Medical Journal 100(12): 832-835, 2010. (25 refs.)

Objective. To investigate the association between preconception and prenatal alcohol use and abruptio placentae. Methods. A case-control study of women with the clinical diagnosis of abruptio placentae, 65 cases and 66 controls, at Tygerberg Academic Hospital, Western Cape, South Africa. Women in whom a retroplacental blood clot, covering at least 15% of the placental surface, was found at delivery at 24 weeks' gestation or later were asked to complete a timeline follow-back questionnaire to determine their alcohol intake 12 and 3 months before and during pregnancy. The same questionnaire was administered to a control group of high-risk women who had no antepartum haemorrhage. Outcome. Women who drank alcohol 12 months before conception were more than 4 times more likely to develop abruptio placentae than the control group (odds ratio (OR) 4.49, p=0.00009). Women who drank alcohol 3 months prior to conception were 3 times more likely to develop abruptio placentae than the control group (OR 3.06, p=0.003). Drinking alcoholic beverages during pregnancy carried a more than 3 times greater risk of developing abruptio placentae (OR 3.52, p=0.0006). In the study group, women consumed a mean of 13.6, 12.0 and 11.2 standard drinks in a typical week at 12 and 3 months before and during pregnancy, respectively. The study group demonstrated a binge-drinking pattern, with two to four sessions per month. Conclusion. An association was found between preconception and prenatal consumption of alcohol and abruptio placentae.

Eliasen M; Tolstrup JS; Andersen AMN; Gronbaek M; Olsen J; Strandberg-Larsen K. Prenatal alcohol exposure and autistic spectrum disorders: A population-based prospective study of 80,552 children and their mothers. International Journal of Epidemiology 39(4): 1074-1081, 2010. (42 refs.)

Methods: Participants were 80,552 children and their mothers enrolled in the Danish National Birth Cohort from 1996 to 2002. Alcohol consumption was obtained by self-report during pregnancy. Information on ASD was obtained from the Danish Central Psychiatry Register. Follow-up ended on February 2008. Data were analysed by means of Cox regression. Results In total, 401 children were diagnosed with ASD and 157 with infantile autism. No association was found between average alcohol consumption and ASD or infantile autism, respectively. For binge drinking, the adjusted hazard ratio (HR) for ASD was 0.72 [95% confidence interval (CI): 0.53-0.97] among women who binge drank once during pregnancy compared with women who did not binge drink. The corresponding HR for infantile autism was 0.61 (95% CI: 0.36-1.02). However, the HR for ASD was 0.84 (95% CI: 0.51-1.36) when restricting the analysis to first-time pregnancies conceived within 6 months of trying. No estimate was made for infantile autism due to low number of cases. No association was seen for more than one binge episode and for the timing of binge drinking. Conclusion: Our findings do not support that a low prenatal alcohol exposure increases the risk of ASD or infantile autism. The lower risk for women who binge drank once during pregnancy is most likely non-causal.

Hannigan JH; Chiodo LM; Sokol RJ; Janisse J; Ager JW; Greenwald MK et al. A 14-year retrospective maternal report of alcohol consumption in pregnancy predicts pregnancy and teen outcomes. Alcohol 44(7/8, special issue): 583-594, 2010. (77 refs.)

Detecting patterns of maternal drinking that place fetuses at risk for fetal alcohol spectrum disorders (FASDs) is critical to diagnosis, treatment, and prevention but is challenging because information on antenatal drinking collected during pregnancy is often insufficient or lacking. Although retrospective assessments have been considered less favored by many researchers due to presumed poor reliability, this perception may be inaccurate because of reduced maternal denial and/or distortion. The present study hypothesized that fetal alcohol exposure, as assessed retrospectively during child adolescence, would be related significantly to prior measures of maternal drinking and would predict alcohol-related behavioral problems in teens better than antenatal measures of maternal alcohol consumption. Drinking was assessed during pregnancy, and retrospectively about the same pregnancy, at a 14-year follow-up in 288 African-American women using well-validated semistructured interviews. Regression analysis examined the predictive validity of both drinking assessments on pregnancy outcomes and on teacher-reported teen behavior outcomes. Retrospective maternal self-reported drinking assessed 14 years postpartum was significantly higher than antenatal reports of consumption. Retrospective report identified 10.8 times more women as risk drinkers one drink per day) than the antenatal report. Antenatal and retrospective reports were moderately correlated and both were correlated with the Michigan Alcoholism Screening Test. Self-reported alcohol consumption during pregnancy based on retrospective report identified significantly more teens exposed prenatally to at-risk alcohol levels than antenatal, in-pregnancy reports. Retrospective report predicted more teen behavior problems (e.g., attention problems and externalizing behaviors) than the antenatal report. Antenatal report predicted younger gestational age at birth and retrospective report predicted smaller birth size; neither predicted teen IQ. These results suggest that if only antenatal, in-pregnancy maternal report is used, then a substantial proportion of children exposed prenatally to risk levels of alcohol might be misclassified. The validity of retrospective assessment of prior drinking during pregnancy as a more effective indicator of prenatal exposure was established by predicting more behavioral problems in teens than antenatal report. Retrospective report can provide valid information about drinking during a prior pregnancy and may facilitate diagnosis and subsequent interventions by educators, social service personnel, and health-care providers, thereby reducing the life-long impact of FASDs.

Huizink AC. Moderate use of alcohol, tobacco and cannabis during pregnancy: New approaches and update on research findings. Reproductive Toxicology 28(2, Special Issue): 143-151, 2009. (102 refs.)

Interest in fetal origins of adverse offspring outcomes has grown extensively in the last decade. This has resulted in many published studies focusing on exposure in utero to substances and human offspring outcomes. Exposure to maternal substance use in pregnancy is believed to be a preventable hazard, and is therefore a main issue for public health concern and policy. However, an important question in human studies remains whether prenatal substance use exposure has an aetiological role in pathways to adverse developmental and behavioural outcomes via teratological effects. Recent insights and developments in research methodology will aid the adequate and more refined testing of associations between prenatal substance use and offspring outcomes. In particular, novel approaches could assist in disentangling the exposure to substance effects from correlated risk factors. The purpose of this manuscript is therefore to provide an overview of methodological issues involved in studies that focus on the association between maternal substance use during pregnancy and offspring's outcomes, to describe novel approaches to test these associations, and present some examples of new and well-designed studies and discuss their findings.

Keil V; Paley B; Frankel F; O'Connor MJ. Impact of a social skills intervention on the hostile attributions of children with prenatal alcohol exposure. Alcoholism: Clinical and Experimental Research 34(2): 231-241, 2010. (74 refs.)

