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May PA, Hasken JM, de Vries MM, Marais AS, Abdul-Rahman O, Robinson LK, Adam MP, Manning MA, Kalberg WO, Buckley D, Snell CL, Seedat S, Parry CD, Hoyme HE. Maternal risk factors for fetal alcohol spectrum disorders: Distal variables. Alcohol Clin Exp Res (Hoboken) 2024; 48:319-344. [PMID: 38105110 PMCID: PMC10922553 DOI: 10.1111/acer.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND A variety of maternal risk factors for fetal alcohol spectrum disorders (FASD) have been described in the literature. Here, we conducted a multivariate analysis of a large array of potential distal influences on FASD risk. METHODS Interviews were conducted with 2515 mothers of first-grade students whose children were evaluated to assess risk for FASD. Topics included: physical/medical status, childbearing history, demographics, mental health, domestic violence, and trauma. Regression modeling utilized usual level of alcohol consumption by trimester and six selected distal variables (maternal head circumference, body mass index, age at pregnancy, gravidity, marital status, and formal years of education) to differentiate children with FASD from control children. RESULTS Despite individual variation in distal maternal risk factors among and within the mothers of children with each of the common diagnoses of FASD, patterns emerged that differentiated risk among mothers of children with FASD from mothers whose children were developing typically. Case-control comparisons indicate that mothers of children with FASD were significantly smaller physically, had higher gravidity and parity, and experienced more miscarriages and stillbirths, were less likely to be married, reported later pregnancy recognition, more depression, and lower formal educational achievement. They were also less engaged with a formal religion, were less happy, suffered more childhood trauma and interpersonal violence, were more likely to drink alone or with her partner, and drank to deal with anxiety, tension, and to be part of a group. Regression analysis showed that the predictor variables explain 57.5% of the variance in fetal alcohol syndrome (FAS) diagnoses, 30.1% of partial FAS (PFAS) diagnoses, and 46.4% of alcohol-related neurodevelopmental disorder (ARND) diagnoses in children with FASD compared to controls. While the proximal variables explained most of the diagnostic variance, six distal variables explained 16.7% (1 /6 ) of the variance in FAS diagnoses, 13.9% (1 /7 ) of PFAS, and 12.1% (1 /8 ) of ARND. CONCLUSIONS Differences in distal FASD risks were identified. Complex models to quantify risk for FASD hold promise for guiding prevention/intervention.
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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
- Department of Psychiatry, 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
| | - Julie M. Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
| | - Marlene M. de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Omar Abdul-Rahman
- Department of Pediatrics, New York- Presbyterian Weill Cornell Medicine, Columbia University, 505 E 70 St, New York, NY 10021
| | - Luther K. Robinson
- Department of Pediatrics, State University of New York, 1001 Main Street, Buffalo, NY 14203, United States
| | - Margaret P. Adam
- Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Seattle, WA 98175, USA
| | - Melanie A. Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, 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
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Cudore L. Snell
- School of Social Work, Howard University, Washington D.C., 20059, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Charles D.H. Parry
- Department of Psychiatry, 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
- Department of Psychiatry, 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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May PA, Marais AS, Kalberg WO, de Vries MM, Buckley D, Hasken JM, Snell CL, Barnard Röhrs R, Hedrick DM, Bezuidenhout H, Anthonissen L, Bröcker E, Robinson LK, Manning MA, Hoyme HE, Seedat S, Parry CDH. Multifaceted case management during pregnancy is associated with better child outcomes and less fetal alcohol syndrome. Ann Med 2023; 55:926-945. [PMID: 36919586 PMCID: PMC10026770 DOI: 10.1080/07853890.2023.2185808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Pregnant women participated in multifaceted case management (MCM) to prevent Fetal Alcohol Spectrum Disorders (FASD). METHODS Women recruited from antenatal clinics for a longitudinal child development study were screened for alcohol use. Forty-four pregnant women were defined as high-risk drinkers on the Alcohol Use Disorder Identification Test (AUDIT) by an AUDIT score ≥8 and participated in 18 months of MCM to facilitate reduction or cessation of alcohol consumption. Forty-one women completed MCM. Fifty-five equally high-risk women who received standard antenatal