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Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18–44 Years — United States, 2015–2017
Abstract
Drinking alcohol during pregnancy can cause fetal alcohol spectrum disorders (FASDs), including birth defects that involve central nervous system impairment, behavioral disorders, and impaired intellectual development, which can lead to difficulties with school and employment. A recent study in four U.S. communities found a 1.1%-5.0% prevalence of FASDs among first-grade students (1). Drinking during pregnancy might also be a risk factor for other adverse pregnancy and birth outcomes, including miscarriage and stillbirth (2). CDC estimated the prevalence of self-reported current drinking (at least one alcohol drink in the past 30 days) and binge drinking (consuming four or more drinks on at least one occasion in the past 30 days) among pregnant women aged 18-44 years, using 2015-2017 data from the Behavioral Risk Factor Surveillance System (BRFSS). Current drinking and binge drinking in the past 30 days were reported by 11.5% and 3.9% of pregnant women, respectively. Among pregnant women who binge drink, the average frequency of binge drinking in the past 30 days was 4.5 episodes, and the average intensity of binge drinking (the average largest number of drinks reported consumed on any occasion among binge drinkers) was 6.0 drinks. Increased implementation of evidence-based community-level and clinic-level interventions, such as universal alcohol screening and brief counseling in primary and prenatal care, could decrease the prevalence of drinking during pregnancy, which might ultimately reduce the prevalence of FASDs and other adverse pregnancy and birth outcomes.
... Alcohol use during pregnancy is a critical public health issue that results in a number of adverse outcomes for both mother and child. Globally, it is estimated that about 9.8% of women consume alcohol during pregnancy (Popova et al., 2018) and in the United States, 1 in 9 pregnant women report drinking alcohol in the past 30 days (Denny et al., 2019). Among those who reported consuming alcohol during pregnancy, one third also reported binge drinking with an average of 4.5 binge-drinking episodes within a 30-day period (Denny et al., 2019). ...
... Globally, it is estimated that about 9.8% of women consume alcohol during pregnancy (Popova et al., 2018) and in the United States, 1 in 9 pregnant women report drinking alcohol in the past 30 days (Denny et al., 2019). Among those who reported consuming alcohol during pregnancy, one third also reported binge drinking with an average of 4.5 binge-drinking episodes within a 30-day period (Denny et al., 2019). These prevalence rates depict an increasingly dire picture for birth outcomes as alcohol has been identified as a teratogen; an exogenous factor that results in the malformation of a fetus (Ornoy & Ergaz, 2010). ...
... The purpose of this study was to determine the effect of the intersectionality of racial/ethnic identity and veteran status on the prevalence of binge drinking among pregnant women. Among the 6101 pregnant women included in the study, the binge-drinking prevalence was 3.60% which closely mirrors the 3.9% prevalence rate found in a similar study utilizing data from the 2015-2017 BRFSS (Denny et al., 2019). For the interaction between racial/ethnic identity and veteran status, the prevalence rate of binge drinking between the four groups was highest for racial/ethnic minority veterans at 17.42%, compared to 5.34% among white veterans, 4.05% among non-veteran racial/ethnic minorities, and 3% among non-veteran whites. ...
Objectives
Alcohol use during pregnancy is a critical public health issue that results in several adverse outcomes for both mother and child. While the prevalence of and consequences of binge drinking among pregnant women is well-documented in the literature, little is known about the intersectional effect of racial/ethnic identity and veteran status. The purpose of this study was to examine the prevalence of binge drinking among pregnant women using the intersectionality of racial/ethnic identity and veteran status.Methods
This study utilized combined data from the 2016, 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a telephone survey that collects health-related risk behaviors, chronic health conditions and use of preventative services among U.S residents. Generalized linear mixed models were used to examine the prevalence of binge drinking using the interaction between race/ethnicity and veteran status.ResultsOverall binge drinking prevalence was 3.60% among the sample of 6101 pregnant women. Binge drinking prevalence was the highest among racial/ethnic minority veterans at 17.42%, compared to 5.34% among white veterans, 4.05% among non-veteran racial/ethnic minorities and 3% among non-veteran whites, supporting the theory of intersectionality.Conclusions
Intersectionality Theory suggests that the stressors from membership in two vulnerable groups may lead to increased disparities. The results of this study highlight the unique experience of being a veteran and identifying as a member of a racial/ethnic minority group. This calls for a need to customize preventative measures that address the combined impact of both racial/ethnic minority group status and veteran status.
... 1 Notwithstanding community education endeavors and recommendations to evade alcohol use while pregnant, alcohol use during pregnancy remains widespread. [2][3][4][5][6][7] Alcohol use by pregnant women in the USA has also risen steadily over the years. 3,7 Ethanol abuse during pregnancy and its impacts on the developing fetus has received widespread consideration since the first report that fetal ethanol exposure can have damaging and persistent complications. ...
... [2][3][4][5][6][7] Alcohol use by pregnant women in the USA has also risen steadily over the years. 3,7 Ethanol abuse during pregnancy and its impacts on the developing fetus has received widespread consideration since the first report that fetal ethanol exposure can have damaging and persistent complications. 8 Among the likely effects of fetal ethanol exposure, defects in brain maturation, followed by lifetime physical, emotional and behavioral problems, are preeminent. ...
... Additionally, nearly 25% of this population engaged in binge drinking (consuming five drinks or more in men and more than four drinks in women within approximately 2 h) within the last month [1]. Despite public education endeavors and recommendations to avoid alcohol use while pregnant, alcohol use by pregnant women remains widespread [2][3][4][5][6][7]. The use of alcohol during pregnancy in the USA has also soared over the years [3,7]. ...
... Despite public education endeavors and recommendations to avoid alcohol use while pregnant, alcohol use by pregnant women remains widespread [2][3][4][5][6][7]. The use of alcohol during pregnancy in the USA has also soared over the years [3,7]. ...
The brain’s ability to strengthen or weaken synaptic connections is often termed synaptic plasticity. It has been shown to function in brain remodeling following different types of brain damage (e.g., drugs of abuse, alcohol use disorders, neurodegenerative diseases, and inflammatory conditions). Although synaptic plasticity mechanisms have been extensively studied, how neural plasticity can influence neurobehavioral abnormalities in alcohol use disorders (AUDs) is far from being completely understood. Alcohol use during pregnancy and its harmful effects on the developing offspring are major public health, social, and economic challenges. The significant attribute of prenatal alcohol exposure on offspring is damage to the central nervous system (CNS), causing a range of synaptic structural, functional, and behavioral impairments, collectively called fetal alcohol spectrum disorder (FASD). Although the synaptic mechanisms in FASD are limited, emerging evidence suggests that FASD pathogenesis involves altering a set of molecules involved in neurotransmission, myelination, and neuroinflammation. These studies identify several immediate and long-lasting changes using many molecular approaches that are essential for synaptic plasticity and cognitive function. Therefore, they can offer potential synaptic targets for the many neurobehavioral abnormalities observed in FASD. In this review, we discuss the substantial research progress in different aspects of synaptic and molecular changes that can shed light on the mechanism of synaptic dysfunction in FASD. Increasing our understanding of the synaptic changes in FASD will significantly advance our knowledge and could provide a basis for finding novel therapeutic targets and innovative treatment strategies.
... There is a higher prevalence of FASD cases in higher-risk populations, such as those with a lower socioeconomic status [3]. A study conducted by the Center for Disease Control and Prevention (CDC), using data collected from pregnant women between 2015 and 2017, showed that one in nine women drank at least one alcoholic drink in the past month while pregnant, and around one third of these women reported binge drinking (drinking at least four alcoholic drinks in one sitting) [4]. Due to social biases against pregnant women consuming alcohol, there may be an underreporting of prenatal alcohol exposure incidences [4]. ...
... A study conducted by the Center for Disease Control and Prevention (CDC), using data collected from pregnant women between 2015 and 2017, showed that one in nine women drank at least one alcoholic drink in the past month while pregnant, and around one third of these women reported binge drinking (drinking at least four alcoholic drinks in one sitting) [4]. Due to social biases against pregnant women consuming alcohol, there may be an underreporting of prenatal alcohol exposure incidences [4]. ...
Fetal alcohol spectrum disorder (FASD) results from prenatal ethanol exposure. The zebrafish (Danio rerio) is an outstanding in vivo FASD model. Early development produced the three germ layers and embryonic axes patterning. A critical pluripotency transcriptional gene circuit of sox2, pou5f1 (oct4; recently renamed pou5f3), and nanog maintain potency and self-renewal. Ethanol affects sox2 expression, which functions with pou5f1 to control target gene transcription. Various genes, like elf3, may interact and regulate sox2, and elf3 knockdown affects early development. Downstream of the pluripotency transcriptional circuit, developmental signaling activities regulate morphogenetic cell movements and lineage specification. These activities are also affected by ethanol exposure. Hedgehog signaling is a critical developmental signaling pathway that controls numerous developmental events, including neural axis specification. Sonic hedgehog activities are affected by embryonic ethanol exposure. Activation of sonic hedgehog expression is controlled by TGF-ß family members, Nodal and Bmp, during dorsoventral (DV) embryonic axis establishment. Ethanol may perturb TGF-ß family receptors and signaling activities, including the sonic hedgehog pathway. Significantly, experiments show that activation of sonic hedgehog signaling rescues some embryonic ethanol exposure effects. More research is needed to understand how ethanol affects early developmental signaling and morphogenesis.
... Observa-se que o padrão de uso de drogas, o poliuso de álcool, maconha e tabaco, aumentou nas últimas décadas 18,[21][22] . O tabaco é a substância mais comumente usada durante a gravidez, concomitante ao álcool, maconha e cocaína, nesta ordem 20,23 . ...