Background: Prenatal alcohol exposure (PAE) has been linked to a wide array of developmental deficits, including significant impairments in social skills. Given the extensive body of evidence linking social information-processing patterns with social behavior, it is possible that social information-processing may represent one mechanism of behavioral change. The present investigation sought to answer the question of whether a well-established social skills intervention decreased the hostile attributions of children with PAE. Further, was there a differential impact of the intervention on hostile attributions in the context of peer provocation versus group entry scenarios? Methods: Participants consisted of 100 children (51% male) with PAE between the ages of 6 and 12 years. Participants were randomly assigned to either a social skills intervention, Children's Friendship Training (CFT), or to a Delayed Treatment Control (DTC) condition. Results: Analyses indicated that the social skills intervention resulted in a significantly lower proportion of hostile attributions in peer group entry, but not peer provocation, scenarios. This decrease was maintained over a 3-month follow-up period. Conclusions: Deficits in social information-processing among individuals with PAE can be improved through social skills intervention, and these changes may lead to more positive developmental outcomes.

Lanting CI; Buitendijk SE; Crone MR; Segaar D; Gravenhorst JB; van Wouwe JP. Clustering of xocioeconomic, behavioural, and neonatal risk factors for infant health in pregnant smokers. PLoS one 4(12): e-8363, 2009. (31 refs.)

Background: Tobacco smoking is a major cause of morbidity and mortality, including during pregnancy. Although effective ways of promoting smoking cessation during pregnancy exist, the impact of these interventions has not been studied at a national level. We estimated the prevalence of smoking throughout pregnancy in the Netherlands and quantified associations of maternal smoking throughout pregnancy with socioeconomic, behavioural, and neonatal risk factors for infant health and development. Methodology/Principal Findings: Data of five national surveys, containing records of 14,553 Dutch mothers and their offspring were analyzed. From 2001 to 2007, the overall rate of smoking throughout pregnancy fell by 42% (from 13.2% to 7.6%) mainly as a result of a decrease among highly educated women. In the lowest-educated group, the overall rate of smoking throughout pregnancy was six times as high as in the highest-educated group (18.7% versus 3.2%). Prenatal tobacco smoke exposure was associated with increased risk of extremely preterm (<= 28 completed weeks) (OR 7.25; 95% CI 3.40 to 15.38) and small-for-gestational age (SGA) infants (OR 3.08; 95% CI 2.66 to 3.57). Smoking-attributable risk percents in the population (based on adjusted risk ratios) were estimated at 29% for extremely preterm births and at 17% for SGA outcomes. Infants of smokers were more likely to experience significant alcohol exposure in utero (OR 2.08; 95%CI 1.25 to 3.45) and formula feeding in early life (OR 1.91; 95% CI 1.69 to 2.16). Conclusions: The rates of maternal smoking throughout pregnancy decreased significantly in the Netherlands from 2001 to 2007. If pregnant women were to cease tobacco use completely, an estimated 29% of extremely preterm births and 17% of SGA infants may be avoided annually.

Lee SH; Shin SJ; Won SD; Kim EJ; Oh DY. Alcohol use during pregnancy and related risk factors in Korea. Psychiatry Investigation 7(2): 86-92, 2010. (22 refs.)

Objective: The number of Korean women of childbearing age who drink alcohol and binge drink has increased remarkably in recent years. En the present study, we examined self-reported rates of alcohol use before and during pregnancy and identified maternal characteristics associated with drinking in pregnancy. Methods: One thousand pregnant Korean women who visited the Department of Obstetrics and Gynecology (OB/GYN) completed a self-administered questionnaire that sought information on their demographic characteristics and incorporated features of the Alcohol Use Disorder Identification Test (AUDIT)-C to investigate their use of alcohol, including binge drinking, during three time periods ("in the year before this pregnancy," "during this pregnancy," and "in the previous 30 days"). Results: Of these participants, 16.4% reported using alcohol during their pregnancy, 12.2% had used alcohol in the previous 30 days, and 1.7% reported binge drinking during their pregnancy. In the year before pregnancy, 77.1% had used alcohol, and 22.3% had binge drunk. The group using any amount of any alcohol during pregnancy showed a lower educational level, a lower rate of planned pregnancy, a lower level of knowledge relating to the risks of drinking alcohol during pregnancy, and a higher frequency of alcohol drinking in the year before pregnancy when compared with the abstinent group. Low educational level and unplanned pregnancy were revealed to be significant risk factors for alcohol consumption in pregnant women. Conclusion: This is the first study to examine any alcohol and binge alcohol drinking during pregnancy in Korea. Clinical attention and monitoring system on alcohol use during pregnancy are necessary in Korea.

Lowe P; Lee E; Yardley L. Under the influence? The construction of foetal alcohol syndrome in UK Newspapers. Sociological Research Online 15: e-article 4, 2010. (30 refs.)

Today, alongside many other proscriptions, women are expected to abstain or at least limit their alcohol consumption during pregnancy. This advice is reinforced through warning labels on bottles and cans of alcoholic drinks. In most (but not all) official policies, this is linked to a risk of Foetal Alcohol Syndrome (FAS) or one of its associated conditions. However, given that there is little medical evidence that low levels of alcohol consumption have an adverse impact on the foetus, we need to examine broader societal ideas to explain why this has now become a policy concern. This paper presents a quantitative and qualitative assessment of analysis of the media in this context. By analysing the frames over time, this paper will trace the emergence of concerns about alcohol consumption during pregnancy. It will argue that contemporary concerns about FAS are framed around a number of pre-existing discourses including alcohol consumption as a social problem, heightened concerns about children at risk and shifts in ideas about the responsibility of motherhood including during the pre-conception and pregnancy periods. Whilst the newspapers regularly carried critiques of the abstinence position now advocated, these challenges focused did little to refute current parenting cultures.

Lowe PK; Lee EJ. Advocating alcohol abstinence to pregnant women: Some observations about British policy. Health Risk & Society 12(4): 301-311, 2010. (37 refs.)

In 2007, the English Department of Health (DH) issued advice stating 'pregnant woman' and 'those trying to conceive' should abstain from drinking alcohol. As others have noted, this advice was issued despite their being no new evidence about the deleterious effects of low levels of alcohol consumption. In this paper, we argue this development is significant for the social construction of 'risk', since in advocating abstinence without an evidence base for this advice, policy makers formalise a connection between uncertainty and danger. We suggest this development has important implications, most obviously for pregnant women, certainly impacting on the nature of the advice they will now receive and likely more generally on their experience of the transition to motherhood. We suggest it has wider implications for individuals' experience also, as policy makers appear to be advocating the same approach to risk to non-pregnant people. Further, it suggests a noteworthy formalisation of a new definition of risk, which should be debated far more extensively, as it matters for the future development of health policy.

