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CORK Bibliography: Maternal Drinking

63 citations. January 2003 to present

Prepared: June 2008

Alati R; Al Mamun A; Williams GM; O'Callaghan M; Najman JM; Bor W. In utero alcohol exposure and prediction of alcohol disorders in early adulthood: A birth cohort study. Archives of General Psychiatry 63(9): 1009-1016, 2006. (31 refs.)

Context: Little is known about the contribution of fetal alcohol exposure to the development of alcohol disorders in early adulthood. Objective: To examine the independent effect of maternal alcohol use during early vs late periods in pregnancy on the time of onset of alcohol disorders in offspring. Design: Follow-up study of the Mater-University of Queensland Study of Pregnancy and Its Outcomes (MUSP), a population-based birth cohort study commenced in Brisbane, Australia, in 1981 and designed to examine the association of maternal alcohol exposure with the onset of alcohol disorders. Mothers and children were followed up at birth, 6 months, and 5, 14, and 21 years after the initial interview. Maternal alcohol use was assessed before pregnancy, in early and late pregnancy, and at the 5- and 14-year follow-up visits. Alcohol disorders in early adulthood were assessed at age 21 years using the lifetime version of the Composite International Diagnostic Interview-computerized version. Setting: Population-based birth cohort study. Participants: A subsample of 2138 participants for whom complete data were available at the 21-year follow-up. Main Outcome Measure: Onset of alcohol disorder from adolescence to 21 years of age. Results: In utero alcohol exposure of 3 or more glasses was associated with alcohol disorders. The fully adjusted odds ratios (95% confidence intervals) of developing early-onset alcohol disorders at age 21 years were 2.95 (1.62-5.36) for those exposed to maternal drinking in early pregnancy and 1.35 (0.69-2.63) for those exposed in late pregnancy. There was also a strong association between alcohol exposure in early pregnancy and late-onset alcohol disorders (odds ratio, 3.29 [95% confidence interval, 1.74-6.24]). Conclusions: Our results provide support for a biological origin of adult alcohol disorders and suggest that the association is not explained solely by maternal drinking or smoking during childhood and adolescence or other intervening factors. Further research is needed to understand the mechanisms underlying the association.

Alati R; Najman JM; Kinner SA; Mamun AA; Williams GM; O'Callaghan M et al. Early predictors of adult drinking: A birth cohort study. American Journal of Epidemiology 162(11): 1098-1107, 2005. (40 refs.)

Few studies have explored early predictors of problem drinking in youth, and fewer still have simultaneously considered the role of biologic, familial, and intrapersonal factors. The present study explored early life course and later life course predictors of alcohol abuse and dependence in young adulthood. Data were taken from a cohort of 2,551 mothers and their children recruited as part of the longitudinal Mater University Study of Pregnancy and its outcomes (MUSP) carried out in Brisbane, Australia, from 1981 to 1984. Data were collected prenatally and then postnatally at 6 months and at 5, 14, and 21 years. A range of biologic, familial, and intrapersonal factors was considered. A series of logistic regression models with inverse probability weighting was used to explore pathways to problem drinking from adolescence to early adulthood. For males and females, no association was found between either birth factors or childhood factors and a lifetime diagnosis of alcohol disorders at age 21 years. Externalizing symptoms and maternal factors at age 14 years were significantly associated with alcohol problems. For youth aged 14 years, maternal moderate alcohol consumption accounted for the highest percentage of attributable risk among those exposed. Results show that exposure to maternal drinking in adolescence is a strong risk factor for the development of alcohol problems in early adulthood.

Arfsten DP; Silbergeld EK; Loffredo CA. Fetal ADH23, maternal alcohol consumption, and fetal growth. International Journal of Toxicology* 23(1): 47-54, 2004. (47 refs.)

There is some evidence suggesting the allele for alcohol dehydrogenase 2*3 (ADH2*3) is associated with a protective effect against alcohol-related intrauterine growth retardation (IUGR). This study was conducted to explore the affect of the ADH2*3 allele on fetal growth. Bloodspots (n = 1016) belonging to individual infants of a subgroup of the Baltimore-Washington Infant Study (BWIS) were assayed for the presence of the ADH2*3 allele by a polymerase chain reaction (PCR)-based method. Infants genotyped for ADH2*3 were those for whom bloodspots were identified and obtained from the Maryland Newborn Screening Program. The effect of ADH2*3 and maternal alcohol consumption on intrauterine growth was explored by multivariable linear regression analysis. Twenty-six percent of the 306 blood spots belonging to African-American infants were positive for ADH2*3 (4% were homozygous and 22% were heterozygous). Only a small percentage of bloodspots for Caucasian (1.3%) were positive for the ADH2*3 allele. Consequently, further analysis concentrated on gene-exposure interactions for African-American infants. It was found that the incidence of being small-for-gestation-age (SGA) was lower for ADH2*3-positive infants (2.5% versus 8.8%; p =.08). SGA infants had elevated odds for being ADH2*3 negative (OR: 3.15, 95% C.I.: 0.70-14.26) and for being born to mothers that consumed alcohol during pregnancy (OR: 2.31, 95% C.I.: 0.77-6.91). A negative trend between maternal alcohol consumption and mean offspring birthweight was found; however, ADH2*3 did not have a significant impact on mean birthweight for infants born to mothers that drank during pregnancy. These results could be interpreted as possible support for the hypothesis that ADH2 genotype in the infant may impact risk for alcohol-related IUGR. However, this study has limitations in that it is a "nested study of convenience" and involves a relatively small number of infants born to mothers reporting moderate to heavy alcohol use during pregnancy.

Avaria MD; Mills JL; Kleinsteuber K; Aros S; Conley MR; Cox C et al. Peripheral nerve conduction abnormalities in children exposed to alcohol in utero. Journal of Pediatrics 144(3): 338-343, 2004. (14 refs.)

Objective: We performed a longitudinal study of nerve conduction velocity to determine the effect of prenatal alcohol exposure on the peripheral nervous system. Study design: We studied 17 children exposed to >2 oz of absolute alcohol/day prenatally and 13 unexposed children, identified prospectively from a cohort of pregnant women screened during prenatal care. Nerve conduction assessment was done on the median, ulnar, peroneal and tibial nerves during the newborn period and between 12 and 14 months of age. Results At both assessments the alcohol-exposed subjects had significantly slower ulnar motor nerve velocity (P =.007), smaller proximal (P =.018) and distal amplitude (P =.051). They also showed reduced tibial nerve velocity (P =.06) and a decrease in distal amplitude. Conclusions: This study demonstrates that prenatal alcohol exposure is associated with abnormalities in nerve electrical properties, and that the pattern is different from that.seen in adults. Electrophysiologic abnormalities in peripheral nerves should be added to the problems found in children of alcohol abusing mothers.

Baer JS; Sampson PD; Barr HM; Connor PD; Streissguth AP. A 21-year longitudinal analysis of the effects of prenatal alcohol exposure on young adult drinking. Archives of General Psychiatry. 60(4): 377-385, 2003. (48 refs.)

Prenatal alcohol exposure may be a risk factor for the development of alcohol problems in humans. The authors used data beginning with interviews of women in prenatal care at midpregnancy to predict alcohol use and alcohol-related problems in 433 offspring now aged 20.8-23.4 yrs. Maternal drinking, smoking, use of caffeine and other drugs, and demographic factors were assessed. Family history of alcohol problems was assessed from interviews with parents when offspring were 14 yrs old and updated when offspring were 21 yrs old. Measures of parental use of alcohol and other drugs and many aspects of the family environment were assessed 7 times, prenatally through 21 yrs. 433 21-yr-olds provided self-reports of drinking quantity and frequency and completed the Alcohol Dependence Scale as a measure of alcohol-related problems and dependence. Univariate, partial least squares, and regression analyses indicate that prenatal alcohol exposure is associated with alcohol problems at 21 yrs of age. The relationship persists independent of the effects of family history of alcohol problems, nicotine exposure, other prenatal exposures, and postnatal environmental factors including parental use of other drugs. Prenatal nicotine exposure was not associated with alcohol problems by offspring.

Barr HM; Bookstein FL; O'Malley KD; Connor PD; Huggins JE; Streissguth AP. Binge drinking during pregnancy as a predictor of psychiatric disorders on the Structured Clinical Interview for DSM-IV in young adult offspring. American Journal of Psychiatry 163(6): 1061-1065, 2006. (28 refs.)

Objective: This study explored the extent to which the high frequency of psychiatric problems reported in clinical groups with fetal alcohol spectrum disorders might also be observed in a nonclinical group of young adults and the psychiatric conditions that are related to prenatal alcohol exposure in this group. Method: From a longitudinal prospective study beginning with interviews of 1,529 pregnant women, a birth cohort of about 500 newborns was chosen to include all of the most heavily alcohol exposed plus a sampling of the continuum of alcohol exposures from total abstinence through heavy drinking. At an average age of 25.7 years, 400 members of this birth cohort were administered valid Structured Clinical Interviews for DSM-IV ( SCID), including both the SCID for axis I disorders and the SCID for axis II personality disorders. Results: The odds of the appearance of six psychiatric disorders and traits were more than double in adults exposed to one or more binge alcohol episodes in utero. Three of these six odds ratios were uniformly stable against confounding: axis I substance dependence or abuse disorders and axis II passive-aggressive and antisocial personality disorders or traits. Conclusions: Prenatal exposure to alcohol may be a risk factor for specific psychiatric disorders and traits in early adulthood, even in a nonclinical group.

Bearer CF; Jacobson JL; Jacobson SW; Barr D; Croxford J; Molteno CD et al. Validation of a new biomarker of fetal exposure to alcohol. Journal of Pediatrics 143(4): 463-469, 2003. (36 refs.)

Objective: To test the sensitivity and specificity of fatty acid ethyl esters (FAEEs) extracted from meconium to identify alcohol-using pregnant women with a sensitive and specific methodology, gas chromatography-tandem mass spectroscopy (GC/MS/MS).Study design: Twenty-seven samples of meconium were obtained from infants from the mixed race community in Cape Town, South Africa, who were enrolled in a longitudinal neurobehavioral study. Maternal alcohol use was reported prospectively during pregnancy. FAEEs were isolated from meconium and quantitated by GC/MS/MS. Results: Ethyl oleate was the FAEE that correlated most strongly with maternal self-reported drinking, especially with the average ounces of absolute alcohol ingested per drinking day. Ethyl oleate was most strongly related to drinking in the second and third trimesters (Pearson r = .55 and .40, respectively). At a threshold of 1.5 average ounces of absolute alcohol. ingested per drinking day, die area under the receiving operator characteristic curve was Using a cut-off value of 92 (95% confidence interval 0.74-0.97). 32 ng/g, sensitivity was 84.2% and specificity was 83.3%. Conclusions: Ethyl oleate concentration in meconium assayed by GC/MS/MS provides a highly sensitive and specific indicator of maternal alcohol use during pregnancy.