... O uso de bebidas alcoólicas está concomitantemente relacionado ao uso de tabaco e seus derivados, e atuam como precursores de vulnerabilidade para uso de outras drogas de abuso 10,24 . O álcool é um agente teratogênico comum e potente, que ultrapassa a barreira placentária, prejudicando o concepto em decorrência de seu metabolismo e mecanismo de detoxificação lento 22,25 . ...
Objective
to verify the contexts that enhance the dimensions of individual, social, and programmatic vulnerability associated with the use of alcohol and other drugs during pregnancy.
Method
qualitative, descriptive, and exploratory, cross-sectional study. Participants were 38 pregnant women who used alcohol and other drugs, at a moderate and severe level, in low-risk prenatal care in the Primary Health Care of two cities in the Metropolitan Region of Maringá - Paraná. Data was collected from, December 2019 to March 2020. The Vulnerability analytical framework guided the discussion.
Results
at the individual level, the vulnerability contexts were issues of gender, brown and black ethnicity/color, low education, reproductive period, and high parity. At the social level, the lack of insertion in the job market, family income below the poverty line, abusive intra-family relationships, addictive behavior in the family, and violence in the living community. In the programmatic plan, there was a low demand for health services, lack of welcoming for the treatment of drug use, screening for deficient drug use, low bond with family health teams, absence of dental, psychological, and social services, insertion in the inadequate level of prenatal care, usual risk, while they should have been classified as high risk, and mean prenatal consultations below recommended.
Conclusion
the study made it possible to advance in the contexts of the vulnerability of these pregnant women. Recognizing these contexts makes it possible to formulate strategies to reduce harm and damages to maternal and fetal health related to drug use during pregnancy, leading to a favorable gestational outcome.
DESCRIPTORS:
Pregnant women; Drugs of abuse; Addictive behavior; Prenatal care; Nursing in public health; Vulnerability analysis
... Prenatal alcohol exposure (PAE) causes physical, cognitive, and behavioral deficits in affected offspring [1]. In the United States, 11.5% of pregnant women report alcohol consumption within the past month, while 3.9% report binge drinking [2]. Despite more than forty years of interventions to inform people of the dangers of alcohol consumption during pregnancy, PAE remains a significant and expensive public health issue [3,4]. ...
... Although the best prevention of FASD is the cessation of alcohol consumption during pregnancy, this is difficult in practice, and rates of gestational alcohol consumption remain high [2]. Alcohol increases prenatal iron needs beyond what is generally considered adequate, and perhaps beyond what is typically provided by an iron-adequate diet. ...
Prenatal alcohol exposure causes neurodevelopmental disability and is associated with a functional iron deficiency in the fetus and neonate, even when the mother consumes an apparently iron-adequate diet. Here, we test whether gestational administration of the clinically relevant iron supplement Fer-In-Sol mitigates alcohol’s adverse impacts upon the fetus. Pregnant Long-Evans rats consumed an iron-adequate diet and received 5 g/kg alcohol by gavage for 7 days in late pregnancy. Concurrently, some mothers received 6 mg/kg oral iron. We measured maternal and fetal weights, hematology, tissue iron content, and oxidative damage on gestational day 20.5. Alcohol caused fetal anemia, decreased fetal body and brain weight, increased hepatic iron content, and modestly elevated hepatic malondialdehyde (p’s < 0.05). Supplemental iron normalized this brain weight reduction in alcohol-exposed males (p = 0.154) but not female littermates (p = 0.031). Iron also reversed the alcohol-induced fetal anemia and normalized both red blood cell numbers and hematocrit (p’s < 0.05). Iron had minimal adverse effects on the mother or fetus. These data show that gestational iron supplementation improves select fetal outcomes in prenatal alcohol exposure (PAE) including brain weight and hematology, suggesting that this may be a clinically feasible approach to improve prenatal iron status and fetal outcomes in alcohol-exposed pregnancies.
... During 2018-2020, approximately one in seven pregnant adults reported drinking alcohol in the past 30 days and, among those, approximately 40% reported binge drinking. Current and binge drinking increased by approximately 2 percentage points in 2018-2020 estimates compared with estimates from the previous 3-year period, consistent with an upward trend observed since 2011 (2,4). There was no evidence of increased alcohol consumption by pregnant adults in 2020 relative to 2019, despite possible increased alcohol sales and consumption among the general population during the first months of the COVID-19 pandemic (5). ...
... There was no evidence of increased alcohol consumption by pregnant adults in 2020 relative to 2019, despite possible increased alcohol sales and consumption among the general population during the first months of the COVID-19 pandemic (5). § § § This report found several factors correlated with drinking during pregnancy including age, education, and marital status, which are generally consistent with other nationally representative studies (4,6). Having a usual health care provider was associated with lower alcohol consumption. ...
There is no known safe amount of alcohol consumption during pregnancy; drinking alcohol during pregnancy can cause fetal alcohol spectrum disorders and might increase the risk for miscarriage and stillbirth (1). The prevalence of drinking among pregnant women increased slightly during 2011-2018; however, more recent estimates are not yet reported (2). CDC estimated the prevalence of self-reported current drinking (at least one alcoholic drink in the past 30 days) and binge drinking (consuming four or more drinks on at least one occasion in the past 30 days) among pregnant adults aged 18-49 years, overall and by selected characteristics, using 2018-2020 Behavioral Risk Factor Surveillance System (BRFSS) data. During 2018-2020, 13.5% of pregnant adults reported current drinking and 5.2% reported binge drinking: both measures were 2 percentage points higher than during 2015-2017. Pregnant adults with frequent mental distress were 2.3 and 3.4 times as likely to report current and binge drinking, respectively, compared with those without frequent mental distress. In addition, pregnant adults without a usual health care provider were 1.7 times as likely to report current drinking as were those with a current provider. Alcohol consumption during pregnancy continues to be a serious problem. Integration of mental health services into clinical care and improving access to care might help address alcohol consumption and mental distress during pregnancy to prevent associated adverse outcomes (3).
... Alcohol use among women of childbearing age in the United States continues to rise despite its well-established teratogenic effects and widespread recommendations against alcohol use during pregnancy [1]. More than half of all nonpregnant women of childbearing age report alcohol use during the previous month, and more than one in six report binge drinking in that time [2]. ...
... More than half of all nonpregnant women of childbearing age report alcohol use during the previous month, and more than one in six report binge drinking in that time [2]. One in nine pregnant women also reports alcohol use during the previous month and one in twenty reports binge drinking [1] [2]. Over the course of a pregnancy, more than 30% of women report alcohol consumption, with greater than 8% reporting an episode of binge drinking [3]. ...
... The U.S. Centers for Disease Control and Prevention estimates that 1 in 20 infants is affected by prenatal alcohol exposure (AE) annually, creating one of the largest pediatric public health crises in America [1][2][3]. Prenatal AE may result in facial dysmorphologies (e.g., smooth philtrum, thin upper lip, and orbital hypertelorism) and cognitive and behavioral impairments including hyperactivity, reduced executive function, deficits with perceptual learning and abstract conceptualization, reduced visuospatial processing, disrupted language and mathematical learning development, impulsivity, and disrupted social behaviors [3]. The severity of an individual's physical, behavioral, and cognitive deficits is primarily determined by the timing and amount of prenatal AE [4]. ...
A total of 1 in 20 infants born annually are exposed to alcohol prenatally, which disrupts neurodevelopment and results in several disorders categorized under the umbrella term Fetal Alcohol Spectrum Disorders (FASD). Children and adolescents affected by FASD exhibit delayed maturation of cerebral white matter, which contributes to deficits in executive function, visuospatial processing, sensory integration, and interhemispheric communication. Research using animal models of FASD have uncovered that oligoglia proliferation, differentiation, and survival are vulnerable to alcohol teratogenesis in the male brain due in part to the activation of the neuroimmune system during gestation and infancy. A comprehensive investigation of prenatal alcohol exposure on white matter development in the female brain is limited. This study demonstrated that the number of mature oligodendrocytes and the production of myelin basic protein were reduced first in the female corpus callosum following alcohol exposure in a rat model of FASD. Analysis of myelin-related genes confirmed that myelination occurs earlier in the female corpus callosum compared to their counterparts, irrespective of postnatal treatment. Moreover, dysregulated oligodendrocyte number and myelin basic protein production was observed in the male and female FASD brain in adolescence. Targeted interventions that support white matter development in FASD-affected youth are nonexistent. The capacity for an adolescent exercise intervention to upregulate corpus callosum myelination was evaluated: we discovered that volunteer exercise increases the number of mature oligodendrocytes in alcohol-exposed female rats. This study provides critical evidence that oligoglia differentiation is difficult but not impossible to induce in the female FASD brain in adolescence following a behavioral intervention.
... According to the Centers for Disease Control and Prevention (CDC), 1 in 13 women report drinking alcohol during pregnancy [1,2]. This is concerning, as alcohol can cross the placenta to the fetus and lead to developmental disturbances referred to as fetal alcohol spectrum disorders (FASD) [3]. ...
Alcohol (ethanol) exposure during pregnancy can adversely affect development, with long-lasting consequences that include neuroimmune, cognitive, and behavioral dysfunction. Alcohol-induced alterations in cytokine levels in the hippocampus may contribute to abnormal cognitive and behavioral outcomes in individuals with fetal alcohol spectrum disorders (FASD). Nutritional intervention with the essential nutrient choline can improve hippocampal-dependent behavioral impairments and may also influence neuroimmune function. Thus, we examined the effects of choline supplementation on hippocampal cytokine levels in adolescent and adult rats exposed to alcohol early in development. From postnatal day (PD) 4–9 (third trimester-equivalent), Sprague–Dawley rat pups received ethanol (5.25 g/kg/day) or sham intubations and were treated with choline chloride (100 mg/kg/day) or saline from PD 10–30; hippocampi were collected at PD 35 or PD 60. Age-specific ethanol-induced increases in interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), and keratinocyte chemoattractant/human growth-regulated oncogene (KC/GRO) were identified in adulthood, but not adolescence, whereas persistent ethanol-induced increases of interleukin-6 (IL-6) levels were present at both ages. Interestingly, choline supplementation reduced age-related changes in interleukin-1 beta (IL-1β) and interleukin-5 (IL-5) as well as mitigating the long-lasting increase in IFN-γ in ethanol-exposed adults. Moreover, choline influenced inflammatory tone by modulating ratios of pro- to -anti-inflammatory cytokines. These results suggest that ethanol-induced changes in hippocampal cytokine levels are more evident during adulthood than adolescence, and that choline can mitigate some effects of ethanol exposure on long-lasting inflammatory tone.