May PA; Gossage JP. Maternal risk factors for fetal alcohol spectrum disorders not as simple as it might seem. Alcohol Research & Health 34(1): 15-26, 2011. (76 refs.)

Gathering information about drinking during pregnancy is one of the most difficult aspects of studying fetal alcohol spectrum disorders (FASD). This information is critical to linking specific risk factors to any particular diagnosis within the FASD continuum. This article reviews highlights from the literature on maternal risk factors for FASD and illustrates that maternal risk is multidimensional, including factors related to quantity, frequency, and timing of alcohol exposure; maternal age; number of pregnancies; number of times the mother has given birth; the mother's body size; nutrition; socioeconomic status; metabolism; religion; spirituality; depression; other drug use; and social relationships. More research is needed to more clearly define what type of individual behavioral, physical and genetic factors are most likely to lead to having children with FASD.

McCowan L; Horgan RP. Risk factors for small for gestational age infants. (review). Best Practice & Research in Clinical Obstetrics & Gynaecology 23(6): 779-793, 2009. (124 refs.)

There are many established risk factors for babies who are small for gestational age (SGA) by population birth weight centiles (usually defined as <10th centile). The confirmed maternal risk factors include short statute, low weight, Indian or Asian ethnicity, nulliparity, mother born SGA, cigarette smoking and cocaine use. Maternal medical history of: chronic hypertension, renal disease, anti-phospholipid syndrome and malaria are associated with increased SGA. Risk factors developing in pregnancy include heavy bleeding in early pregnancy, placental abruption, pre-eclampsia and gestational hypertension. A short or very long inter-pregnancy interval, previous SGA infant or previous stillbirth are also risk factors. Paternal factors including changed paternity, short stature and father born SGA also contribute. Factors associated with reduced risk of SGA or increased birth weight include high maternal milk consumption and high intakes of green leafy vegetables and fruit. Future studies need to investigate risk factors for babies SGA by customised centiles as these babies have greater morbidity and mortality than babies defined as SGA by population centiles.

Molteno CD; Jacobson SW; Carter RC; Jacobson JL. Infant symbolic play as an early indicator of fetal alcohol-related deficit. Infancy 15(6): 586-607, 2010. (43 refs.)

Infant symbolic play was examined in relation to prenatal alcohol exposure and socioenvironmental background and to predict which infants met criteria for fetal alcohol syndrome (FAS) at 5 years. A total of 107 Cape-Colored, South African infants born to heavy drinking mothers and abstainers/light drinkers were recruited prenatally. Complexity of play, sociodemographic and psychological correlates of maternal alcohol use, and quality of parenting were assessed at 13 months, and intelligence quotient and FAS diagnosis at 5 years. The effect of drinking on spontaneous play was not significant after control for social environment. In contrast, prenatal alcohol and quality of parenting related independently to elicited play. Elicited play predicted 5-year Digit Span and was poorer in infants subsequently diagnosed with FAS/partial FAS and in nonsyndromal heavily exposed infants, compared with abstainers/light drinkers. Thus, symbolic play may provide an early indicator of risk for alcohol-related deficits. The independent effects of prenatal alcohol and quality of parenting suggest that infants whose symbolic play is adversely affected by alcohol exposure may benefit from stimulation from a responsive caregiver.

Morojele NK; London L; Olorunju SA; Matjila MJ; Davids AS; Rendall-Mkosi KM. Predictors of risk of alcohol-exposed pregnancies among women in an urban and a rural area of South Africa. Social Science & Medicine 70(4): 534-542, 2010. (43 refs.)

The study sought to determine the prevalence and predictors of being at risk of an alcohol-exposed pregnancy (AEP) among women of child-bearing age in an urban and rural location in South Africa. We conducted a cross-sectional household survey of 1018 women aged 18-44 years in one urban (n = 606) and one rural (n = 412) site. The women were interviewed using a structured questionnaire. We defined the primary dependent variable, being at risk of having an AEP, as current alcohol use, not being pregnant, being fertile, and no effective use of contraceptives. The independent variables included demographic, substance use, health perceptions, psycho-social, and partner characteristics. The rural women (21.84%) were more likely than their urban counterparts (11.22%) to be at risk of an AEP. In multiple logistic regression analyses, significant predictors of being in the "at risk" group for the urban women were (a) being 'white' as opposed to 'black/African', and being 'coloured' as opposed to 'black/African'; and (b) current smoking. For the rural women, significant risk factors were (a) current smoking and (b) early onset of alcohol use. The significant protective factors were (a) education: (b) knowledge about Fetal Alcohol Syndrome; (c) parity. Use of stricter alcohol use criteria (i.e., three or more drinks and five or more drinks per sitting) in the definition of risk of an AEP yielded slightly different patterns of significant predictors. The results revealed high levels of risk of an alcohol-exposed pregnancy, especially amongst the rural women, and a need for location-specific prevention programmes. The high burden of AEP in South Africa calls for the establishment of national AEP prevention strategies and programmes as a matter of urgency.

Muckle G; Laflamme D; Gagnon J; Boucher O; Jacobson JL; Jacobson SW. Alcohol, smoking, and drug use among Inuit women of childbearing age during pregnancy and the risk to children. Alcoholism: Clinical and Experimental Research 35(6): 1081- 1091, 2011. (62 refs.)

Background: Alcohol consumption during pregnancy, a known teratogen often associated with drug use and smoking is a well-known public health concern. Aim: This study provides prevalence data for alcohol, smoking, and illicit drug use before, during, and after pregnancy among Inuit. Factors associated with alcohol use are also identified. Methods: Two hundred and eight Inuit women from Arctic Quebec were interviewed at mid-pregnancy, and at 1 and 11 months postpartum to provide descriptive data on smoking, alcohol, and drug use during pregnancy, and the year before and after pregnancy. Sociodemographic and family characteristics potentially associated with alcohol use were documented. Results: Ninety-two percent of the women reported smoking and 61% reported drinking during pregnancy. Episodes of binging during pregnancy were reported by 62% of the alcohol users, which correspond to 38% of pregnant women. Thirty-six percent of the participants reported using marijuana during pregnancy. Alcohol use and binge drinking during pregnancy were more likely to be reported by women who lived in less crowded houses, had a better knowledge of a second language, drank alcohol more often and in larger amounts prior to pregnancy, and used illicit drugs. Binge drinkers were more likely to be single women and to have had fewer previous pregnancies. Postpartum distress and violence were more likely to be experienced by women who used alcohol during pregnancy. Binge drinking during pregnancy was best predicted by drinking habits before pregnancy, maternal symptoms of depression, the use of illicit drugs during pregnancy, and the number of young children living with the mother. Conclusions: These results confirm that alcohol is a major risk factor to maternal and child health in this population, underscoring the need for culturally relevant and effective prevention programs.

