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Louw JG, Broodryk M, White L, Acker D, Viljoen DL, Olivier L. A multi-year, multi-site study of the prevalence of fetal alcohol syndrome in South Africa. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:867-879. [PMID: 38548386 DOI: 10.1111/acer.15306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD prevalence of 310 per 1000 in a community in the Western Cape Province. Because there is as yet no reliable estimate of the national burden of FASD in South Africa, further epidemiological studies are needed in diverse settings. This paper reports on a multiyear, multisite FASD epidemiological study that took place from 2015 to 2022 at eight study sites in four provinces. METHODS The cross-sectional epidemiological study used an active case-ascertainment method, specifically in primary schools. All children were recruited when they were enrolled in Grade 1 at a participating school. All consented participants progressed through a tiered-screening recruitment and diagnostic process. RESULTS Overall, 3033 children were included in the study. A total of 3001 children were screened for FASD in the first tier, with 1086 progressing to the second and 495 to the third tier. Of the 495 children referred, 475 were discussed during the final case conference. A total of 309 participants were diagnosed with FAS across the eight study sites. The highest reported prevalence was in the Northern Cape Province, with a rate of 199.3/1000 (95% CI, 147.6-251) using all eligible participants as the denominator. The lowest prevalence was in the Eastern Cape Province, with a rate of 57.4/1000 (95% CI, 36.5-78.3). The pooled FAS prevalence for the eight study sites was 80.2/1000 (95% CI, 70.4-89.9). CONCLUSIONS As with previous studies, we found a concerningly high prevalence of FASD in South Africa. Given the scope of the problem it should be a high priority for health and welfare services to address.
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Affiliation(s)
- Jacobus Gidion Louw
- Foundation for Alcohol Related Research, Cape Town, South Africa
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mandi Broodryk
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Liska White
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Debbie Acker
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | | | - Leana Olivier
- Foundation for Alcohol Related Research, Cape Town, South Africa
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Gordon BK, Bila NJ. Developing a psychoeducational programme for caregivers of people with intellectual disability. Afr J Disabil 2023; 12:1195. [PMID: 37794955 PMCID: PMC10546245 DOI: 10.4102/ajod.v12i0.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/24/2023] [Indexed: 10/06/2023] Open
Abstract
Background In the Western Cape, South Africa, a significant number of individuals with intellectual disabilities are cared for by caregivers who receive little or no compensation, education or support. Despite the unique challenges faced by these caregivers, no psychoeducational programmes have been implemented for this particular population. Objectives The study aimed to examine the factors contributing to caregiver distress and develop a solution in the form of a psychoeducational programme for caregivers. Methods A mixed-methods research approach was employed. The qualitative phase involved exploratory research to gather fundamental information and gain new insights into caregiver distress. The quantitative phase utilised a 'one-group pre-test, post-test design' with a Likert-scale questionnaire to enable meaningful interpretations and comparisons of the psychoeducational programme's impact and value. The paired t-test was employed to determine significant differences between pre-test and post-test results. Results The statistical findings demonstrated a significant increase in knowledge, with 99% of respondents indicating a positive impact in reducing caregiver distress and 85% feeling better equipped to care for individuals with intellectual disabilities. Conclusion The psychoeducational programme developed in this study had a positive effect on reducing caregiver distress. Contribution This knowledge provides valuable insights for healthcare professionals in designing relevant intervention programmes, offering support and providing resources not only for individuals with intellectual disabilities but also for their caregivers.
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Affiliation(s)
- Bonita K Gordon
- Department of Social Work and Criminology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Nontembeko J Bila
- Department of Social Work and Criminology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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Pielage M, El Marroun H, Odendaal HJ, Willemsen SP, Hillegers MHJ, Steegers EAP, Rousian M. Alcohol exposure before and during pregnancy is associated with reduced fetal growth: the Safe Passage Study. BMC Med 2023; 21:318. [PMID: 37612658 PMCID: PMC10463675 DOI: 10.1186/s12916-023-03020-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) is a worldwide public health concern. While PAE is known to be associated with low birth weight, little is known about timing and quantity of PAE on fetal growth. This study investigated the association between periconceptional and prenatal alcohol exposure and longitudinal fetal growth, focusing on timing and quantity in a high exposure cohort. METHODS The Safe Passage Study was a prospective cohort study, including 1698 pregnant women. Two-dimensional transabdominal ultrasound examinations were performed to measure fetal femur length, abdominal and head circumference, and biparietal diameter, at three time points during pregnancy. Estimated fetal weight and Z-scores of all parameters were calculated. Trimester-specific alcohol exposure was assessed using the Timeline Followback method. To investigate the associations of specific timing of PAE and fetal growth, two models were built. One with alcohol exposure as accumulative parameter over the course of pregnancy and one trimester specific model, in which PAE was separately analyzed. Linear mixed models adjusted for potential confounders were applied with repeated assessments of both alcohol exposure and fetal growth outcomes. RESULTS This study demonstrated that periconceptional and prenatal alcohol exposure were associated with reduced fetal growth. Effect sizes are displayed as estimated differences (ED) in Z-score and corresponding 95% confidence intervals (95% CIs). When investigated as accumulative parameter, PAE was related to a smaller femur length (ED30; - 0.13 (95% CI; - 0.22; - 0.04), ED36; - 0.14 (95% CI; - 0.25; - 0.04)) and a smaller abdominal circumference (ED36; - 0.09 (95% CI; - 0.18; - 0.01)). Periconceptional alcohol exposure was associated with a smaller abdominal circumference (ED30; - 0.14 (95% CI; - 0.25; - 0.02), ED36; - 0.22 (95% CI; - 0.37; - 0.06)) and a smaller estimated fetal weight (ED36; - 0.22 (95% CI; - 0.38; - 0.05)). Second trimester alcohol exposure was associated with a smaller abdominal circumference (ED30; - 0.49 (95% CI; - 0.86; - 0.12), ED36; - 0.70 (95% CI; - 1.22; - 0.17)) and estimated fetal weight (ED30; - 0.54 (95% CI; - 0.94; - 0.14), ED36; - 0.69 (95% CI; - 1.25; - 0.14)). No additional association of binge drinking was found besides the already observed association of PAE and fetal growth. CONCLUSIONS This study demonstrated that PAE negatively affects fetal growth, in particular when exposed during the periconception period or in second trimester. Our results indicate that potential negative consequences of PAE are detectable already before birth. Therefore, healthcare providers should actively address and discourage alcohol use during pregnancy.
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Affiliation(s)
- Marin Pielage
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Room Sp-4469, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Sophia Children's Hospital, 3000 CB, Rotterdam, the Netherlands
- Department of Psychology, Education and Child Studies - Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hein J Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Room Sp-4469, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Sophia Children's Hospital, 3000 CB, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Room Sp-4469, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Room Sp-4469, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Xia Y, Rebello V, Bodison SC, Jonker D, Steigelmann B, Donald KA, Charles W, Stein DJ, Ipser J, Ahmadi H, Kan E, Sowell ER, Narr KL, Joshi SH, Odendaal HJ, Uban KA. Contextualizing the impact of prenatal alcohol and tobacco exposure on neurodevelopment in a South African birth cohort: an analysis from the socioecological perspective. Front Integr Neurosci 2023; 17:1104788. [PMID: 37534335 PMCID: PMC10390790 DOI: 10.3389/fnint.2023.1104788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/19/2023] [Indexed: 08/04/2023] Open
Abstract
Background Alcohol and tobacco are known teratogens. Historically, more severe prenatal alcohol exposure (PAE) and prenatal tobacco exposure (PTE) have been examined as the principal predictor of neurodevelopmental alterations, with little incorporation of lower doses or ecological contextual factors that can also impact neurodevelopment, such as socioeconomic resources (SER) or adverse childhood experiences (ACEs). Here, a novel analytical approach informed by a socio-ecological perspective was used to examine the associations between SER, PAE and/or PTE, and ACEs, and their effects on neurodevelopment. Methods N = 313 mother-child dyads were recruited from a prospective birth cohort with maternal report of PAE and PTE, and cross-sectional structural brain neuroimaging of child acquired via 3T scanner at ages 8-11 years. In utero SER was measured by maternal education, household income, and home utility availability. The child's ACEs were measured by self-report assisted by the researcher. PAE was grouped into early exposure (<12 weeks), continued exposure (>=12 weeks), and no exposure controls. PTE was grouped into exposed and non-exposed controls. Results Greater access to SER during pregnancy was associated with fewer ACEs (maternal education: β = -0.293,p = 0.01; phone access: β = -0.968,p = 0.05). PTE partially mediated the association between SER and ACEs, where greater SER reduced the likelihood of PTE, which was positively associated with ACEs (β = 1.110,p = 0.01). SER was associated with alterations in superior frontal (β = -1336.036, q = 0.046), lateral orbitofrontal (β = -513.865, q = 0.046), caudal anterior cingulate volumes (β = -222.982, q = 0.046), with access to phone negatively associated with all three brain volumes. Access to water was positively associated with superior frontal volume (β=1569.527, q = 0.013). PTE was associated with smaller volumes of lateral orbitofrontal (β = -331.000, q = 0.033) and nucleus accumbens regions (β = -34.800, q = 0.033). Conclusion Research on neurodevelopment following community-levels of PAE and PTE should more regularly consider the ecological context to accelerate understanding of teratogenic outcomes. Further research is needed to replicate this novel conceptual approach with varying PAE and PTE patterns, to disentangle the interplay between dose, community-level and individual-level risk factors on neurodevelopment.
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Affiliation(s)
- Yingjing Xia
- Public Health, University of California, Irvine, Irvine, CA, United States
| | - Vida Rebello
- Public Health, University of California, Irvine, Irvine, CA, United States
| | - Stefanie C. Bodison
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Deborah Jonker
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Kirsten A. Donald
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Weslin Charles
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC), Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Jonathan Ipser
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Hedyeh Ahmadi
- University Statistical Consulting, LLC, Irvine, CA, United States
| | - Eric Kan
- Department of Pediatrics, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Elizabeth R. Sowell
- Department of Pediatrics, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Katherine L. Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shantanu H. Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hein J. Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Kristina A. Uban
- Public Health, University of California, Irvine, Irvine, CA, United States
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Bariselli S, Reuveni N, Westcott N, Mateo Y, Lovinger DM. Postnatal ethanol exposure impairs social behavior and operant extinction in the adult female mouse offspring. Front Neurosci 2023; 17:1160185. [PMID: 37260840 PMCID: PMC10229070 DOI: 10.3389/fnins.2023.1160185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Fetal Alcohol Spectrum Disorder (FASD) comprises a group of neurodevelopmental deficits caused by alcohol exposure during pregnancy. Clinical studies suggest that while the male progeny experiences serious neurodevelopmental defects, female patients have more severe cognitive, social, and affective symptoms. Other than sex, dose, frequency, and timing of exposure determine the neurobehavioral outcomes in young and adult progeny. In this regard, human studies indicate that some individuals relapse during late-term gestational periods. In mice, this interval corresponds to the first 10 days after birth (postnatal, P0-P10). In our model of postnatal ethanol exposure (PEEP0-P10), we tested whether adult female and male offspring show deficits in sociability, anxiety-like, reward consumption, and action-outcome associations. We report that female PEEP0-P10 offspring have mild social impairments and altered extinction of operant responding in the absence of anxiety-like traits and reward consumption defects. None of these deficits were detected in the male PEEP0-P10 offspring. Our data provide novel information on sex-specific neurobehavioral outcomes of postnatal ethanol exposure in female adult offspring.
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Kalberg WO, Marais AS, De Vries MM, Laurel M, Taylor K, Hasken JM, Tabachnick BG, Buckley D, Ortega MA, Seedat S, May PA. Relationship-based intervention for children who were prenatally alcohol exposed in South Africa. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 136:104479. [PMID: 36963311 PMCID: PMC10103540 DOI: 10.1016/j.ridd.2023.104479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND This early intervention study investigated the effectiveness of a relationship-based, developmental enhancement process for children who were prenatally exposed to alcohol in the South African context. METHODS Groups were created according to the child's level of risk for alcohol-related developmental issues based on each mother's alcohol use during pregnancy as assessed using the Alcohol Use Disorders Identification Test (AUDIT). Primary caregiver/child dyads were the focus of the intervention and child development was monitored by the Ages and Stages Questionnaire (ASQ). Eighteen caregiver/child dyads were in the heavily alcohol-exposed group, and 20 caregiver/child dyads were in the no or light alcohol-exposure group. The Home Observation Measurement of the Environment (HOME) was measured pre and post intervention. RESULTS The results indicated significant improvements in the home environment (p < .001) post-intervention for the entire cohort. For the total HOME score, there was a statistically significant main effect for time (pre- vs post-test), F(1, 36)= 65.205, p < .001, partial η2 = .64. with 99% confidence limits from .35 to .78. The offspring and parents from both the heavy alcohol exposure group and the no/low alcohol exposure group benefitted from the intervention over the duration of the intervention. Of the HOME domains affected, responsivity was the most improved in the households. The children's scores on the ASQ varied substantially over the months of the intervention, and the offspring of the heavy exposure group often performed significantly worse than the no/low exposure group. Nevertheless, further analysis revealed that children with the lowest performance at baseline improved their performance on most ASQ domains throughout the intervention and performed significantly better on all ASQ domains over time and at completion of the intervention. CONCLUSIONS This relationship-based, early intervention program for children resulted in benefits to all of the children over time.
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Affiliation(s)
- Wendy O Kalberg
- The University of New Mexico, Center on Alcohol, Substance Abuse and Addictions, 2650 Yale Blvd. SE, Albuquerque, NM, USA
| | - Anna-Susan Marais
- Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Marlene M De Vries
- Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Marci Laurel
- The University of New Mexico, Center for Development and Disability, 2300 Menaul Blvd. NE, Albuquerque, NM, USA
| | - Kathleen Taylor
- The University of New Mexico, Occupational Therapy Department, 2500 Marble Ave. NE, Albuquerque, NM, USA
| | - Julie M Hasken
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, 500 Laureate Way, Kannapolis, NC 28081, USA
| | | | - David Buckley
- The University of New Mexico, Center on Alcohol, Substance Abuse and Addictions, 2650 Yale Blvd. SE, Albuquerque, NM, USA
| | - Marian A Ortega
- The University of New Mexico, Center on Alcohol, Substance Abuse and Addictions, 2650 Yale Blvd. SE, Albuquerque, NM, USA
| | - Soraya Seedat
- Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Philip A May
- The University of New Mexico, Center on Alcohol, Substance Abuse and Addictions, 2650 Yale Blvd. SE, Albuquerque, NM, USA; Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa; The University of North Carolina at Chapel Hill, Nutrition Research Institute, 500 Laureate Way, Kannapolis, NC 28081, USA.
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May PA, de Vries MM, Marais AS, Kalberg WO, Buckley D, Hasken JM, Abdul-Rahman O, Robinson LK, Manning MA, Seedat S, Parry CD, Hoyme HE. The prevalence of fetal alcohol spectrum disorders in rural communities in South Africa: A third regional sample of child characteristics and maternal risk factors. Alcohol Clin Exp Res 2022; 46:1819-1836. [PMID: 35971629 PMCID: PMC9588757 DOI: 10.1111/acer.14922] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/13/2022] [Accepted: 08/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study is the ninth cross-sectional community study of fetal alcohol spectrum disorders (FASD) conducted by the multidisciplinary Fetal Alcohol Syndrome Epidemiology Research team in the Western Cape Province of South Africa. It is the third comprehensive study of FASD in a rural, agricultural region of South Africa. METHODS Population-based, active case ascertainment methods were employed among a school-based cohort to assess child physical and neurobehavioral traits, and maternal risk factor interviews were conducted to identify all children with FASD to determine its prevalence. RESULTS Consent was obtained for 76.7% of 1158 children attending first grade in the region's public schools. Case-control results are presented for 95 with fetal alcohol syndrome (FAS), 64 with partial fetal alcohol syndrome (PFAS), 77 with alcohol-related neurodevelopmental disorder (ARND), 2 with alcohol-related birth defects (ARBD), and 213 randomly-selected controls. Four techniques estimating FASD prevalence from in-person examinations and testing yielded a range of total FASD prevalence of 206-366 per 1000. The final weighted, estimated prevalence of FAS was 104.5 per 1000, PFAS was 77.7 per 1000, ARND was 125.2 per 1000, and total FASD prevalence was 310 per 1000 (95% CI = 283.4-336.7). Expressed as a percentage, 31% had FASD. Although the rate of total FASD remained steady over 9 years, the proportion of children within the FASD group has changed significantly: FAS trended down and ARND trended up. A detailed evaluation is presented of the specific child physical and neurobehavioral traits integral to assessing the full continuum of FASD. The diagnosis of a child with FASD was significantly associated with maternal proximal risk factors such as: co-morbid prenatal use of alcohol and tobacco (OR = 19.1); maternal drinking of two (OR = 5.9), three (OR = 5.9), four (OR = 38.3), or more alcoholic drinks per drinking day; and drinking in the first trimester (OR = 8.4), first and second trimesters (OR = 17.7), or throughout pregnancy (OR = 18.6). Distal maternal risk factors included the following: slight or small physical status (height, weight, and head circumference), lower BMI, less formal education, late recognition of pregnancy, and higher gravidity, parity, and older age during the index pregnancy. CONCLUSION The prevalence of FASD remained a significant problem in this region, but the severity of physical traits and anomalies within the continuum of FASD is trending downwards.
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Affiliation(s)
- Philip A. May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Marlene M. de Vries
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anna-Susan Marais
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Julie M. Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
| | - Omar Abdul-Rahman
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska
| | - Luther K. Robinson
- Department of Pediatrics, State University of New York, 1001 Main Street, Buffalo, NY 14203, United States
| | - Melanie A. Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, United States
| | - Soraya Seedat
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Charles D.H. Parry
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, 7505, South Africa
| | - H. Eugene Hoyme
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Sanford Children’s Genomic Medicine Consortium, Sanford Health, 1600 W. 22 St. Sioux Falls, SD, 57117, United States
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Hasken JM, Adair LS, Martin SL, Thompson AL, Marais AS, de Vries MM, Kalberg WO, Buckley D, Eugene Hoyme H, Seedat S, Parry CD, May PA. The Influence of Maternal Weight and Alcohol Exposure on Infant Physical Characteristics and Neurodevelopmental Outcomes. Curr Res Toxicol 2022; 3:100076. [PMID: 35694418 PMCID: PMC9178472 DOI: 10.1016/j.crtox.2022.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/23/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022] Open
Abstract
Maternal weight was inversely related with infant dysmorphology score. The rate of change was similar among all infants regardless of maternal weight. Maternal weight may be protective but does not eliminate adverse effects of alcohol. Regardless of maternal weight during pregnancy, alcohol remains a teratogen.
Background Mothers of children with fetal alcohol spectrum disorders tend to have lower weight compared to other mothers. Yet how alcohol and maternal weight may predispose infants to poorer physical growth and neurodevelopmental trajectories is relatively unexplained. Methods South African mothers (n = 406) were recruited prenatally and their offspring were provided standardized dysmorphology and neurodevelopment examinations at 6 weeks and 9 months of age. Maternal weight was obtained postpartum, and linear mixed modeling determined whether postpartum maternal weight and prenatal alcohol exposure significantly influenced infant growth, dysmorphology, and neurodevelopment within the first year of life. Results Postpartum maternal weight was positively associated with birth length, weight, and head circumference centile, but the rate of growth from birth to nine months was similar among all infants. Maternal weight was inversely associated with dysmorphology. Many infants in this population were performing within the borderline or extremely low range. Higher maternal weight was associated with significantly better cognitive and motor performance at 6 weeks; however, the rate of developmental growth was similar among all infants, regardless of postpartum maternal weight. Conclusion Higher postpartum maternal weight may be a protective factor but does not eliminate the adverse effects of alcohol on infant growth and dysmorphology. Regardless of maternal weight, alcohol remains a powerful teratogen and moderate to high use prenatally can result in adverse infant physical and neurocognitive development.
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Trajectories of prenatal alcohol exposure and behavioral outcomes: Findings from a community-based sample. Drug Alcohol Depend 2022; 233:109351. [PMID: 35228080 PMCID: PMC9310559 DOI: 10.1016/j.drugalcdep.2022.109351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To characterize patterns of prenatal alcohol exposure (PAE), and determine whether PAE trajectories were associated with behavior from a community-based sample of first-grade children. METHODS Using data collected as part of the Collaboration of Fetal Alcohol Spectrum Disorders Prevalence study (n = 1663), we performed longitudinal cluster analysis on prenatal alcohol use reported for four time points around conception and pregnancy. From the sample, 638 respondents reported any alcohol use in pregnancy and were included in trajectories for average daily and maximum drinks per drinking day (max DDD). We then estimated the association with behavioral problems measured by the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) with multivariable linear regression. The reference group had 1025 children with no reported PAE. RESULTS Five trajectories were selected to describe max DDD patterns: very low/discontinuing (n = 186), low/discontinuing (n = 111), very low/continuing (n = 47), med/high (n = 245), and high (n = 49). Six trajectories best described average daily alcohol use: very low/discontinuing (n = 378), very low/continuing (n = 98), low/continuing (n = 56), low/discontinuing (n = 37), medium/high (n = 35), and high (n = 31). When assessing max DDD trajectories for both the CBCL and TRF, individuals with PAE in the two highest trajectories and the very low/continuing trajectory had more behavioral problems relative to children with no PAE, although confidence intervals for most estimates included the null. PAE modeled as average drinks per day did not predict behavior in any consistent pattern. CONCLUSIONS In this community-based sample, select PAE trajectories were associated with behavior, even at relatively low levels of PAE that continued later in gestation.
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10
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Biffen SC, Dodge NC, Warton CMR, Molteno CD, Jacobson JL, Meintjes EM, Jacobson SW. Compromised interhemispheric transfer of information partially mediates cognitive function deficits in adolescents with fetal alcohol syndrome. Alcohol Clin Exp Res 2022; 46:517-529. [PMID: 35187666 PMCID: PMC9018477 DOI: 10.1111/acer.14795] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) has been associated with compromised interhemispheric transfer of tactile stimuli in childhood and structural changes to the corpus callosum (CC). In this study, we used a finger localization task (FLT) to investigate whether interhemispheric transfer deficits persist in adolescence; whether effects of PAE on perceptual reasoning, working memory, and executive function are mediated by deficits in interhemispheric transfer of information; and whether CC size in childhood predicts FLT performance in adolescence. METHODS Participants, aged 16 to 17 years, were from the Cape Town Longitudinal Cohort, whose mothers were recruited during pregnancy and interviewed regarding their alcohol use using the timeline follow-back method. Diagnoses of fetal alcohol syndrome (FAS) and partial FAS (PFAS) were determined by two expert dysmorphologists; nonsyndromal exposed children were designated as heavily exposed (HE); those born to abstainers or light drinkers, as controls. The FLT was administered to 74 participants (12 FAS, 16 PFAS, 14 HE and 32 controls). CC size at age 9 to 12 years was available for 35 participants (7 FAS, 13 PFAS, 5 HE and 10 control). RESULTS Although the degree of PAE was similar in the FAS, PFAS, and HE groups, only the adolescents with FAS showed more transfer-related errors than controls in conditions in which one finger was stimulated. FLT performance mediated the effects of FAS on perceptual reasoning and executive function. In the subsample for which neuroimaging data from childhood were available, there was an association among adolescents with PAE of smaller CC volumes with more transfer-related errors on the one-finger/hand hidden condition, suggesting that CC damage previously seen in childhood continues to impact function through adolescence. CONCLUSIONS This study provides evidence of compromised interhemispheric transfer of information in adolescents with FAS, while those with PFAS or heavy exposed nonsyndromal individuals are apparently spared. It is the first to show that PAE effects on important aspects of cognitive function are partially mediated by deficits in the interhemispheric transfer of information.
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Affiliation(s)
- Stevie C Biffen
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
| | - Neil C Dodge
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Christopher M R Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ernesta M Meintjes
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, Cape Town, South Africa
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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11
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May PA, Hasken JM, Manning MA, Robinson LK, Abdul-Rahman O, Adam MP, Jewett T, Elliott AJ, Kalberg WO, Buckley D, Hoyme HE. Characteristic physical traits of first-grade children in the United States with fetal alcohol spectrum disorders (FASD) and associated alcohol and drug exposures. Am J Med Genet A 2022; 188:2019-2035. [PMID: 35357075 DOI: 10.1002/ajmg.a.62738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/20/2022] [Accepted: 03/13/2022] [Indexed: 11/10/2022]
Abstract
We compared growth, physical features, and minor anomalies in 131 first-grade children with fetal alcohol spectrum disorders (FASD) to those of a representative comparison group of typically developing children from the same populations (n = 1212). The data were collected from three regional sites in the NIAAA-funded Collaboration on FASD Prevalence (CoFASP). Dysmorphology examinations were performed by a team of expert clinical geneticists, and FASD diagnoses were assigned according to the Revised Institute of Medicine Guidelines, which include assessments of growth, dysmorphology, neurobehavior, and maternal risk interviews. We present detailed data on 32 physical traits, minor anomalies, and a summary dysmorphology score for children within each of the four diagnostic categories in the continuum of FASD. There were few differences in the frequency of FASD diagnoses by race or Hispanic ethnicity. Children with FASD were born to mothers who reported using alcohol, tobacco (28.3%), and other drugs (14.2%) during pregnancy. Controlling for tobacco and other drug use, risk analysis indicated that women with a drinking pattern of 3 drinks per drinking day prior to pregnancy were 10 times more likely (p < 0.001, OR = 9.92, 95% CI: 4.6-21.5) to bear a child with FASD than those who reported abstinence prior to pregnancy.
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Affiliation(s)
- Philip A May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA.,Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Julie M Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA
| | - Melanie A Manning
- Departments of Pathology and Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Luther K Robinson
- Department of Pediatrics, State University of New York, Buffalo, New York, USA
| | - Omar Abdul-Rahman
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Margaret P Adam
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Tamison Jewett
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Amy J Elliott
- Avera Health, Sioux Falls, South Dakota, USA.,Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Wendy O Kalberg
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico, USA
| | - David Buckley
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico, USA
| | - H Eugene Hoyme
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA.,Sanford Children's Genomic Medicine Consortium, Sanford Health, Sioux Falls, South Dakota, USA
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12
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May PA, Hasken JM, Hooper SR, Hedrick DM, Jackson-Newsom J, Mullis CE, Dobbins E, Kalberg WO, Buckley D, Robinson LK, Abdul-Rahman O, Adam MP, Manning MA, Jewett T, Hoyme HE. Estimating the community prevalence, child traits, and maternal risk factors of fetal alcohol spectrum disorders (FASD) from a random sample of school children. Drug Alcohol Depend 2021; 227:108918. [PMID: 34388579 PMCID: PMC8499999 DOI: 10.1016/j.drugalcdep.2021.108918] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Utilize a random sample to estimate the prevalence, child traits, and maternal risk for fetal alcohol spectrum disorders (FASD) in a Southeastern United States county. METHODS From all first-grade students (n = 1073) a simple random sample was drawn, and 32 % (n = 231) were consented. All 231 children were examined for dysmorphology and growth, 84 were tested and rated on neurobehavior, and 72 mothers were interviewed for maternal risk. RESULTS Significant differences (α = .05) between the physical traits of children diagnosed with FASD and the entire sample were height, weight, head circumference, body mass index, and total dysmorphology scores, and all three cardinal features of fetal alcohol syndrome: palpebral fissure length, smooth philtrum, and narrow vermilion. Intellectual function and inhibition were not significantly different between FASD and typically-functioning children, but two executive function measures and one visual/spatial measure approached significance (α = .10). Three behavioral measures were significantly worse for the FASD group: parent-rated problems of communication, daily living, and socialization. Significant maternal risk factors reported were postpartum depression, frequency of drinking, and recovery from problem drinking. The prevalence of FASD was 71.4 per 1,000 or 7.1 %. This rate falls clearly within the prevalence range identified in eight larger samples of other communities in the Collaboration on FASD Prevalence (CoFASP) study in four regions of the United States. CONCLUSION Careful and detailed clinical evaluation of children from small random samples can be useful for estimating the prevalence and traits of FASD in a community.
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Affiliation(s)
- Philip A. May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina,Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico,Corresponding author: Philip A. May, Nutrition Research Institute, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States.
| | - Julie M. Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina
| | - Stephen R. Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dixie M. Hedrick
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina
| | - Julia Jackson-Newsom
- Office of the Vice Chancellor for Research, The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Chalise E. Mullis
- Office of the Vice Chancellor for Research, The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Elizabeth Dobbins
- Office of the Vice Chancellor for Research, The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico
| | - Luther K. Robinson
- Department of Pediatrics, State University of New York, Buffalo, New York
| | - Omar Abdul-Rahman
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska
| | - Margaret P. Adam
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Melanie A. Manning
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Tamison Jewett
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - H. Eugene Hoyme
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona,Sanford Children’s Genomic Medicine Consortium, Sanford Health, Sioux Falls, South Dakota
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13
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The Importance of Creating Habilitation Programs for Children with Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim of the study: to analyze the data of studies aimed at studying and substantiating the urgent need to create in Russia comprehensive habilitation programs for people with fetal alcohol syndrome, fetal alcohol spectrum disorders and other mental disorders.Methods. The results of Russian and foreign studies have been analyzed concerning the following problems: observation and diagnosis of people with fetal alcohol syndrome and fetal alcohol spectrum disorders; studying the experience of foreign countries in addressing issues of prevention and overcoming of fetal alcohol syndrome and fetal alcohol spectrum disorders; studying the experience of Russian specialists (obstetricians-gynecologists, neurologists, psychiatrists, psychologists, correctional teachers, etc.) working with the diagnosis of “Alcohol syndrome in the fetus”; assessing the socio-economic impact of organizing programs for the prevention of fetal alcohol syndrome and fetal alcohol spectrum disorders by comparison with similar indicators in other countries.Results. The presented analysis of the data indicates that there is an urgent need for timely diagnosis of the disease, the search/creation of new drugs, for the treatment of the consequences of alcohol syndrome and the organization of training of specialists in this area. The article shows the importance of providing lifelong medical and social assistance to people with fetal alcohol spectrum disorders, as well as to their families. The effectiveness of the creation of a system of measures for the prevention of fetal alcohol syndrome and fetal alcohol spectrum disorders throughout the country has been confirmed.Conclusion. The development at the state level and implementation of prevention programs will significantly reduce the birth rate of children diagnosed with “Alcohol syndrome in the fetus” and, thus, reduce the costs of the state and society on overcoming the consequences of FAS/FASD. At the same time, timely and well-organized habilitation of people with FAS/FASD will significantly improve the social situation in society as a whole, as well as reduce the psychological burden on every family faced with this problem.
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14
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Miles M, Warton FL, Meintjes EM, Molteno CD, Jacobson JL, Jacobson SW, Warton CMR. Effects of Prenatal Alcohol Exposure on the Volumes of the Lateral and Medial Walls of the Intraparietal Sulcus. Front Neuroanat 2021; 15:639800. [PMID: 34163333 PMCID: PMC8215540 DOI: 10.3389/fnana.2021.639800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/08/2021] [Indexed: 11/16/2022] Open
Abstract
Fetal alcohol spectrum disorders (FASD) continue to be the leading preventable cause of intellectual disability in the U.S., Europe, and in endemic areas, such as the Western Cape region of South Africa. Arithmetic is highly sensitive to prenatal alcohol exposure (PAE). The intraparietal sulcus (IPS) is known to play a critical role in number processing. In this study, we investigate whether smaller IPS volumes play a role in the number-processing deficits observed in children with PAE. Participants were 52 9- to 14-year-old children from a historically disadvantaged community in Cape Town, who are participating in our ongoing studies on the effects of PAE on the brain. The IPS was manually parcellated into its medial (MIPS) and lateral (LIPS) walls on magnetic resonance images. The study aimed to examine: (1) the effects of PAE on IPS regional volumes and asymmetry, (2) whether IPS regional volumes are related to number processing performance and, if so, whether these relations are moderated by PAE and (3) potential mediation by regional IPS volumes of the relation between PAE and number processing performance. Total intracranial volume (TIV) was associated with volumes in all regions except the right LIPS. Both left MIPS and left LIPS volumes were significantly smaller in children in the fetal alcohol syndrome (FAS)/partial FAS (PFAS) group compared to controls. The finding in the left LIPS remained significant after controlling for potential confounders and after adjustment for the smaller overall brain size of the children in the FAS/PFAS group. Smaller left LIPS volumes in the FAS/PFAS group may account for the absence of left-right asymmetry in the LIPS in children with FAS/PFAS compared to controls and nonsyndromal heavily exposed (HE) children. Bilaterally, larger MIPS volumes were associated with better WISC IQ Arithmetic scores. These effects, however, were not moderated by the degree of PAE, and regional IPS volumes did not mediate the effect of PAE on WISC Arithmetic scores. Although we found that certain regions of the IPS were smaller in children with FAS and PFAS, these PAE-induced changes in IPS volume did not mediate the alcohol-related deficits in arithmetic.
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Affiliation(s)
- Marlie Miles
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Biomedical Engineering Research Centre, Division of Biomedical Engineering, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Fleur L Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Biomedical Engineering Research Centre, Division of Biomedical Engineering, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Ernesta M Meintjes
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Biomedical Engineering Research Centre, Division of Biomedical Engineering, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Joseph L Jacobson
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Sandra W Jacobson
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Christopher M R Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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15
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Ford SM, Pedersen CJ, Ford MR, Kim JW, Karunamuni GH, McPheeters MT, Jawaid S, Jenkins MW, Rollins AM, Watanabe M. Folic acid prevents functional and structural heart defects induced by prenatal ethanol exposure. Am J Physiol Heart Circ Physiol 2021. [DOI: 10.1152/ajpheart.00817.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
State-of-the-art biophotonic tools captured blood flow and endocardial cushion volumes in tiny beating quail embryo hearts, an accessible model for studying four-chambered heart development. Both hemodynamic flow and endocardial cushion volumes were altered with ethanol exposure but normalized when folic acid was introduced with ethanol. Folic acid supplementation preserved hemodynamic function that is intimately involved in sculpting the heart from the earliest stages of heart development.
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Affiliation(s)
- Stephanie M. Ford
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Division of Pediatric Cardiology, Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Cameron J. Pedersen
- Department of Biomedical Engineering, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Matthew R. Ford
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland Ohio
| | - Jun W. Kim
- Division of Pediatric Cardiology, Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ganga H. Karunamuni
- Division of Pediatric Cardiology, Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Matthew T. McPheeters
- Department of Biomedical Engineering, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Safdar Jawaid
- Division of Pediatric Cardiology, Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael W. Jenkins
- Division of Pediatric Cardiology, Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Biomedical Engineering, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michiko Watanabe
- Division of Pediatric Cardiology, Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
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16
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Modjadji P, Pitso M. Maternal Tobacco and Alcohol Use in Relation to Child Malnutrition in Gauteng, South Africa: A Retrospective Analysis. CHILDREN-BASEL 2021; 8:children8020133. [PMID: 33670265 PMCID: PMC7918556 DOI: 10.3390/children8020133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/16/2022]
Abstract
Tobacco and alcohol use among mothers is associated with numerous adverse consequences for affected offspring, including poor growth and development. This study determined the association between maternal tobacco and alcohol use, and malnutrition, among infants aged ≤ 12 months (n = 300), in selected health facilities situated in Gauteng, South Africa. Data on alcohol and tobacco use were collected using a validated questionnaire, in addition to mothers’ socio-demographic characteristics and obstetric history. Stunting (low height/length-for-age), underweight (low weight-for-age) and thinness (low body mass index-for-age) were calculated using z-scores based on the World Health Organization child growth standards. The association of tobacco and alcohol use with stunting, underweight and thinness was analysed using logistic regression analysis. The results showed a mean age of 29 years (24.0; 35.0) for mothers and 7.6 ± 3 months for infants, and over half of the mothers were unemployed (63%). Approximately 18.7% of mothers had used tobacco and 3% had used alcohol during pregnancy. The prevalence of current tobacco and alcohol use among mothers were estimated at 14.3% and 49.7%, respectively, and almost three-quarters (67.3%) of them were still breastfeeding during the study period. Stunting (55%) was the most prevalent malnutrition indicator among infants, while underweight was 41.7%, and thinness was 22%. Current tobacco use was associated with increased odds of being thin [OR = 2.40, 95% CI: 1.09–5.45), and after adjusting for confounders, current alcohol use was associated with the likelihood of being underweight [AOR = 1.96, 95% CI: 1.06–3.63] among infants. Future prospective cohort studies that examine growth patterns among infants who are exposed to maternal tobacco and alcohol use from the intrauterine life to infancy are necessary to inform, partly, the public health programmes, to reduce malnutrition among children.
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17
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Obladen M. Ignored Papers, Invented Quotations: A History of Fetal Alcohol Syndrome. Neonatology 2021; 118:647-653. [PMID: 34535605 DOI: 10.1159/000518534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022]
Abstract
Given the high rate of alcoholism throughout history, its effects on the fetus may have existed for millennia. But, the claim that Greeks and Romans were aware of fetal alcohol syndrome rests on incorrect citations. From 1725, maternal alcohol consumption was associated with retarded fetal growth and neurological anomalies. From 1809, scientists followed Lamarck's theory that the disorders parents acquire during their lifetime are passed on to their offspring. Fetal effects were thought to be inherited mainly from the father. During the 19th century, parental alcoholism became associated with malformations. In 1915, Ballantyne distinguished genetic influence via germ cells from toxin's effect on the embryo. Fetal alcohol syndrome was characterized by Rouquette [Influence de la toxicomanie alcoolique parentale sur le développement physique et psychique des jeunes enfants] in 1957 and Lemoine et al. [Ouest Medical. 1968;21:476-482] in 1968 as consisting of 4 features: (A) facial anomalies (narrow forehead, retracted upper lip, and cupped ears), (B) severe growth retardation (prenatal and postnatal), (C) malformations (limbs, cardiac, and visceral), and (D) central nervous system anomalies (hyperexcitability and mental retardation). But, their studies, written in French, remained disregarded. In 1973, Jones et al. [Lancet. 1973;302:999-1001] reported "the first association between maternal alcoholism and aberrant morphogenesis in the offspring." The history of fetal alcohol syndrome reveals shortcomings in citation practice. Alleged quotations remained unverified, non-English publications neglected, and short quotations taken out of context. Prejudiced by religious and abstinence groups, reports on alcohol damage to the unborn were fraught with emotions, moralizing, social implications, and presentism, the interpretation of past events with present knowledge.
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Affiliation(s)
- Michael Obladen
- Department of Neonatology, Charité University Medicine, Berlin, Germany
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18
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May PA, Marais AS, De Vries MM, Buckley D, Kalberg WO, Hasken JM, Stegall JM, Hedrick DM, Robinson LK, Manning MA, Tabachnick BG, Seedat S, Parry CDH, Hoyme HE. The prevalence, child characteristics, and maternal risk factors for the continuum of fetal alcohol spectrum disorders: A sixth population-based study in the same South African community. Drug Alcohol Depend 2021; 218:108408. [PMID: 33250379 PMCID: PMC7756187 DOI: 10.1016/j.drugalcdep.2020.108408] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prevalence and characteristics of fetal alcohol spectrum disorders (FASD) have been described previously in this community. METHODS Active case ascertainment methods were employed in a new cross-sectional study with Revised Institute of Medicine criteria among first grade students (n = 735) via dysmorphology examinations and neurobehavioral assessments. Their mothers were interviewed regarding risk factors. Final diagnoses were assigned via structured case conferences. RESULTS Children with fetal alcohol syndrome (FAS), partial FAS (PFAS), and alcohol related-neurodevelopmental disorder (ARND) were significantly different from controls on all cardinal variables, multiple dysmorphology traits and neurobehavioral performance. Mothers of children with FASD reported significantly more drinking before and during pregnancy (mothers of children with FAS reported 7.8 (±6.1) drinks per drinking day (DDD) prior to pregnancy and 5.1 (±5.9) after pregnancy recognition). Distal risk variables for a diagnosis on the continuum of FASD were: lower maternal height, weight, and body mass index; higher gravidity; lower education and household income; and later pregnancy recognition. Alcohol and tobacco remain the only commonly used drugs. Women reporting first trimester drinking of two DDD were 13 times more likely (95 % CI:1.3-133.4) to have a child with FASD than non-drinkers; and those who reported drinking throughout pregnancy were 19.4 times more likely (95 % CI:8.2-46.0) to have a child with FASD. CONCLUSION Seventeen years after the first study in this community, FASD prevalence remains high at 16 %-31 %. The FAS rate may have declined somewhat, but rates of PFAS and ARND seemed to plateau, at a high rate.
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Affiliation(s)
- Philip A May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC, 28081, United States; Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa; Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM, 87106, United States.
| | - Anna-Susan Marais
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Marlene M De Vries
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM, 87106, United States
| | - Wendy O Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM, 87106, United States
| | - Julie M Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC, 28081, United States
| | - Julie M Stegall
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC, 28081, United States
| | - Dixie M Hedrick
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC, 28081, United States
| | - Luther K Robinson
- Department of Pediatrics, State University of New York, 1001 Main Street, Buffalo, NY, 14203, United States
| | - Melanie A Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States
| | - Barbara G Tabachnick
- California State University, 18111 Nordhoff Street, Northridge, CA, 91330, United States
| | - Soraya Seedat
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Charles D H Parry
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa; Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, 7505, South Africa
| | - H Eugene Hoyme
- Sanford Children's Genomic Medicine Consortium, Sanford Health, and the University of South Dakota Sanford School of Medicine, Department of Pediatrics, 1600 W. 22nd St., Sioux Falls, SD, 57117, United States; Department of Pediatrics and the Center for Applied Genetics and Genomic Medicine, The University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, Arizona, 85724, United States
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Alcohol. Alcohol 2021. [DOI: 10.1016/b978-0-12-816793-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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20
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Feldmann R. The present and historical prevalence of foetal alcohol syndrome in children living in wine-producing communities. Acta Paediatr 2020; 109:1928-1929. [PMID: 32274815 DOI: 10.1111/apa.15297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/13/2020] [Accepted: 04/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Reinhold Feldmann
- FASD‐Clinic Walstedde Drensteinfurt Germany
- Westfälische Wilhelms‐Universität Münster DEAL‐eligible
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21
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Gomez DA, May PA, Tabachnick BG, Hasken JM, Lyden ER, Kalberg WO, Hoyme HE, Manning MA, Adam MP, Robinson LK, Jones KL, Buckley D, Abdul-Rahman OA. Ocular measurements in fetal alcohol spectrum disorders. Am J Med Genet A 2020; 182:2243-2252. [PMID: 32677343 DOI: 10.1002/ajmg.a.61759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/30/2020] [Accepted: 06/13/2020] [Indexed: 01/03/2023]
Abstract
Fetal alcohol spectrum disorders (FASD) describe a range of physical, behavioral, and neurologic deficits in individuals exposed to alcohol prenatally. Reduced palpebral fissure length is one of the cardinal facial features of FASD. However, other ocular measurements have not been studied extensively in FASD. Using the Fetal Alcohol Syndrome Epidemiologic Research (FASER) database, we investigated how inner canthal distance (ICD), interpupillary distance (IPD), and outer canthal distance (OCD) centiles differed between FASD and non-FASD individuals. We compared ocular measurement centiles in children with FASD to non-FASD individuals and observed reductions in all three centiles for ICD, IPD, and OCD. However, when our non-FASD children who had various forms of growth deficiency (microcephaly, short-stature, or underweight) were compared to controls, we did not observe a similar reduction in ocular measurements. This suggests that reductions in ocular measurements are a direct effect of alcohol on ocular development independent of its effect on growth parameters, which is consistent with animal models showing a negative effect of alcohol on developing neural crest cells. Interpupillary distance centile appeared to be the most significantly reduced ocular measure we evaluated, suggesting it may be a useful measure to be considered in the diagnosis of FASD.
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Affiliation(s)
- Diego A Gomez
- College of Arts and Sciences, Creighton University, Omaha, Nebraska, USA
| | - Philip A May
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Barbara G Tabachnick
- Department of Psychology, California State University, Northridge, California, USA
| | - Julie M Hasken
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Elizabeth R Lyden
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Wendy O Kalberg
- Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - H Eugene Hoyme
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, USA
- Sanford Children's Genomic Medicine Consortium, Sanford Health, Sioux Falls, South Dakota, USA
| | - Melanie A Manning
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Margaret P Adam
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Luther K Robinson
- Department of Pediatrics, State University of New York, Buffalo, New York, USA
| | - Kenneth Lyons Jones
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - David Buckley
- Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Omar A Abdul-Rahman
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
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22
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May PA, Hasken JM, Stegall JM, Mastro HA, Kalberg WO, Buckley D, Brooks M, Hedrick DM, Ortega MA, Elliott AJ, Tabachnick BG, Abdul-Rahman O, Adam MP, Robinson LK, Manning MA, Jewett T, Hoyme HE. Fetal Alcohol Spectrum Disorders in a Southeastern County of the United States: Child Characteristics and Maternal Risk Traits. Alcohol Clin Exp Res 2020; 44:939-959. [PMID: 32293734 DOI: 10.1111/acer.14313] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To detail the characteristic traits of children with fetal alcohol spectrum disorders (FASDs) and maternal risk factors in a southeastern U.S. County. METHODS Independent samples were drawn from 2 different cohorts of first-grade students. All consented children (49.8%) were measured for height, weight, and head circumference, and those ≤ 25th centile entered the study along with a random sample drawn from all enrolled students. Study children were examined for physical growth, dysmorphology, and neurobehavior, and their mothers were interviewed. RESULTS Total dysmorphology scores discriminated well the physical traits of children across the FASD continuum: fetal alcohol syndrome (FAS) = 15.8, partial FAS (PFAS) = 10.8, alcohol-related neurobehavioral disorder (ARND) = 5.2, and typically developing controls = 4.4. Additionally, a neurobehavioral battery distinguished children with each FASD diagnosis from controls. Behavioral problems qualified more children for FASD diagnoses than cognitive traits. Significant proximal maternal risk variables were as follows: reports of prepregnancy drinking, drinking in any trimester, and comorbid use of other drugs in lifetime and during pregnancy, especially alcohol and marijuana (14.9% among mothers of children with FASD vs. 0.4% for controls). Distal maternal risks included reports of other health problems (e.g., depression), living unmarried with a partner during pregnancy, and a lower level of spirituality. Controlling for other drug use during pregnancy, having a child diagnosed with a FASD was 17.5 times greater for women who reported usual consumption of 3 drinks per drinking day prior to pregnancy than for nondrinking mothers (p < 0.001, 95% CI = 5.1 to 59.9). There was no significant difference in the prevalence of FASD by race, Hispanic ethnicity, or socioeconomic status. The prevalence of FASD was not lower than 17.3 per 1,000, and weighted estimated prevalence was 49.0 per 1,000 or 4.9%. CONCLUSION This site had the second lowest rate in the CoFASP study, yet children with FASD are prevalent.
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Affiliation(s)
- Philip A May
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.,Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Julie M Hasken
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Julie M Stegall
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Heather A Mastro
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Wendy O Kalberg
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Marita Brooks
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Dixie M Hedrick
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Marian A Ortega
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Amy J Elliott
- Avera Research, Sioux Falls, South Dakota.,Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | | | | | | | - Luther K Robinson
- Department of Pediatrics, State University of New York at Buffalo, Buffalo, New York
| | - Melanie A Manning
- Departments of Pathology and Pediatrics, Stanford University, Stanford, California
| | - Tamison Jewett
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - H Eugene Hoyme
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota.,Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona.,Sanford Research, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
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23
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May PA, Hasken JM, Bozeman R, Jones JV, Burns MK, Goodover J, Kalberg WO, Buckley D, Brooks M, Ortega MA, Elliott AJ, Hedrick DM, Tabachnick BG, Abdul-Rahman O, Adam MP, Jewett T, Robinson LK, Manning MA, Hoyme HE. Fetal Alcohol Spectrum Disorders in a Rocky Mountain Region City: Child Characteristics, Maternal Risk Traits, and Prevalence. Alcohol Clin Exp Res 2020; 44:900-918. [PMID: 32293732 DOI: 10.1111/acer.14315] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/03/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To document prevalence and traits of children with fetal alcohol spectrum disorders (FASD) and maternal risk factors in a Rocky Mountain city. METHODS Variations on active case ascertainment methods were used in 2 first-grade cohorts in all city schools. The consent rate was 59.2%. Children were assessed for physical growth, dysmorphology, and neurobehavior and their mothers interviewed. RESULTS Thirty-eight children were diagnosed with FASD and compared with 278 typically developing controls. Total dysmorphology scores summarized well the key physical indicators of FASD and defined specific diagnostic groups. On average, children with FASD performed significantly poorer than controls on intellectual, adaptive, learning, attention, and behavioral tasks. More mothers of children with FASD reported drinking prior to pregnancy and in the first and second trimesters, and had partners with drinking problems than mothers of controls; however, reports of comorbid alcohol use and 6 other drugs were similar for mothers of children with FASD and mothers of controls. Mothers of children with FASD were significantly younger at pregnancy, had lower average weight before pregnancy and less education, initiated prenatal clinic visits later, and reported more health problems (e.g., stomach ulcers and accidents). Children with FASD had significantly lower birth weight and more problems at birth, and were less likely to be living with biological mother and father. Controlling for other drug and tobacco use, a FASD diagnosis is 6.7 times (OR = 6.720, 95% CI = 1.6 to 28.0) more likely among children of women reporting prepregnancy drinking of 3 drinks per drinking day (DDD) and 7.6 times (OR = 7.590, 95% CI = 2.0 to 31.5) more likely at 5 DDD. Prevalence of FAS was 2.9-5.8 per 1,000 children, and total FASD was 34.9 to 82.5 per 1,000 children or 3.5 to 8.3% at this site. CONCLUSION This site had the second highest prevalence of FASD of the 4 Collaboration on FASD Prevalence sites and clearly identifiable child and maternal risk traits.
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Affiliation(s)
- Philip A May
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina.,Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Julie M Hasken
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina
| | | | | | - Mary Kay Burns
- City/County Health Department or City Schools, Montana, Montana
| | | | - Wendy O Kalberg
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Marita Brooks
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Marian A Ortega
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Amy J Elliott
- Avera Research, Sioux Falls, South Dakota.,Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - Dixie M Hedrick
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Tamison Jewett
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Luther K Robinson
- Department of Pediatrics, State University of New York at Buffalo, Buffalo, New York
| | - Melanie A Manning
- Departments of Pathology and Pediatrics, Stanford University, Stanford, California
| | - H Eugene Hoyme
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota.,Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona.,Sanford Research, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
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24
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May PA, Hasken JM, Baete A, Russo J, Elliott AJ, Kalberg WO, Buckley D, Brooks M, Ortega MA, Hedrick DM, Tabachnick BG, Abdul-Rahman O, Adam MP, Jewett T, Robinson LK, Manning MA, Hoyme HE. Fetal Alcohol Spectrum Disorders in a Midwestern City: Child Characteristics, Maternal Risk Traits, and Prevalence. Alcohol Clin Exp Res 2020; 44:919-938. [PMID: 32293735 DOI: 10.1111/acer.14314] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the characteristics of children with fetal alcohol spectrum disorders (FASD) and their mothers in a Midwestern city. METHODS Case-control samples were drawn from 2 separate first-grade cohorts (combined N = 4,047) in every city school using different methods. In Cohort Sample 1, all consented small children (≤25th centile on height, weight, and/or head circumference) entered the study along with a random sample from all enrolled students. Cohort Sample 2 was drawn totally at random. Child growth, dysmorphology, and neurobehavior were assessed using the Collaboration on FASD Prevalence (CoFASP) criteria, and mothers were interviewed. RESULTS For the samples combined, 891 children received dysmorphology examinations, and 692 were case-conferenced for final diagnosis. Forty-four children met criteria for FASD. Total dysmorphology scores differentiated diagnostic groups: fetal alcohol syndrome (FAS), 16.7; partial FAS, 11.8; alcohol-related neurodevelopmental disorder (ARND), 6.1; and typically developing controls, 4.2. Neurobehavioral tests distinguished children with FASD from controls, more for behavioral problems than cognitive delay. Children with ARND demonstrated the poorest neurobehavioral indicators. An adjusted regression model of usual prepregnancy drinking indicated that maternal reports of 3 drinks per drinking day (DDD) were significantly associated with a FASD diagnosis (p = 0.020, OR = 10.1, 95% CI = 1.44 to 70.54), as were 5 or more DDD (p < 0.001, OR = 26.47, 95% CI = 4.65 to 150.62). Other significant maternal risk factors included the following: self-reported drinking in any trimester; smoking and cocaine use during pregnancy; later pregnancy recognition and later and less prenatal care; lower maternal weight, body mass index (BMI), and head circumference; and unmarried status. There was no significant difference in FASD prevalence by race, Hispanic ethnicity, or socioeconomic status at this site, where the prevalence of FASD was 14.4 to 41.2 per 1,000 (1.4 to 4.1%). CONCLUSION This city displayed the lowest prevalence of FASD of the 4 CoFASP sites. Nevertheless, FASD were common, and affected children demonstrated a common, recognizable, and measurable array of traits.
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Affiliation(s)
- Philip A May
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina.,Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico
| | - Julie M Hasken
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Amy Baete
- Sanford Research, Sioux Falls, South Dakota
| | | | - Amy J Elliott
- Avera Research, Sioux Falls, South Dakota.,Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - Wendy O Kalberg
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico
| | - Marita Brooks
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico
| | - Marian A Ortega
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico
| | - Dixie M Hedrick
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina
| | | | - Omar Abdul-Rahman
- Department of Pediatrics, University of Nebraska College of Medicine, Omaha, Nebraska
| | - Margaret P Adam
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Tamison Jewett
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Luther K Robinson
- Department of Pediatrics, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Melanie A Manning
- Departments of Pathology and Pediatrics, Stanford University School of Medicine, Stanford, California
| | - H Eugene Hoyme
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota.,Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona.,Sanford Health, Sanford Children's Genomic Medicine Consortium, Sioux Falls, South Dakota
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Bowers Y, Davids A, London L. Alcohol Outlet Density and Deprivation in Six Towns in Bergrivier Municipality before and after Legislative Restrictions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030697. [PMID: 31973145 PMCID: PMC7037425 DOI: 10.3390/ijerph17030697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 11/16/2022]
Abstract
Introduction. In 2016, after the Western Cape Liquor Act was enacted, alcohol outlets were mapped in the six towns from a previous 2008 study to determine: (1) alcohol outlet density; (2) the association between deprivation and alcohol outlet density; (3) geospatial trends of alcohol outlet densities; and (4) the impact of alcohol legislation. Methods. Latitude and longitude coordinates were collected of legal and illegal alcohol outlets, and alcohol outlet density was calculated for legal, illegal and total alcohol outlets by km2 and per 1000 persons. To determine the impact of legislation, t-tests and hot spot analyses were calculated for both 2008 and 2016 studies. Spearman coefficients estimated the relationship between alcohol outlet density and deprivation. Results. Although not statistically significant, the number of alcohol outlets and the density per 1000 population declined by about 12% and 34%, respectively. Illegal outlets were still more likely to be located in more deprived areas, and legal outlets in less deprived areas; and a reduction or addition of a few outlets can change a town’s hot spot status. Conclusions. Further studies with larger sample sizes might help to clarify the impacts of the Liquor Act, and the more recent 2017 Alcohol-Related Harms Reduction Policy on alcohol outlet density in the province.
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Affiliation(s)
- Yasmin Bowers
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa;
- Correspondence:
| | - Adlai Davids
- Human Sciences Research Council, Port Elizabeth 6045, South Africa;
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth 6031, South Africa
| | - Leslie London
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa;
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McQuire C, Daniel R, Hurt L, Kemp A, Paranjothy S. The causal web of foetal alcohol spectrum disorders: a review and causal diagram. Eur Child Adolesc Psychiatry 2020; 29:575-594. [PMID: 30648224 PMCID: PMC7250957 DOI: 10.1007/s00787-018-1264-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022]
Abstract
Foetal alcohol spectrum disorders (FASDs) are a leading cause of developmental disability. Prenatal alcohol use is the sole necessary cause of FASD, but it is not always sufficient. Multiple factors influence a child's susceptibility to FASD following prenatal alcohol exposure. Much of the FASD risk factor literature has been limited to discussions of association, rather than causation. While knowledge of predictor variables is important for identifying who is most at risk of FASD and for targeting interventions, causal knowledge is important for identifying effective mechanisms for prevention and intervention programmes. We conducted a systematic search and narrative synthesis of the evidence and used this to create a causal diagram (directed acyclic graph; DAG) to describe the causal pathways to FASD. Our results show that the aetiology of FASD is multifaceted and complex. FASD risk is determined by a range of lifestyle, sociodemographic, maternal, social, gestational, and genetic factors. The causal diagram that we present in this review provides a comprehensive summary of causal risk factors for FASD and can be used as a tool to inform data collection and statistical modelling strategies to minimise bias in future studies of FASD.
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Affiliation(s)
- Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - R. Daniel
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - L. Hurt
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - A. Kemp
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - S. Paranjothy
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
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27
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Kalberg WO, May PA, Buckley D, Hasken JM, Marais AS, De Vries MM, Bezuidenhout H, Manning MA, Robinson LK, Adam MP, Hoyme DB, Parry CD, Seedat S, Elliott AJ, Hoyme HE. Early-Life Predictors of Fetal Alcohol Spectrum Disorders. Pediatrics 2019; 144:peds.2018-2141. [PMID: 31744890 PMCID: PMC6889972 DOI: 10.1542/peds.2018-2141] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Fetal alcohol spectrum disorders (FASD) comprise the continuum of disabilities associated with prenatal alcohol exposure. Although infancy remains the most effective time for initiation of intervention services, current diagnostic schemes demonstrate the greatest confidence, accuracy, and reliability in school-aged children. Our aims for the current study were to identify growth, dysmorphology, and neurodevelopmental features in infants that were most predictive of FASD at age 5, thereby improving the timeliness of diagnoses. METHODS A cohort of pregnant South African women attending primary health care clinics or giving birth in provincial hospitals was enrolled in the project. Children were followed longitudinally from birth to 60 months to determine their physical and developmental trajectories (N = 155). Standardized protocols were used to assess growth, dysmorphology, and development at 6 weeks and at 9, 18, 42, and 60 months. A structured maternal interview, including estimation of prenatal alcohol intake, was administered at 42 or 60 months. RESULTS Growth restriction and total dysmorphology scores differentiated among children with and without FASD as early as 9 months (area under the receiver operating characteristic curve = 0.777; P < .001; 95% confidence interval: 0.705-0.849), although children who were severely affected could be identified earlier. Assessment of developmental milestones revealed significant developmental differences emerging among children with and without FASD between 18 and 42 months. Mothers of children with FASD were significantly smaller, with lower BMIs and higher alcohol intake during pregnancy, than mothers of children without FASD. CONCLUSIONS Assessment of a combination of growth, dysmorphology, and neurobehavioral characteristics allows for accurate identification of most children with FASD as early as 9 to 18 months.
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Affiliation(s)
- Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Philip A. May
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico;,Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;,Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - David Buckley
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Julie M. Hasken
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna-Susan Marais
- Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Marlene M. De Vries
- Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Heidre Bezuidenhout
- Division of Molecular Biology and Human Genetics, Departments of Biomedical Sciences and
| | - Melanie A. Manning
- Departments of Pathology and Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Luther K. Robinson
- Department of Pediatrics, School of Medicine, State University of New York at Buffalo, Buffalo, New York
| | - Margaret P. Adam
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Derek B. Hoyme
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| | - Charles D.H. Parry
- Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa;,Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Soraya Seedat
- Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Amy J. Elliott
- Avera Research Institute Center for Pediatric and Community Research, Sioux Falls, South Dakota;,Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - H. Eugene Hoyme
- Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa;,Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota;,Sanford Children’s Genomic Medicine Consortium, Sanford Health, Sioux Falls, South Dakota; and,Departments of Pediatrics and Medicine, College of Medicine, University of Arizona, Tucson, Arizona
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"The Dop System of Alcohol Distribution is Dead, but It's Legacy Lives On….". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193701. [PMID: 31581441 PMCID: PMC6801681 DOI: 10.3390/ijerph16193701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 12/02/2022]
Abstract
Objective: Determine the prevalence of Dop, a system of labor payment via alcoholic beverages, in a South African province, and its influence on maternal drinking and fetal alcohol spectrum disorders (FASD). Methods: Data from studies of FASD epidemiology were analyzed. Results: Forty-two percent to 67% of mothers reported drinking. In 1999, 5% of women reported Dop allocations in their lifetime: 14% of mothers of FASD children and 1% of controls. In 2010, 1.1% of mothers reported lifetime Dop: 1.6% of FASD mothers and 0.7% of controls. Commercial alcohol sales have replaced the Dop system. Total FASD rates remained high in rural areas in 2010 and rose in urban settings. Urban rates of total FASD surpassed rural area rates in 2010. Correlation analysis did not reveal a strong or significant, direct relationship between Dop experience and heavy drinking (r = 0.123, p < 0.001, r2 = 0.015), or the diagnosis of FASD in children (OR = 0.003, p = 0.183). Conclusion: Dop, as a systematic practice, is dead and does not have a direct influence on alcohol availability, heavy maternal drinking, or the probability of an FASD diagnosis. Nevertheless, today’s problematic drinking patterns were heavily influenced (shaped) by Dop and have negatively impacted the prevalence and severity of FASD.
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Brown JM, Bland R, Jonsson E, Greenshaw AJ. The Standardization of Diagnostic Criteria for Fetal Alcohol Spectrum Disorder (FASD): Implications for Research, Clinical Practice and Population Health. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:169-176. [PMID: 29788774 PMCID: PMC6405816 DOI: 10.1177/0706743718777398] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Fetal Alcohol Spectrum Disorder (FASD) is a preventable disorder caused by maternal alcohol consumption and marked by a range of physical and mental disabilities. Although recognized by the scientific and medical community as a clinical disorder, no internationally standardized diagnostic tool yet exists for FASD. METHODS AND RESULTS This review seeks to analyse the discrepancies in existing diagnostic tools for FASD, and the repercussions these differences have on research, public health, and government policy. CONCLUSIONS Disagreement on the adoption of a standardised tool is reflective of existing gaps in research on the conditions and factors that influence fetal vulnerability to damage from exposure. This discordance has led to variability in research findings, inconsistencies in government messaging, and misdiagnoses or missed diagnoses. The objective measurement of the timing and level of prenatal alcohol exposure is key to bridging these gaps; however, there is conflicting or limited evidence to support the use of existing measures.
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Affiliation(s)
- Jasmine M Brown
- 1 Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Roger Bland
- 1 Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Egon Jonsson
- 1 Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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Roozen S, Peters GJY, Kok G, Townend D, Nijhuis J, Koek G, Curfs L. Systematic literature review on which maternal alcohol behaviours are related to fetal alcohol spectrum disorders (FASD). BMJ Open 2018; 8:e022578. [PMID: 30573481 PMCID: PMC6303602 DOI: 10.1136/bmjopen-2018-022578] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Fetal alcohol spectrum disorders (FASD) is a worldwide problem. Maternal alcohol consumption is an important risk factor for FASD. It remains unknown which alcohol consumption patterns most strongly predict FASD. The objective of this study was to identify these. DESIGN Systematic literature review. METHODS We searched in PubMed, PsychINFO, PsycARTICLES, ERIC, CINAHL, Embase and MEDLINE up to August 2018. The query consisted of keywords and their synonyms related to FASD, pregnancy and behaviour. Studies were excluded when not published in English, were reviews or involved non-human subjects. Substantial heterogeneity precluded aggregation or meta-analysis of the data. Instead, data were qualitatively inspected. RESULTS In total, 21 studies were eligible for further data analysis. All studies that measured both maternal alcohol drinking behaviours and FASD reported retrospective data on maternal drinking patterns, employing both continuous and categorical measures and exhibiting substantial heterogeneity in measures of alcohol consumption (eg, timing of exposure, quantification of alcohol measure and definition of a standard drink). Study quality improved over time and appeared higher for studies based on active case ascertainment, especially when conducted in schools and when behaviour was assessed through interviews. CONCLUSIONS We aimed to identify specific maternal drinking behaviour(s) related to FASD. The state of the literature precludes such conclusions. Evidence-based preventive measures necessitate identifying which prenatal alcohol drinking behaviour(s) are most in need of intervention. Therefore, we formulate three recommendations for future research. First, future studies can optimise the value of the collected dataset through specifying measurements and reporting of maternal drinking behaviours and avoiding categorised measures (nominal or ordinal) whenever possible. Second, samples should not be selected based on FASD status, but instead, FASD status as well as maternal alcohol consumption should both be measured in a general population sample. Finally, we provide 10 reporting guidelines for FASD research.
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Affiliation(s)
- Sylvia Roozen
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Gjalt-Jorn Ygram Peters
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- Faculty of Psychology and Education Science, Open University of The Netherlands, Heerlen, The Netherlands
| | - Gerjo Kok
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - David Townend
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Health, Ethics & Society, Maastricht University, Maastricht, The Netherlands
| | - Jan Nijhuis
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Obstretrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ger Koek
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Leopold Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
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Terband H, Spruit M, Maassen B. Speech Impairment in Boys With Fetal Alcohol Spectrum Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1405-1425. [PMID: 30398563 DOI: 10.1044/2018_ajslp-17-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/11/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Fetal alcohol spectrum disorders (FASD) are a highly prevalent spectrum of patterns of congenital defects resulting from prenatal exposure to alcohol. Approximately 90% of the cases involve speech impairment. Yet, to date, no detailed symptom profiles nor dedicated treatment plans are available for this population. PURPOSE This study set out to chart the speech and speech motor characteristics in boys with FASD to profile the concomitant speech impairment and identify possible underlying mechanisms. METHOD Ten boys with FASD (4.5-10.3 years old) and 26 typically developing children (4.1-8.7 years old; 14 boys, 12 girls) participated in the study. Speech production and perception, and oral motor data were collected by standardized tests. RESULTS The boys with FASD showed reduced scores on all tasks as well as a deviant pattern of correlations between production and perception tasks and intelligibility compared with the typically developing children. Speech motor profiles showed specific problems with nonword repetition and tongue control. CONCLUSIONS Findings indicate that the speech impairment in boys with FASD results from a combination of deficits in multiple subsystems and should be approached as a disorder rather than a developmental delay. The results suggest that reduced speech motor planning/programming, auditory discrimination, and oral motor abilities should be considered in long-term, individually tailored treatment.
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Affiliation(s)
- Hayo Terband
- Utrecht Institute of Linguistics - OTS, Utrecht University, the Netherlands
| | - Manon Spruit
- Utrecht Institute of Linguistics - OTS, Utrecht University, the Netherlands
- Logopedie & Stottertherapie, Lingen, Germany
| | - Ben Maassen
- Centre for Language and Cognition & University Medical Centre, University of Groningen, the Netherlands
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Viljoen D, Louw JG, Lombard C, Olivier L. Comparing diagnostic outcomes of children with fetal alcohol syndrome in South Africa with diagnostic outcomes when using the updated Institute of Medicine diagnostic guidelines. Birth Defects Res 2018; 110:1335-1342. [PMID: 30347134 DOI: 10.1002/bdr2.1399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/16/2018] [Accepted: 08/22/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION During fetal alcohol spectrum disorder (FASD) prevalence studies in South Africa, cases of fetal alcohol syndrome (FAS) were identified that presented differently from the 2016 Hoyme et al. modified Institute of Medicine (IOM) criteria. We compared diagnostic outcomes of children diagnosed with FAS using a combination of the 2005 Hoyme et al. criteria and the "gestalt method" in South Africa to the diagnosis they would have received using the latest Hoyme et al. criteria. The frequency with which dysmorphic features presented was compared to the frequency with which they were reported in the revised criteria which drew on a larger sample. METHODS Data were gathered from four South African FASD prevalence studies. Dysmorphology data, anthropometric data, and final diagnosis for participants (N = 917) were extracted. RESULTS Of the 390 participants with diagnoses of "full FAS," 175 would not have received a "full FAS" diagnosis using the 2016 criteria. Of these, 21 would have received a pFAS diagnosis, and 154 would have received a diagnosis of ARND or a "no-FASD" diagnosis. The frequency of all but five dysmorphic features differ significantly between this sample and the sample examined for the 2016 criteria. There is more variability in the features present in the current sample. DISCUSSION Differences regarding diagnostic outcomes and prevalence of dysmorphic features suggest that strict application of the diagnostic criteria may miss children who present with FAS. We recommend including gestalt-based screening in a research setting where the clinical experience is available to inform future guidelines.
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Affiliation(s)
- Denis Viljoen
- Foundation for Alcohol-Related Research (FARR), Cape Town, South Africa.,Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Jacobus G Louw
- Foundation for Alcohol-Related Research (FARR), Cape Town, South Africa.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Chanelle Lombard
- Foundation for Alcohol-Related Research (FARR), Cape Town, South Africa
| | - Leana Olivier
- Foundation for Alcohol-Related Research (FARR), Cape Town, South Africa.,Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Suttie M, Wozniak JR, Parnell SE, Wetherill L, Mattson SN, Sowell ER, Kan E, Riley EP, Jones KL, Coles C, Foroud T, Hammond P. Combined Face-Brain Morphology and Associated Neurocognitive Correlates in Fetal Alcohol Spectrum Disorders. Alcohol Clin Exp Res 2018; 42:1769-1782. [PMID: 29935097 PMCID: PMC6120799 DOI: 10.1111/acer.13820] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Since the 1970s, a range of facial, neurostructural, and neurocognitive adverse effects have been shown to be associated with prenatal alcohol exposure. Typically, these effects are studied individually and not in combination. Our objective is to improve the understanding of the teratogenic effects of prenatal alcohol exposure by simultaneously considering face-brain morphology and neurocognitive measures. METHODS Participants were categorized as control (n = 47), fetal alcohol syndrome (FAS, n = 22), or heavily exposed (HE) prenatally, but not eligible for a FAS diagnosis (HE, n = 50). Structural brain MRI images and high-resolution 3D facial images were analyzed using dense surface models of features of the face and surface shape of the corpus callosum (CC) and caudate nucleus (CN). Asymmetry of the CN was evaluated for correlations with neurocognitive measures. RESULTS (i) Facial growth delineations for FAS, HE, and controls are replicated for the CN and the CC. (ii) Concordance of clinical diagnosis and face-based control-FAS discrimination improves when the latter is combined with specific brain regions. In particular, midline facial regions discriminate better when combined with a midsagittal profile of the CC. (iii) A subset of HE individuals was identified with FAS-like CN dysmorphism. The average of this HE subset was FAS-like in its facial dysmorphism. (iv) Right-left asymmetry found in the CNs of controls is not apparent for FAS, is diminished for HE, and correlates with neurocognitive measures in the combined FAS and HE population. CONCLUSIONS Shape analysis which combines facial regions with the CN, and with the CC, better identify those with FAS. CN asymmetry was reduced for FAS compared to controls and is strongly associated with general cognitive ability, verbal learning, and recall in those with prenatal alcohol exposure. This study further extends the brain-behavior relationships known to be vulnerable to alcohol teratogenesis.
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Affiliation(s)
- Michael Suttie
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, UK
- Big Data Institute, University of Oxford, UK
| | | | - Scott E. Parnell
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA
| | - Sarah N. Mattson
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Elizabeth R. Sowell
- Department of Pediatrics, University of Southern California and Children’s Hospital Los Angeles, USA
| | - Eric Kan
- Department of Pediatrics, University of Southern California and Children’s Hospital Los Angeles, USA
| | - Edward P. Riley
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Kenneth L. Jones
- Department of Pediatrics, School of Medicine, UCSD, San Diego, USA
| | - Claire Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA
| | - Peter Hammond
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, UK
- Big Data Institute, University of Oxford, UK
| | - CIFASD
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, UK
- Big Data Institute, University of Oxford, UK
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McCormack C, Hutchinson D, Burns L, Youssef G, Wilson J, Elliott E, Allsop S, Najman J, Jacobs S, Rossen L, Olsson C, Mattick R. Maternal and partner prenatal alcohol use and infant cognitive development. Drug Alcohol Depend 2018; 185:330-338. [PMID: 29499553 DOI: 10.1016/j.drugalcdep.2017.12.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Teratogenicity of heavy prenatal alcohol exposure is established, but uncertainty remains regarding the impact of moderate alcohol exposure on cognitive deficits in infants. Separating in utero effects from environmental confounding is a challenge for observational studies; consideration of alcohol use by partners as well as mothers may help clarify this. This study examined associations between prenatal alcohol use by both mothers and their partners and infant cognitive developmental outcomes at 12-months. METHODS Pregnant women (n = 1331) and their partners (n = 699) were recruited from antenatal clinics of three metropolitan public hospitals in Australia, and completed detailed interviews about alcohol consumptions throughout pregnancy. Infants were assessed with the Bayley Scales of Infant Development - Third edition (Bayley) at 12-months of age. RESULTS Alcohol use during pregnancy was reported by 65.7% of mothers and 84.1% of partners. Using multiple methods to adjust for confounding factors, no evidence for impaired cognitive ability associated with alcohol use by mothers or their partners was observed. Children born to women who drank low-levels of alcohol had slightly higher Bayley cognitive scores than those born to abstaining women. There was some evidence for an interaction between sociodemographic factors and prenatal alcohol exposure on infant cognitive outcomes. CONCLUSION This finding corroborates existing evidence to suggest there are no detrimental effects to infant cognitive development at 12-months of age following low-level prenatal alcohol exposure. Future prospective studies involving families of a broad range of backgrounds would be informative to clarify interaction between alcohol exposure and environmental factors on developmental outcomes.
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Affiliation(s)
- Clare McCormack
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia; Department of Psychiatry, Columbia University Medical Center, 622 West 168th St., New York, NY 10032, USA.
| | - Delyse Hutchinson
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia; Centre for Social and Early Emotional Development, Deakin University, 221 Burwood Hwy., Burwood, VIC 3125, Australia; Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd., Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital, 50 Flemington Rd., Parkville, VIC 3052, Australia
| | - Lucy Burns
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia
| | - George Youssef
- Centre for Social and Early Emotional Development, Deakin University, 221 Burwood Hwy., Burwood, VIC 3125, Australia; Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd., Parkville, VIC 3052, Australia
| | - Judy Wilson
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia
| | - Elizabeth Elliott
- Paediatrics and Child Health, University of Sydney, NSW 2006, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Kent St., Bentley, Perth 6102, Australia
| | - Jake Najman
- Queensland Alcohol and Drug Research Education Centre, University of Queensland, Brisbane, St. Lucia, QLD 4072, Australia
| | - Sue Jacobs
- Dept of Obstetrics, Royal Prince Alfred Hospital,Missenden Rd., Camperdown, NSW 2050, Australia
| | - Larissa Rossen
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia
| | - Craig Olsson
- Centre for Social and Early Emotional Development, Deakin University, 221 Burwood Hwy., Burwood, VIC 3125, Australia; Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd., Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital, 50 Flemington Rd., Parkville, VIC 3052, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St., Randwick, NSW 2031, Australia
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Ophthalmologic Findings in Russian Children with Fetal Alcohol Syndrome. Eur J Ophthalmol 2018; 23:823-30. [DOI: 10.5301/ejo.5000296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2013] [Indexed: 11/20/2022]
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Lee KSK, Wilson S, Perry J, Room R, Callinan S, Assan R, Hayman N, Chikritzhs T, Gray D, Wilkes E, Jack P, Conigrave KM. Developing a tablet computer-based application ('App') to measure self-reported alcohol consumption in Indigenous Australians. BMC Med Inform Decis Mak 2018; 18:8. [PMID: 29334962 PMCID: PMC5769490 DOI: 10.1186/s12911-018-0583-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The challenges of assessing alcohol consumption can be greater in Indigenous communities where there may be culturally distinct approaches to communication, sharing of drinking containers and episodic patterns of drinking. This paper discusses the processes used to develop a tablet computer-based application ('App') to collect a detailed assessment of drinking patterns in Indigenous Australians. The key features of the resulting App are described. METHODS An iterative consultation process was used (instead of one-off focus groups), with Indigenous cultural experts and clinical experts. Regular (weekly or more) advice was sought over a 12-month period from Indigenous community leaders and from a range of Indigenous and non-Indigenous health professionals and researchers. RESULTS The underpinning principles, selected survey items, and key technical features of the App are described. Features include culturally appropriate questioning style and gender-specific voice and images; community-recognised events used as reference points to 'anchor' time periods; 'translation' to colloquial English and (for audio) to traditional language; interactive visual approaches to estimate quantity of drinking; images of specific brands of alcohol, rather than abstract description of alcohol type (e.g. 'spirits'); images of make-shift drinking containers; option to estimate consumption based on the individual's share of what the group drank. CONCLUSIONS With any survey platform, helping participants to accurately reflect on and report their drinking presents a challenge. The availability of interactive, tablet-based technologies enables potential bridging of differences in culture and lifestyle and enhanced reporting.
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Affiliation(s)
- K S Kylie Lee
- University of Sydney, Discipline of Addiction Medicine, Indigenous Health and Substance Use, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia. .,Centre for Alcohol Policy Research, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia.
| | - Scott Wilson
- University of Sydney, Discipline of Addiction Medicine, Indigenous Health and Substance Use, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.,Aboriginal Drug and Alcohol Council (ADAC) South Australia, 155 Holbrooks Road Underdale, Adelaide, South Australia, 5032, Australia
| | - Jimmy Perry
- Aboriginal Drug and Alcohol Council (ADAC) South Australia, 155 Holbrooks Road Underdale, Adelaide, South Australia, 5032, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia
| | - Robert Assan
- Alcohol, Tobacco and other Drugs Service, Queensland Health, 190 Palmerston Vincent, Townsville, QLD, 4814, Australia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, 37 Wirraway Parade, Inala, QLD, 4077, Australia.,School of Medicine, University of Queensland, Herston Road, Brisbane, QLD, 4006, Australia.,School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, Brisbane, QLD, 4222, Australia
| | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, 10 Selby St, Shenton Park, WA, 6008, Australia
| | - Dennis Gray
- National Drug Research Institute, Curtin University, 10 Selby St, Shenton Park, WA, 6008, Australia
| | - Edward Wilkes
- National Drug Research Institute, Curtin University, 10 Selby St, Shenton Park, WA, 6008, Australia
| | - Peter Jack
- Drug Health Services, Royal Prince Alfred Hospital, Sydney Local Health District, KGV Building, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Katherine M Conigrave
- University of Sydney, Discipline of Addiction Medicine, Indigenous Health and Substance Use, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Sydney Local Health District, KGV Building, Missenden Road, Camperdown, NSW, 2050, Australia
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37
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Biffen SC, Warton CMR, Lindinger NM, Randall SR, Lewis CE, Molteno CD, Jacobson JL, Jacobson SW, Meintjes EM. Reductions in Corpus Callosum Volume Partially Mediate Effects of Prenatal Alcohol Exposure on IQ. Front Neuroanat 2018; 11:132. [PMID: 29379419 PMCID: PMC5771245 DOI: 10.3389/fnana.2017.00132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022] Open
Abstract
Disproportionate volume reductions in the basal ganglia, corpus callosum (CC) and hippocampus have been reported in children with prenatal alcohol exposure (PAE). However, few studies have investigated these reductions in high prevalence communities, such as the Western Cape Province of South Africa, and only one study made use of manual tracing, the gold standard of volumetric analysis. The present study examined the effects of PAE on subcortical neuroanatomy using manual tracing and the relation of volumetric reductions in these regions to IQ and performance on the California Verbal Learning Test-Children's Version (CVLT-C), a list learning task sensitive to PAE. High-resolution T1-weighted images were acquired, using a sequence optimized for morphometric neuroanatomical analysis, on a Siemens 3T Allegra MRI scanner from 71 right-handed, 9- to 11-year-old children [9 fetal alcohol syndrome (FAS), 19 partial FAS (PFAS), 24 non-syndromal heavily exposed (HE) and 19 non-exposed controls]. Frequency of maternal drinking was ascertained prospectively during pregnancy using timeline follow-back interviews. PAE was examined in relation to volumes of the CC and left and right caudate nuclei, nucleus accumbens and hippocampi. All structures were manually traced using Multitracer. Higher levels of PAE were associated with reductions in CC volume after adjustment for TIV. Although the effect of PAE on CC was confounded with smoking and lead exposure, additional analyses showed that it was not accounted for by these exposures. Amongst dysmorphic children, smaller CC was associated with poorer IQ and CVLT-C scores and statistically mediated the effect of PAE on IQ. In addition, higher levels of PAE were associated with bilateral volume reductions in caudate nuclei and hippocampi, effects that remained significant after control for TIV, child sex and age, socioeconomic status, maternal smoking during pregnancy, and childhood lead exposure. These data confirm previous findings showing that PAE is associated with decreases in subcortical volumes and is the first study to show that decreases in callosal volume may play a role in fetal alcohol-related impairment in cognitive function seen in childhood.
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Affiliation(s)
- Stevie C Biffen
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher M R Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nadine M Lindinger
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Steven R Randall
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Catherine E Lewis
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Joseph L Jacobson
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Sandra W Jacobson
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Ernesta M Meintjes
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Lange S, Probst C, Rehm J, Popova S. Prevalence of binge drinking during pregnancy by country and World Health Organization region: Systematic review and meta-analysis. Reprod Toxicol 2017; 73:214-221. [DOI: 10.1016/j.reprotox.2017.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
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Lubbe M, van Walbeek C, Vellios N. The Prevalence of Fetal Alcohol Syndrome and Its Impact on a Child's Classroom Performance: A Case Study of a Rural South African School. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080896. [PMID: 28792446 PMCID: PMC5580600 DOI: 10.3390/ijerph14080896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/26/2017] [Accepted: 08/04/2017] [Indexed: 12/13/2022]
Abstract
Alcohol consumption is high among farm labourers in the Western and Northern Cape of South Africa. Excessive alcohol consumption during pregnancy is common, resulting in a high prevalence of Fetal Alcohol Syndrome (FAS) among children. FAS causes intellectual and behavioural problems, which create considerable obstacles to a child’s education. The aim of this study is to provide a prevalence estimate of FAS in a rural school and to examine the effects of FAS on learners’ educational outcomes. The study was conducted at a farm school near Clanwilliam in the Western Cape of South Africa. The sample comprises 166 learners from Grades 1 to 4. Educational outcomes include class scores (Afrikaans home language and mathematics), reading ability, and classroom behaviour. A physician diagnosed FAS using a three-stage process. We find FAS prevalence of 127 per 1000 (12.7%). Children with FAS score significantly lower (at the 10% level) for home language and behaviour than children who do not have FAS. Large-scale interventions in rural areas of the Western and Northern Cape that specifically target females of child-bearing age, as well as children with FAS, are necessary.
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Affiliation(s)
- Melissa Lubbe
- School of Economics, University of Cape Town, Cape Town 7700, South Africa.
| | - Corné van Walbeek
- School of Economics, University of Cape Town, Cape Town 7700, South Africa.
- Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town 7700, South Africa.
| | - Nicole Vellios
- Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town 7700, South Africa.
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May PA, Tabachnick B, Hasken JM, Marais AS, de Vries MM, Barnard R, Joubert B, Cloete M, Botha I, Kalberg WO, Buckley D, Burroughs ZR, Bezuidenhout H, Robinson LK, Manning MA, Adnams CM, Seedat S, Parry CDH, Hoyme HE. Who is most affected by prenatal alcohol exposure: Boys or girls? Drug Alcohol Depend 2017. [PMID: 28624747 DOI: 10.1016/j.drugalcdep.2017.04.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine outcomes among boys and girls that are associated with prenatal alcohol exposure. METHODS Boys and girls with fetal alcohol spectrum disorders (FASD) and randomly-selected controls were compared on a variety of physical and neurobehavioral traits. RESULTS Sex ratios indicated that heavy maternal binge drinking may have significantly diminished viability to birth and survival of boys postpartum more than girls by age seven. Case control comparisons of a variety of physical and neurobehavioral traits at age seven indicate that both sexes were affected similarly for a majority of variables. However, alcohol-exposed girls had significantly more dysmorphology overall than boys and performed significantly worse on non-verbal IQ tests than males. A three-step sequential regression analysis, controlling for multiple covariates, further indicated that dysmorphology among girls was significantly more associated with five maternal drinking variables and three distal maternal risk factors. However, the overall model, which included five associated neurobehavioral measures at step three, was not significant (p=0.09, two-tailed test). A separate sequential logistic regression analysis of predictors of a FASD diagnosis, however, indicated significantly more negative outcomes overall for girls than boys (Nagelkerke R2=0.42 for boys and 0.54 for girls, z=-2.9, p=0.004). CONCLUSION Boys and girls had mostly similar outcomes when prenatal alcohol exposure was linked to poor physical and neurocognitive development. Nevertheless, sex ratios implicate lower viability and survival of males by first grade, and girls have more dysmorphology and neurocognitive impairment than boys resulting in a higher probability of a FASD diagnosis.
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Affiliation(s)
- Philip A May
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States.
| | | | - Julie M Hasken
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States
| | - Anna-Susan Marais
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marlene M de Vries
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Ronel Barnard
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Belinda Joubert
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marise Cloete
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Isobel Botha
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Wendy O Kalberg
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - David Buckley
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | | | - Heidre Bezuidenhout
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - Luther K Robinson
- State University of New York, Buffalo, Department of Pediatrics, United States
| | - Melanie A Manning
- Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States
| | - Colleen M Adnams
- University of Cape Town, Department of Psychiatry and Mental Health, South Africa
| | - Soraya Seedat
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Charles D H Parry
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, South Africa
| | - H Eugene Hoyme
- Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States; University of Arizona, Department of Pediatrics, United States
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Dukes K, Tripp T, Petersen J, Robinson F, Odendaal H, Elliott A, Willinger M, Hereld D, Raffo C, Kinney HC, Groenewald C, Angal J, Young R, Burd L. A modified Timeline Followback assessment to capture alcohol exposure in pregnant women: Application in the Safe Passage Study. Alcohol 2017; 62:17-27. [PMID: 28755748 DOI: 10.1016/j.alcohol.2017.02.174] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 12/14/2022]
Abstract
Prenatal alcohol exposure (PAE) has been linked to poor pregnancy outcomes, yet there is no recognized standard for PAE assessment, and the specific effects of quantity, frequency, and timing remain largely unknown. The Safe Passage Study was designed to investigate the role of PAE in a continuum of poor peri- and postnatal outcomes. The objective of this manuscript is to describe the rationale for, and feasibility of, modifications to the traditional Timeline Followback (TLFB) for collecting PAE information in a large cohort of pregnant women. Participants from the Northern Plains region (in the United States) and Cape Town, South Africa, were followed prospectively using a modified 30-day TLFB interview, administered up to five times, to obtain detailed PAE information. Required modifications for our population included capturing information regarding sharing, type/brand, container size, and duration, in order to accurately record the amount of alcohol consumed. PAE status was defined for 99.9% of the 11,892 enrolled pregnancies at least once during pregnancy and for 92% across all trimesters. Of 53,823 drinks reported, 98% had all items necessary for standard drink computation. Sharing was reported for 74% of drinks in Cape Town, South Africa and for 10% in the Northern Plains. Compared to referent values from the traditional TLFB, 74% and 67% of drinks had different alcohol-by-volume and container size, respectively. Furthermore, a statistically significant difference was found between the number of containers reported and the number of standard drinks computed, using information from the modified TLFB. This is the first study of this size to wholly encompass all of these changes into a single measure in order to more accurately calculate daily consumption and assess patterns over time. The methods used to collect PAE information and create alcohol exposure measures likely increased the accuracy of standard drinks reported and could be generalized to other populations.
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Affiliation(s)
- Kimberly Dukes
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA.
| | - Tara Tripp
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Julie Petersen
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Fay Robinson
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Hein Odendaal
- Stellenbosch University, Department of Obstetrics and Gynecology, Francie van Zijl Avenue, Tygerberg 7505, South Africa
| | - Amy Elliott
- Sanford Research, Center for Health Outcomes and Prevention Research, 2301 E. 60th Street North, Sioux Falls, SD 57104, USA
| | - Marian Willinger
- National Institute of Child Health and Human Development, 31 Center Drive, Building 31, Room 2A32, Bethesda, MD 20892-2425, USA
| | - Dale Hereld
- National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Rockville, MD 20852, USA
| | - Cheryl Raffo
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Hannah C Kinney
- Boston Children's Hospital, Department of Pathology, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Coen Groenewald
- Stellenbosch University, Department of Obstetrics and Gynecology, Francie van Zijl Avenue, Tygerberg 7505, South Africa
| | - Jyoti Angal
- Sanford Research, Center for Health Outcomes and Prevention Research, 2301 E. 60th Street North, Sioux Falls, SD 57104, USA
| | - Rebecca Young
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Larry Burd
- University of North Dakota, Fetal Alcohol Syndrome Center, School of Medicine & Health Sciences, 501 North Columbia Road, Grand Forks, ND 58203-9037, USA
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42
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Unrealistic optimism with regard to drinking during pregnancy among women of childbearing age in a South African community. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246317717105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drinking alcohol during pregnancy is a risk factor in a range of adverse birth outcomes, including fetal alcohol spectrum disorders, and is a major health concern. For this behaviour to change one of the necessary conditions is for women to have an accurate perception of the risks drinking during pregnancy poses. A major obstacle to this is the presence of unrealistic optimism which leads to women believing they are less at risk than others. This study examined a sample of women ( N = 129) from a community in the Northern Cape Province in South Africa with a high prevalence of fetal alcohol spectrum disorder for signs of unrealistic optimism. A questionnaire about the perception of personal and general risk was administered during a one-on-one interview and responses compared. Neither a Student’s t-test ( t(115) = −1.720, p = .088, 95% confidence interval [−0.180, 0.013]) nor a Wilcoxon matched-pairs signed-rank test ( z = −1.72, p = .285) showed a significant difference. The perception of risk posed by drinking during pregnancy to others, knowledge of fetal alcohol spectrum disorder, and the perception of how easy it would be for the participant to quit drinking were significant predictors of the perception of personal risk. Only the perception of personal risk predicted the perception of general risk. There was no evidence that participants believed themselves to be less at risk than their peers when it came to the risks of drinking during pregnancy. Future directions for research into unrealistic optimism and drinking during pregnancy are discussed.
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Hafekost K, Lawrence D, O'Leary C, Bower C, Semmens J, Zubrick SR. Maternal Alcohol Use Disorder and Risk of Child Contact with the Justice System in Western Australia: A Population Cohort Record Linkage Study. Alcohol Clin Exp Res 2017. [PMID: 28641361 PMCID: PMC5575459 DOI: 10.1111/acer.13426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early contact with the justice system is associated with a multitude of negative outcomes across the life course. This includes an increased risk of ongoing justice contact, social disadvantage and marginalization, and mental health and substance use issues. Children whose mothers have an alcohol use disorder may be at risk of early justice system contact, and we sought to quantify this relationship in a Western Australian cohort. METHODS This population cohort study made use of linked administrative data. Those in-scope for the study were women who had a birth recorded on the Midwives Notification System (1983 to 2007). The exposed cohort were mothers who had an alcohol-related diagnosis (ICD9/10), recorded on administrative data. This included mental and behavioral disorders which were alcohol related, diseases which could be entirely attributed to alcohol and other ICD alcohol codes. These women were considered to have an alcohol use disorder, which was a proxy for heavy drinking. The comparison cohort was frequency-matched sample with no alcohol-related diagnosis identified on administrative data sets. RESULTS After adjusting for potential confounders, children whose mothers had a maternal alcohol use disorder had a significantly increased odds of justice contact when compared to those whose mothers had no diagnosis (odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.60 to 1.99). Additional significant maternal factors associated with child justice contact included being Indigenous (OR = 5.14, 95% CI = 4.54 to 5.81), low maternal age, low socioeconomic status, being unmarried, and a history of a mental health problems. Significant child-level factors, which were associated with increased odds of justice contact, included being male, a mental health diagnosis, child protection contact, parity, and academic failure. CONCLUSIONS Children who were exposed to a maternal alcohol use disorder had significantly increased odds of contact with the justice system. Additional risk was associated with being Indigenous and with markers of social disadvantage. These results suggest that prevention and early intervention services should span across agencies in an effort to reduce risk.
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Affiliation(s)
- Katherine Hafekost
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Colleen O'Leary
- Office of the Chief Psychiatrist, Western Australian Department of Health, Perth, Western Australia, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - James Semmens
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
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Replication of High Fetal Alcohol Spectrum Disorders Prevalence Rates, Child Characteristics, and Maternal Risk Factors in a Second Sample of Rural Communities in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14050522. [PMID: 28498341 PMCID: PMC5451973 DOI: 10.3390/ijerph14050522] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 11/17/2022]
Abstract
Background: Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods: Active case ascertainment focused on children with height, weight and/or head circumference ≤25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results: Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 89–129 per 1000 children. Total FASD affect 196–276 per 1000 or 20–28% of the children in these communities. Conclusions: Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions.
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45
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Brittain K, Remien RH, Phillips T, Zerbe A, Abrams EJ, Myer L, Mellins CA. Factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa. Drug Alcohol Depend 2017; 173:69-77. [PMID: 28199918 PMCID: PMC5429399 DOI: 10.1016/j.drugalcdep.2016.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/21/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Alcohol use during pregnancy is prevalent in South Africa, but there are few prospectively-collected data exploring patterns of consumption among HIV-infected women, which may be important to improve maternal and child health outcomes. We examined patterns of and factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa. METHODS Participants were enrolled when entering antenatal care at a large primary care clinic, and alcohol use was assessed using the AUDIT (Alcohol Use Disorders Identification Test). In analysis, the AUDIT-C scoring was used as a measure of hazardous drinking, and we examined factors associated with patterns of alcohol use in logistic regression models. RESULTS Among 580 women (median age: 28.1 years), 40% reported alcohol use during the 12 months prior to pregnancy, with alcohol use characterised by binge drinking and associated with single relationship status, experience of intimate partner violence (IPV), and lower levels of HIV-related stigma. Of this group, 65% had AUDIT-C scores suggesting hazardous alcohol use, with hazardous alcohol users more likely to report having experienced IPV and having higher levels of education. Among hazardous alcohol users, 70% subsequently reported reduced levels of consumption during pregnancy. Factors independently associated with reduced consumption included earlier gestation when entering antenatal care and report of a better patient-healthcare provider relationship. CONCLUSIONS These unique data provide important insights into alcohol use trajectories in this context, and highlight the urgent need for an increased focus on screening and intervention at primary care level.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa.
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tamsin Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa,Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Allison Zerbe
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Elaine J. Abrams
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA,College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa,Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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46
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Neuropsychological Aspects of Prevention and Intervention for FASD in South Africa. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2017. [DOI: 10.1007/s40817-017-0035-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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47
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May PA, Marais AS, de Vries MM, Kalberg WO, Buckley D, Hasken JM, Adnams CM, Barnard R, Joubert B, Cloete M, Tabachnick B, Robinson LK, Manning MA, Jones KL, Bezuidenhout H, Seedat S, Parry CDH, Hoyme HE. The continuum of fetal alcohol spectrum disorders in a community in South Africa: Prevalence and characteristics in a fifth sample. Drug Alcohol Depend 2016; 168:274-286. [PMID: 27736681 PMCID: PMC5086258 DOI: 10.1016/j.drugalcdep.2016.09.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence and characteristics of the continuum of diagnoses within fetal alcohol spectrum disorders (FASD) were researched in a fifth sample in a South African community. METHODS An active case ascertainment approach was employed among all first grade learners in this community (n=862). Following individual examination by clinical geneticists/dysmorphologists, cognitive/behavioral testing, and maternal interviews, final diagnoses were made in multidisciplinary case conferences. RESULTS Physical measurements, cardinal facial features of FAS, and total dysmorphology scores clearly differentiated diagnostic categories in a consistent, linear fashion, from severe to mild. Neurodevelopmental delays and behavioral problems were significantly worse for each of the FASD diagnostic categories, although not as consistently linear across diagnostic groups. Alcohol use was documented by direct report from the mother in 71% to 100% of cases in specific diagnostic groups. Significant distal maternal risk factors in this population are: advanced maternal age at pregnancy; low height, weight, and body mass index (BMI); small head circumference; low education; low income; and rural residence. Even when controlling for socioeconomic status, prenatal drinking correlates significantly with total dysmorphology score, head circumference, and five cognitive and behavioral measures. In this community, FAS occurs in 59-79 per 1,000 children, and total FASD in 170-233 per 1,000 children, or 17% to 23%. CONCLUSIONS Very high rates of FASD continue in this community where entrenched practices of regular binge drinking co-exist with challenging conditions for childbearing and child development in a significant portion of the population.
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Affiliation(s)
- Philip A May
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States.
| | - Anna-Susan Marais
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marlene M de Vries
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Wendy O Kalberg
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - David Buckley
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - Julie M Hasken
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States
| | - Colleen M Adnams
- University of Cape Town, Department of Psychiatry and Mental Health, South Africa
| | - Ronel Barnard
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Belinda Joubert
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marise Cloete
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | | | - Luther K Robinson
- State University of New York, Buffalo, Department of Pediatrics, United States
| | - Melanie A Manning
- Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States
| | - Kenneth Lyons Jones
- University of California San Diego School of Medicine, Department of Pediatrics, United States
| | - Heidre Bezuidenhout
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Soraya Seedat
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Charles D H Parry
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; South African Medical Research Council, South Africa
| | - H Eugene Hoyme
- Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States; The University of Arizona College of Medicine, Department of Pediatrics and the Center for Applied Genetics and Genomic Medicine, United States
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48
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Urban MF, Olivier L, Louw JG, Lombard C, Viljoen DL, Scorgie F, Chersich MF. Changes in drinking patterns during and after pregnancy among mothers of children with fetal alcohol syndrome: A study in three districts of South Africa. Drug Alcohol Depend 2016; 168:13-21. [PMID: 27610936 DOI: 10.1016/j.drugalcdep.2016.08.629] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mixed ancestry populations in South Africa have amongst the highest rates of fetal alcohol syndrome (FAS) worldwide. Defining the drinking patterns of women with a FAS child guides FAS preventive interventions. METHODS Data were drawn from FAS prevalence surveys conducted in three districts: Witzenberg (Cape Winelands), Frances Baard (inland mining town) and Saldanha Bay (coastal towns). 156 mothers and 50 proxy informants of school-entry children diagnosed with FAS and partial-FAS were interviewed, and compared with 55 controls recruited in Saldanha Bay. RESULTS Study participants were of low socio-economic status (SES), and a majority of children were either in foster care (12%) or had been cared for by relatives for long periods (44%). Of cases, 123/160 (77%) reported current drinking, similar between sites. During pregnancy, only 35% (49/139) of cases had stopped drinking, varying between sites (from 21% to 54% in chronological order of surveys; p<0.001), while 6% (7/109) increased drinking. Though many women who stopped in pregnancy resumed postpartum, cessation in pregnancy was strongly associated with discontinuation in the long run (OR=3.3; 95%CI=1.2-8.9; p=0.005). At interview, 36% of cases (54/151) and 18% of controls (9/51) were at risk of an alcohol-exposed pregnancy (p=0.02). Median maternal mass of cases was 22kg lower than controls, with 20% being underweight and 14% microcephalic. CONCLUSIONS Increasing rates of drinking cessation during pregnancy over time suggest rising awareness of FAS. Cessation is associated with recidivism after pregnancy but also with reduced long-term drinking. Interventions should target alcohol abstinence in pregnancy, but extend into the puerperium.
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Affiliation(s)
- Michael F Urban
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Private Bag X1, Matieland, 7602 Stellenbosch, South Africa; International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZ P114-9000 Ghent, Belgium.
| | - Leana Olivier
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Private Bag X1, Matieland, 7602 Stellenbosch, South Africa; Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa; Governor Kremer's Centre, Maastricht University Medical Centre, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands
| | - Jacobus G Louw
- Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa
| | - Chanelle Lombard
- Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa
| | - Denis L Viljoen
- Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa
| | - Fiona Scorgie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZ P114-9000 Ghent, Belgium
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Roozen S, Peters GJY, Kok G, Townend D, Nijhuis J, Curfs L. Worldwide Prevalence of Fetal Alcohol Spectrum Disorders: A Systematic Literature Review Including Meta-Analysis. Alcohol Clin Exp Res 2016; 40:18-32. [PMID: 26727519 DOI: 10.1111/acer.12939] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/14/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although fetal alcohol spectrum disorders (FASD) affect communities worldwide, little is known about its prevalence. The objective of this study was to provide an overview of the global FASD prevalence. METHODS We performed a search in multiple electronic bibliographic databases up to August 2015, supplemented with the ascendancy and descendancy approach. Studies were considered when published in English, included human participants, and reported empirical data on prevalence or incidence estimates of FASD. Raw prevalence estimates were transformed using the Freeman-Tukey double arcsine transformation so that the data followed an approximately normal distribution. Once the pooled prevalence estimates, 95% confidence intervals and prediction intervals were calculated based on multiple meta-analyses with transformed proportions using random effects models, these estimates were transformed back to regular prevalence rates. Heterogeneity was tested using Cochran's Q and described using the I(2) statistic. RESULTS Among studies that estimated prevalence in general population samples, considerable differences in prevalence rates between countries were found and therefore separate meta-analyses for country were conducted. Particularly high-prevalence rates were observed in South Africa for fetal alcohol syndrome (55.42 per 1,000), for alcohol-related neurodevelopmental disorder (20.25 per 1,000), and FASD (113.22 per 1,000), For partial fetal alcohol syndrome high rates were found in Croatia (43.01 per 1,000), Italy (36.89 per 1,000), and South Africa (28.29 per 1,000). In the case of alcohol-related birth defects, a prevalence of 10.82 per 1,000 was found in Australia. However, studies into FASD exhibited substantial heterogeneity, which could only partly be explained by moderators, most notably geography and descent, in meta-regressions. In addition, the moderators were confounded, making conclusions as to each moderator's relevance tentative at best. CONCLUSIONS The worldwide pooled prevalence estimates are higher than assumed so far, but this was largely explained by geography and descent. Furthermore, prevalence studies varied considerably in terms of used methodology and methodological quality. The pooled estimates must therefore be interpreted with caution and for future research it is highly recommended to report methodology in a more comprehensive way. Finally, clear guidelines on assessing FASD prevalence are urgently needed, and a first step toward these guidelines is presented.
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Affiliation(s)
- Sylvia Roozen
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Gjalt-Jorn Y Peters
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.,Faculty of Psychology and Education Science, Open University of the Netherlands, Heerlen, the Netherlands
| | - Gerjo Kok
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - David Townend
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Health, Ethics & Society, Maastricht University, Maastricht, the Netherlands
| | - Jan Nijhuis
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Obstretrics & Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Leopold Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Genetics, Maastricht University Medical Centre, Maastricht, the Netherlands
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50
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Popova S, Lange S, Probst C, Shield K, Kraicer-Melamed H, Ferreira-Borges C, Rehm J. Actual and predicted prevalence of alcohol consumption during pregnancy in the WHO African Region. Trop Med Int Health 2016; 21:1209-1239. [PMID: 27429168 DOI: 10.1111/tmi.12755] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the prevalence of alcohol consumption and binge drinking during pregnancy among the general population in the World Health Organization (WHO) African Region, by country. METHODS First, a comprehensive systematic literature search was performed to identify all published and unpublished studies. Then, several meta-analyses, assuming a random-effects model, were conducted to estimate the prevalence of alcohol consumption and binge drinking during pregnancy among the general population for countries in the WHO African Region with two or more studies available. Lastly, for countries with less than two studies or no known data predictions were obtained using regression modelling. RESULTS The estimated prevalence of alcohol consumption during pregnancy among the general population ranged from 2.2% (95% confidence interval [CI]: 1.6-2.8%; Equatorial Guinea) to 12.6% (95% CI: 9.9-15.4%; Cameroon) in Central Africa, 3.4% (95% CI: 2.6-4.3%; Seychelles) to 20.5% (95% CI: 16.4-24.7%; Uganda) in Eastern Africa, 5.7% (95% CI: 4.4-7.1%; Botswana) to 14.2% (95% CI: 11.1-17.3%; Namibia) in Southern Africa, 6.6% (95% CI: 5.0-8.3%; Mauritania) to 14.8% (95% CI: 11.6-17.9%; Sierra Leone) in Western Africa, and 4.3% (95% CI: 3.2-5.3%; Algeria) in Northern Africa. CONCLUSIONS The high prevalence of alcohol consumption and binge drinking during pregnancy in some African countries calls for educational campaigns, screening and targeted interventions for women of childbearing age.
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Affiliation(s)
- Svetlana Popova
- Institute for Mental Health Policy Research, Pan American Health Organization and World Health Organization Collaborating Centre, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Shannon Lange
- Institute for Mental Health Policy Research, Pan American Health Organization and World Health Organization Collaborating Centre, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Pan American Health Organization and World Health Organization Collaborating Centre, Toronto, ON, Canada
- Epidemiological Research Unit, Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Kevin Shield
- Institute for Mental Health Policy Research, Pan American Health Organization and World Health Organization Collaborating Centre, Toronto, ON, Canada
- International Agency for Research on Cancer, Cancer Surveillance, Lyon, France
| | - Hannah Kraicer-Melamed
- Institute for Mental Health Policy Research, Pan American Health Organization and World Health Organization Collaborating Centre, Toronto, ON, Canada
| | - Carina Ferreira-Borges
- Instituto de Higiene e Medicina Tropical & Global Health and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Pan American Health Organization and World Health Organization Collaborating Centre, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Epidemiological Research Unit, Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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