... We used the Block FFQ to calculate diet quality scores for four dietary quality indices: Healthy Eating Index 2010 (HEI-2010), Dietary Approaches to Stop Hypertension (DASH), alternate Mediterranean Diet (aMED), and Empirical Dietary Inflammatory Pattern (EDIP). We excluded alcohol intake in diet quality scores because its consumption is not recommended for pregnant people and therefore is unlikely to be accurately reported [20]. ...
Meeting the Institute of Medicine (IOM) gestational weight gain (GWG) guidelines is associated with a reduced risk of adverse perinatal outcomes. Overall diet quality comprehensively assesses dietary components and accounts for interactions between them. While GWG is influenced by maternal diet, its association with overall diet quality—measured by various dietary quality indices—is not well-defined. We prospectively estimated the relationship between four established dietary quality indices and the risk of GWG rate above (excessive) or below (inadequate) IOM guidelines in a multi-racial and ethnic cohort of 2914 pregnant people from the Pregnancy Environment and Lifestyle Study (2014–2019). We assessed diet quality using the Healthy Eating Index 2010 (HEI-2010), alternate Mediterranean Diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and Empirical Dietary Inflammatory Index (EDIP). Following the first trimester, 56% of the cohort had excessive GWG, and 14% had inadequate GWG. Poor diet quality (below the 75th percentile), measured by HEI-2010, was associated with a higher risk of excessive GWG in the second and third trimesters [RR = 1.03 (1.00, 1.06)]. Effect modification of this relationship by race and ethnicity and pre-pregnancy BMI was assessed. We found poor diet quality to be associated with elevated risk of excessive GWG among Black participants [RR = 1.14 (1.02, 1.28)] and White participants [RR 1.07 (1.01, 1.12)]. This was also the case for participants with pre-pregnancy BMI < 25.0 [RR 1.05 (1.00, 1.10)]. These results suggest that diet quality measured by the HEI-2010 is associated with excessive GWG, and the associations appear to be stronger among pregnant people without overweight or obesity and pregnant people who identify as Black or White race and ethnicity.
... Alcohol use among pregnant persons remains a public health concern. During 2015-2017, 11.5% of pregnant U.S. women aged 18-44 years reported current drinking (4), and during 2018-2020, 13.5% of pregnant adults aged 18-49 years reported current drinking (5). Brief * https://www.cdc.gov/ncbddd/fasd/alcohol-use.html ...
Alcohol use during pregnancy is a major preventable cause of adverse alcohol-related outcomes, including birth defects and developmental disabilities.* Alcohol screening and brief intervention (ASBI) is an evidence-based primary care tool that has been shown to prevent or reduce alcohol consumption during pregnancy; interventions have resulted in an increase in the proportion of pregnant women reporting abstinence (odds ratio = 2.26; 95% CI = 1.43-3.56) (1). Previous national estimates have not characterized ASBI in populations of pregnant persons. Using 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) data, CDC examined prevalence of ASBI and characteristics of pregnant persons and nonpregnant women aged 18-49 years (reproductive-aged women) residing in jurisdictions that participated in the BRFSS ASBI module. During their most recent health care visit within the past 2 years, approximately 80% of pregnant persons reported being asked about their alcohol use; however, only 16% of pregnant persons who self-reported current drinking at the time of the survey (at least one alcoholic beverage in the past 30 days) were advised by a health care provider to quit drinking or reduce their alcohol use. Further, the prevalence of screening among pregnant persons who did not graduate from high school was lower than that among those who did graduate from high school or had at least some college education. This gap between screening and brief intervention, along with disparities in screening based on educational level, indicate missed opportunities to reduce alcohol use during pregnancy. Strategies to enhance ASBI during pregnancy include integrating screenings into electronic health records, increasing reimbursement for ASBI services, developing additional tools, including electronic ASBI, that can be implemented in a variety of settings (2,3).
... were considered as they consumed. 20,21 Data collection tools Alcohol use Disorder identification test. We used a 10-item alcohol use screening instrument to measure the frequency of alcohol consumption and alcohol use disorder. ...
Objective:
Alcohol consumption during pregnancy can cause many major severe illnesses to both mothers and their offspring. Despite this, many pregnant women consume both homemade and manufactured alcoholic beverages. We conducted this study to assess the prevalence and determinants of alcohol consumption among pregnant women in Gozamin district, Amhara, Ethiopia, in 2020.
Methods:
Community-based cross-sectional study was employed from 1 to 30 November, 2020. The participants were recruited using a stratified multi-stage sampling technique. A structured and pretested interviewer-administered questionnaire was utilized for data collection. The collected data were entered into Epi-data Version 3.1 and exported to SPSS Version 25 for further analysis. The model fitness was checked by Hosmer and Lemeshow's goodness of fit test. Then, logistic regression models were considered to determine the associations of independent variables with the outcome variable. Variables with p < 0.25 in bivariable logistic regression were considered for multivariable logistic regression. Finally, variables with p < 0.05 in multivariable logistic regression were considered as determinants of alcohol consumption.
Result:
A total of 555 pregnant women participated in this study, making the response rate of 97.4%. The prevalence of alcohol consumption among the participants was 45.6% (95% confidence interval = 41.4-49.2). The determinants of alcohol consumption among the participants were highest wealth index (adjusted odds ratio = 3.21; 95% CI = 1.68-6.14), pre-pregnancy alcohol consumption (adjusted odds ratio = 3.67; 95% confidence interval = 2.36-5.71), poor social support (adjusted odds ratio = 3.08; 95% confidence interval = 1.60-5.94), and unplanned pregnancy (adjusted odds ratio = 1.66; 95% confidence interval = 1.04-2.66).
Conclusion:
In this study, the prevalence of alcohol consumption was high among the pregnant women. Our findings suggest introduction of policies and interventions that can help reduce alcohol consumption during pregnancy. The health education priority should be creation of awareness about the negative health impacts of alcohol on the health of pregnant mothers and their offspring.
... These rates went down to 9, 3, and 4% in the months before study visits 1, 2, and 3, respectively. 23 We believe this is not due to undercapture but rather effective education about the dangers of excessive alcohol consumption during pregnancy. We utilized a standard survey used in a U.S. population-based study and operated under a Certificate of Confidentiality in an attempt to mitigate underreporting as much as possible. ...
Objective The objective of this study was to derive profiles of alcohol, tobacco, and recreational drug use during pregnancy for first-time mothers with latent class growth analysis (LCGA) and determine the association of these classes with the risk of adverse pregnancy outcomes (APO).
Study Design A secondary analysis of a prospective cohort of Nulliparous Outcomes in Pregnancy: Monitoring Mothers-to-Be was conducted in eight medical centers across the United States from September 30, 2010, to September 23, 2013. Self-reported use of any alcohol, tobacco, or recreational drugs in the 1 month prior to the visit was assessed at up to four visits throughout pregnancy, and APOs included a composite of preterm birth, hypertensive disorder of pregnancy (HDP), small for gestational age (SGA) infant, or stillbirth, and each adverse outcome separately.
Results Four latent classes were identified from the LCGA for 10,031 nulliparous pregnant women that were on average 26.9 years old (standard deviation [SD] = 5.7) and mostly non-Hispanic White (59.7%). Classes included consistent tobacco users (N = 517, 5.2%), nonusers (N = 8,945, 89.2%), alcohol users (N = 500, 5.0%), and a combination of alcohol/tobacco/drug users (N = 69, 0.7%). Logistic regression demonstrated that the class of tobacco users was more likely to have an APO (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.22–1.81), preterm birth (OR = 1.53, 95% CI = 1.15–2.02), and SGA (OR = 1.79, 95% CI = 1.36–2.35) relative to the class of nonusers. The class of alcohol users was more likely to have HDP (OR = 1.37, 95% CI = 1.11–1.70) and less likely to have preterm birth (OR = 0.59, 95% CI = 0.38–0.90) and SGA (OR = 0.61, 95% CI = 0.40–0.93) compared to nonusers.
Conclusion Trajectories of substance use are associated with APOs; thus, interventions to mitigate the use when encountered early in pregnancy are warranted.
Key Points
... Also, a study from one NBDPS site (2003)(2004)(2005)(2006)(2007)) that compared maternal interview responses for maternal smoking with birth certificate data and medical record data observed that smoking reported from interview data was of higher quality with less misclassification compared to data obtained from medical records or birth certificates (Srisukhumbowornchai, Krikov, & Feldkamp, 2012). The social stigma that may be associated with reporting cigarette smoking and alcohol consumption during pregnancy may have produced underreporting of these exposures, although we believe that this limitation was minimized given that the proportion of mothers who reported any early pregnancy exposure to cigarette smoking or alcohol consumption in our study exceeded some national estimates (Denny, Acero, Naimi, & Kim, 2019;Drake, Driscoll, & Mathews, 2018). Another limitation of our study was that NBDPS interview questions about drink volume were not defined in terms of standard drinks, but rather as a "glass" of alcohol, which may result in inaccurate estimates of actual amount consumed. ...