Namagembe I; Jackson LW; Zullo MD; Frank SH; Byamugisha JK; Sethi AK. Consumption of alcoholic beverages among pregnant urban Ugandan women. Maternal and Child Health Journal 14(4): 492-500, 2010. (30 refs.)

The World Health Organization estimated alcohol consumption in Uganda to be one of the highest in the world. We examined alcohol consumption among Ugandan women prior to and after learning of pregnancy. We developed a screening algorithm using factors that predicted alcohol consumption in this study. In 2006, we surveyed 610 women attending antenatal care at the national referral hospital in Kampala, Uganda about consumption of traditional and commercial alcoholic beverages before and after learning of pregnancy. Predictors of alcohol consumption during pregnancy were examined and a practical screening algorithm was developed for use in antenatal clinics. One hundred eighty women (30%) drank alcohol at least monthly before learning of their pregnancy. Among these women, almost one-third reported usual consumption of at least one beverage type at quantities that equal binging levels for women. Overall, 151 women (25%) consumed alcohol after learning of pregnancy. Commercial beverages, particularly beer, were consumed more often than traditional drinks. A two-stage screening algorithm asking women about their religion, male partner or friends' drinking, and any lifetime drinking predicted self-reported consumption of alcohol during pregnancy with 97% sensitivity and 89% specificity. Alcohol consumption among pregnant Ugandan women attending antenatal care is high. A feasible screening algorithm can help providers target education and counseling to women who are likely drinking during pregnancy. Given the preference for commercial alcoholic beverages, it is recommended that labels be placed prominently on bottled alcoholic beverages warning of the adverse effects of consuming alcohol during pregnancy.

Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Substance Use among Women During Pregnancy and Following Childbirth. (May 21, 2009). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (6 refs.)

This issue of "The NSDUH Report" examines past month use of alcohol, cigarettes, and marijuana among pregnant and parenting women aged 18 to 44 to shed light on how rapidly use of these substances resumes after childbirth. It differentiates pregnant women by trimester of pregnancy and recent mothers by age of the youngest child in the household. When compared with women in the third trimester of pregnancy, nonpregnant women with children under 3 months old in the household had much higher rates of past month alcohol use (6.2 vs. 31.9%), binge alcohol use (1.0 vs. 10.0%), cigarette use (13.9 vs. 20.4%, and marijuana use (1.4 vs. 3.8%). Consistent with other research this strongly suggests the resumption of use among mothers in the 3 months after childbirth. The increase in rates of substance use among parenting women tended to level off as the age of the youngest child increased. For alcohol, past month use increased from 31.9% for women with children under 3 months old to 43.9% for those with 3 to 5 month olds and 52.1% for those with 9 to 11 month olds. similar patterns were seen with binge alcohol use was 15.5 percent among women whose youngest children were aged 3 to 5 months and 19.7 percent for those whose youngest children were aged 18 months or older. Cigarette use among parenting women increased to 30.3 percent for those whose youngest children were aged 18 months or older. For marijuana, there was no significant increase in use among women who had children aged 3 months or older. Combined 2002 to 2007 data show that past month alcohol use among women aged 18 to 44 was highest for those who were not pregnant and did not have children living in the household (63.0 percent) but comparatively low for women in the first trimester of pregnancy (19.0 percent), and even lower for those in the second (7.8 percent) or third trimester (6.2 percent); similar patterns were seen with marijuana, cigarette, and binge alcohol use.

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Alcohol Use among Pregnant Women and Recent Mothers: 2002 to 2007. (September 11, 2008). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (6 refs.)

Alcohol use during pregnancy is a public health concern. Both the U.S. Surgeon General and the March of Dimes Foundation recommend that pregnant women not consume any alcohol. Additionally, because small amounts of alcohol can be transmitted in breast milk, they recommend alcohol abstinence for women who are breast-feeding. Findings in this report indicate that many women may not be getting this message. Pregnant women aged 15 to 17 may be in particular need of alcohol prevention services tailored for their age group because nearly 16.0 percent of them used alcohol in the past month. Pregnant women in this age group consumed an average of 24 drinks in the past month (i.e., they drank on an average of 6 days during the past month and an average of about four drinks on the days that they drank. Among the major findings: Combined 2006 and 2007 data indicate that the rate of past month alcohol use among women aged 15 to 44 was lower for those who were pregnant (11.6%) than for recent mothers (42.1%), who in turn had a lower rate than those who were not pregnant and not recent mothers (54.0%). Data is also provided on rates of drinking in terms of race/ethnicity, age, education, and income.

Public Domain

O'Leary CM; Bower C; Zubrick SR; Geelhoed E; Kurinczuk JJ; Nassar N. A new method of prenatal alcohol classification accounting for dose, pattern and timing of exposure: Improving our ability to examine fetal effects from low to moderate alcohol. Journal of Epidemiology and Community Health 64(e-11), 2010. (36 refs.)

Background: When examining the association between prenatal alcohol exposure and fetal effects, the timing and intensity of exposure have been ignored in epidemiological studies. The effect of using dose, pattern and timing of consumption ("composite" method) was investigated in this study, to examine the association between prenatal alcohol exposure and fetal effects. Methods The composite method resulted in six categories of exposure (abstinent, low, moderate, binge Copyright 2010, BMJ Publishing Group

O'Leary CM; Nassar N; Kurinczuk JJ; Bower C. The effect of maternal alcohol consumption on fetal growth and preterm birth. Obstetrical & Gynecological Survey 64(5): 299-300, 2009