Burd L; Klug MG; Martsolf JT. Increased sibling mortality in children with fetal alcohol syndrome. Addiction Biology 9(2): 179-186, 2004. (18 refs.)

We compared the rate of all-cause mortality in siblings of children diagnosed with fetal alcohol syndrome (FAS) with the siblings of matched controls. The siblings of children with FAS had increased mortality (11.4%) compared with matched controls (2.0%), a 530% increase in mortality. The age of death in case siblings deaths occurred later (between 1 day and 7 years) compared with the controls (1 day to 4 years) [odds ratio (OR) = 2.4 (0.4-15.6)]. Siblings of children with FAS had increased risk of death due to infectious illness [OR = 13.7 (1.2-361)] and sudden infant death syndrome compared with controls [OR = 10.2 (1.2-75.1)]. A diagnosis of FAS is an important risk marker for mortality in the siblings of the proband even if they do not have FAS. Maternal alcoholism appears to be a useful risk marker for increased mortality risk in diagnosed cases and their siblings. This has important implications in the management of family members of children with FAS.

Chan D; Bar-Oz B; Pellerin B; Paciorek C; Klein J; Kapur B et al. Population baseline of meconium fatty acid ethyl esters among infants of nondrinking women in Jerusalem and Toronto. Therapeutic Drug Monitoring 25(3): 271-278, 2003. (27 refs.)

The detection of fatty acid ethyl esters (FAEE) in meconium may provide an objective estimate of prenatal alcohol exposure independent of maternal history. The authors report the results of the first population-based study conducted to investigate basal FAEE levels in the meconium of neonates not exposed to alcohol. Two hundred seven nondrinking women and their neonates were recruited from Toronto and Jerusalem. FAEE were extracted from meconium by solid-phase extraction and analyzed by GC/FID. Similar procedures were conducted in six neonates born to confirmed heavy drinkers. Low levels of meconium FAEE were detected from both cohorts (mean, 1.37 nmol/g vs. 2.08 nmol/g, Toronto vs. Jerusalem). Ethyl stearate, oleate, and linoleate were below the limit of detection in >80% of all samples, whereas ethyl laurate and palmitate were detected in >50% of the samples. Ethyl myristate was the FAEE most commonly detected (>80%). All six meconium samples with confirmed maternal drinking histories tested positive for FAEE at significantly higher levels (mean, 11.08 nmol/g). The use of 2 nmol total FAEE/g meconium as the positive cutoff, when lauric and myristic acid ethyl esters were excluded, yielded the greatest sensitivity (100%) and specificity (98.4%). The authors conclude that certain FAEE are present at measurable levels in the meconium of neonates not exposed to maternal drinking, and correction is needed to allow high specificity.

Chiaffarino F; Parazzini F; Chatenoud L; Ricci E; Sandretti F; Cipriani S et al. Alcohol drinking and risk of small for gestational age birth. European Journal of Clinical Nutrition 60(9): 1062-1066, 2006. (17 refs.)

Objective: To assess if alcohol drinking is a risk factor for small for gestational age (SGA) birth. Methods: Case-control study. Cases were 555 women (mean age 31 years, range 16-43) who delivered SGA babies at the Clinica Luigi Mangiagalli and the Obstetric and Gynecology Clinic of the University of Verona. The controls were 1966 women (mean age 31 years, range 14-43) who gave birth at term (>= 37 weeks of gestation) to healthy infants of normal weight at the hospitals where cases had been identified. Results: No increase in the risk of SGA birth was observed in women drinking one or two drinks/day in pregnancy, but three or more per day increased the risk: odds ratios (OR) were 3.2 (1.7-6.2) for >= 3 drinks during the first trimester, 2.7 (1.4-5.3) during the second and 2.9 (1.5-5.7) during the third. Conclusions: The study shows an increased risk of SGA births in mothers who drink >= 3 units/day of alcohol in pregnancy.

Christoffersen MN; Soothill K. The long-term consequences of parental alcohol abuse: A cohort study of children in Denmark. Journal of Substance Abuse Treatment 25(2): 107-116, 2003. (40 refs.)

The aim of this study is to consider whether parents' abuse of alcohol has an impact on children during their formative years. The research is based on data from 84,765 children born in Denmark in 1966. These children and their parents were followed between 1979 and 1993. Information was analyzed from government registers covering health, education, family separation, suicidal behavior, criminality, and unemployment, using a discrete time Cox-regression model. Results showed that the parents' alcohol abuse may frame the childhood with parental violence, very high occurrence of family separations, and often foster care. The parental abuse of alcohol may influence several long-term consequences for their 15- to 27-year-old children such as increased mortality, self-destructive behaviors (e.g. attempted suicide or drug addiction). Hospitalization due to violence, an increased risk of teenage pregnancy and unemployment were also seen more frequently among cases where the parents were alcohol abusers. Mothers' alcohol abuse seemed to be associated with higher occurrences of all the mentioned disadvantages.

Coffelt NL; Forehand R; Olson AL; Jones DJ; Gaffney CA; Zens MS. A longitudinal examination of the link between parent alcohol problems and youth drinking: The moderating roles of parent and child gender. Addictive Behaviors 31(4): 593-605, 2006. (40 refs.)

The unique and interactive effects of paternal and maternal alcohol problems on the drinking behavior of adolescent girls and boys were investigated. A prospective design was employed to examine changes in youth drinking behavior over a 3-year period in a community-based sample of 695 families. Results revealed that, as maternal alcohol problems increased, the likelihood of adolescent alcohol use increased. Paternal alcohol problems were associated with an increased likelihood of alcohol use for girls only. Findings point to the need for future research to investigate both maternal and paternal alcohol problems in community samples and with a sample size large enough to examine both parent and adolescent gender. Implications for preventive and interventive efforts are considered.

Crandall M; Chiu B; Sheehan K. Injury in the first year of life: Risk factors and solutions for high-risk families. Journal of Surgical Research 133(1): 7-10, 2006. (22 refs.)

Background. Injury is one of the leading causes of death for infants younger than 1 year of age. We investigated potential contributing factors for injury among children born to high-risk families. Methods. The Fragile Families and Child Wellbeing Study is a longitudinal cohort of approximately 5000 children from mostly unwed parents across the United States. Data from interviews with mothers conducted shortly after birth and follow-up surveys at 1year were used for this analysis. Injuries sustained in the first year of life that required medical attention were studied. Multivariate regression analysis was used to identify independent risk factors for injury in this population. Results. A total of 13.7% of mothers reported that their child had sustained an injury in the first year of life. We identified 17 potential maternal, paternal, and environmental risk factors for injury, including socioeconomic, mental health, relationship violence, criminal justice system involvement, and substance abuse challenges. Multivariate regression analyses revealed two significant independent risk factors, maternal alcohol use (odds ratio 2.15, P = 0.044) and mother spanking child in the previous month (odds ration 2.32, P = 0.027). Conclusions. Among this higher-risk group, injury in the first year of life is more than twice the national incidence. Predisposing factors to injury often are complex and interrelated, but with focused education and prevention efforts, including discussions of maternal alcohol use and attitudes toward physical discipline, we may decrease the burden of infant injury in this vulnerable population.

Davidson-Arad B; Englechin-Segal D; Wozner Y; Gabriel R. Why social workers do not implement decisions to remove children at risk from home. Child Abuse and Neglect 27(6): 687-697, 2003. (45 refs.)

Objectives: The study explores why social workers do not always implement their decisions to remove children at risk from their homes. Method: Social workers in Israel filled out questionnaires for 96 children at risk at two points of time: When they began to consider whether or not to remove the child, they completed questionnaires tapping their own, the parents', and the children's features. Six months later, they reported their decision, whether or not they had carried it out, and if not, why not. Results: Some 21% of the workers' decisions were not implemented, almost all of them decisions to remove. The main reasons given were the objections of the parents and/or the child. Decisions were implemented for all the children whose mothers were alcohol or drug addicts. Implementation was lower for older children, children who were uncooperative with the social worker, and for children whose parents were uncooperative. It was also lower among experienced workers than novices. Conclusions: Further study is required to examine the generalizability of these findings to other countries, to understand better the reasons for the non-implementation, and to follow-up on the consequences of the non-implementation.

Dew PC; Guillory VJ; Okah FA; Cai JW; Hoff GL. The effect of health compromising behaviors on preterm births. Maternal and Child Health Journal 11(3): 227-233, 2007. (45 refs.)

Objectives: The objective of our study was to determine whether there were combined effects of smoking, alcohol, and illicit drug use during pregnancy on the frequency of preterm births, and if so, the magnitude of the association after adjusting for confounding factors. Methods: We conducted a retrospective cohort study of singleton live births in Kansas City, Missouri from 1990-2002. We defined health compromising behaviors as the use of cigarettes, alcohol, and illicit drugs. The effect of these behaviors on preterm births was considered for each substance individually, and in combination. The rates of preterm births for these groups were calculated. Using logistic regression, adjusted odds ratios were used to estimate the relative risk of preterm births among these groups. Results: Over 13% of infants born to women who smoked were preterm, compared to 9.6% for non-smokers. Of infants born to women who reported alcohol use, 17.3% were preterm compared to 10.1% for non-drinkers. Smoking and alcohol use in combination was associated with 18.0% preterm births, while alcohol and drug use in combination was associated with 20.8% preterm births. The use of all three substances was associated with 31.4% preterm births. Conclusion: Women who engaged in health compromising behaviors during pregnancy showed an increased proportion of preterm births compared to those who did not. There is significant interaction between these behaviors leading to higher rates of preterm births than predicted by their additive effects. To decrease preterm births, we must deal with the effects of smoking, drinking, and drug use simultaneously.

Dowd JB. Early childhood origins of the income/health gradient: The role of maternal health behaviors. Social Science & Medicine 65(6): 1202-1213, 2007. (56 refs.)