Background:
Congenital diaphragmatic hernia (CDH) occurs when abnormal diaphragm development allows herniation of abdominal organs into the thoracic cavity. Its etiopathogenesis is not well understood, but cigarette smoking and alcohol exposure may impact diaphragm development. Using data from a large, population-based case-control study, we examined associations between maternal cigarette smoking and alcohol consumption and CDH in offspring.
Methods:
We analyzed maternal interview reports of cigarette smoking and alcohol consumption during early pregnancy for 831 children with CDH and 11,416 children without birth defects with estimated dates of delivery during 1997-2011. Generalized linear mixed effects models with a random intercept for study site were used to estimate associations between measures of exposure to smoking (any, type, frequency, duration) and alcohol (any, quantity, frequency, variability, type) for all CDH combined and selected subtypes (Bochdalek and Morgagni).
Results:
Mothers of 280 (34.0%) case and 3,451 (30.3%) control children reported early pregnancy exposure to cigarette smoking. Adjusted odds ratios for all CDH were increased for any (1.3; 95% confidence interval 1.1-1.5), active (1.3, 1.0-1.7), and passive (1.4, 1.1-1.7) smoking. Early pregnancy alcohol consumption was reported by mothers of 286 (34.9%) case and 4,200 (37.0%) control children; odds were near the null for any consumption (0.9, 0.8-1.1) and consumption with (0.9, 0.7, 1.1) or without (0.9, 0.8, 1.1) binging. Estimates for smoking and alcohol tended to be higher for Bochdalek CDH and Morgagni CDH than those for all CDH.
Conclusions:
Findings suggest that maternal early pregnancy exposure to cigarette smoking, but less so to alcohol consumption, contributes to CDH. These findings need to be replicated in additional large studies that use systematic case ascertainment and classification, detailed exposure assessment, and examine subtype-specific associations.
... It is observed that the pattern of drug use, the polyuse of alcohol, marijuana, and tobacco, has increased in recent decades 18,[21][22] . Tobacco is the most commonly used substance during pregnancy, along with alcohol, marijuana, and cocaine, in that order 20,23 . ...
Objective
to verify the contexts that enhance the dimensions of individual, social, and programmatic vulnerability associated with the use of alcohol and other drugs during pregnancy.
Method
qualitative, descriptive, and exploratory, cross-sectional study. Participants were 38 pregnant women who used alcohol and other drugs, at a moderate and severe level, in low-risk prenatal care in the Primary Health Care of two cities in the Metropolitan Region of Maringá - Paraná. Data was collected from, December 2019 to March 2020. The Vulnerability analytical framework guided the discussion.
Results
at the individual level, the vulnerability contexts were issues of gender, brown and black ethnicity/color, low education, reproductive period, and high parity. At the social level, the lack of insertion in the job market, family income below the poverty line, abusive intra-family relationships, addictive behavior in the family, and violence in the living community. In the programmatic plan, there was a low demand for health services, lack of welcoming for the treatment of drug use, screening for deficient drug use, low bond with family health teams, absence of dental, psychological, and social services, insertion in the inadequate level of prenatal care, usual risk, while they should have been classified as high risk, and mean prenatal consultations below recommended.
Conclusion
the study made it possible to advance in the contexts of the vulnerability of these pregnant women. Recognizing these contexts makes it possible to formulate strategies to reduce harm and damages to maternal and fetal health related to drug use during pregnancy, leading to a favorable gestational outcome.
DESCRIPTORS:
Pregnant women; Drugs of abuse; Addictive behavior; Prenatal care; Nursing in public health; Vulnerability analysis
... None of the partners reported quitting alcohol use during their partner's pregnancy. The women, in general, used substantially less alcohol during their pregnancy than their partners Moreover, binge drinking prior to pregnancy recognition is prevalent (Alvik et al., 2006;Denny et al., 2019;Dumas et al., 2017;Ethen et al., 2009;McCormack et al., 2017) especially among younger women (Pryor et al., 2017). Together with late pregnancy recognition, this has been associated with a risk of FASD in children (May et al., 2014). ...
Background:
The partners' role in determining the alcohol consumption behavior of pregnant women is not well studied. We measured alcohol use before and during pregnancy in pregnant women and their partners to evaluate the correlation in their levels of consumption.
Methods:
We evaluated the self-reported alcohol use of 14,822 women and their partners during 21,472 singleton pregnancies delivered in Kuopio University Hospital, Finland during the period 2009-2018. The information was gathered during pregnancy and at the time of childbirth and recorded in two databases that were merged to yield a single cohort. Missing data were accounted for by multiple imputation using the predictive mean matching method.
Results:
In 86% of the pregnancies, women reported alcohol use before pregnancy, whereas in 4.5% of the pregnancies women reported alcohol use during pregnancy. In contrast, no decrease was detected in their partners' alcohol use before or during pregnancy. In 26% of the pregnancies, the woman reported stopping alcohol use only after recognizing that she was pregnant. Before pregnancy, there were strong correlations between the pregnant women and their partners in the total Alcohol Use Disorders Identification Test score (rs = 0.69, p < 0.0001) and the self-reported average weekly amount of alcohol consumed (rs = 0.56, p < 0.0001). During pregnancy, there were weak correlations between the pregnant women and their partners in the frequency of drinking (rs = 0.20, p < 0.0001) and the average weekly amount of alcohol consumed (rs = 0.18, p < 0.0001).
Conclusions:
The self-reported alcohol consumption of pregnant women and their partners was positively correlated both before and during pregnancy, though the correlation declined substantially during pregnancy. Evaluating the alcohol consumption of both parents before pregnancy could assist in identifying women at risk of prenatal alcohol exposure. Supporting a reduction in partners' alcohol use could help to reduce pregnant women's alcohol consumption and prevent its associated harms.
... FASD affects between 1-5% of the population [2,3]; however, this may be an underestimation due to difficulties in diagnosis. Although the abstinence of alcohol consumption during pregnancy is the only way to prevent FASD, prominent social issues such as poor education around the risks of PNEE, domestic violence, or mental health disorders contribute to the estimated 10% of women who continue to drink during pregnancy [4,5]. Given these complex social issues, there is still a significant need to research potential therapies following PNEE. ...
Prenatal ethanol exposure (PNEE) is a leading cause of neurodevelopmental impairments, yet treatments for individuals with PNEE are limited. Importantly, postnatal supplementation with the essential nutrient choline can attenuate some adverse effects of PNEE on cognitive development; however, the mechanisms of action for choline supplementation remain unclear. This study used an animal model to determine if choline supplementation could restore hippocampal synaptic plasticity that is normally impaired by prenatal alcohol. Throughout gestation, pregnant Sprague Dawley rats were fed an ethanol liquid diet (35.5% ethanol-derived calories). Offspring were injected with choline chloride (100 mg/kg/day) from postnatal days (PD) 10–30, and then used for in vitro electrophysiology experiments as juveniles (PD 31–35). High-frequency conditioning stimuli were used to induce long-term potentiation (LTP) in the medial perforant path input to the dentate gyrus of the hippocampus. PNEE altered synaptic transmission in female offspring by increasing excitability, an effect that was mitigated with choline supplementation. In contrast, PNEE juvenile males had decreased LTP compared to controls, and this was rescued by choline supplementation. These data demonstrate sex-specific changes in plasticity following PNEE, and provide evidence that choline-related improvements in cognitive functioning may be due to its positive impact on hippocampal synaptic physiology.
... Furthermore, an increasing number of women use marijuana during pregnancy due to the recent decriminalization and legalization in 47 states across the country [8][9][10]. Meanwhile, the rates of alcohol and tobacco use during pregnancy have remained relatively constant over the past few decades, with the national prevalence of alcohol use during pregnancy estimated at around 8-15% and the national prevalence of tobacco use during pregnancy estimated at around 7% [11][12][13]. This evidence underscores that polysubstance use during pregnancy is a public health emergency and the long-term health effects on the fetus should be investigated. ...
Background
Polysubstance use during pregnancy typically includes use of one or more illicit substances in addition to tobacco and/or alcohol. Rates of polysubstance use during pregnancy range from 5 to 10% and continue to increase each year. However, to date there are no studies using longitudinal data exploring cardiovascular disease risk in adolescents exposed to polysubstances in utero.
Objective
The objective of this analysis was to discover the possible association between maternal substance use and cardiovascular disease risk (i.e., increased blood pressure) in adolescence.
Methods
The National Institute on Drug Abuse (NIDA)-funded Maternal Lifestyle Study (MLS) cohort was used for this analysis. Briefly, in 1993 MLS enrolled mothers by substance use during pregnancy status (Y/N) at four US locations (Detroit, MI; Miami, FL; Providence, RI; and Memphis, TN) and followed offspring until 2011. Generalized linear modeling assessed cardiovascular disease risk in offspring via systolic blood pressure (mm Hg) at age 16 comparing those exposed and not exposed to substances in utero.
Results
The most prevalent singular substance used during pregnancy in this sample (n = 910) was alcohol (n = 121, 16%), while the most common polysubstance used during pregnancy was a combination of tobacco, alcohol, and cocaine (n = 123, 16%). Those born normal birthweight (≥2500 g) and exposed to tobacco, alcohol, and opioids in utero had 22 mm Hg higher systolic blood pressure at age 16 compared to those not exposed to any substances (β coefficient = 22.44, 95% CI: 10.53–34.35).
Conclusion
Singularly, tobacco, alcohol, and opioids are among the most used during pregnancy and when used in combination, pose great risk for cardiovascular disease in offspring. Given its recent rise and high prevalence, targeting maternal substance use is critical for cardiovascular disease prevention.
... Despite public education efforts and a suggested guideline to avoid alcohol consumption when pregnant, the global prevalence of alcohol use during pregnancy remains high [22][23][24][25]. The percentage of pregnant women consuming alcohol in the USA has increased steadily over time [25][26][27][28]. Excessive alcohol intake is neurotoxic and causes profound damage to the nervous system, affecting the structure, physiology, and function of both the mature and developing brain [29]. ...