Although numerous studies have investigated the effects of alcohol intake during pregnancy, currently available data linking prenatal alcohol exposure with abnormal fetal growth or preterm birth are inconclusive. This population-based cohort study assessed the effects of prenatal exposure to alcohol via a questionnaire given to a 10% random sample of all nonindigenous women in Western Australia who had delivered a singleton infant (n = 4719) between 1995 and 1997. The investigators examined the quantity of alcohol consumed per occasion, the frequency of consumption, and the total quantity consumed during the 3 months before and during each trimester of pregnancy. Multivariate logistic regression analysis was used to assess the possible association between alcohol consumption, both before and during pregnancy, with abnormal fetal growth (both small-for-gestational-age [SGA] and large-for-gestational-age infants [LGA]), and with preterm birth (<37 weeks of gestation). The control group consisted of infants born to abstinent women. In unadjusted analysis, moderate to heavy alcohol consumption during pregnancy was associated with an increased proportion of SGA infants born preterm. Adjustment for smoking status eliminated this effect in SGA infants. Binge drinking, defined as 5 or more drinks per occasion, in the first trimester was associated with a nonsignificant increase in the odds of preterm birth (adjusted odds ratio [aOR], 1.31; 95% confidence interval [CI], 0.67-2.58) as was binge drinking in late pregnancy (OR, 1.61; 95% CI: 0.68-3.77). Compared to the controls, women with moderate and heavy alcohol consumption had a significantly increased risk of preterm birth only if they ceased drinking before the second trimester (OR 1.78; 95% CI: 1.01-3.14). Low levels of alcohol intake during pregnancy (less than 60 gm/week or two or less standard drinks per occasion) was not associated with preterm. birth or SGA. These findings suggest that heavy and binge drinking among pregnant women may increase the likelihood of preterm birth, although the small number of patients makes the significance of these data unclear.

Parackal SM; Parackal MK; Harraway JA; Ferguson EL. Opinions of non-pregnant New Zealand women aged 16-40 years about the safety of alcohol consumption during pregnancy. Drug and Alcohol Review 28(2): 135-141, 2009. (28 refs.)

Introduction and Aims. Premenopausal women's opinions on the safety of alcohol consumption during pregnancy are not well documented. This study aims to assess the opinions of New Zealand women on the safety of alcohol consumption in pregnancy and the sociodemographic and lifestyle factors associated with these opinions. Design and Methods. A nationwide, cross-sectional survey was conducted in 2005 on a random sample of 1109 non-pregnant women aged 16-40 years. Data were collected via an interviewer-administered questionnaire using a web-assisted telephone interviewing system. Results. Overall, 44% (95% confidence interval 41-47) of women surveyed were of the opinion that no alcohol is safe in pregnancy. Those who stated that no alcohol is safe in pregnancy were more likely to be of Pacific Island ethnicity (P < 0.05) and abstainers (P < 0.001). Women who drank more than two standard drinks of alcohol on a typical occasion and/or who binged were more likely to be of the opinion that 'more than one standard drink' of alcohol is safe on a typical drinking day during pregnancy (P < 0.001). Discussion and Conclusions. The association of drinking style with opinions about the safety of alcohol consumption in pregnancy accentuates the need for public health education to reduce risky drinking behaviours in this population. Such efforts may also address the risk associated with many women unintentionally drinking in early pregnancy, especially if the pregnancy is unplanned.

Parackal SM; Parackal MK; Harraway JA. Warning labels on alcohol containers as a source of information on alcohol consumption in pregnancy among New Zealand women. International Journal of Drug Policy 21(4): 302-305, 2010. (20 refs.)

Background: The addition of a warning label on alcohol containers is a policy measure yet to be adopted in New Zealand. The current study aims to report the rating of a national sample of 16-40-year-old nonpregnant New Zealand women on a warning label on alcohol containers as a source of information on risks associated with alcohol consumption in pregnancy. Methods: A nationwide, cross-sectional survey was conducted in 2005 on a random sample of 1129 nonpregnant women aged 16-40 years. Data were collected via an interviewer-administered questionnaire using a Web-assisted telephone interviewing system. Results: Overall, the survey achieved a response rate of 65%. Just over half of the women surveyed (53%; 95% Cl 50.2-56.0) gave a high rating for a warning label as a source of information on alcohol consumption in pregnancy. Women below 30 years of age and who were of non-European ethnicity were more likely to give a high rating compared with older women and European women, respectively (p<0.05). Conclusions: Introduction of a warning label on alcohol containers in New Zealand may be effective in increasing awareness of the risks associated with alcohol consumption in pregnancy among at-risk drinkers, namely, younger women and New Zealand women of Maori and Pacific ethnicities. However, to accentuate behavioural change, other prevention approaches within a health promotion framework may be needed to complement this approach.

Peadon E; Payne J; Henley N; D'Antoine H; Bartu A; O'Leary C et al. Women's knowledge and attitudes regarding alcohol consumption in pregnancy: A national survey. BMC Public Health 10: 510, 2010. (22 refs.)

Background: Alcohol exposure in pregnancy is a common and modifiable risk factor for poor pregnancy and child outcomes. Alcohol exposure in pregnancy can cause a range of physical and neurodevelopmental problems in the child including the Fetal Alcohol Spectrum Disorders (FASD). In order to improve prevention strategies, we sought to describe the knowledge and attitudes of women of childbearing age regarding alcohol consumption during pregnancy and its effects on the fetus. Methods: We conducted a national cross-sectional survey via computer assisted telephone interview of 1103 Australian women aged 18 to 45 years. Participants were randomly selected from the Electronic White Pages. Pregnant women were not eligible to participate. Quotas were set for age groups and a minimum of 100 participants per state to ensure a national sample reflecting the population. The questionnaire was based on a Health Canada survey with additional questions constructed by the investigators. Descriptive statistics were calculated and logistic regression analyses were used to assess associations with participants' knowledge and attitudes. Results: Of women surveyed, 61.5% had heard about effects of alcohol on the fetus and 55.3% had heard of Fetal Alcohol Syndrome. Although 92.7% agreed alcohol can affect the unborn child, 16.2% did not agree that the disabilities could be lifelong. Most women agreed that pregnant women should not drink alcohol (80.2%) and 79.2% reported having negative feelings towards pregnant women drinking alcohol. Women with higher education levels were more likely to know the effects of alcohol consumption in pregnancy (adjusted OR 5.62; 95% CI 3.20 to 9.87) but education level and knowledge were not associated with attitude. Conclusions: There was a disjunction between knowledge and attitudes towards alcohol consumption in pregnancy. These findings will assist in developing effective health promotion campaigns to reduce fetal alcohol exposure and subsequent fetal damage.

Powers JR; Loxton DJ; Burns LA; Shakeshaft A; Elliott EJ; Dunlop AJ. Assessing pregnant women's compliance with different alcohol guidelines: An 11-year prospective study. Medical Journal of Australia 192(12): 690-693, 2010. (26 refs.)