Several recent studies in the US, Canada, and the UK have demonstrated a positive relationship between family income and child health, though the mechanisms underlying this relationship are poorly understood. Using data from the 1988 US National Maternal and Infant Health Survey and the 1991 follow-up, this paper tests whether maternal health status and health behaviors during pregnancy and early infancy can explain the relationship between family income and subjective health status at age 3. We find that, while a detailed set of controls for health risk factors including maternal smoking, drinking, and vitamin use during pregnancy, as well as breastfeeding and secondhand smoke exposure after birth, are significantly related to family income and maternal education, they do not explain the relationship between family income and maternal-assessed health of the child. We suggest that these results point to either more salient pathways through which family income impacts child health, such as maternal stress, or to the possibility that differences in subjective health status do not correspond to differences in objective health status in the same way for higher- and lower-income respondents.

Elkins IJ; McGue M; Malone S; Iacono WG. The effect of parental alcohol and drug disorders on adolescent personality. American Journal of Psychiatry 161(4): 670-676, 2004. (36 refs.)

Objective: The relationship of parental alcohol or drug diagnosis to offspring personality was examined in a population-based sample of 17-year-old twins (568 girls and 479 boys) participating in the Minnesota Twin Family Study. Whether offspring personality characteristics 1) are specific to the type of substance use disorder in parents (alcohol versus drug) and 2) are found in high-risk offspring without substance use disorders as well as in offspring with substance use disorders was investigated. Method: Personality was assessed with the Multidimensional Personality Questionnaire; substance use disorders were assessed in person through diagnostic interviews. Results: In both male and female offspring, parental history of alcohol dependence was associated with greater negative emotionality, aggression, stress reaction, and alienation but lower well-being; parental history of drug disorders was associated with lower constraint, control, harm avoidance, and traditionalism but higher social potency. Excluding offspring with a substance use disorder had virtually no effect on the statistical significance of these findings. Conclusions: In contrast to findings in some adult samples, personality characteristics associated with a family history of substance use disorders are found even in adolescent offspring who have not yet developed these disorders themselves, suggesting that personality might be one indicator of familial risk for substance use disorders during this developmental stage. Personality profiles of offspring of parents with substance use disorders also show some diagnostic specificity, with constraint associated with parental drug abuse and negative emotionality with parental alcoholism.

Flynn HA; Cain SA; O'Mahen HA; Davis MM. Detection of maternal alcohol use problems in the pediatric emergency department. Alcoholism: Clinical and Experimental Research 30(7): 1160-1164, 2006. (29 refs.)

Background: Maternal alcohol use problems may impact the health and well-being of children, but often remain unrecognized. Mothers of young children seldom seek outpatient care for themselves; thus, pediatric settings may present an opportunity for the detection of maternal alcohol use problems. This study examines the feasibility of screening for and prevalence of alcohol use problems in mothers of young children in the context of seeking pediatric emergency care. We also examined the relationship of maternal alcohol use problems with use of pediatric emergency care. Methods: A total of 361 English-speaking mothers of children aged 7 and younger completed screening measures during their child's emergency care visit. TWEAK was used to screen for alcohol use problems. The screening survey also included information on children's health status and health care use, demographics, and the Center for Epidemiological Studies Depression Scale. Results: Of the women approached, 90% agreed to complete the screening measure. On the basis of cutoff score of 2 or more, 7% of women had elevated TWEAK scores. Those women with a TWEAK score > 2 reported greater use of the pediatric emergency department (PED) than women scoring below the cutoff. On the basis of multivariate analyses, significant predictors of recent PED use included the presence of child chronic illness, younger maternal age, and TWEAK score. Conclusions: Screening for alcohol use problems among mothers of young children using the TWEAK appears to be feasible in a busy PED setting. The PED setting is promising for identifying risk drinking among women who may be less likely to be otherwise detected and for whom alcohol use may be impacting child outcomes.

Garcia-Algar O; Kulaga V; Gareri J; Koren G; Vall O; Zuccaro P et al. Alarming prevalence of fetal alcohol exposure in a Mediterranean city. Therapeutic Drug Monitoring 30(2): 249-254, 2008. (19 refs.)

The prevalence of gestational ethanol exposure and subsequent fetal exposure has been assessed in a cohort of mother-infant dyads in a Mediterranean city (Barcelona, Spain) by mcconium analysis of fatty acid ethyl esters (FAEEs) after showing in this population a high prevalence of meconium opiates (8.7%), cocaine (4.4%), and cannabis (5.3%). Of the 353 mcconium samples analyzed for FAEEs, 159 (45%) contained a total amount of seven FAEEs equal or above 2 nmol/g meconium, the cutoff internationally accepted to differentiate heavy maternal alcohol consumption during pregnancy from occasional use or no use at all. No parental sociodemographic differences or maternal features differentiated exposed from unexposed newborns. The prevalence of gestational consumption of ethanol was similar between women using and not using drugs of abuse during pregnancy (45.7% and 44.7% of samples with total FAEEs equal or higher than 2 nmol/g meconium, respectively). Meconium samples from newborns exposed in utero to ethanol, and positive for at least one illicit drug (cocaine, opiates, or cannabis), had total FAEEs and five of nine individual FAEEs statistically higher than the meconium samples that were negative for the most frequently used illicit drugs of abuse. Among the most prevalent FAEEs, oleic acid ethyl ester showed the best correlation to total FAEE concentration followed by palmitoleic acid ethyl ester. This study, which highlights a 45% ethanol consumption during pregnancy in a low socioeconomic status cohort, may serve as an eye opener for Europeans that gestational alcohol exposure is not endemic only in areas outside of Europe.

Gareri J; Lynn H; Handley M; Rao C; Koren G. Prevalence of fetal ethanol exposure in a regional population-based sample by meconium analysis of fatty acid, ethyl esters. Therapeutic Drug Monitoring 30(2): 239-245, 2008. (39 refs.)

Challenges in identifying children exposed prenatally to ethanol necessitate the development of a biomarker for neonates at risk for fetal alcohol spectrum disorder. Meconium fatty acid ethyl esters (FAEE), products of nonoxidative ethanol metabolism, have been established as a novel biomarker of fetal ethanol exposure. We present the first application of this biomarker to a population-based sample in Canada. Six-hundred eighty-two meconium specimens were anonymously collected in the region of Grey Bruce, Ontario, Canada. Meconium FAEE were extracted by liquid-liquid and solid-phase extraction and analyzed by gas chromatography with flame-ionization detection confirmed by gas chromatography with mass spectrometry. We measured ethyl palmitate (E16:0), ethyl palmitoleate (E16:1), ethyl stearate (E18:0), ethyl oleate (E18:1), ethyl linoleate (E18:2), ethyl linolenate (E18:3), and ethyl arachidonate (E20:4). Seventeen of 682 meconium samples tested positive for significant prenatal ethanol exposure (> 2.0 nmol/g). FAEE analysis detected fivefold more ethanol-exposed pregnancies than standard postpartum questionnaires in this population (2.5% versus 0.5%) (P < 0.001). The prevalence of ethanol-exposed pregnancies was consistent with Centers for Disease Control and Prevention estimates of "frequent" prenatal drinking and previously published estimates of fetal alcohol spectrum disorder disease prevalence in the general North American population. The FAEE concentrations of negative (95% confidence interval, 0.38-0.49 nmol/g) versus positive (95% confidence interval, 7.74-151.28 nmol/g) samples were distinct, further demonstrating the specificity of this.biomarker in determining significant prenatal ethanol exposure. Meconium FAEE analysis demonstrates a fivefold increase in sensitivity over currently used methods of self-report-based screening in Ontario for the detection of ethanol-exposed pregnancies in a clinical setting.

Giglia RC; Binns CW. Patterns of alcohol intake of pregnant and lactating women in Perth, Australia. Drug and Alcohol Review 26(5): 493-500, 2007. (37 refs.)

Introduction and Aims. Australian alcohol consumption data for women during the period of pregnancy and lactation is limited. The purpose of this paper is to provide current alcohol consumption data for pregnant and lactating women in Perth, Western Australia (WA). Data were collected from 587 women between mid-September 2002 and mid-july 2003. Design and Methods. Women from two public hospitals with maternity wards in the Perth metropolitan area completed a self-administered baseline questionnaire while in hospital or shortly after discharge. All women, regardless of their chosen infant feeding method, were followed-up by telephone interview at 4, 10, 16, 22, 32, 40 and 52 weeks postpartum. Data were analysed to determine alcohol use patterns of the women during the period of pregnancy and lactation and results were compared to national guidelines for alcohol consumption. Results. Approximately 32% of women stopped drinking alcohol during pregnancy. A remaining 35% of pregnant women consumed alcohol during pregnancy, with 82.2% of these women consuming up to two standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breast feeding women were consuming alcohol, respectively. Discussion and Conclusions. The majority of breast feeding women consumed up to two standard drinks per week, which is within levels recommended by national authorities. There is, however, a small proportion of women consuming alcohol at levels above national recommendations for pregnancy and lactation. The development of 'safe' alcohol intake practices, within national recommendations, during the postnatal period would remove any potential health risks to the infant from alcohol exposure at this vulnerable growth stage.

Gillmore MR; Gilchrist L; Lee J; Oxford ML. Women who gave birth as unmarried adolescents: Trends in substance use from adolescence to adulthood. Journal of Adolescent Health 39(2): 237-243, 2006. (27 refs.)

Purpose: To determine whether adolescent childbearing mothers "mature out" of substance use as they transition into adulthood, how their substance use compares to that of typical young women of the same ages, and whether there are different patterns of substance use evident in this vulnerable population. Methods: The data come from an ongoing longitudinal study of 240 young women who were unmarried, pregnant, and under age 18 at enrollment. They have been interviewed regularly from pregnancy through 11.5 years postpartum. The data are based on self-reported substance use verified by random urinalysis for drug metabolites. Results: Substance use did not decline during the transition to adulthood nor into early adulthood. With the exception of alcohol, the prevalence of substance use was higher than that of a nationally representative sample of same-aged women. Three distinct patterns of substance use were identified: licit users (cigarettes and/or alcohol), marijuana users, and "hard" drug users. Conclusions: Clinicians should routinely assess substance use among young mothers who bore children as teenagers, and make referrals for appropriate treatment. Cigarette smoking is especially a cause for concern, given its widespread use and harmful effects for both mothers and their children. Although only a small proportion (about 5%) of young mothers used hard drugs consistently over time, this group will likely require comprehensive interventions that address multiple issues such as mental health and contextual factors to be effective. Future research should address reasons for continued substance use in this population.