Alcohol exposure during pregnancy is harmful to the fetus and causes a wide range of long-lasting physiological and neurocognitive impairments, collectively referred to as fetal alcohol spectrum disorders (FASD). The neurobehavioral deficits observed in FASD result from structural and functional damages in the brain, with neurodegeneration being the most destructive consequence. Currently, there are no therapies for FASD. It is exigent to delineate the underlying mechanisms of alcohol neurotoxicity and develop an effective strategy of treatment. ER stress, caused by the accumulation of unfolded/misfolded proteins in the ER, is the hallmark of many neurodegenerative diseases, including alcohol-induced neurodegeneration. Mesencephalic astrocyte-derived neurotrophic factor (MANF) is a newly discovered endoplasmic reticulum (ER) stress responsive neurotrophic factor that regulates diverse neuronal functions. This review summarizes the recent findings revealing the effects of MANF on the CNS and its protective role against neurodegeneration. Particularly, we focus the role of MANF on alcohol-induced ER stress and neurodegeneration and discuss the therapeutic potential of MANF in treating alcohol neurotoxicity such as FASD.
... Current smoking was defined as smoking at least one day over the past 30 days (15). Current drinking was defined as consuming at least one alcoholic drink over the previous 30 days ( 16). ...
Objective
Data regarding the influence of arterial stiffness on myocardial work (MW) has been scarce. This study was performed to investigate the association between brachial-ankle pulse wave velocity (baPWV) and MW by non-invasive left ventricular pressure–strain in a population of non-hypertensive and hypertensive individuals.
Methods
Two hundred and eight participants (104 hypertensive and 104 non-hypertensive individuals) were prospectively enrolled into the study. All participants underwent conventional echocardiography, as well as 2D speckle-tracking echocardiography to assess MW by non-invasive left ventricular pressure–strain and global longitudinal strain (GLS). baPWV measurements were made at the same day as the echocardiography. Then, participants were categorized according to baPWV tertiles. Correlation between baPWV and MW were analyzed. Predicting ability of baPWV for abnormal WM was analyzed using receiver operating characteristic (ROC) curve.
Results
The median baPWV from the low to high tertile groups were 1286.5 (1197.5–1343.5), 1490.0 (1444.5–1544.0), and 1803.8(1708.3–1972.0) cm/s, respectively. In simple linear regression analysis, baPWV had a significant positive association with global work index (GWI), global constructed work (GCW), and global wasted work (GWW), and a negative association with global work efficiency (GWE). The association remained significant after adjusting for major confounding factors in multiple linear regression analysis. The areas under the ROC curve of baPWV for predicting abnormal GWI, GCW, GWW, and GWE were 0.653, 0.666, 0.725, and 0.688, respectively (all p < 0.05).
Conclusions
BaPWV is significantly associated with all four components of MW using non-invasive left ventricular pressure-strain method in a mixed population of non-hypertensive and hypertensive individuals.
... As the effective window for emergency contraception is ~120 h at most [26][27][28][29] , and as safe abortion access continues to be limited around the world 16,30 , delayed confirmation poses considerable risks to pregnant individuals 16,17 . Early, passive pregnancy detection could increase the agency of a pregnant individual, speed adoption of pregnancy-safe behaviors (e.g., avoidance of environmental risk factors 7 , cessation of alcohol consumption 8,31 or drug use 32 ), or provide the choice to discontinue a pregnancy at an earlier gestational age 33 . ...
The majority of American women become aware of pregnancy ~3-7 weeks after conception, and all must seek testing to confirm their pregnant status. The delay between conception and awareness is often a time in which contraindicated behaviors take place. However, there is long standing evidence that passive, early pregnancy detection may be possible using body temperature. To address this possibility, we analyzed 30 individuals continuous distal body temperature (DBT) in the 180 days surrounding self-reported conception in comparison to self-reported pregnancy confirmation. Features of DBT nightly maxima changed rapidly following self-reported conception, reaching uniquely elevated values after a median of 5.5 +/- 3.5 days, whereas individuals reported a positive pregnancy test result at a median of 14.5 +/- 4.2 days. Together, we were able to generate a retrospective, hypothetical alert a median of 9 +/- 3.9 days prior to the date at which individuals received a positive pregnancy test. Continuous temperature-derived features can provide early, passive indication of pregnancy onset. We propose these features for testing and refinement in clinical settings, and for exploration in large, diverse cohorts. The development of pregnancy detection using DBT may reduce the delay from conception to awareness and increase the agency of pregnant individuals.
... In the present study, working was associated with alcohol use in early and middle pregnancy. The associations between work status and alcohol use during pregnancy are inconsistent [7]; some studies showed that working women had a higher risk of alcohol use during pregnancy than non-working women [9,37], whereas other studies found no association [38,39]. One possible explanation is that working may increase the opportunity for alcohol use. ...
Background
There is inconsistent evidence on the associations of education and work status with alcohol use during pregnancy. Our aim was to examine the associations of education and work status with alcohol use and alcohol cessation during pregnancy in Japan.
Methods
Data were analyzed from 11,839 pregnant women who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study from 2013 to 2017 in Japan. Women were dichotomized as current drinkers or non-drinkers in both early and middle pregnancy. Alcohol cessation was defined as alcohol use in early pregnancy, but not in middle pregnancy. Multivariable log-binomial regression analyses were conducted to examine associations of education and work status with alcohol use in early and middle pregnancy and alcohol cessation, adjusted for age and income. The prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated by work status and education.
Results
The prevalence of alcohol use in early and middle pregnancy was 20.9 and 6.4%, respectively. Higher education was associated with alcohol use in early pregnancy both among working and non-working women; the PRs of university education or higher compared with high school education or lower were 1.62 (95% CI, 1.34–1.96) and 1.29 (95% CI, 1.16–1.45), respectively. Higher education was associated with alcohol cessation during pregnancy among working women; the corresponding PR was 1.09 (95% CI, 1.01–1.17). Working was associated with alcohol use in early and middle pregnancy. Working was associated with a decreased probability of alcohol cessation among women with lower education but with an increased probability of alcohol cessation among women with higher education; the PRs of working compared with not working were 0.91 (95% CI, 0.82–1.00) and 1.10 (95% CI, 1.00–1.20), respectively.
Conclusions
Women with higher education were more likely to consume alcohol in early pregnancy and to cease alcohol use between early and middle pregnancy, especially working women. Working women were more likely to consume alcohol throughout pregnancy. Working women with lower education were less likely to cease alcohol use, whereas working women with higher education were more likely to cease alcohol use between early and middle pregnancy.
... 4.98%, and 8.4-11.3%, respectively) [21][22][23][24]. ...
Background: This study investigated COVID-19 related psychological distress among expectant and new mothers, with and without infection, in metropolitan New York. It also examined the trajectories of participants' distress during pregnancy and postpartum, and the moderating effect of socioeconomic status (SES).
Methods: An online survey was conducted April through June 2020 among expectant and new mothers with infants (<12 months) (N=642). Associations between infection status and psychological symptoms, suicidal ideation, and substance use were examined. Changes in distress related to COVID-19 infection and SES were then examined.
Results: We found elevated anxiety and depression among infected compared to uninfected women. Similarly, infected, compared to uninfected women, had elevated risk for suicidal thoughts (quite often, AOR=3.97, sometimes AOR=13.2), and for substance use [alcohol (AOR=3.30); tobacco (AOR=4.54); cannabis (AOR=7.01); heroin (AOR=7.09); cocaine (AOR=10.05)]. Differences in trajectories of distress across pregnancy between the two groups were significant. Among infected women, distress was consistently high throughout. Among uninfected women, it started low and intensified toward the end of pregnancy. SES further moderated the impact of infection on distress. During earlier trimesters, infected/low SES women had greatest, and uninfected/high SES women had lowest, levels of distress. Their trajectories converged nearing childbirth.
Conclusions: New and expectant mothers, especially those infected, have suffered substantial psychological distress due to the pandemic. Moreover, SES moderated the trajectory of distress. Infected women who also had low SES experienced the highest distress levels among all groups. Mitigating strategies are imperative to alleviate this distress.
Introduction:
Alcohol consumption during pregnancy can produce multiple damaging outcomes to the foetus, commonly referred to as fetal alcohol spectrum disorders (FASD). FASD represents the leading non-genetic cause of preventable birth defects in the United States where alcohol guidelines recommend pregnant woman abstain from alcohol use. This study examined: (i) midwives' knowledge, attitude and intent to screen for prenatal alcohol use; and (ii) assessed perceived barriers to communicating alcohol-related information.
Methods:
Using an online questionnaire, data were obtained from midwives (n = 61) in a southwestern US state between March and May 2018. Descriptive statistics were used to describe midwives' knowledge, attitude, intent and perceived barriers.
Results:
Several midwives considered one alcoholic beverage per occasion to be safe for the foetus (20.3%), some thought alcohol was safe during the 3rd trimester (14.8%) only and few thought it was safe in all trimesters. Many midwives (63.3%) were unaware that the TWEAK and T-ACE were validated alcohol screening tools for pregnant women. Furthermore, most midwives (>50%) agreed that limited time with patients, a need for additional training and lack of information on referral resources interfered with their sharing of alcohol abstinence guidelines. Midwives reported highly favourable attitudes and intentions toward sharing alcohol abstinence messages with their pregnant patients.
Discussion and conclusions:
More in-depth research and larger samples are needed to explore barriers (knowledge gaps, limited time with patients, need for additional training) that hinder midwives' dissemination of abstinence messages to pregnant women and limit the uptake of validated alcohol screening tools.