Objective: To assess women's compliance with different Australian guidelines on alcohol intake during pregnancy and examine factors that might influence compliance Design, setting and participants: We analysed prospective, population-based data on women aged 22-33 years who were pregnant before October 2001, when guidelines recommended zero alcohol (n = 419), or were first pregnant after October 2001, when guidelines recommended low alcohol intake (n = 829) Data were obtained from surveys conducted in 1996, 2000, 2003 and 2006 as part of the Australian Longitudinal Study on Women's Health. Main outcome measures: Relative risks (RRs) for zero alcohol intake, low alcohol intake and compliance with alcohol guidelines, estimated by a modified Poisson regression model with robust error variance. Results: About 80% of women consumed alcohol during pregnancy under zero and low alcohol guidelines Compliance with zero alcohol guidelines or low alcohol guidelines (up to two drinks per day and less than seven drinks per week) was the same for women who were pregnant before October 2001 and women who were first pregnant after October 2001 (20% v 17% for compliance with zero alcohol guidelines, P>0 01, 75% v 80% for compliance with low alcohol guidelines, P>0 01) Over 90% of women drank alcohol before pregnancy and prior alcohol intake had a strong effect on alcohol intake during pregnancy, even at low( levels (RR for zero alcohol, 0 21 [95% CI, 0 16-0 28], RR for low alcohol, 091 [95% Cl, 086096]) 96]) RR for compliance with guidelines was 3 54 (95% CI, 2 85-4 40) for women who were pregnant while low alcohol intake was recommended, compared with those who were pregnant while zero alcohol guidelines were in place. Conclusion: The October 2001 change in alcohol guidelines does not appear to have changed behaviour risks associated with different levels of alcohol intake during pregnancy need to be clearly established and communicated

Raymond N; Beer C; Glazebrook C; Sayal K. Pregnant women's attitudes towards alcohol consumption. BMC Public Health 9: article 175, 2009. (34 refs.)

Background: There is uncertainty as to whether there is a safe threshold for drinking alcohol during pregnancy. We explored pregnant women's attitudes towards drinking alcohol in pregnancy and their attitudes towards sources of information about drinking in pregnancy following recent changes in UK government guidance. Methods: A qualitative study involving individual, semi-structured interviews with 20 pregnant women recruited from community organisations in the UK. Interview transcripts were analysed qualitatively using thematic analysis. Results: Most women found information and advice about safe levels of drinking in pregnancy confusing and lacking in evidence and detail. Although most women considered that there were risks involved with drinking in pregnancy and these perceptions influenced their behaviour, only six women reported abstinence. Women reported being influenced by advice from family and friends and their experiences of previous pregnancies. Many had received no individual advice from general practitioners or midwives relating to drinking during pregnancy. Conclusion: Pregnant women wished to take responsibility for their own health and make choices based on informed advice. In order to do so, they require clear and consistent advice about safe levels of drinking from policy makers and health professionals. This is an important issue as women might drink socially during their pregnancy.

Robinson M; Oddy WH; McLean NJ; Jacoby P; Pennell CE; de Klerk NH et al. Low-moderate prenatal alcohol exposure and risk to child behavioral development: A prospective cohort study. (editorial). Obstetrical & Gynecological Survey 65(12): 759-760, 2010. (0 refs.)

The detrimental effects of fetal exposure to extreme levels of alcohol during pregnancy, such as the subsequent occurrence of childhood physical, cognitive, and behavioral deficits, are well known. Some investigators have suggested that there is a dose-response effect, with light drinking during pregnancy primarily affecting behavioral and adaptive functions and heavy drinking causing more serious developmental defects and problems. Accordingly, mild to moderate social drinking during pregnancy could be associated with long-term infant morbidity. The relatively few studies examining the long-term risk of fetal exposure to light-moderate levels of alcohol have failed to reach consensus, possibly due to deficiencies in study design. This prospective longitudinal cohort study investigated the effect of different levels of fetal alcohol exposure during pregnancy on child and adolescent behavioral development. The Western Australian Pregnancy Cohort (Raine) Study enrolled 2900 pregnancies between 1989 and 1991, with a 14-year follow-up. Maternal self-reported data for 5 levels of weekly alcohol intake were obtained at 18 and 34 weeks' gestation: no drinking, occasional drinking (up to one standard drink per week), light drinking (2-6 standard drinks per week), moderate drinking (7-10 standard drinks per week), and heavy drinking (11 or more standard drinks per week). A linear regression model was used to determine whether prenatal alcohol exposure could produce changes in Child Behavior Checklist scores over 14 years that reflected clinically meaningful differences in child behavioral development, after adjustment for maternal and sociodemographic confounders. Detailed clinical assessments of study children were conducted at birth, with follow-up conducted at 2, 5, 8, 10, and 14 years. The adjusted data showed that light and moderate drinking during the first 3 months of pregnancy resulted in Child Behavior Checklist z-scores indicative of positive behavior over 14 years. The z-scores reflected a clinically meaningful reduction in total, internalizing, and externalizing behavioral problems across the 14 years of follow-up. These findings suggest that low-moderate alcohol intake early in pregnancy is not associated with poor behavioral outcomes in offspring.

Rosenberg MJ; Wolff CR; El-Emawy A; Staples MC; Perrone-Bizzozero NI; Savage DD. Effects of moderate drinking during pregnancy on placental gene expression. Alcohol 44(7/8, special issue): 673-690, 2010. (67 refs.)

Many children adversely affected by maternal drinking during pregnancy cannot be identified early in life using current diagnostic criteria for fetal alcohol spectrum disorder (FASD). We conducted a preliminary investigation to determine whether ethanol-induced alterations in placental gene expression may have some utility as a diagnostic indicator of maternal drinking during pregnancy and as a prognostic indicator of risk for adverse neurobehavioral outcomes in affected offspring. Pregnant Long-Evans rats voluntarily consumed either a 0 or 5% ethanol solution 4 h each day throughout gestation. Ethanol consumption produced a mean maternal daily intermittent peak serum ethanol concentration of 84 mg/dL. Placentas were harvested on gestational day 20 for gene expression studies. Microarray analysis of more than 28,000 genes revealed that the expression of 304 known genes was altered twofold or greater in placenta from ethanol-consuming dams compared with controls. About 76% of these genes were repressed in ethanol-exposed placentas. Gene expression changes involved proteins associated with central nervous system development; organ morphogenesis; immunological responses; endocrine function; ion homeostasis; and skeletal, cardiovascular, and cartilage development. To date, quantitative real-time polymerase chain reaction analysis has confirmed significant alterations in gene expression for 22 genes, including genes encoding for three calcium binding proteins, two matrix metalloproteinases, the cannabinoid 1, galanin 2 and toll-like receptor 4, iodothyronine deiodinase 2, 11-beta hydroxysteroid dehydrogenase 2, placental growth factor, transforming growth factor alpha, gremlin 1, and epithelial growth factor (EGF)-containing extracellular matrix protein. These results suggest that the expression of a sufficiently large number of placental mRNAs is altered after moderate drinking during pregnancy to warrant more detailed investigation of the placenta as a biomarker system for maternal drinking during pregnancy and as an early indicator of FASD. Furthermore, these results provide new insights into novel mechanisms on how ethanol may directly or indirectly mediate its teratogenic effects through alterations in placental function during pregnancy.