Gogineni A. Gender differences in parental alcoholism and alcohol use problems and depression among adult daughters. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 190A-190A, 2004. (0 refs.)

Hayatbakhsh MR; Alati R; Hutchinson DM; Jamrozik K; Najman JM; Mamun AA et al. Association of maternal smoking and alcohol consumption with young adults' cannabis use: A prospective study. American Journal of Epidemiology 166(5): 592-598, 2007. (30 refs.)

This 2006 study examined 1) whether maternal use of tobacco and consumption of alcohol when a child is 5 and 14 years of age predict cannabis use in young adults, and 2) whether this association is explained by possible confounding or mediating factors. Data were taken from a prospective birth cohort study of mothers and their children in Brisbane, Australia. This study was based on a cohort of 3,176 young adults who participated at the 21-year follow-up of the study and for whom data were available on maternal smoking and alcohol consumption 5 and 14 years after their birth. After controlling for possible confounders, the authors found that maternal smoking at 14 years was associated with frequent use of cannabis in offspring at 21 years, regardless of maternal smoking at 5 years. Children of mothers who drank more than one glass of alcohol at 5 years and continued at 14 years were more likely to use cannabis in early adulthood. The association between maternal substance use and offspring cannabis use was partially mediated by adolescent externalizing behavior and smoking measured at 14 years. Prevention programs that address maternal and adolescent tobacco use and adolescent externalizing behavior should be considered as strategies to reduce cannabis use by young adults.

Hennigan KM; O'Keefe M; Noether CD; Rinehart DJ; Russell LA. Through a mother's eyes: Sources of bias when mothers with co-occurring disorders assess their children. Journal of Behavioral Health Services & Research 33(1): 87-104, 2006. (64 refs.)

Mothers are the principal informants on children's emotional and behavioral functioning. Maternal assessments of child functioning can be influenced by a mother's own psychological state. The magnitude and valence of distortion in maternal assessments associated with current maternal mental health and substance abuse symptoms were explored in a clinical sample of 253 mothers with co-occurring disorders and histories of trauma. Analyses estimated the correlation between current maternal symptoms and child assessments after controlling for maternal history of disorders, child's history of service utilization for emotional and behavioral problems, and demographic characteristics. Current maternal psychological distress was associated with more pessimistic assessments on the problem-focused Child Behavior Checklist, whereas current maternal substance abuse problems were associated with more optimistic assessments on both problem-focused and strength-based measures. Clinicians and researchers may choose to take distortion into account when treatment plans or measures of change are based on maternal assessments.

Infante-Rivard C; El-Zein M. Parental alcohol consumption and childhood cancers: A review. (review). Journal of Toxicology and Environmental Health. Part B, Critical Reviews 10(1-2): 101-129, 2007. (79 refs.)

The etiology of childhood cancers remains generally unknown. Given that the metabolites of alcohol are likely carcinogens and that leukemia, the most frequent childhood cancer, can arise in utero, the study of alcohol consumption as a potential risk factor for the development of childhood cancer is justified. This article summarizes the epidemiological evidence on the association between parental exposure to alcohol and the risk of childhood cancers. To do this, a thorough search of the literature from 1960 to 2003 using the PubMed database was carried out. It yielded 33 case-control studies published between 1982 and 2003, including 13 studies that considered paternal exposure in the preconceptional period. In 10 of the 33 studies at least 1 statistically significant risk increase was reported in relation with parental alcohol consumption; in 7 of these studies the increase was related to maternal consumption, whereas in 3 studies, it was related to paternal consumption. The cancers most often found associated with parental drinking were leukemia, brain tumors, and neuroblastoma. A few studies also reported a protective effect with maternal exposure at modest levels. Inconsistencies in the results and the low risks reported do not suggest an association between childhood cancer and parental consumption of alcohol. However, before reaching any definitive conclusions, methodological issues need to be addressed in future studies, as well as the role of genetic susceptibility. Moreover, subtypes of specific cancers need to be studied separately.

Jagodzinski T; Fleming MF. Postpartum and alcohol-related factors associated with the relapse of risky drinking. Journal of Studies on Alcohol and Drugs 68(6): 879-885, 2007. (26 refs.)

Objective: The purposes of this investigation were (1) to describe postpartum drinking patterns among women who were frequent drinkers before pregnancy and (2) to identify factors correlated with postpartum "risky" drinking among women who were frequent drinkers before pregnancy Method: Information was gathered through a self-administered questionnaire completed at the postpartum visit and a subsequent face-to-face interview of 381 women, recruited from 35 obstetric/gynecologic clinics throughout Wisconsin, who reported frequent drinking before pregnancy. Multivariate analyses were used to identify correlates of postpartum risky drinking, defined as consuming four or more drinks per occasion (heavy episodic drinking) at least twice in the past 28 days or drinking an average of seven or more drinks per week. Results: Overall, 37.8% (n = 144) of women reported postpartum risky drinking. Eighteen percent reported heavy episodic drinking only, 5% reported frequent drinking only, and 15% reported both behaviors. Postpartum risky drinkers were more likely than other women to have had a partner who engaged in risky drinking (odds ratio [OR] = 2.6, 95% confidence interval [CI 1.5-4.5), to have been unemployed (OR = 3.0, 95% CI 1.2-7.7), to have smoked following pregnancy (OR = 1.9, 95% CI 1.0-3.5), and to have consumed alcohol after the recognition of pregnancy (OR = 4.8, 95% CI 2.2-10.6). Women who breast-fed their child were less likely to report risky drinking (OR = 0.3, 95% CI 0.2-0.5). Conclusions: In the postpartum period, health care providers may want to focus alcohol screening efforts on former frequent drinkers who are smokers, are unemployed, have a partner who is a risky drinker, or are not breast-feeding.

James C; Klenka H; Manning D. Sudden infant death syndrome: Bed sharing with mothers who smoke. Archives of Disease in Childhood 88(2): 112-113, 2003. (10 refs.)

Aim: To examine the sleeping arrangements of sudden infant death syndrome (SIDS) cases on the Wirral. In particular to determine the prevalence of bed sharing with mothers who smoke, a known risk factor for SIDS. Methods: Retrospective study of postmortem determined cases of SIDS from 1995 to 2000 on the Wirral peninsula (population 350 000, 3500 annual births). Ambulance crew reports, case notes, health visitor reports, postmortem reports, and case discussion records were studied for each case. Results: There were 25 cases of SIDS in the postneonatal age group over the six year period. In nine cases the baby was bed sharing with the mother, of whom seven were smokers. Five of these mothers reported using alcohol or illicit drugs on the night of their infant's death. In two further cases the baby slept on a sofa with a parent. Conclusions: Bed sharing and smoking remain important risk factors for SIDS. Mothers should be advised ante-and postnatally of this combination of risk factors. Such advice should also include a recommendation not to sleep with their baby if under the influence of alcohol or illicit drugs, and never to sleep on a sofa with their baby. All "Child Health Record" books given to parents on the Wirral now include this advice. "Reduce the Risk" advice leaflets given to parents pre- and postnatally also now carry the recommendation, and health visitors and midwives have been educated with respect to these additions.

Jones AS. Maternal alcohol abuse/dependence, children's behavior problems, and home environment: Estimates from the National Longitudinal Survey of Youth using propensity score matching. Journal of Studies on Alcohol and Drugs 68(2): 266-275, 2007. (65 refs.)

Objective: Propensity score (PS) matching was used to investigate the relationship between maternal alcohol abuse (AA) and alcohol dependence (AD), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and three child outcomes: child behavior problems and two characteristics of the child's home environment as measured by the Home Observation and Measurement of the Environment-Short Form, cognitive stimulation and emotional support. Method: A cohort of children (N = 2,193; 49% female) whose mothers were drawn from the 1994 National Longitudinal Survey of Youth were stratified by gender and matched on maternal propensity to exhibit AA or AD. Results: After matching, sons of mothers with AA/ AD had higher behavior problem scores (p <= .05), and daughters of mothers with AA/AD lived in homes with significantly less emotional support (p <= 05) and cognitive stimulation (p :<= .005). Results were robust to alternative specifications of PS regressions. Conclusions: The findings suggest that policies aimed at reducing AA and AD among young adult women with children are justified. PS matched results also suggest that school counselors and mental health providers who encounter young boys with elevated behavior problems should consider maternal AA/AD as one possible causal factor. Future research should be directed toward understanding the trajectory of these outcomes and their sequelae over the child's life cycle and toward developing improved methods of identifying and intervening with at-risk children of both genders and their mothers.

Jones L. The prevalence and characteristics of substance abusers in a child protective service sample. Journal of Social Work Practice in the Addictions 4(2): 33-50, 2004. (31 refs.)

The purpose of this research was to identify characteristics of substance abusers in a child protective services caseload. The random sample of 443 children was drawn from an urban county from all children with a substantiated abuse case. Files of children were reviewed to derive data. Sixty-eight percent of the children had mothers who abused alcohol or drugs, and 37 percent of them had mothers who abused both. Substance abuse, service contacts, public assistance, homelessness, and household conditions in the service plan were all associated with child removal from the home. These findings suggest that the risks associated with substance abuse are not necessarily ameliorated with social work intervention.

Kaemingk KL; Mulvaney S; Halverson PT. Learning following prenatal alcohol exposure: Performance on verbal and visual multitrial tasks. Archives of Clinical Neuropsychology 18(1): 33-47, 2003. (50 refs.)

Learning following prenatal alcohol exposure was studied, with a focus on performance on verbal and visual multi-trial tasks. Specifically, this study examined verbal and visual multi-trial learning in children with fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE). The research sample included 20 Native American children, ranging in age from 6 to 16, who had been diagnosed with FAS or FAE and 20 age- and sex-matched Native American controls from the same cultural and socioeconomic background. All FAS/FAE children were in regular classrooms for part of each school day and received special education services. Intelligence and learning were assessed using the Wechsler Intelligence Scale for Children-Third Edition (WISC-III), the Verbal Learning and Visual Learning tasks from the Wide Range Assessment of Memory and Learning (WRAML). The following results of the study were seen: (1) significantly weaker memory on the Verbal Learning and Visual Learning tasks from the Wide Range Assessment of Memory and Learning (WRAML) for the FAS/FAE group than for controls; and (2) retention by the FAS/FAE group of an equivalent proportion of the visual and verbal information as compared to the control group. It is concluded that despite weaker learning, the relative retention of information by the FAS/FAE group was not different than that of the control group.