In this handbook, the world's leading researchers answer fundamental questions about dyslexia and dyscalculia based on authoritative reviews of the scientific literature. It provides an overview from the basic science foundations to best practice in schooling and educational policy, covering research topics ranging from genes, environments, and cognition to prevention, intervention and educational practice. With clear explanations of scientific concepts, research methods, statistical models and technical terms within a cross-cultural perspective, this book will be a go-to reference for researchers, instructors, students, policymakers, educators, teachers, therapists, psychologists, physicians and those affected by learning difficulties.
As U.S. states legalize recreational cannabis, some enact policies requiring Mandatory Warning Signs for cannabis during pregnancy (MWS-cannabis). While previous research has found MWS for alcohol during pregnancy (MWS-alcohol) associated with increases in adverse birth outcomes, research has not examined effects of MWS-cannabis. This study uses Vital Statistics birth certificate data from June 2015 - June 2017 in seven western states and policy data from NIAAA's Alcohol Policy Information System and takes advantage of the quasi-experiment created by Washington State's enactment of MWS-cannabis in June 2016, while nearby states did not. Outcomes are birthweight, low birthweight, gestation, and preterm birth. Analyses use a Difference-in-Difference approach and compare changes in outcomes in Washington to nearby states in the process of legalizing recreational cannabis (Alaska, California, Nevada) and, as a secondary analysis, nearby states continuing to criminalize recreational cannabis (Idaho, Montana, Wyoming). Birthweight was -7.03 g lower (95% CI -10.06, -4.00) and low birthweight 0.3% higher (95% CI 0.0, 0.6) when pregnant people were exposed to MWS-cannabis than when pregnant people were not exposed to MWS-cannabis, both statistically significant (p = 0.005 and p = 0.041). Patterns for gestation, -0.014 weeks earlier (95% CI -0.038, 0.010) and preterm birth 0.2% higher (95% CI -0.2, 0.7), were similar, although not statistically significant (p = 0.168 and 0.202). The direction of findings was similar in secondary analyses, although statistical significance varied. Similar to MWS-alcohol, enacting MWS-cannabis is associated with an increase in adverse birth outcomes. The idea that MWS-cannabis provide a public health benefit is not evidence-based.
EFSA established cumulative assessment groups and conducted retrospective cumulative risk assessments for two types of craniofacial alterations (alterations due to abnormal skeletal development, head soft tissue alterations and brain neural tube defects) for 14 European populations of women in childbearing age. Cumulative acute exposure calculations were performed by probabilistic modelling using monitoring data collected by Member States in 2017, 2018 and 2019. A rigorous uncertainty analysis was performed using expert knowledge elicitation. Considering all sources of uncertainty, their dependencies and differences between populations, it was concluded with varying degrees of certainty that the MOET resulting from cumulative exposure is above 100 for the two types of craniofacial alterations. The threshold for regulatory consideration established by risk managers is therefore not exceeded. Considering the severity of the effects under consideration, it was also assessed whether the MOET is above 500. This was the case with varying levels of certainty for the head soft tissue alterations and brain neural tube defects. However, for the alterations due to abnormal skeletal development, it was found about as likely as not that the MOET is above 500 in most populations. For two populations, it was even found more likely that the MOET is below 500. These results were discussed in the light of the conservatism of the methodological approach.
Alzheimer’s disease (AD) is the most common cause of dementia, affecting approximately 50 million people worldwide. Early life risk factors for AD, including prenatal exposures, remain underexplored. Exposure of the fetus to alcohol (ethanol) is not uncommon during pregnancy, and may result in physical, behavioral and cognitive changes that are first detected during childhood but result in lifelong challenges. Whether or not prenatal ethanol exposure may contribute to Alzheimer’s disease risk is not yet known. Here we exposed a mouse model of Alzheimer’s disease (3xTg-AD), bearing 3 dementia associated transgenes: presenilin1 (PS1M146V), human amyloid precursor protein (APPSwe) and human tau (TauP301S), to ethanol on gestational days 13.5-16.5 using an established binge-type maternal ethanol exposure paradigm. We sought to investigate if prenatal ethanol exposure resulted in a precocious onset or increased severity of AD progression, or both. We found that a brief binge-type gestational exposure to ethanol during a period of peak neuronal migration to the developing cortex resulted in an earlier onset of spatial memory deficits and behavioral inflexibility in the progeny, as assessed by performance on the modified Barnes maze task. The observed cognitive changes coincided with alterations to both GABAergic and glutamatergic synaptic transmission in layer V/VI neurons, diminished GABAergic interneurons and increased β-amyloid accumulation in the medial prefrontal cortex. These findings provide the first preclinical evidence for prenatal ethanol exposure as a potential factor for modifying the onset of AD-like behavioral dysfunction and set the groundwork for more comprehensive investigations into the underpinnings of AD-like cognitive changes in individuals with fetal alcohol spectrum disorders.
Most American women become aware of pregnancy ~3–7 weeks after conceptive sex, and all must seek testing to confirm their pregnant status. The delay between conceptive sex and pregnancy awareness is often a time in which contraindicated behaviors take place. However, there is long standing evidence that passive, early pregnancy detection may be possible using body temperature. To address this possibility, we analyzed 30 individuals’ continuous distal body temperature (DBT) in the 180 days surrounding self-reported conceptive sex in comparison to self-reported pregnancy confirmation. Features of DBT nightly maxima changed rapidly following conceptive sex, reaching uniquely elevated values after a median of 5.5 ± 3.5 days, whereas individuals reported a positive pregnancy test result at a median of 14.5 ± 4.2 days. Together, we were able to generate a retrospective, hypothetical alert a median of 9 ± 3.9 days prior to the date at which individuals received a positive pregnancy test. Continuous temperature-derived features can provide early, passive indication of pregnancy onset. We propose these features for testing and refinement in clinical settings, and for exploration in large, diverse cohorts. The development of pregnancy detection using DBT may reduce the delay from conception to awareness and increase the agency of pregnant individuals.
Individuals with fetal alcohol spectrum disorders (FASD) incur enduring brain damage and neurodevelopmental impairments from prenatal alcohol exposure (PAE). Preclinical rodent models have demonstrated that choline supplementation during development can improve adverse neurodevelopmental consequences of PAE. This study used the sheep model to evaluate dietary choline supplementation during pregnancy as a therapeutic intervention, testing the hypothesis that choline can ameliorate alcohol-induced cerebellar Purkinje cell loss. Pregnant ewes were randomly assigned either to a normal control [NC] group (n=8), or to groups given intravenous infusions of alcohol (or saline) from gestational days 4-41 (the first trimester-equivalent). A weekly binge-drinking pattern was modeled, with three consecutive days of infusions of saline [SAL], 1.75 g/kg/day alcohol [1.75ALC], or 2.5 g/kg/day alcohol [2.5ALC] followed by four days off. Infused ewes were randomly assigned to receive dietary supplements throughout pregnancy of choline (10 mg/kg/day) or placebo (n=8 per group). Mean blood alcohol concentrations (BAC) were significantly higher in the 2.5ALC groups (287 mg/dl) than the 1.75ALC groups (197 mg/dl). Lamb cerebella were harvested on postnatal day 180 and processed for stereological counts of Purkinje cells. Both alcohol doses caused significant reductions in Purkinje number relative to NC and SAL-Placebo groups, confirming previous findings. Effects of choline supplementation depended on infusion group: it significantly protected against Purkinje cell loss in the 2.5ALC group, had no effect in the 1.75ALC group, and significantly reduced numbers in the SAL-Choline group (though neither the SAL-Choline nor the SAL-Placebo group differed from the NC group). The protection by choline evident only in the 2.5ALC group suggests that multiple, BAC-dependent mechanisms of cerebellar damage may be activated with alcohol exposure in the first trimester, and that choline may protect against pathogenic mechanisms that emerge at higher BACs. These outcomes extend the evidence that early choline supplementation can mitigate some neurodevelopmental defects resulting from binge-like PAE.
Background: Adverse childhood experiences (ACEs) are a major public health issue linked to negative health outcomes. Yet, few recent studies drawing on national data have examined the association between ACEs and binge drinking. Objective: The objective of this study was to examine the association between ACEs and binge drinking among adults in the United States and whether this association is dependent on sex. Methods: Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 41,322 adults aged 18–64 years (50.7% male) from 17 states was analyzed using binary logistic regression. The outcome variable was binge drinking, and the main explanatory variable was ACEs. Results: Of the 41,322 respondents, 21.3% engaged in binge drinking. About 30% of the respondents had no ACEs and 23.9% had four or more ACEs. In the multivariable logistic regression, we observed that sex moderated the association between ACEs and binge drinking. Odds were 1.36 times higher for females who experienced two ACEs (aOR = 1.36 p < .05, 95% CI = 1.04–1.77) and 1.58 times higher for females who experienced three ACEs (aOR = 1.58 p < .01, 95% CI = 1.17–2.12) to engage in binge drinking. Other factors associated with binge drinking include younger age, non-Hispanic White, higher income level, higher education, not being married, being overweight, and history of cigarette smoking. Conclusion: The findings of this study underscore the importance of developing sex-appropriate screening and intervention strategies to support individuals exposed to ACEs and potentially mitigate negative health outcomes later in life.
Background
Prenatal alcohol exposure (PAE) is associated with an increased incidence of congenital heart defects (CHD), in particular outflow tract (OFT) defects. However, the variability in the incidence of CHD following PAE has not been fully explored. We hypothesize that a concomitant, relevant genetic defect would potentiate the adverse effect of PAE and partially explain the variability of PAE-induced CHD incidence.
Methods
The OFT is formed by the second heart field (SHF). Our PAE model consisted of two intraperitoneal injections (3 g/kg, separated by 6 hr) of 30% ethanol on E6.5 during SHF specification. The impact of genetic defects was studied by SHF-specific loss of Delta-like ligand 4 (Dll4), fibroblast growth factor 8 (Fgf8) and Islet1.