Salihu HM; Kornosky JL; Lynch O; Alio AP; August EM; Marty PJ. Impact of prenatal alcohol consumption on placenta-associated syndromes. Alcohol 45(1): 73-79, 2011. (31 refs.)

The biology of placental and fetal development suggests that alcohol may play a significant role in increasing the risk of feto-infant morbidity and mortality, but study results are inconsistent and the mechanism remains poorly defined. Previous studies have not examined the risk of placenta-associated syndromes (PASs: defined as the occurrence of either placental abruption, placenta previa, preeclampsia, small for gestational age, preterm, or stillbirth) as a unique entity. Therefore, we sought to examine the relationship between prenatal alcohol use and the risk of PAS among singleton births in the Missouri maternally linked data files covering the period 1989-2005. Logistic regression with adjustment for intracluster correlation was used to generate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Compared with nondrinkers, drinkers were more likely to be smokers, 35 years of age or older, black, and multiparous. Drinkers had an increased risk of PAS (OR = 1.26, 95% CI = 1.22,1.31) when compared with their nondrinking counterparts. The risk of PAS was progressively amplified with increasing prenatal alcohol consumption (P for trend <.01). Women who reported consuming five or more alcoholic drinks per week had more than twofold increased risk of PASs, whereas women in the lowest drinking category (one to two drinks per week) had only a slight increased risk of PAS (OR = 1.09, 95% CI = 1.05, 1.14). Enhanced understanding of the mechanism by which prenatal alcohol consumption leads to PAS may aid in the development of more targeted interventions designed to prevent adverse pregnancy outcomes. Screening women for alcohol use may assist providers in protecting developing fetuses from the potential dangers of prenatal alcohol use.

Sanders JL. What might have been: Sullivan may have impacted modern prenatal alcohol research under different circumstances. (editorial). International Journal of Epidemiology 40(2): 283-285, 2011. (21 refs.)

Santhanam P; Li ZH; Hu XP; Lynch ME; Coles CD. Effects of prenatal alcohol exposure on brain activation during an arithmetic task: An FMRI study. Alcoholism: Clinical and Experimental Research 33(11): 1901-1908, 2009. (41 refs.)

Background: While behavioral studies have established that prenatal alcohol exposure (PAE) can result in diminished arithmetic processing capability, the underlying neural correlates of this deficit are still unclear. The aim of the present study was to use functional magnetic resonance imaging to determine the effect of PAE on neuronal activation during a subtraction task. Methods: Participants were young adults from a low socio-economic status population who were identified prenatally; the sample consisted of healthy unexposed controls (n = 17) and PAE who were subdivided based on the presence (n = 19) or absence of physical dysmorphic signs (n = 18). Multiple regression analysis was used to determine extent of activation and percent signal change during arithmetic processing, using a letter-matching task as the baseline. Region of interest analysis of activation was performed in the native space and normalized for each individual to compensate for the considerable variability in head size observed in the alcohol-exposed population. Results: An exposure-dependent response was observed in task performance and neuronal activation. Dysmorphic PAE individuals showed significantly lower task-related performance and activation in regions known to be associated with arithmetic processing, including left superior and right inferior parietal regions and medial frontal gyrus, while the nondysmorphic PAE group was generally intermediate but not significantly different from the control group in task performance and activation. Conclusions: Results indicate that there is a range of effects of PAE on arithmetic processing and that the severity of this deficit may be dependent on degree of impairment demonstrated by the exposed individual. Evidence of physical dysmorphia may be indicative of functional damage to regions associated with arithmetic calculation, resulting in markedly impaired neuronal recruitment.

Sayal K. Commentary. Light drinking in pregnancy: Can a glass or two hurt? (editorial). International Journal of Epidemiology 38(1): 140-142, 2009. (11 refs.)

Sayers S; Boyle J. Indigenous perinatal and neonatal outcomes: A time for preventive strategies. (review). Journal of Paediatrics and Child Health 46(9): 475-478, 2010. (28 refs.)

Pregnancy outcomes for Indigenous mothers and babies have improved, but marked disparities remain between Indigenous and non-Indigenous women. Many contributors to these disparities such as smoking, alcohol use, poor nutrition, infection, teenage pregnancy and stress are preventable or modifiable particularly if addressed prior to pregnancy. It is suggested that we expand our reproductive health research, education and care to a life course approach beginning in early adolescence.

Schlotz W; Phillips DIW. Fetal origins of mental health: Evidence and mechanisms. (review). Brain, Behavior and Immunity 23(7): 905-916, 2009. (231 refs.)

The concept of fetal programming states that changes in the fetal environment during sensitive periods of organ development may cause long-lasting changes in the structure and functioning of these organs later in life and influence the risk for chronic diseases such as coronary heart disease and type 2 diabetes. Fetal growth is a summary marker of the fetal environment and is reflected by relatively easy-to-obtain measures of size at birth such as birth weight. In the last two decades, a body of evidence emerged linking fetal growth with behavioural and mental health outcomes later in life. Cognitive functioning and behavioural problems in childhood, in particular inattention/hyperactivity, have been shown to be inversely related to fetal growth. Although results are mixed, risk for personality disorders and schizophrenia seems to be linked with fetal growth and adversity, while the evidence for mood disorders is weak. Vulnerability for psychopathology may also be influenced by prenatal adversity. There is evidence for associations of fetal growth with temperament in childhood as well as stress reactivity and distress. The associations of fetal growth with mental health later in life are potentially caused by specific prenatal factors such as maternal smoking, alcohol, toxins/drugs, nutrition, psychosocial stress and infection during pregnancy. The mechanisms likely involve changes in neurodevelopment and in the set point of neuroendocrine systems, and there is evidence that prenatal adversity interacts with genetic and postnatal environmental factors. Future studies should examine the effects of specific prenatal factors and attempt to disentangle genetic and prenatal environmental effects.

Simmons RW; Madra NJ; Levy SS; Riley EP; Mattson SN. Co-regulation of movement speed and accuracy by children with heavy prenatal alcohol exposure. Perceptual and Motor Skills 112(1): 172-182, 2011. (37 refs.)