Kalter H. Teratology in the 20th century. Environmental causes of congenital malformations in humans and how they were established. Neurotoxicology and Teratology 25(2): 131-282, 2003. (1464 refs.)

This comprehensive review of teratology in the 20th century, begins with the chance findings at the beginning of the 20th century, the "rediscovery of Mendel's laws of inheritance" and Roentgen ray's ability to induce malformations. This review covers early human studies, early experiments, and then in the wake of abnormalities associated with thalidomide, the advent of drug testing for teratogenic effects, surveillance efforts, and epidemiological studies. The focus of the concluding chapters address congenital malformations associated with human disease, environmental hazards, medications, and the concluding chapter deals with alcohol, As part of this review, there is discussion of alcohol. This discussion covers the early Seattle study, the description of fetal alcohol syndrome and the subsequent expansion to include fetal alcohol effects. Attention then turns to diagnosis, both epidemiological studies and retrospective and prospective studies. The major and minor malformations are outlined, as well as the long term effects on growth, orofacial defects, limb defects, neurodevelopmental studies. There is also discussion of the role of drinking patterns, including moderate drinking, and the relationship of alcohol use to spontaneous abortion.

Kelley SM; Lewis K; Sigal J. The impact of risk factors on the treatment of adolescent sex offenders. Journal of Addictions & Offender Counseling 24(2): 67-81, 2004. (30 refs.)

The authors investigated the impact that 5 selected risk factors have on the treatment outcome of adolescent male sex offenders. The results indicated that the greatest risk factor among sex offenders was having a mother who had a substance abuse problem.

Kunins HV; Bellin E; Chazotte C; Du E; Arnsten JH. The effect of race on provider decisions to test for illicit drug use in the peripartum setting. Journal of Women's Health 16(2): 245-255, 2007. (33 refs.)

Background: Testing for illicit drugs may expose women who test positive to severe legal and social consequences. It is unknown whether racial disparities in drug testing practices underlie observed disparities in legal and social consequences of positive tests. Methods: Using administrative hospital and birth certificate data, we analyzed factors associated with both receipt and results of illicit drug testing among women with live births during 2002 - 2003. We assessed the independent association of race and other sociodemographic factors with both receipt of a drug test by the mother or her newborn infant and positive maternal or neonatal toxicology results, after controlling for obstetrical conditions and birth outcomes associated with maternal substance abuse. Results: Of the 8487 women with live births, 244 mother-newborn pairs (3%) were tested for illicit drug use. Black women and their newborns were 1.5 times more likely to be tested for illicit drugs as nonblack women in multivariable analysis. However, race was not independently associated with a positive result. Conclusions: We identified racial differences in rates of testing for illicit drug use between black and nonblack women. We found equivalent positivity rates among tested black and nonblack women. The prevalence of drug use among untested women is unknown, however, so although tested women had equivalent rates of substance use detected, whether black and nonblack substance users are equally likely to be identified in the course of peripartum care remains uncertain.

Leonardson GR; Loudenburg R; Struck J. Factors predictive of alcohol use during pregnancy in three rural states. Behavioral and Brain Functions 3: article 8, 2007. (25 refs.)

Background: A substance use screening instrument was used to determine factors predictive of drinking during pregnancy. Alcohol consumption during pregnancy can lead to negative birth outcomes. Methods: The participants (n = 4,828) for the study were sampled from pregnant women attending prenatal clinics in Montana, South Dakota, and North Dakota. Clinic sites for the administration of the screening instrument were selected in each state, based on geographic and known population characteristics. Univariate and multivariate statistical procedures were used to determine factors predictive of drinking during pregnancy. Results: Women who drank tended to: be single, be between 21-25 years old, have had fewer children, have had abortions, and be unemployed. Demographic factors that were protective of drinking when pregnant were married and full-time housewife status. Other variables associated with maternal alcohol use were: past sexual abuse, current or past physical abuse, tobacco use, other drug use, lived with substance users, and had mates who were substance users. Other contributing factors for alcohol use included: feeling sad, believing that drinking any amount of alcohol while pregnant was acceptable, had been in treatment, could use treatment now, and were able to hold four or more drinks. Conclusion: Because drinking rates were high and factors correlated with drinking are known, alcohol screening for this population is essential.

Linnet KM; Dalsgaard S; Obel C; Wisborg K; Henriksen TB; Rodriguez A et al. Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: Review of the current evidence. (review). American Journal of Psychiatry 160(6): 1028-1040, 2003. (103 refs.)

Objective: The purpose of this review was to examine the literature assessing the relationship between prenatal exposure to nicotine, alcohol, caffeine, and psychosocial stress during pregnancy to the risk of developing behavioral problems related to attention deficit hyperactivity disorder (ADHD) in childhood. Method: PubMed, MEDLINE, EMBASE, and PsycINFO were searched systematically. Studies using DSM diagnostic criteria and other validated diagnostic or screening instruments for ADHD and those examining ADHD symptoms were included. A narrative approach was used because the studies differed too much in methods and data sources to permit a quantitative meta-analysis. Results: Twenty-four studies on nicotine (tobacco smoking), nine on alcohol, one on caffeine, and five on psychosocial stress were identified. All were published between 1973 and 2002. in spite of inconsistencies, the studies on nicotine indicated a greater risk of ADHD-related disorders among children whose mothers smoked during pregnancy. Contradictory findings were reported in the alcohol studies, and no conclusion could be reached on the basis of the caffeine study. Results from studies on psychological stress during pregnancy were inconsistent but indicated a possible modest contribution to ADHD symptoms in the offspring. Many studies suffered from methodological shortcomings, such as recall bias, crude or inaccurate exposure assessments, low statistical power, and lack of or insufficient control of confounders. A general lack of information on familial psychopathology also limited the interpretations. Conclusions: Exposure to tobacco smoke in utero is suspected to be associated with ADHD and ADHD symptoms in children. Other maternal lifestyle factors during pregnancy may also be associated with these disorders. Further studies are needed to reach conclusions.

Luthar SS; Sexton CC. Maternal drug abuse versus maternal depression: Vulnerability and resilience among school-age and adolescent offspring. Development and Psychopathology 19(1): 205-225, 2007. (66 refs.)

In this study of 360 low-income mother-child dyads, our primary goal was to disentangle risks linked with commonly co-occurring maternal diagnoses: substance abuse and affective/anxiety disorders. Variable- and person-based analyses suggest that, at least through children's early adolescence, maternal drug use is no more inimical for them than is maternal depression. A second goal was to illuminate vulnerability and protective processes linked with mothers' everyday functioning, and results showed that negative parenting behaviors were linked with multiple adverse child outcomes. Conversely, the other parenting dimensions showed more domain specificity; parenting stress was linked with children's lifetime diagnoses, and limit setting and closeness with children's externalizing problems and everyday competence, respectively. Results are discussed in terms of implications for resilience theory, interventions, and social policy.

Northam S; Knapp TR. The reliability and validity of birth certificates. (review). Journal of Obstetric, Gynecologic and Neonatal Nursing 35(1): 3-12, 2006. (56 refs.)

Objectives: To summarize the reliability and validity of birth certificate variables and encourage nurses to spearhead data improvement. Data Sources: A Medline key word search of reliability and validity of birth certificate, and a reference review of more than 60 articles were done. Study Selection: Twenty-four primary research studies of U.S. birth certificates that involved validity or reliability assessment. Data Extraction: Studies were reviewed, critiqued, and organized as either a reliability or a validity study and then grouped by birth certificate variable. Data Synthesis: The reliability and validity of birth certificate data vary considerably by item. Insurance, birthweight, Apgar score, and delivery method are more reliable than prenatal visits, care, and maternal complications. Tobacco and alcohol use, obstetric procedures, and delivery events are unreliable. Birth certificates are not valid sources of information on tobacco and alcohol use, prenatal care, maternal risk, pregnancy complications, labor, and delivery. Conclusions: Birth certificates are a key data source for identifying causes of increasing U.S. infant mortality but have serious reliability and validity problems. Nurses are with mothers and infants at birth, so they are in a unique position to improve data quality and spread the word about the importance of reliable and valid data. Recommendations to improve data are presented.

Ohannessian CM; Hesselbrock VM; Kramer J; Bucholz KK; Schuckit MA; Kuperman S; Nurnberger JI. Parental substance use consequences and adolescent psychopathology. Journal of Studies on Alcohol 65(6): 725-730, 2004. (25 refs.)

Objective: This study examines the relationship between parental substance use consequences and adolescent psychological problems by gender of the adolescent and gender of the parent. Method: The data in this study were collected between 1989 and 1994 from 173 (116 proband and 57 control) families participating in the Collaborative Study on the Genetics of Alcoholism (COGA) project. All 173 adolescents (89 [51%] boys) completed the Structured Assessment Record of Alcoholic Homes (SARAH) to assess parental substance use consequences. In addition. the Semi-Structured Assessment for the Genetics of Alcoholism for Adolescents (C-SSAGA-A) was administered to all adolescents to obtain clinical psychiatric diagnoses. Results: Concern about mother's substance use was significantly associated with adolescent alcohol dependence and major depressive disorder. In addition, concern about father's substance use was significantly related to adolescent alcohol dependence. Avoidance of mother when she was drinking or using drugs and maternal anger when drinking or using drugs also was significantly associated with adolescent alcohol dependence, conduct disorder and major depressive disorder. In contrast, avoidance of father and paternal anger when drinking or using drugs was not related to any of the adolescent diagnoses. Conclusions: These results suggest that maternal substance use consequences may be more closely linked to adolescent psychological adjustment than are paternal substance use consequences.

Ondersma SJ; Delaney-Black V; Covington CY; Nordstrom B; Sokol RJ. The association between caregiver substance abuse and self-reported violence exposure among young urban children. Journal of Traumatic Stress 19(1): 107-118, 2006. (41 refs.)

This study examined the relative importance of caregiver substance abuse as a correlate of child-reported exposure to violence. A total of 407 female African-American primary caregivers and their children age 6 to 7 were evaluated. The association between child report of violence and exposure to substance abuse by others (both within and outside the home) was considered after controlling for variance accounted for by child characteristics, caregiver characteristics, home environment, and neighborhood environment (including neighborhood crime). Caregiver alcohol abuse, children witnessing of drug use in the home, and children witnessing of drug deals all explained significant additional variance in violence exposure. These findings suggest that for early elementary-age children, meaningful prevention of violence exposure may be possible via addressing their exposure to substance abuse in their home and community.

Ornoy A. The impact of intrauterine exposure versus postnatal environment in neurodevelopmental toxicity: Long-term neurobehavioral studies in children at risk for developmental disorders. Toxicology Letters 140(Special Issue): 171-181, 2003. (38 refs.)

Various investigators have shown that enriched environment may positively affect the early brain development of experimental animals. Environment was also shown to positively affect the development of young children born to mothers of low socio-economic class (low SES). It is unknown, however, to what extent can an enriched environment improve the developmental outcome of children born with slight brain damage. We studied the development of preschool and early school age children born to heroin dependent parents raised at home or adopted in comparison to children suffering only from environmental deprivation (low parental SES) and to controls. They were examined by several professionals, using standard, age appropriate, neurological and psychological tests. Similar evaluations were performed on a group of early school age children born to mothers with pregestational or with gestational diabetes and on a group of children born prematurely, with a birth weight of less than 1500 g using various developmental tests. Young children born to heroin dependent mothers and fathers raised at home and children of low SES had, in comparison to controls, lower intellectual skills and a higher rate of inattention. This persisted at school age, too. Children born to heroin dependent mothers adopted at a young age and hence being raised in a good environment had normal intellectual function but a high rate of inattention and behavioral problems. We also examined the school age children for possible presence of ADHD and found a high rate of ADHD among all children born to heroin dependent parents including those adopted, as well as in the children with low parental SES. Similar findings regarding the strong positive influence of an enriched environment were observed in children born to diabetic mothers, where the intellectual abilities of the children were directly related with parental education. The cognitive abilities of the children born prematurely were also strongly associated with parental education and not with the degree of perinatal complications. In conclusion, in all groups of children at high risk for developmental problems was found that the environment has a strong influence on their intellectual abilities but not on motor skills or attention span. A good environment (high parental SES) may significantly improve the outcome.

Patock-Peckham JA; Morgan-Lopez AA. College drinking behaviors: Mediational links between parenting styles, parental bonds, depression, and alcohol problems. Psychology of Addictive Behaviors 21(3): 297-306, 2007. (83 refs.)

Mediational links between parenting styles (authoritative, authoritarian, permissive), parental bond (positive, negative), depression, alcohol use and abuse were tested. A 2-group, multiple-indicator, multiple-cause structural equation model with 441 (216 female, 225 male) college students was examined. In general, a poor parental bond with one's father was highly predictive of depression, a well-known predictor of alcohol abuse and related problems for both genders. In contrast, a positive parental bond with one's father significantly mediated the positive effects of authoritative fathering on depression, which then decreased alcohol use problems for both genders. For women, a negative parental bond with one's father significantly mediated the effect of having an authoritarian father on depression, which increased alcohol use problems. These findings suggest that parental influences on pathways to alcohol abuse through depression (primarily through fathers for both genders) are distinct from pathways stemming from poor impulse control (with influences primarily from the same-sex parents for both genders).

Peiponen S; Laukkanen E; Korhonen V; Hintikka U; Lehtonen J. The association of parental alcohol abuse and depression with severe emotional and behavioural problems in adolescents: A clinical study. International Journal of Social Psychiatry 52(5): 395-407, 2006. (35 refs.)

Background: Earlier studies have indicated associations between parental psychiatric problems, such as depression, and substance abuse and adolescent problems. Aims: This study aimed to determine whether parental psychiatric problems are associated with problems and problem behaviour in adolescents in a clinical sample. Methods: The study subjects were 70 outpatient adolescents (age 13-18 years, boys 30%) and their parents. The adolescents were assessed using the structural clinical interview for DSM-III-R (SCID) and a semi-structured questionnaire, and the parents were interviewed using a semi-structured questionnaire. Results: Maternal alcohol abuse and depression were associated with serious problems, especially among girls, and paternal alcohol abuse was associated with adolescent health-compromising behaviour. Maternal depression and alcohol abuse had no association with adolescent health-compromising behaviour. Maternal depression without alcohol abuse was associated with the diagnosis of major depressive disorder in adolescents, but not with other adolescent problems, while paternal depression without alcohol abuse was not associated with any adolescent problems. Conclusions: Despite the small study sample, these findings indicate that parental psychiatric problems and alcohol abuse are correlated with adolescent psychological problems and should be considered and assessed when assessing adolescents.

Pragst F; Yegles M. Determination of fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) in hair: A promising way for retrospective detection of alcohol abuse during pregnancy? Therapeutic Drug Monitoring 30(2): 255-263, 2008. (51 refs.)

The retrospective detection of alcohol consumption during pregnancy is an important part of the diagnosis of the fetal alcohol syndrome. A promising way to solve this problem can be the determination of fatty acid ethyl esters (FAEE) or/and ethyl glucuronide (EtG) in hair of the mothers. In this article, the present state in analytical determination and interpretation of FAEE and EtG concentrations in hair are reviewed. Both FAEE and EtG are minor metabolites of ethanol and as direct alcohol markers very specific for alcohol. They are durably deposited in hair, which enables taking advantage of the long diagnostic time window of this sample material. In the last years, specific and sensitive methods for determination of both alcohol markers in hair were developed. Headspace solid phase microextraction in combination with gas chromatography-mass spectroscopy after hair extraction with an n-heptane/dimethylsulfoxide mixture proved to be a favorable technique for determination of four characteristic FAEE (ethyl myristate, ethyl palmitate, ethyl oleate, and ethyl stearate). EtG is extracted from hair by water and analyzed either by gas chromatography-mass spectroscopy with negative chemical ionization after cleanup with solid phase extraction and derivatization with pentafluoropropionic anhydride or by liquid chromatography-mass spectroscopy-mass spectroscopy. The detection limits of the single FAEE as well as of EtG are in the range of 1 to 10 pg/mg. FAEE as well as EtG were determined in a larger number of hair samples of teetotalers, social drinkers, patients in alcohol withdrawal treatment, and death cases with previous known heavy drinking. From the results, the following criteria were derived: strict abstinence is excluded or improbable at C-FAEE > 0.2 ng/mg or C-EtG > 7 pg/mg. Moderate social drinkers should have CFAEE < 0.5 ng/mg and CEtG < 25 pg/mg; above these values, alcohol abuse is probable. Until now, there has been no evaluation in context of FAS diagnosis; however, a successful application for this purpose can be expected from the good experience in driving ability examination.

Reichman NE; Teitler JO. Effects of psychosocial risk factors and prenatal interventions on birth weight: Evidence from New Jersey's HealthStart program. Perspectives on Sexual and Reproductive Health 35(3): 130-137, 2003. (30 refs.)

CONTEXT: Many states developed and implemented multifaceted Medicaid prenatal care programs in the late 1980s in response to expansions in Medicaid eligibility. Although these new programs were based on the presumed relationships between psychosocial risk factors, early prenatal care, prenatal interventions and birth outcomes, research has not verified all of these linkages. METHODS., Data were collected on 90,117 women who took part in New Jersey's comprehensive prenatal care program, Health Start, between 1988 and 1996. The impact of psychosocial risk factors and prenatal interventions on mean birth weight and the odds of low birth weight (less than 2,500 g) was assessed using ordinary least-squares regression and logistic regression, respectively. RESULTS: After controls were introduced for social and demographic, psychosocial and behavioral factors, as well as the woman's county of residence and the year of her baby's birth, smoking, drinking and using hard drugs (but not marijuana) during pregnancy were independently associated with reductions in mean birth weight (of 123 g, 29 g and 137 g, respectively) and with increases in the odds of low birth weight (odds ratios, 1.4, 1.2 and 1.7, respectively). However, according to the fully adjusted model, which also controlled for medical risk factors and prenatal services, the interventions designed to reduce those behaviors had no favorable effects on birth weight. In contrast, the receipt of services in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) was associated with an increase in mean birth weight of 22 g (and of 48 g among inadequately nourished women only), and with a reduction in the risk of low birth weight (odds ratio, 0.87).CONCLUSION. Referrals to WIC services should be a key feature of prenatal care programs for poor women.

Romitti PA; Sun LX; Honein MA; Reefhuis J; Correa A; Rasmussen SA. Maternal periconceptional alcohol consumption and risk of orofacial clefts. American Journal of Epidemiology 166(7): 775-785, 2007. (55 refs.)

Using data from the National Birth Defects Prevention Study, the authors investigated the association between maternal reports of periconceptional alcohol consumption and clefting. Cases with a cleft lip, cleft palate, or both and unaffected controls delivered from 1997 through 2002 were ascertained. Interview reports of alcohol consumption were obtained from 1,749 (75.1%) case and 4,094 (68.2%) control mothers. Adjusted odds ratios and 95% confidence intervals were calculated to assess associations. Compared with odds ratios for mothers with no reported consumption, those for mothers who consumed alcohol tended to be near to (cleft lip, cleft lip with cleft palate) or to exceed (cleft palate) unity. The odds ratios associated with binge drinking were elevated but did not demonstrate significantly increased risk for any phenotype; however, the odds ratios differed by the type of alcohol consumed, particularly for cleft palate (distilled spirits > wine > beer). These odds ratios were further increased among mothers with no reported folic acid intake. Although these findings suggest that the association between alcohol consumption and clefting might be most influenced by the type of beverage consumed and folic acid intake, they are preliminary and might reflect chance associations. Such findings need exploration in additional, large studies.

Rosen D; Seng JS; Tolman RM; Mallinger G. Intimate partner violence, depression, and posttraumatic stress disorder as additional predictors of low birth weight infants among low-income mothers. Journal of Interpersonal Violence 22(10): 1305-1314, 2007. (27 refs.)

Estimates of intimate partner violence (IPV) during pregnancy vary by population being studied, measures, and other methodological limitations, hindering the ability to gauge the relationship between IPV and negative birth outcomes. The authors report aggregated data from a subsample (n = 148) of the first three waves of the Womens Employment Study. The authors compared groups of women who did and did not give birth to low birth weight infants on demographic, material deprivation, risk behavior, mental health, and lPV factors. The prevalence of domestic violence was more than twice as high for women with low birth weight infants as those women who had a normal weight infant. When considering additional risk factors, including food insufficiency, substance dependence, and depression and/or posttraumatic stress disorder, lPV remained a significant indicator, but it was most strongly associated with low birth weight among women also experiencing depression and/or posttraumatic stress disorder.