Results
Acute PAE alone significantly increased CHD incidence (4% vs. 26%, p = .015) with a particular increase in OFT alignment defects, viz., double outlet right ventricle (0 vs. 9%, p = .02). In embryos with a SHF genetic defect, acute PAE significantly increased CHD incidence (14 vs. 63%, p < .001), including double outlet right ventricle (6 vs. 50%, p < .001) compared to controls. PAE (p = .01) and heterozygous loss of Dll4 (p = .04) were found to independently contribute to CHD incidence, while neither Islet1 nor Fgf8 defects were found to be significant.
Conclusions
Our model recapitulates the increased incidence of OFT alignment defects seen in the clinic due to PAE. The presence of a concomitant SHF genetic mutation increases the incidence of PAE-related OFT defects. An apparent synergistic interaction between PAE and the loss of DLL4-mediated Notch signaling in OFT alignment requires further analysis.
Alcohol use is extremely prevalent throughout society and alcohol remains one of the most commonly-used substances across the globe. In this chapter, we review the various molecular targets of alcohol and how genetic variants contribute to increased or decreased sensitivity to alcohol exposure. In addition, this chapter describes the consequences of alcohol use and the development of alcohol use disorders (AUDs), which are characterized by intoxication, the emergence of withdrawal/negative affect, and the preoccupation/anticipation that develops with progressive alcohol use. This cycle involves a number of receptors, brain structures and networks including reward circuitry, stress systems, and deficits in cortical control. In each of the stages, different neurotransmitters are selectively engaged by increasing levels of alcohol exposure and withdrawal. Furthermore, we review the potential for each of these systems to provide pharmacological targets to treat various components of AUDs. Alcohol also affects neural development, and the risk factors and mechanisms of fetal alcohol spectrum disorders are briefly discussed. Current FDA-approved treatments for AUDs, alcohol withdrawal syndrome, and off-label/emerging treatments are also reviewed. As new research uncovers individual differences in AUDs and differential responsivity to pharmacological treatment, an improved understanding of the underlying pharmacology of alcohol use is important and warranted.
Parturients with substance use disorder require expertise to manage the complexity of intoxication, withdrawal, and chronic use as well as ensure adequate analgesia throughout labor. Opioid use disorder in pregnancy has increased more than 4-fold in the past decade, with a 50-fold geographic variability that now dwarfs other substance use in this population. Understanding not only the medical but also the public health and criminal justice implications of substance use disorder is essential to providing optimal care to this at-risk population.
Introduction
In 2013, the U.S. Preventive Services Task Force again recommended alcohol misuse screening and provision of brief behavioral counseling interventions to those engaged in risky drinking for all adults aged ≥18 years in primary care. This report presents national estimates of the provision of alcohol screening and brief intervention by U.S. primary care physicians, the screening methods, and the resources they identified as helpful in implementing alcohol/substance screening and intervention in primary care settings.
Methods
Data included 876 self-identified primary care physicians from the Physician Induction Interview portion of the 2015–2016 National Ambulatory Medical Care Survey, an annual nationally representative sample survey of nonfederal, office-based physicians in the U.S., encompassing all the 50 states and the District of Columbia. Descriptive estimates (annualized percentages) of alcohol misuse screening were generated for selected primary care physician characteristics. Estimates of how primary care physicians reported screening, the frequency of brief intervention, and resources identified as helpful in the implementation of screening/intervention procedures were also generated. Two-tailed significance tests were used to determine the differences between the compared groups. Data analyses were conducted in 2019–2020.
Results
In total, 71.7% of office-based primary care physicians reported screening patients for alcohol misuse. Statistically significant differences in screening were observed geographically and by provider specialty.
Conclusions
Less than 40% of primary care physicians who screened patients for alcohol misuse reported always intervening with patients who screened positive for risky alcohol use. Collection of data on resources that primary care physicians report as being helpful for alcohol/substance screening and intervention implementation may be useful in continuous improvement efforts.
Importance:
Substance use during pregnancy is a major health issue for both the mother and the fetus, but it also represents an important public health concern.
Objective:
The aim of this review was to summarize and compare recommendations from recently published guidelines on substance use during pregnancy and especially regarding alcohol, smoking, and drug use.
Evidence acquisition:
A descriptive review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the World Health Organization (WHO), the Society of Obstetricians and Gynaecologists of Canada, and the American College of Obstetricians and Gynecologists on substance use was conducted. Regarding the term "substance use," the most recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition substances were used.
Results:
All the reviewed guidelines recommend appropriate counseling and screening women regarding alcohol, smoking, and drug use during the antenatal period, while the management options vary. More specifically, the prompt management of alcohol dependence is emphasized by all the guidelines except from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, which makes no recommendation upon. The use of alcohol during breastfeeding should be avoided. Regarding smoking cessation, all guidelines recommend the use of certain psychosocial, behavioral interventions, and pharmacotherapy. All the guidelines, except the one from the WHO, suggest screening drug users for coexistent sexually transmitted infections. Brief interventions are considered beneficial, while a gradual decrease in benzodiazepines is suggested, as well as the discontinuation of marijuana and methamphetamine use. However, there is controversy regarding breastfeeding in those women as the WHO recommends in favor, whereas the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists recommend against this practice. Finally, all the guidelines state that, following delivery, close monitoring of the neonate is needed.
Conclusions:
The diversity of guidelines' recommendations concerning substance use reflects the different ways of the management of pregnant women during routine antenatal care due to absence of strong evidence. More research in the areas of dispute may allow the adoption of an international consensus, in order to early detect and appropriately manage pregnant women with harmful addictions.
Background
Fetal alcohol spectrum disorders (FASD) are preventable adverse outcomes consequent to prenatal alcohol exposure. Supplemental choline confers neuroprotection to the alcohol-exposed offspring, but its actions outside the brain are unclear. We previously reported that prenatal exposure of mice to 4.5g/kg alcohol decreased placental weight in females only, but decreased body weight and liver-to-body weight ratio and increased brain-to-body weight ratio in both sexes. Here we test the hypotheses that a lower alcohol dose will elicit similar outcomes, and concurrent choline treatment will mitigate these outcomes.
Methods
Pregnant C57BL/6J mice were gavaged with alcohol (3g/kg; Alc) or maltodextrin (MD) from embryonic day (E) 8.5-17.5. Some also received subcutaneous injection of 100mg/kg choline chloride (Alc+Cho, MD+Cho). Outcomes were evaluated on E17.5.
Results
Alc dams had lower gestational weight gain than MD; this was normalized by choline. In males, Alc decreased placental weight whereas choline increased placental efficiency, and Alc+Cho (vs. MD) trended to further reduce placental weight and increase efficiency. Despite no significant alcohol effects on these measures, choline increased fetal body weight but not brain weight, thus reducing brain-to-body weight ratio in both sexes. This ratio was also lower in the Alc+Cho (vs. MD) fetuses. Alc reduced liver weight and liver-to-body weight ratio; choline did not improve these. Placental weight and efficiency correlated with litter size, whereas placental efficiency correlated with fetal morphometric measurements.
Conclusions
Choline prevents the alcohol-reduced gestational weight gain and fetal body weight and corrects fetal brain sparing, consistent with clinical findings of improvements in alcohol-exposed children born to mothers receiving choline supplementation. Importantly, we show that choline enhances placental efficiency in the alcohol-exposed offspring but does not normalize fetal liver growth. Our findings support supplementing choline during pregnancy to mitigate the severity of FASD, and emphasize the need to examine choline’s actions in different organ systems.
Background
Alcohol-exposed pregnancy (AEP) is an ongoing concern, especially within low-resource, high-risk areas such as rural American Indian/Alaska Native (AIAN) communities. Brief preconceptual AEP-reduction interventions are popular in such areas but have a weak impact on alcohol use. Developing a strategic alcohol-change plan is a key program component, however, there is little research on strategy selection, especially within contexts that positively or negatively impact selection (e.g., cultural strengths, trauma, collective efficacy within AIAN communities). This study qualitatively analyzed strategies chosen for reducing alcohol use by AIAN women participating in a culturally-tailored brief preconceptual AEP-reduction intervention.
Methods
160 Northern Plains AIAN women developed a plan to accomplish an alcohol reduction/abstention goal at first and last program sessions. This plan included choosing one or more strategies to 1) achieve the goal, 2) mitigate barriers, and 3) use cultural strengths. Qualitative analysis of the data involved thematic open and structured coding of all three strategies separately. We also examined how many different themes (different individual strategies) participants reported for each strategy component.
Results
Common goal-achieving and barrier-mitigation strategies included positive social supports and avoiding negative or alcohol-involved social environments. Other strategies involved circular logic (e.g., the strategy to reduce drinking was to drink less). Both traditional and western cultural strengths were reported as important resources, although many participants had no cultural-resource strategy. Most participants reported only one strategy (theme) for each of the three components.
Conclusion
Programs may need to provide participants more support to develop strong strategies to reduce alcohol use when implemented within areas with increased trauma and contextual barriers that can impact strategy selection, which may include ways to improve health on interpersonal and community levels.