care comprised the comparison/control group. Development in offspring was evaluated by a blinded interdisciplinary team of examiners through 5 years of age. RESULTS At five years of age, more children (34%) of MCM participating women did not meet the criteria for FASD vs. non-MCM offspring (22%). Furthermore, a statistically significant (p = .01) lower proportion of MCM offspring (24%) was diagnosed with fetal alcohol syndrome (FAS) compared to controls (49%). Children of MCM participants had significantly (p < .05) better physical outcomes: lower total dysmorphology scores, larger head circumferences, longer palpebral fissures, and higher midfacial measurements. Neurodevelopment results showed mixed outcomes. While Bayley developmental scores indicated that MCM offspring were performing significantly worse on most domains through 18 months, group scores equalized and were not significantly different on Kaufman Assessment Battery neurobehavioral measures by five years. Regression analyses indicated that offspring of women who received standard antenatal care were associated with significantly more negative outcomes than MCM offspring: a diagnosis of FAS (OR = 3.2; 95% CI: 1.093-9.081), microcephaly (OR = 5.3; 95% CI: 2.1-13.5), head circumference ≤10th centile (OR = 4.3; 95%CI: 1.8-10.4), and short palpebral fissures (OR = 2.5; 95% CI: 1.0-5.8). CONCLUSION At age five, proportionally fewer children of MCM participants qualified for a diagnosis of FAS, and proportionally more had physical outcomes indicating better prenatal brain development. Neurobehavioral indicators were not significantly different from controls by age five.KEY MESSAGESMultifaceted Case Management (MCM) was designed and employed for 18 months during the prenatal and immediate postpartum period to successfully meet multiple needs of women who had proven to be very high risk for birthing children with fetal alcohol spectrum disorders (FASD).Offspring of the women who participated in MCM were followed up through age five years and were found to have significantly better physical outcomes on multiple variables associated with fetal alcohol syndrome (FAS) and FASD, such as larger head circumferences and fewer minor anomalies, than those children born to equally at-risk women not receiving MCM.Fewer children of women receiving MCM were diagnosed with FASD than the offspring of equally-at-risk controls, and significantly (p = .01) fewer MCM offspring had FAS, the most severe FASD diagnosis.
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Affiliation(s)
- Philip A May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC, USA
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, NM, USA
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Wendy O Kalberg
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, NM, USA
| | - Marlene M de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Buckley
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, NM, USA
| | - Julie M Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Cudore L Snell
- School of Social Work, Howard University, Washington, DC, USA
| | - Ronel Barnard Röhrs
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dixie M Hedrick
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Heidre Bezuidenhout
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lise Anthonissen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Erine Bröcker
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luther K Robinson
- Department of Pediatrics, State University of New York, Buffalo, NY, USA
| | - Melanie A Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - H Eugene Hoyme
- Sanford Children's Genomic Medicine Consortium, Sanford Health, Sioux Falls, SD, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Charles D H Parry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
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May PA, Hasken JM, de Vries MM, Marais AS, Abdul-Rahman O, Robinson LK, Adam MP, Manning MA, Kalberg WO, Buckley D, Seedat S, Parry CD, Hoyme HE. Maternal and paternal risk factors for fetal alcohol spectrum disorders: Alcohol and other drug use as proximal influences. Alcohol Clin Exp Res (Hoboken) 2023; 47:2090-2109. [PMID: 38226752 PMCID: PMC10792253 DOI: 10.1111/acer.15193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/16/2023] [Accepted: 09/11/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To explore and analyze the significance of proximal influences of maternal and paternal traits associated with bearing a child with a fetal alcohol spectrum disorder (FASD). METHODS Aggregated, maternal interview-collected data (N = 2515) concerning alcohol, tobacco, and other drug use were examined to determine risk for FASD from seven cross-sectional samples of mothers of first-grade students who were evaluated for a possible diagnosis of FASD. RESULTS Mothers of children with fetal alcohol syndrome (FAS) reported the highest alcohol use throughout pregnancy, proportion of binge drinking, drinks per drinking day (DDD), drinking days per week, and total drinks per week. Mothers of children with FAS also consumed significantly more alcohol than mothers of children with partial FAS (PFAS), alcohol-related neurodevelopmental disorder (ARND), or typically developing controls. Mothers of children with PFAS and ARND reported similar drinking patterns, which exposed fetuses to 3-4 times more alcohol than mothers of controls, but the PFAS group was more likely than the ARND group to abstain in latter trimesters. Fathers of all children were predominantly drinkers (70%-85%), but more fathers of children with FASD binged heavily on more days than fathers of controls. Compared to the few mothers of controls who used alcohol during pregnancy, the ARND group binge drank more (3+ DDD) throughout pregnancy and drank more DDD before pregnancy and first trimester. Regression analysis, controlling for tobacco use, indicated that mothers who reported drinking <1 DDD were significantly more likely than abstainers to bear a child with FASD (OR = 2.75) as were those reporting higher levels such as 5-5.9 DDD (OR = 32.99). Exclusive, first-trimester maternal drinking increased risk for FASD five times over that of abstinence (p < 0.001, OR = 5.05, 95% CI: 3.88-6.58), first- and second-trimester drinking by 12.4 times, and drinking all trimesters by 16 times (p < 0.001, OR = 15.69, 95% CI: 11.92-20.64). Paternal drinking during and prior to pregnancy, without adjustment, increased the likelihood of FASD significantly (OR = 1.06 and 1.11, respectively), but the significance of both relationships disappeared when maternal alcohol and tobacco use were controlled. CONCLUSIONS Differences in FASD risk emerged from the examination of multiple proximal variables of maternal alcohol and tobacco use, reflecting increased FASD risk at greater levels of maternal alcohol consumption.
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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
- Department of Psychiatry, 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
| | - Julie M. Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
| | - Marlene M. de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Omar Abdul-Rahman
- Department of Pediatrics, New York- Presbyterian Weill Cornell Medicine, Columbia University, 505 E 70 St, New York, NY 10021
| | - Luther K. Robinson
- Department of Pediatrics, State University of New York, 1001 Main Street, Buffalo, NY 14203, United States
| | - Margaret P. Adam
- Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Seattle, WA 98175, USA
| | - Melanie A. Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, 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
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Charles D.H. Parry
- Department of Psychiatry, 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
- Department of Psychiatry, 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, de Vries MM, Marais AS, Kalberg WO, Buckley D, Parry CDH, Seedat S, May PA. Maternal dietary intake among alcohol-exposed pregnancies is linked to early infant physical outcomes in South Africa. Reprod Toxicol 2023; 121:108467. [PMID: 37678653 DOI: 10.1016/j.reprotox.2023.108467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
Maternal dietary intake is likely a contributing factor to fetal alcohol spectrum disorders (FASD). Two, 24-hour dietary recalls were completed by pregnant women (n = 196) in South African communities with high rates of FASD. More than 50% of all women in this study were below the Estimated Average Requirement (EAR) for pregnancy for vitamins A, C, D, E, riboflavin, vitamin B6, folate, calcium, magnesium, iron, and zinc. More than 90% of mothers were below the Recommended Dietary Allowance (RDA) or Adequate Intake (AI) for pregnancy on vitamin A, K, D, E, choline, calcium, magnesium, zinc, and potassium. More than 80% were below RDA/AI for pantothenic acid, vitamin B6, and folate. Women who consumed alcohol reported significantly lower intake of calcium and three saturated fatty acids and significantly higher intake of two monounsaturated fatty acids. On average, infants were < 40th centile on length, weight, and head circumference at 6 weeks old, regardless of alcohol exposure. Twenty nutrients correlated with at least one measure of 1st trimester drinking (drinks per drinking day, number of drinking days per week, and/or total drinks per week). Nutrients included four saturated fatty acids, eight amino acids, calcium, B-complex vitamins, choline, and betaine. Calcium correlated with all three drinking measures. Further analyses revealed seven nutrients were associated with infant length, weight, and/or head circumference among unexposed infants, and 12 nutrients were associated among infants with prenatal alcohol exposure. Inadequate maternal dietary intake, with alcohol exposure, may increase risk for poor infant growth and likelihood of FASD in this population.
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Affiliation(s)
- Julie M Hasken
- University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC, USA.
| | - Marlene M de Vries
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - Anna-Susan Marais
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - Wendy O Kalberg
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - David Buckley
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Charles D H Parry
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa; Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Soraya Seedat
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - Philip A May
- University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC, USA; Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa; Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
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Hasken JM, Marais AS, de Vries MM, Kalberg WO, Buckley D, Parry CD, Seedat S, May PA. Assessing the sensitivity and specificity of phosphatidylethanol (PEth) cutoffs to identify alcohol exposed pregnancies. Curr Res Toxicol 2023; 4:100105. [PMID: 37102125 PMCID: PMC10123138 DOI: 10.1016/j.crtox.2023.100105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
In the literature on alcohol use biomarkers, there has been debate as to what a valid and/or utilitarian cut off level should be for various research applications. In this manuscript, we assessed the sensitivity and specificity of multiple cutoff values for phosphatidylethanol (PEth) from bloodspots relative to self-report, the Alcohol Use Disorder Identification Test (AUDIT) scores, and another alcohol use biomarker ethyl glucuronide (EtG) from fingernails in a sample of 222 pregnant women in the Western Cape Province of South Africa. Receiver operating characteristic (ROC) curves were used to assess the area under the curve (AUC) and assess PEth cutoff values of ≥2, ≥4, ≥8, ≥14, and ≥20 nanograms per milliliter (ng/ml). The highest AUC value was attained when PEth was compared to an AUDIT score of 1 or more. Depending on the cutoff used to determine alcohol consumption, PEth identified 47%-70% of the individuals as alcohol-consuming while 62.6%-75.2% were identified by self-reported measures, and 35.6% were identified by EtG. In this sample, sensitivity and accuracy were highest at less stringent PEth cutoffs when compared to self-report, AUDIT score of 1 or more, 5 or more, 8 or more, and EtG ≥ 8 picograms per milligram (pg/mg). For research purposes, less stringent cutoffs, such as PEth ≥ 8 ng/ml, may be considered a valid, positive cutoff for identifying women who consume alcohol during pregnancy in this population. A cutoff of PEth ≥ 20 ng/ml may miss individuals who reported consuming alcohol (false negatives).
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Affiliation(s)
- Julie M. Hasken
- University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC, United States
| | - Anna-Susan Marais
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - Marlene M. de Vries
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - Wendy O. Kalberg
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, United States
| | - David Buckley
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, United States
| | - Charles D.H. Parry
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
- Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Soraya Seedat
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - Philip A. May
- University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC, United States
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Corresponding author at: University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC, United States.
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Hasken JM, de Vries MM, Marais AS, May PA, Parry CDH, Seedat S, Mooney SM, Smith SM. Untargeted Metabolome Analysis of Alcohol-Exposed Pregnancies Reveals Metabolite Differences That Are Associated with Infant Birth Outcomes. Nutrients 2022; 14:nu14245367. [PMID: 36558526 PMCID: PMC9786146 DOI: 10.3390/nu14245367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Prenatal alcohol exposure can produce offspring growth deficits and is a leading cause of neurodevelopmental disability. We used untargeted metabolomics to generate mechanistic insight into how alcohol impairs fetal development. In the Western Cape Province of South Africa, 52 women between gestational weeks 5-36 (mean 18.5 ± 6.5) were recruited, and they provided a finger-prick fasting bloodspot that underwent mass spectrometry. Metabolomic data were analyzed using partial least squares-discriminant analyses (PLS-DA) to identify metabolites that correlated with alcohol exposure and infant birth outcomes. Women who consumed alcohol in the past seven days were distinguished by a metabolite profile that included reduced sphingomyelins, cholesterol, and pregnenolones, and elevated fatty acids, acyl and amino acyl carnitines, and androsterones. Using PLS-DA, 25 of the top 30 metabolites differentiating maternal groups were reduced by alcohol with medium-chain free fatty acids and oxidized sugar derivatives having the greatest influence. A separate ortho-PLS-DA analysis identified a common set of 13 metabolites that were associated with infant length, weight, and head circumference. These included monoacylglycerols, glycerol-3-phosphate, and unidentified metabolites, and most of their associations were negative, implying they represent processes having adverse consequences for fetal development.
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Affiliation(s)
- Julie M. Hasken
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Correspondence: ; Tel.: +1-(704)-250-5002
| | - Marlene M. de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7602, South Africa
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7602, South Africa
| | - Philip A. May
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7602, South Africa
- Department of Nutrition, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM 87131, USA
| | - Charles D. H. Parry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7602, South Africa
- Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town 7760, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7602, South Africa
| | - Sandra M. Mooney
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
| | - Susan M. Smith
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, 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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 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] [What about the content of this article? (0)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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May PA, Hasken JM, Blankenship J, Marais AS, Joubert B, Cloete M, de Vries MM, Barnard R, Botha I, Roux S, Doms C, Gossage JP, Kalberg WO, Buckley D, Robinson LK, Adnams CM, Manning MA, Parry CDH, Hoyme HE, Tabachnick B, Seedat S. Breastfeeding and maternal alcohol use: Prevalence and effects on child outcomes and fetal alcohol spectrum disorders. Reprod Toxicol 2016; 63:13-21. [PMID: 27174445 PMCID: PMC4987236 DOI: 10.1016/j.reprotox.2016.05.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Determine any effects that maternal alcohol consumption during the breastfeeding period has on child outcomes. METHODS Population-based samples of children with fetal alcohol spectrum disorders (FASD), normally-developing children, and their mothers were analyzed for differences in child outcomes. RESULTS Ninety percent (90%) of mothers breastfed for an average of 19.9 months. Of mothers who drank postpartum and breastfed (MDPB), 47% breastfed for 12 months or more. In case control analyses, children of MDPB were significantly lighter, had lower verbal IQ scores, and more anomalies in comparisons controlling for prenatal alcohol exposure and final FASD diagnosis. Utilizing a stepwise logistic regression model adjusting for nine confounders of prenatal drinking and other maternal risks, MDPB were 6.4 times more likely to have a child with FASD than breastfeeding mothers who abstained from alcohol while breastfeeding. CONCLUSIONS Alcohol use during the period of breastfeeding was found to significantly compromise a child's development.
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Affiliation(s)
- Philip A May
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
| | - Julie M Hasken
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States
| | - Jason Blankenship
- 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
| | - Belinda Joubert
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marise Cloete
- 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
| | - Isobel Botha
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Sumien Roux
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Cate Doms
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - J Phillip Gossage
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - 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
| | - Luther K Robinson
- State University of New York, Buffalo, Department of Pediatrics, United States
| | - Colleen M Adnams
- University of Cape Town, Department of Psychiatry and Mental Health, South Africa
| | - Melanie A Manning
- Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States
| | - Charles D H Parry
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; Medical Research Council of South Africa, Alcohol, Tobacco & Other Drug Research Unit, South Africa
| | - H Eugene Hoyme
- Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States
| | | | - Soraya Seedat
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
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May PA, de Vries MM, Marais AS, Kalberg WO, Adnams CM, Hasken JM, Tabachnick B, Robinson LK, Manning MA, Jones KL, Hoyme D, Seedat S, Parry CDH, Hoyme HE. The continuum of fetal alcohol spectrum disorders in four rural communities in South Africa: Prevalence and characteristics. Drug Alcohol Depend 2016; 159:207-18. [PMID: 26774945 PMCID: PMC4724497 DOI: 10.1016/j.drugalcdep.2015.12.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prevalence and characteristics of the continuum of diagnoses within fetal alcohol spectrum disorders (FASD) were researched in previously unstudied rural, agricultural, lower socioeconomic populations in South Africa (ZA). METHODS Using an active case ascertainment approach among first grade learners, 1354 (72.6%) were consented into the study via: height, weight, and/or head circumference ≤ 25th centile and/or random selection as normal control candidates. Final diagnoses were made following: examination by pediatric dysmorphologists/geneticists, cognitive/behavioral testing, and maternal risk factor interviews. RESULTS FASD children were significantly growth deficient and dysmorphic: physical measurements, cardinal facial features of FAS, and total dysmorphology scores clearly differentiated diagnostic categories from severe to mild to normal in a consistent, linear fashion. Neurodevelopmental delays were also significantly worse for each of the FASD diagnostic categories, although not as consistently linear across groups. Alcohol use is well documented as the proximal maternal risk factor for each diagnostic group. Significant distal maternal risk factors in this population are: low body weight, body mass, education, and income; and high gravidity, parity, and age at birth of the index child. In this low SES, highly rural region, FAS occurs in 93-128 per 1000 children, PFAS in 58-86, and, ARND in 32-46 per 1000. Total FASD affect 182-259 per 1000 children or 18-26%. CONCLUSIONS Very high rates of FASD exist in these rural areas and isolated towns where entrenched practices of regular binge drinking co-exist with challenging conditions for childbearing and child development.
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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.
| | - Marlene M de Vries
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Anna-Susan Marais
- 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
| | - Colleen M Adnams
- University of Cape Town, Department of Psychiatry and Mental Health, South Africa
| | - Julie M Hasken
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, 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
| | - Kenneth Lyons Jones
- University of California San Diego School of Medicine, Department of Pediatrics, United States
| | - Derek Hoyme
- University of Iowa, Department of Pediatrics, United States
| | - Soraya Seedat
- South African Medical Research Council, United States
| | - Charles D H Parry
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; South African Medical Research Council, United States
| | - H Eugene Hoyme
- Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States
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de Vries MM, Joubert B, Cloete M, Roux S, Baca BA, Hasken JM, Barnard R, Buckley D, Kalberg WO, Snell CL, Marais AS, Seedat S, Parry CDH, May PA. Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management. Int J Environ Res Public Health 2015; 13:ijerph13010076. [PMID: 26703708 PMCID: PMC4730467 DOI: 10.3390/ijerph13010076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/11/2015] [Accepted: 12/21/2015] [Indexed: 11/16/2022]
Abstract
In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM) was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI) techniques and the Community Reinforcement Approach (CRA). Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD.
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Affiliation(s)
- Marlene M de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
| | - Belinda Joubert
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
| | - Marise Cloete
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
| | - Sumien Roux
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
| | - Beth A Baca
- Center on Alcoholism, Substance Abuse, and Additions (CASAA), The University of New Mexico, Albuquerque, NM 87106, USA.
| | - Julie M Hasken
- Gillings School of Global Public Health, Department of Nutrition, Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA.
| | - Ronel Barnard
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
| | - David Buckley
- Center on Alcoholism, Substance Abuse, and Additions (CASAA), The University of New Mexico, Albuquerque, NM 87106, USA.
| | - Wendy O Kalberg
- Center on Alcoholism, Substance Abuse, and Additions (CASAA), The University of New Mexico, Albuquerque, NM 87106, USA.
| | - Cudore L Snell
- School of Social Work, Howard University, Washington, DC 20059, USA.
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
| | - Charles D H Parry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
- Tobacco & Other Drug Research Unit, Medical Research Council of South Africa, Alcohol, Tygerberg 7505, South Africa.
| | - Philip A May
- Center on Alcoholism, Substance Abuse, and Additions (CASAA), The University of New Mexico, Albuquerque, NM 87106, USA.
- Gillings School of Global Public Health, Department of Nutrition, Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA.
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