Rouleau M; Levichek Z; Koren GA. Are mothers who drink heavily in pregnancy victims of FAS? Journal of FAS International 1(1): e4, 2003. (10 refs.)

Consumption of large amounts of alcohol in pregnancy adversely affects the fetus and may result in Fetal Alcohol Spectrum Disorder. Because of the familial trend of problem drinking, it is possible that women drinking heavily in pregnancy were also victims of FAS through their mother's drinking. This study sought to examine the possibility that women drinking in pregnancy were also affected by alcohol use in their mothers. A cohort study was conducted at "Breaking the Cycle" program in Toronto, where mothers of young children or expecting mothers with problem drinking and drug abuse, and their children are followed and treated. Women's alcohol use, depression, alcohol use in pregnancy, as well as learning difficulties, and their mother's alcohol consumption were assessed and compared to the general population. All 173 women who passed the first contact stage and were followed by the program were included in this study. One hundred and sixty-five women reported problem drinking, and 64 of them reported being raised by a mother with problem drinking. Rates of depression, learning difficulties, suicide attempts, drinking in pregnancy and criminality were 6-fold higher than in the general population, and their educational levels substantially lower than the Canadian average. A substantial proportion of women drinking heavily in pregnancy were born to women who drank heavily. Their characteristics, including rates of learning, disability, criminality and psychiatric morbidity, suggest that a substantial proportion of them are afflicted by ethanol embryopathy. Further studies should examine these women directly for the diagnosis of FAS.

Savage C; Wray J. Family history of alcohol use as predictor of alcohol and tobacco use during pregnancy. Journal of Addictions Nursing 15(3): 119-123, 2004. (33 refs.)

Because alcohol and tobacco use are known teratogenic substances that negatively affect the fetus, screening for alcohol and tobacco use during pregnancy is included as part of the nursing standard of care in obstetrical nursing (and some screening tools include family history as a risk factor for use during pregnancy. However, the only empirical evidence for including family history as a risk factor is located in the general addictions literature. The purpose of this study was to determine if parental history of alcohol and/or tobacco use increases the risk for use of these substances during pregnancy. This was a descriptive retrospective study based on the epidemiological model of risk. Mothers in the third month of pregnancy provided self-reported data on their use of alcohol and tobacco during pregnancy and their parents' lifetime use of these substances. Maternal history of alcohol use increased the odds of tobacco use during pregnancy (OR = 4.02, CI 1.732-9.343). Maternal family history of alcohol and tobacco use had a greater impact on increasing the odds for alcohol and tobacco use during pregnancy than paternal history of alcohol and tobacco use.

Schonfeld AMG. Moral judgment and reasoning in children and adolescents with prenatal alcohol exposure. Dissertation Abstracts International 63(8): 3937B, 2003

Children and adolescents with (ALC) and without (CON) prenatal alcohol exposure were evaluated on measures of moral judgment and reasoning and delinquency. Results revealed that while those in the ALC group performed at a lower level of moral maturity than the CON group, differences were not significant. Verbal IQ primarily accounted for these differences. However, this suggests that a deficit on the value judgment having to do with relationships with others is specific to prenatal alcohol exposure. Delinquency was higher for those in the ALC group; however, moral maturity did not predict delinquent behavior. In the CON group only, as the age of the subjects increased, more delinquent behaviors were endorsed. For the ALC group, socially desirable responding predicted delinquent behavior suggesting under-endorsement of such behavior. Measures of inhibition did not predict delinquency or moral maturity beyond control measures. More children and adolescents with heavy prenatal alcohol exposure, but without fetal alcohol syndrome (FAS), met criteria for Conduct Disorder (CD). Findings indicate that those with prenatal alcohol exposure are at a lower developmental level with respect to their moral reasoning about their affiliation with others. Alcohol-exposed individuals, specifically those without a diagnosis of FAS, are at higher risk for delinquency, particularly CD. These findings indicate that children and adolescents with prenatal alcohol exposure will benefit from social skills training in light of their continued deficits in interpersonal relations. Interventions aimed at their delinquent tendencies are warranted; however targeting moral judgment in an intervention may not yield additional benefit.

Scott DM; Taylor RE. Health-related effects of genetic variations of alcohol-metabolizing enzymes in African Americans. Alcohol Research & Health 30(1): 18-21, 2007. (27 refs.)

Alcohol metabolism involves two key enzymes-alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). There are several types of ADH and ALDH, each of which may exist in several variants (i.e., isoforms) that differ in their ability to break down alcohol and its toxic metabolite acetaldehyde. The isoforms are encoded by different gene variants (i.e., alleles) whose distribution among ethnic groups differs. One variant of ADH Is ADH1B, which is encoded by several alleles. An allele called ADH1B*3 is unique to people of African descent and certain Native American tribes. This allele is associated with more rapid breakdown of alcohol, leading to a transient accumulation of acetaldehyde. African Americans carrying this allele are less likely to have a family history of alcoholism and experience a less rewarding subjective response to alcohol. Moreover, children of mothers with this allele are less vulnerable to alcohol-related birth defects. The enzyme ALDH1 also is encoded by several alleles. Two of these alleles that are found in African Americans - ALDH1 A1 *2 and ALDH1 A1 *3 - may be associated with a reduced risk of alcoholism.

Public Doman

Sher L. Etiology, pathogenesis, and treatment of seasonal and non-seasonal mood disorders: Possible role of circadian rhythm abnormalities related to developmental alcohol exposure. Medical Hypotheses 62(5): 797-801, 2004. (43 refs.)

Developmental alcohol exposure adversely influences the developing brain. Alcohol exposure during rapid brain growth causes cell loss, alters connections between brain regions, and lowers the production of biological substances responsible for the communication among neurons. It is reasonable to suggest that alcohol may adversely affect the development of suprachiasmatic nuclei (SCN), the master circadian pacemaker. Multiple research reports suggest that abnormalities in circadian rhythms are involved in the etiopathogenesis of seasonal affective disorder (SAD), a syndrome in which depression develops during autumn or winter and remits the following spring or summer. Several lines of evidence suggest that changes in the circadian system are also involved in the development of nonseasonal mood disorders, such as major depression and bipolar disorder. Thus, developmental alcohol exposure produces subtle abnormalities in circadian rhythms that may contribute to the development of seasonal and nonseasonal mood disorders. Pharmacological, psychological, and light treatments of mood disorders have multiple effects on circadian function. The state of the circadian system may affect a response to treatment. Circadian rhythms have been reported for neurotransmitters, receptors, enzymes, and the second messenger system in the brain that are involved in the effects of treatments. Some of these rhythms have amplitudes as large as several 100%. Effects of many psychotropic medications depend on the time of administration in relation to body rhythmicity. Therefore, subtle circadian rhythm abnormalities related to developmental alcohol exposure may affect treatment response in patients with mood disorders.

Suchman NE; McMahon TJ; Zhang HP; Mayes LC; Luthar S. Substance-abusing mothers and disruptions in child custody: An attachment perspective. Journal of Substance Abuse Treatment 30(3): 197-204, 2006. (33 refs.)

Using an attachment framework, we examined (1) whether substance-abusing mothers' perceptions of how they were patented were related to the severity of their substance abuse and psychological maladjustment and (2) whether these two factors mediated the association between mothers' perceptions of how they were parented and their children's placement out of home. There were 108 mothers of 248 children who completed interviews upon admission to a methadone maintenance program for women. Measures included lifetime risk composite scores derived from the Addiction Severity Index, the Parental Bonding Instrument, and a demographics questionnaire. A multilevel modeling approach was used to model effects of the hierarchically organized data (e.g., children nested within families). Findings are consistent with an attachment perspective on parenting suggesting that the internal psychological processes of a parent play a critical role in the continuity of parenting.

Tarter RE; Kirisci L; Reynolds M; Mezzich A. Neurobehavior disinhibition in childhood predicts suicide potential and substance use disorder by young adulthood. Drug and Alcohol Dependence 76(Supplement): S45-S52, 2004. (47 refs.)

The objectives of this study were to (a) determine whether two factors that are established components of the risk for substance use disorder (SUD) also impact on the risk for suicide; and (2) evaluate whether SUD manifest by early adulthood predicts suicide propensity. Neurobehavior disinhibition assessed in 227 boys at ages 10-12 and 16 and parental history of SUD were prospectively evaluated to determine their association with the risk for SUD and suicide propensity between ages 16 and 19. The results indicated that neurobehavior disinhibition at age 16 predicts suicide propensity between ages 16 and 19 (p =.04). A trend was observed (p =.08) for SUD manifest between ages 16 and 19 to predict suicide propensity during the same period. Maternal SUD is directly associated with son's SUD risk but not suicide propensity. Paternal SUD predicts son's neurobehavior disinhibition that, in turn, predisposes to SUD. A direct relation between paternal SUD and son's suicide propensity was not observed. These findings suggest that neurobehavior disinhibition, a component of the liability of SUD, is also associated with suicide risk. These results are discussed within a neurobehavioral framework in which prefrontal cortex dysfunction is hypothesized to underlie the risk for these two outcomes.

Tsai J; Floyd RL; Bertrand J. Tracking binge drinking among US childbearing-age women. Preventive Medicine 44(4): 298-302, 2007. (20 refs.)

Objective. The purpose of this analysis was to track the estimated prevalence of binge drinking for the years 2001-2003 among U.S. women of childbearing age in order to inform ongoing efforts to prevent alcohol-exposed pregnancies. Method. A total of 58,431, 64,18 1, and 65,678 women aged 18-44 for the years 2001, 2002, and 2003, respectively, participated in the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey. The estimated binge drinking prevalence for each survey year and changes in these estimates for the entire survey period were calculated for these women. Results. The estimated binge drinking prevalence among childbearing-age women 18-44 years for the years 2001, 2002, and 2003 was 11.9%, 12.4%, and 13.0%, respectively. The estimated number of childbearing-age women who engaged in binge drinking rose from 6.2 million in 2001 to 7.1 million in 2003, an increase of 0.9 million. Conclusion. The results of this analysis provide support for enhancing efforts among healthcare providers to identify and intervene with childbearing-age women who engage in alcohol use that can increase their risks for various health problems, including an alcohol-exposed pregnancy.

Tsai J; Floyd RL; Green PP; Boyle CA. Patterns and average volume of alcohol use among women of childbearing age. Maternal and Child Health Journal 11(5): 437-445, 2007. (53 refs.)