The study investigated how children with heavy prenatal alcohol exposure regulate movement speed and accuracy during goal-directed movements. 16 children ages 7 to 17 years with confirmed histories of heavy in utero alcohol exposure, and 21 nonalcohol-exposed control children completed a series of reciprocal tapping movements between two spatial targets. 5 different targets sets were presented, representing a range of task difficulty between 2 and 6 bits of information. Estimates of percent error rate, movement time, slope, and linear fit of the resulting curve confirmed that for goal-directed, reciprocal tapping responses, performance of the group with prenatal alcohol exposure was described by a linear function, as predicted by Fitts' law, by sacrificing movement accuracy. The index of performance was the same for the two groups: it initially increased, then leveled off for more difficult movements.

Sun YL; Strandberg-Larsen K; Vestergaard M; Christensen J; Andersen AMN; Gronbaek M et al. Binge drinking during pregnancy and risk of seizures in childhood: A study based on the Danish National Birth Cohort. American Journal of Epidemiology 169(3): 313-322, 2009. (41 refs.)

Seizures are often found in children with fetal alcohol syndrome, but it is not known whether binge drinking during pregnancy by nonalcoholic women is associated with an increased risk of seizure disorders in children. The authors conducted a population-based cohort study of 80,526 liveborn singletons in the Danish National Birth Cohort (1996-2002). Information on maternal binge drinking (intake of >= 5 drinks on a single occasion) was collected in 2 computer-assisted telephone interviews during pregnancy. Children were followed for up to 8 years. Information on neonatal seizures, epilepsy, and febrile seizures was retrieved from the Danish National Hospitalital Register. Results showed that exposure to binge drinking episodes during pregnancy was not associated with an increased risk of seizure disorders in children, except for those exposed at 11-16 gestational weeks. These children had a 3.15-fold increased risk of neonatal seizures (95% confidence interval: 1.37, 7.25) and a 1.81-fold increased risk of epilepsy (95% confidence interval: 1.13, 2.90). These findings suggest that maternal binge drinking during a specific time period of pregnancy may be associated with an increased risk of specific seizure disorders in the offspring. The results are exploratory, however, and need to be replicated.

Toutain S. What women in France say about alcohol abstinence during pregnancy. Drug and Alcohol Review 29(2): 184-188, 2010. (15 refs.)

Introduction and Aims. In spite of the implemented policies warning of the dangers of alcohol consumption for pregnant women, many women still continue drinking during pregnancy. This article focuses on the question of the representations of alcohol consumption during pregnancy in France. Design and Methods. A qualitative approach based on discussions with 42 pregnant women in three Internet chat groups in 2007 was used for our study. Results. The recommendation for total abstinence is often misunderstood by women, as are the consequences of drinking for the unborn babies. Besides, these Internet users do not seem to know much about the consequences of alcohol consumption for unborn babies. Finally, their sources of information are varied (written, oral, television, Internet, professionals of health, family networks and friends); however, their mothers remain the most credible source for them. Discussion and Conclusion. Alcohol consumption during pregnancy already constitutes a real taboo for the heath care professionals in France. It is extremely urgent and imperative that they recommend total abstinence during pregnancy, in order to avoid any irreversible consequences for the unborn babies.

Velasquez MM; Ingersoll KS; Sobell MB; Floyd RL; Sobel LC; von Sternberg K. A dual-focus motivational intervention to reduce the risk of alcohol-exposed pregnancy. Cognitive and Behavioral Practice 17(2): 203-212, 2010. (26 refs.)

Project CHOICES developed an integrated behavioral intervention for prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. Settings included primary care, university-hospital based obstetrical/gynecology practices, an urban jail, substance abuse treatment settings, and a media-recruited sample in three large cities. The intervention was based on motivational interviewing and targeted both adoption of effective contraception and reduction of alcohol use. Treatment included 4 manual-guided sessions delivered by mental health clinicians and I contraceptive counseling session delivered by a family planning clinician. This paper describes the rationale for treatment; the use of motivational interviewing and the transtheoretical model for a dual-focused approach to behavior change; the development of the Project CHOICES intervention; development of the study protocol and treatment manual; and selection, training, supervision, and monitoring of study counselors. Implications for future applications of the intervention are discussed.

Willford JA; Chandler LS; Goldschmidt L; Day NL. Effects of prenatal tobacco, alcohol and marijuana exposure on processing speed, visual-motor coordination, and interhemispheric transfer. Neurotoxicology and Teratology 32(6): 580-588, 2010. (120 refs.)

Deficits in motor control are often reported in children with prenatal alcohol exposure (PAE). Less is known about the effects of prenatal tobacco exposure (PTE) and prenatal marijuana exposure (PME) on motor coordination, and previous studies have not considered whether PTE, PAE, and PME interact to affect motor control. This study investigated the effects of PTE, PAE, and PME as well as current drug use on speed of processing, visual-motor coordination, and interhemispheric transfer in 16-year-old adolescents. Data were collected as part of the Maternal Health Practices and Child Development Project. Adolescents (age 16, n = 320) participating in a longitudinal study of the effects of prenatal substance exposure on developmental outcomes were evaluated in this study. The computerized Bimanual Coordination Test (BCT) was used to assess each domain of function. Other important variables, such as demographics, home environment, and psychological characteristics of the mother and adolescent were also considered in the analyses. There were significant and independent effects of PTE, PAE, and PME on processing speed and interhemispheric transfer of information. PTE and PME were associated with deficits in visual-motor coordination. There were no interactions between PAE. PTE, and PME. Current tobacco use predicted deficits in speed of processing. Current alcohol and marijuana use by the offspring were not associated with any measures of performance on the BCT.

Zammit S; Thomas K; Thompson A; Horwood J; Menezes P; Gunnell D et al. Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring. British Journal of Psychiatry 195(4): 294-300, 2009. (52 refs.)

Background: Adverse effects of maternal substance use during pregnancy on fetal development may increase risk of psychopathology. Aims To examine whether maternal use of tobacco, cannabis or alcohol during pregnancy increases risk of offspring psychotic symptoms. Method A longitudinal study of 6356 adolescents, age 12, who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Results Frequency of maternal tobacco use during pregnancy was associated with increased risk of suspected or definite psychotic symptoms (adjusted odds ratio 1.20, 95% CI 1.05-1.37, P=0.007). Maternal alcohol use showed a non-linear association with psychotic symptoms, with this effect almost exclusively in the offspring of women drinking >21 units weekly. Maternal cannabis use was not associated with psychotic Symptoms. Results for paternal smoking during pregnancy and maternal smoking post-pregnancy lend some support for a causal effect of tobacco exposure in utero on development of psychotic experiences. Conclusions: These findings indicate that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena.