Drinking During Pregnancy and the Developing Brain: Is Any Amount Safe
Charness, Riley & Sowell (2016) "Drinking During Pregnancy and the Developing Brain: Is Any Amount Safe?" Trends in Cognitive Sciences, February 2016, Vol. 20, No. 2. (pp. 80-82)
A valuable discussion on research on light-to moderate drinking and the impact of negative research findings in popular media that "underestimate potential adverse outcomes and complicate decisions about risks versus benefits of light-to-moderate drinking during pregnancy."
Popova S., Lange S., Shield K., Mihic A., Chudley AE., Mukherjee RAS., Bekmuradov D., & Rehm J., The Lancet, 5 Jan 2016, doi:10.1016/S0140-6736(15)01345-8
Fetal alcohol spectrum disorder (FASD) is related to many comorbidities because of the permanent effects of prenatal alcohol exposure on the fetus. This study aimed to identify the comorbid conditions that co-occur in individuals with FASD and estimate the pooled prevalence of comorbid conditions occurring in individuals with FAS. The study identified 428 comorbid conditions co-occurring in individuals with FASD, spanning across 18 of 22 chapters of the International Classification of Diseases, tenth revision. The most prevalent conditions were within the sections of congenital malformations, deformities, and chromosomal abnormalities, and mental and behavioural disorders. The high prevalence of comorbid conditions in individuals with FASD highlights the importance of assessing prenatal alcohol exposure as a substantial clinical risk factor for comorbidity. The harmful effects of alcohol on a developing fetus represent many cases of preventable disability, and thus, alcohol use during pregnancy should be recognised as a public health problem globally.
Worldwide Prevalence of Fetal Alcohol Spectrum Disorders: A Systematic Literature Review including Meta-analysis
Roozen S., Peters G-JY., Kok G., Townend D., Nijhuis J., & Curfs L., Alcoholism: Clinical and Experimental Research, 4 Jan 2016, doi: 10.1111/acer.12939
Although fetal alcohol spectrum disorder (FASD) affects communities worldwide, little is known about its prevalence. The objective of this study was to provide an overview of the global FASD prevalence. A search was performed in multiple electronic bibliographic databases up to August 2015. Particularly high-prevalence rates of FASD were found in South Africa, Croatia, Italy, with a high prevalence of alcohol-related birth defects in Australia (10.82 per 1000). The worldwide pooled prevalence estimates are higher than assumed so far, largely explained by geography and descent. They therefore must be interpreted with caution. Clear guidelines on assessing FASD prevalence are urgently needed, and a first step towards these guidelines is presented.
Varadinova M., & Boyadjieva N., Pharmacological Research, 25 September 2015, doi: 10.1016/j.phrs.2015.09.011
The etiology of autism spectrum disorders (ASDs) still remains unclear and seems to involve a considerable overlap between polygenic, epigenetic and environmental factors. This study summarises the current understanding of the interplay between gene expression dysregulation via epigenetic modifications and the potential epigenetic impact of environmental factors in neurodevelopmental deficits. It also discusses the scientific controversies of the relationship between prenatal exposure to alcohol and alcohol-induced epigenetic dysregulations, and gene expression alterations which are associated with disrupted neural plasticity and causal pathways for ASDs. The review of the literature suggests that a better understanding of developmental epigenetics should contribute to furthering our comprehension of the etiology and pathogenesis of ASDs and fetal alcohol spectrum disorders.
Masotti P., Longstaffe S., Gammon H., Isbister J., Maxwell B., & Hanlon-Dearman A., BMC Health Services Research., 5 October 2015, doi: 10.1186/s12913-015-1113-8
The researchers conducted a consensus-generating symposium comprised of 60 experts from different stakeholder groups. Research questions addressed barriers and solutions to integration across systems and group-specific and system-wide research priorities. Results show that FASD capacity (e.g. training, education, awareness) needs to be increased in both medical and non-medical providers. There is a need to better integrate care for individuals and families living with FASD. Primary Care is well positioned to play a central and important role in facilitating and supporting increased integration. Research is needed to better address best practices and long-term individual and family outcomes following a diagnosis of FASD.
Popova S., Lange S., Burd L., & Rehm J., Alcohol and Alcoholism, 21 October 2015, doi: 10.1093/alcalc/agv117
This cost-of-illness study examined the impact of FASD on the material welfare of the Canadian society in 2013 by analysing the direct costs of resources expended on health care, law enforcement, children and youth in care, special education, supportive housing, long-term care, prevention and research, as well as the indirect costs of productivity losses of individuals with FASD due to their increased morbidity and premature mortality. The costs totalled approximately $1.8 billion. FASD is a significant public health and social problem that consumes resources, both economic and societal, in Canada. Many of the costs could be reduced with the implementation of effective social policies and intervention programs.
Godino A., Abate P., Amigone JL., Vivas L., & Molina JC., Neuroscience, 8 October 2015, doi: 10.1016/j.neuroscience.2015.10.004
The aim of this study was to analyse how prenatal binge-like ethanol exposure to a moderate dose during gestational days 17-20 affects hydroelectrolyte regulatory responses. This type of exposure has been observed to increase ethanol consumption during adolescence. Moderate prenatal ethanol exposure produced long-lasting changes in brain organisation, affecting basal activity of central extended amygdala nuclei, AVP neurons and the inhibitory areas of SA.
FASD Prevalence among Schoolchildren in Poland
Okylicz-Kozaryn K., Borkowska M., & Brzozka K., Journal of Applied Research in Intellectual Disabilities, 1 October 2015, doi: 10.1111/jar.12219
Prenatal Alcohol Exposure is a major cause of brain damage and developmental delay, but in Poland is rarely diagnosed and the scale of problem is not known. An active case ascertainment approach was applied to estimate the prevalence of FASD among 7-9 year olds. The results show that prevalence of FASD is not lower than 2%, including 0.4% of Fetal Alcohol Syndrome. Neurodevelopmental disorders associated with PAE are a serious challenge for the public health system. Development of procedures and services to diagnose and to support individuals affected by PAE and their families is an urgent need in Poland.
Donald KA., Fouche JP., Roos A., Koen N., Howells FM., Riley EP., Woods RP., Zar HJ., Narr KL, & Stein DJ., Metabolic Brain Disease, 29 November 2015, doi: 10.1007/s11011-015-9771-0
Neuroimaging studies have indicated that prenatal alcohol exposure is associated with alterations in the structure of specific brain regions. However, the temporal specificity of such changes and their behavioural consequences are less known. Here the brain structure of infants with in utero exposure to alcohol shortly after birth was explored via MRI images. Significantly decreased total gray matter volume was demonstrated for the alcohol-exposed cohort compared to healthy control infants. Regions that were significantly different were the left hippocampus, bilateral amygdala and left thalamus. These findings suggest the effects of prenatal alcohol exposure on brain growth is present very early in the first year of life, a period during which the most rapid growth and maturation occurs.
Alcohol consumption and binge drinking in early pregnancy. A cross-sectional study with data from the Copenhagen Pregnancy Cohort [PDF]
Iversen ML., Sorensen NO., Broberg L., Damm P., Hedegaard M., Tabor A., & Hegaard HK., BMC Pregnancy and Childbirth, 8 December 2015, doi:10.1186/s12884-015-0757-z
Since 2007 the Danish Health and Medicines Authority has advised total alcohol abstinence from the time of trying to conceive and throughout pregnancy. Since the introduction of the recommendation, no studies have examined pre-pregnancy lifestyle and reproductive risk factors associated with this behaviour in a Danish context. Data were collected from September 2012 to August 2013. Self-reported information on each woman’s socio-demographic characteristics, medical history, and lifestyle factors including alcohol habits was obtained from an electronic questionnaire filled out as part of the individual medical record. Results show that prevalence of weekly alcohol consumption decreased considerably during early pregnancy compared with pre-pregnancy levels. Nevertheless, one third of the pregnant women engaged in binge drinking.
Reid N., Dawe S., Shelton D., Harnett P., Warner J., Armstrong E., LeGros K., & O’Callaghan F., Alcoholism: Clinical and Experimental Research, 18 November 2015, doi: 10.1111/acer.12903
Individuals with fetal alcohol spectrum disorders (FASDs) can experience profound impairments and long-term adverse outcomes. This systematic review adopts a life span perspective providing an extensive analysis of the available literature. Conclusions from the review suggest there is a growing evidence for interventions that improve outcomes for early to middle childhood. However, a lack of research exists outside of this developmental period. This lack of research is concerning given the potential positive impact of early intervention, for individuals and, financially, for governments. In addition, the lack of interventions for adolescents and adults further highlights the widening developmental gap and the potential influence of secondary disabilities for this at-risk population.
May PA., de Vries MM., Marais A-S., Kalberg WO., Adnams CM., Hasken JM., Tabachnick B., Robinson LK., Manning MA., Lyons Jones K., Hoyme D., Seedat S., Parry CDH., & Hoyme HE., Drug and Alcohol Dependence, 31 Dec 2015, doi:10.1016/j.drugalcdep.2015.12.023
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). Results show that 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.
The Impact of Prenatal Ethanol Exposure on Neuroanatomical and Behavioral Development in Mice
Abbott CW., Kozanian OO., Kanaan J., Wendel KM., & Huffman KJ., Alcoholism: Clinical and Experimental Research, 4 Jan 2016, doi:10.1111/acer.12936
In utero alcohol, or ethanol (EtOH), exposure produces developmental abnormalities in the brain of the fetus, which can result in lifelong behavioural abnormalities. Results from this study reveal long-term alterations to cortical anatomy, including atypical developmental cortical thinning, and abnormal subcortical development as a result of in utero EtOH exposure. Furthermore, offspring exposed to EtOH during the prenatal period performed poorly on behavioural tasks measuring sensorimotor integration and anxiety. Insight from this study will help provide new information on developmental trajectories of prenatal EtOH exposure and the biological etiologies of abnormal behaviour in people diagnosed with FASD.
Interhemispheric Functional Brain Connectivity in Neonates with Prenatal Alcohol Exposure: Preliminary Findings
Donald KA., Ipser JC., Howells FM., Roos A., Fouche J-P., Riley EP., Koen N., Woods RP., Biswal B., Zar HJ., Narr KL., & Stein DJ., Alcoholism: Clinical and Experimental Research, 4 Jan 2016, doi: 10.1111/acer.12930
Children exposed to alcohol in utero demonstrate reduced white matter microstructural integrity. While early evidence suggests altered functional brain connectivity in the lateralization of motor networks in school-age children with PAE, the specific effects of alcohol on the establishment of intrinsic connectivity in early infancy have not been explored. Sixty subjects received functional imaging at 2-4 weeks of age for 6-8 minutes during quiet, natural sleep. Although results are preliminary, findings suggest PAE may disrupt the temporal coherence in blood oxygenation utilization in intrinsic networks underlying motor performance in newborn infants. Studies that employ longitudinal designs to investigate the effects of in utero alcohol exposure on the evolving resting-state networks will be key in establishing the distribution and timing on connectivity disturbances already described in older children.
Khoury JE. & Milligan K., Journal of Attention Disorders, 3 Jan 2016, doi: 10.1177/1087054715622016
FASD and ADHD are associated with a range of neurocognitive impairments. Executive functioning deficits are a hallmark feature of both disorders. This meta-analysis was undertaken to disentangle the behavioural phenotype of FASD and ADHD by quantitatively differentiating executive functioning differences between these two groups. When compared with typically developing samples, the FASD and ADHD samples demonstrated significant executive functioning deficits. FASD samples experience significantly greater deficits when compared with ADHD samples. Results further our understanding of the cognitive differences between FASD and ADHD samples and have the potential to influence future basic research, assessment, and intervention.