Objectives: Maternal alcohol use is a leading preventable cause of neurobehavioral and developmental abnormalities in children. This study examines the patterns and average volume of alcohol use among U.S. women of childbearing age in order to identify subgroups of high-risk women for selective intervention. Methods: A sample of 188,290 women aged 18-44 years participated in the Centers for Disease Controls and Prevention (CDC)'s Behavioral Risk Factor Surveillance System (BRFSS) survey during the period of 2001-2003. Reported alcohol use patterns and average volume were examined for pregnant and nonpregnant women. Efforts were made to evaluate and characterize women who practiced various levels of binge drinking. Results: The results showed that approximately 2% of pregnant women and 13% of nonpregnant women in the United States engaged in binge drinking during the period of 2001-2003. Among the estimated average of 6.7 million women of childbearing age overall who engaged in binge drinking during the period, approximately 28.5% women also reported consuming an average of 5 drinks or more on typical drinking days, or about 21.4% women consumed at least 45 drinks on average in a month. Larger proportions of binge drinkers with high usual quantity of consumption were found among women of younger ages (18-24 years) or current smokers. Conclusions: Future prevention efforts should include strategies that combine health messages and encourage women of childbearing age, with particular emphasis on women 18-24 years, to avoid alcohol and tobacco use, and take multivitamins and folic acid daily for better pregnancy outcomes. Other efforts must also include broad-based implementation of screening and brief intervention for alcohol misuse in primary and women's health care settings.

Tyler KA; Stone RT; Bersani B. Examining the changing influence of predictors on adolescent alcohol misuse. Journal of Child and Adolescent Substance Abuse 16(2): 95-114, 2006. (37 refs.)

The purpose of this study was to examine whether the influence of key characteristics on adolescent alcohol misuse (i.e., maternal binge drinking, parenting, peers, school characteristics, and the adolescent's own behavior) change over time and whether predictors of adolescent alcohol misuse vary by gender and race/ethnicity. Using prospective, longitudinal data from a community sample, results revealed that mother's binge drinking, peer drinking, and ail early age of onset predicted higher levels of alcohol misuse when respondents were 14-16 years of age. Two years later, when adolescents were 16-18 years of age, maternal binge drinking was no longer significant, however, maternal attachment, school attachment, peer drinking, and early age of onset were found to significantly predict adolescent alcohol misuse. Race differences were found for maternal binge drinking and gender differences were found for school suspension and maternal monitoring on adolescent drinking.

Walden B; Iacono WG; McGue M. Trajectories of change in adolescent substance use and symptomatology: Impact of paternal and maternal substance use disorders. Psychology of Addictive Behaviors 21(1): 35-43, 2007. (47 refs.)

The effects of paternal and maternal substance use disorders (SUDs) on trajectories of change in adolescent offspring nicotine, alcohol, and drug use and symptornatology were investigated in a population-based sample of adolescent twins (N = 1,514). Adolescent and parental substance phenotypes were assessed when most adolescents were I I years old, with 2 assessments of adolescents approximately every 3 years thereafter. Growth curves were fit using hierarchical linear modeling. Results indicated acceleration of substance involvement during adolescence, particularly for boys. Paternal and maternal SUD were each associated with more extreme trajectories. There was evidence for an additive, rather than interactive, combined parental effect. Findings help clarify the impact of paternal and maternal SUD on the development of substance involvement during adolescence.

Willford JA; Leech SL; Day NL. Moderate prenatal alcohol exposure and cognitive status of children at age 10. Alcoholism: Clinical and Experimental Research 30(6): 1051-1059, 2006. (49 refs.)

The effects of prenatal alcohol exposure (PAE) on measures of intelligence have been well documented in children with fetal alcohol syndrome. However, deficits in general intellectual ability in children with low to moderate PAE are less well understood. The objective of this study was to assess the association between moderate PAE and cognitive ability in children at age 10 controlling for other prenatal and birth factors, maternal and child psychosocial factors, and environmental characteristics. Data were collected as part of the Maternal Health Practices and Child Development Project, a prospective study of prenatal substance use with 636 mother-child pairs. Women were assessed during each trimester of pregnancy and with their children at birth; 8 and 18 months; and 3, 6, and 10 years. Each phase included an evaluation of growth, development, cognitive, and psychological functioning. At age 10, cognitive ability was assessed using the composite score and verbal, abstract/visual, quantitative, and short-term memory area scores of the Stanford-Binet Intelligence Test, fourth edition. Maternal intellectual ability, maternal prenatal and current drug use, maternal and child psychosocial characteristics, demographics, and home environment were included in the analysis. A significant relation was found between alcohol exposure during the first and second trimesters and the composite score of the Stanford-Binet for African American children at age 10. Significant relations were also found for the verbal, abstract/visual, and quantitative subscales. Additional predictors of IQ at age 10 included mother's IQ, home environment, and child's report of depression. There is a significant association between PAE and cognitive ability at age 10 among African American offspring. There was no relation between PAE and scores on the Stanford-Binet scales among the Caucasian offspring.

Willford JA; Richardson GA; Leech SL; Day NL. Verbal and visuospatial learning and memory function in children with moderate prenatal alcohol exposure. Alcoholism: Clinical and Experimental Research 28(3): 497-507, 2004. (63 refs.)

Background: This study investigated the effects of moderate prenatal alcohol exposure on learning and memory in 14-year-old adolescents. The Children's Memory Scale was used to assess learning and memory function in the verbal/auditory and visual/spatial domains. In addition, both short- and long-term memory function were assessed. Methods: Data were collected as part of the Maternal Health Practices and Child Development Project, a longitudinal study including 580 children and their mothers. Women were assessed during each trimester of pregnancy and with their children from birth to 16 years of age. At age 14, memory function was evaluated using the Children's Memory Scale, an assessment tool that measures learning and immediate and delayed memory function in the verbal and visual-spatial domains. Results: Prenatal alcohol exposure during the first trimester predicted deficits in learning, short-term memory, and long-term memory, specifically in the verbal domain. Deficits in performance were specific to learning and memory. of word-pairs. In addition, deficits in memory were mediated by learning performance. Conclusions: Results demonstrated that prenatal alcohol exposure lead to deficits in encoding processes as indicated by deficits in verbal learning. Initial deficits in Acquisition were responsible for deficits in immediate and delayed recall of verbal information in children who were exposed to alcohol during pregnancy but did not have fetal alcohol syndrome.

Yuan W; Sorensen HT; Basso O; Olsen J. Prenatal maternal alcohol consumption and hospitalization with asthma in childhood: A population-based follow-up study. Alcoholism: Clinical and Experimental Research 28(5): 765-768, 2004. (21 refs.)

Background: Asthma may have a prenatal origin. We examined whether maternal alcohol consumption during pregnancy increases the risk of hospitalization with asthma in children. Methods: We conducted a follow-up study on 10,440 singletons born at approximately 36 weeks of gestation or later to mothers attending midwife centers between April 1984 and April 1987 in Denmark. The mothers completed a questionnaire regarding lifestyle and socioeconomic factors, including alcohol consumption. The children were followed up through the Danish Hospital Discharge Registry. We determined the first hospitalization with a discharge diagnosis of asthma as recorded in the Danish Hospital Discharge Registry. Results: Most pregnant women (81.5%) drank at least some alcohol during pregnancy, but only a few (2.1%) consumed 120 g or more per week. In total, 307 children were hospitalized at least once with a discharge diagnosis of asthma during follow-up (the cumulative incidence risk was 3.5% from birth to 12 years of age or the end of follow-up). After adjusting for maternal socioeconomic factors, dietary components, and other lifestyle factors, children whose mothers drank alcohol during pregnancy did not have an increased risk of hospitalization with asthma compared with the children of mothers who reported no alcohol consumption during pregnancy (adjusted incidence rate ratio, 0.95; 95% confidence interval, 0.70-1.29). Further analyses showed no association with the dose and type of alcohol or with binge drinking. Conclusions: The study provides no support for a causal link between maternal alcohol intake during pregnancy and asthma in childhood.

Zhang JF; Lu YX; Qiu XX; Fang Y. Relationship between alcohol drinking and alcohol-related health problems. Biomedical and Environmental Sciences 17(2): 196-202, 2004. (6 refs.)

Objective To study the relationship between drinking environment, attitudes and situation and alcohol-related health problems. Methods A sample of 2327 respondents was randomly collected from Wuhan, Hubei Province in China by a face-to-face interview. The structural equation modeling analysis was performed for the data collected. Results Both parents' drinking behaviors and respondents' drinking situation strongly impacted the alcohol-related problems and diseases. Friends' or peers' drinking behaviors influenced the respondents' drinking attitudes and behaviors. Males experienced more alcohol-related problems and diseases than females. Conclusions Comparatively, parents' drinking behaviors exert the most significant influence on drinkers. Therefore, it is beneficial to restrict parents' drinking behaviors for the offsprings and the whole society, and an intensive professional education in early motherhood is also necessary for Chinese women.

Zhang JF; Wang JC; Lu YX; Qiu XX; Fang Y. Alcohol abuse in a metropolitan city in China: A study of the prevalence and risk factors. Addiction 99(9): 1103-1110, 2004. (23 refs.)

Aims: To investigate the prevalence of alcohol abuse in modern China and to explore the risk factors that may be associated with alcohol abuse. Design A face-to-face interview was carried out in a random sample with 2 3 2 7 respondents. Setting: Respondents were selected randomly from Wuhan City, Hubei Province, China, between May and June 2002. Participants Fifteen-65-year-old urban Chinese adults. Measurements Scores for alcohol abuse and related risk factors were the main measures. Findings: (I) Nearly 15% of urban Chinese adults aged 15-65 were alcohol abusers. (2) Deviant drinking habits of mother, schoolmates, colleagues or friends all had a negative impact on the respondent's alcohol drinking behaviours, and higher economic status, current smokers, being male and being older were identified as risk factors related to alcohol abuse. In particular, if a drinker's mother used alcohol frequently then this drinker was more likely to become an alcohol abuser than those drinkers whose mothers did not use alcohol frequently (P = 0.0001). Fathers' drinking behaviours do not have a significant impact on the alcohol abusers. Conclusions: In addition to common risk factors such as economic status, deviant peers' and fellows' drinking behaviours and negative attitudes to alcohol drinking, maternal alcohol drinking habit influenced significantly the offspring's drinking habits. Therefore, efficient intervention and education of healthy drinking habits in early motherhood is necessary for Chinese women.