We previously found that prenatal ethanol exposure (PEE) induced adrenal dysplasia in offspring, which was related to intrauterine maternal glucocorticoid overexposure. This study investigated the intergenerational genetic effect and sex differences of PEE-induced changes in the synthetic function of adrenal corticosterone in offspring, and to clarify the intrauterine origin programming mechanism. Wistar pregnant rats were gavaged with ethanol (4 g/kg bw/d) from gestation day (GD) 9 to 20, and F1 generation was born naturally. The F1 generation female rats in the PEE group were mated with normal male rats to produce F2 generation. Serum and adrenal glands of fetal rats and F1/F2 adult rats were collected at GD20 and postnatal week 28. PEE increased the serum corticosterone level, while diminishing the expression of adrenal steroid synthases of fetal rats. Moreover, PEE enhanced the mRNA expression of GR and HDAC1, but inhibited the mRNA expression of SF1 and reduced the H3K9ac level of P450scc in the fetal adrenal gland. In PEE adult offspring of F1 and F2 generation the serum corticosterone level, the H3K9ac level of P450scc and its expression were decreased in males but were increased in females. In NCI-259R cells, cortisol reduced the production of endogenous cortisol, down-regulated SF1, and up-regulated HDAC1 expression by activating GR, and decreased H3K9ac level and expression of P450scc. In conclusion, PEE could induce adrenal dysplasia in offspring with sex differences and intergenerational genetic effects, and the adrenal insufficiency in male offspring was related to the induction of low functional genetic programming of P450scc by intrauterine high corticosterone through the GR/SF1/HDAC1 pathway.
From the time the constellation of impairments associated with prenatal alcohol exposure was first described in the medical literature as fetal alcohol syndrome (FAS) in 1973, science has refined our understanding of the physical and behavioral signs and symptoms of this brain-based disorder and the consequences for affected individuals through the lifespan. Although phenotype variability remains in medical and behavioral health diagnostic guidelines, it generally is understood that the disability, now generally called fetal alcohol spectrum disorder (FASD), is a multisystem condition that involves the entire body, with the most common and significant impairments related to structural and functional brain damage. Despite its significance as the leading preventable nonhereditary cause of developmental disabilities, affecting as many as one in 20 school-age children in the United States, complex clinical and societal factors contribute to inadequate diagnostic capacity and limited awareness of FASD from the classroom to the courtroom. Systemic ignorance of FASD compounds the untreated progression of disabilities inherent in the disorder and underlies discriminatory treatment of individuals vulnerable to mental and substance use disorders and victimization, who lack accountability beyond their cognitive capacity. This chapter describes an evolution in our understanding of FASD and the models developed to clinically identify the disability. An increase in diagnostic accuracy is noted as well as a need for expanded research and scientific translation. Corresponding advances are essential in recognizing FASD across systems of care and non-medical settings to increase attention to and investment in the disorders, so affected children and adults achieve the outcomes and equitable treatment they deserve.
Fetal alcohol spectrum disorders (FASDs) are common but rarely diagnosed neurodevelopmental disorders. Although research estimates FASDs occur in up to 2–5% of the general population, the conditions are even more prevalent in the child welfare and juvenile justice systems. Diagnosis helps inform alternatives to detention and appropriate treatment planning to reduce risk of recidivism. This chapter outlines a process for forensic teams to use in identifying young offenders with possible FASD and obtaining appropriate evidence to support diagnosis in court under the most recent diagnostic guidelines. Recommendations for interventions target changing the trajectory of delinquency with treatment plans that recognize neurological impairments and include supportive services that maximize the likelihood of independent pro-social living.
Individuals avoid stigma by looking to members of their networks for guidance on how to behave. Health controversies complicate this process by exposing people to inconsistent norms, influence, and control within their networks. To understand this process, we meld perspectives on networks and social psychology. Using the case of light/moderate drinking during pregnancy, we examine how people make health decisions in the face of controversy. Through in-depth interviews with first-time pregnant individuals and their health care providers, we reveal that individuals’ decisions about controversial health behaviors depend on 1) the consistency of the influence and control they encounter, 2) their status relative to enforcers, and 3) the strength of their ties to enforcers. These processes give people from higher social positions more power to resist influence and control. These findings illuminate how medical recommendations and public health interventions should account for the unequal experience of influence and control within networks.
Neurons expressing the neuropeptide hypocretin/orexin (Hcrt) in the hypothalamus promote reward-related behaviors including alcohol consumption and are shown in rodents and zebrafish to be stimulated by embryonic exposure to ethanol (EtOH). We used here in zebrafish three-dimensional analyses of the entire population of Hcrt neurons to examine how embryonic EtOH exposure at low-moderate concentrations (0.1% or 0.5% v/v) alters these neurons in relation to behavior. We found that EtOH in the water for 2 h (22–24 h post fertilization) increases the number of Hcrt neurons on the left but not right side of the brain through a stimulation of cell proliferation, this is accompanied by a decrease in locomotor activity under novel conditions but not after habituation, and these effects are evident in both larvae and adults indicating they are long lasting. Our analyses in adults revealed sexually dimorphic effects, with females consuming more EtOH-gelatin and exhibiting more freezing behavior along with an asymmetric increase in Hcrt neurons and males exhibiting increased aggression with no change in Hcrt. These findings suggest that a long lasting, asymmetric increase in Hcrt neurons induced by EtOH results from an asymmetric increase in proliferation specific to Hcrt and contributes to behavioral changes in females.
Most U.S. states have one or more pregnancy-specific alcohol or drug policies. However, research evidence indicates that some of these policies lead to increases in adverse birth outcomes, including low-birthweight and preterm birth. We offer explanations for why these ineffective policies related to pregnant people’s use of alcohol and drugs in the U.S. exist, including: abortion politics; racism and the ‘War on Drugs’; the design and application of scientific evidence; and lack of a pro-active vision. We propose alternative processes and concepts to guide strategies for developing new policy approaches that will support the health and well-being of pregnant people who use alcohol and drugs and their children. Processes include: involving people most affected by pregnancy-specific alcohol and drug policies in developing alternative policy and practice approaches as well as future research initiatives. Additionally, we propose that research funding support the development of policies and practices that bolster health and well-being rather than primarily documenting the harms of different substances. Concepts include accepting that policies adopted in response to pregnant people’s use of alcohol and drugs cause harms and working to do better, as well as connecting to efforts that re-envision the child welfare system in the U.S.
The etiology of ethanol-related congenital heart defects has been the focus of much study, but most research has concentrated on cellular and molecular mechanisms. We have shown with optical coherence tomography (OCT) that ethanol exposure led to increased retrograde flow and smaller atrioventricular (AV) cushions compared to controls. Since AV cushions play a role in patterning the conduction delay at the atrioventricular junction (AVJ), this study aims to investigate whether ethanol exposure alters the AVJ conduction in early looping hearts and whether this alteration is related to the decreased cushion size. Quail embryos were exposed to a single dose of ethanol at gastrulation, and Hamburger-Hamilton stage 19 - 20 hearts were dissected for imaging. Cardiac conduction was measured using an optical mapping microscope and we imaged the endocardial cushions using OCT. Our results showed that, compared with controls, ethanol-exposed embryos exhibited abnormally fast AVJ conduction and reduced cushion size. However, this increased conduction velocity (CV) did not strictly correlate with decreased cushion volume and thickness. By matching the CV map to the cushion size map, we found that the slowest conduction location was consistently at the atrial side of the AVJ, which had the thinner cushions, not at the thickest cushion location at the ventricular side as expected. Our findings reveal regional differences in the AVJ myocardium even at this early stage in heart development. These findings reveal the early steps leading to the heterogeneity and complexity of conduction at the mature AVJ, a site where arrhythmias can be initiated.
Foetal alcohol spectrum disorder (FASD) is the umbrella term used to describe the physical and mental disabilities induced by alcohol exposure during development. Early alcohol exposure induces cognitive impairments resulting from damage to the central nervous system (CNS). The neuroinflammatory response accompanied by neurodegenerative mechanisms contribute to those detrimental alterations. Cannabidiol (CBD) has recently emerged as an anti-inflammatory drug that might be useful to treat several neuropsychiatric disorders. In our study, we assessed the effects of CBD on long-lasting cognitive deficits induced by early alcohol exposure. Furthermore, we analysed long-term pro-inflammatory and apoptotic markers within the prefrontal cortex and hippocampus. To model alcohol binge drinking during gestational and lactation periods, we used pregnant C57BL/6 female mice with time-limited access to 20% v/v alcohol solution. Following the prenatal and lactation alcohol exposure (PLAE), we treated the male and female offspring with CBD from post-natal day (PD) 25 until PD34, and we evaluated their cognitive performance at PD60. Our results showed that CBD treatment during peri-adolescence period ameliorates cognitive deficits observed in our FASD-like mouse model, without sex differences. Moreover, CBD restores the PLAE-induced increased levels of TNFα and IL-6 in the hippocampus. Thus, our study provides new insights for CBD as a therapeutic agent to counteract cognitive impairments and neuroinflammation caused by early alcohol exposure.
Substance use during pregnancy is a critical public health issue that affects both the mother and the fetus. While research has assessed racial differences in treatment completion among women who are pregnant for specific types of substances, few studies have evaluated treatment completion for a variety of substances. As such, the purpose of this study was to examine racial differences in substance use treatment completion among women who are pregnant. The study derived data from the 2017 Treatment Episode Data-Discharges (TEDS-D) of the Substance Abuse and Mental Health Services Administration (SAMHSA). TEDS-D documents annual discharges from publicly funded substance use treatment programs in the United States, collected by each state and aggregated by SAMHSA. The study used Chi square tests for bivariate analyses and used logistic regression models to predict treatment completion by race and ethnicity. After accounting for other explanatory factors, Black and Hispanic women who were pregnant were significantly less likely to complete treatment compared to Whites. These differences were evident even after examining the interaction between race and substance of use. The study found no differences between Indigenous and Other race women who were pregnant and Whites. Results indicate the need to examine cultural, historical, and systemic factors that could affect lower treatment completion among Black and Hispanic women who are pregnant. Interventions should, therefore, move beyond the impact of socioeconomic factors and focus on the role of social support, external responsibilities, and the criminalizing of substance use during pregnancy.
The ventral tegmental area (VTA) is the origin of dopaminergic neurons and the dopamine (DA) reward pathway. This pathway has been widely studied in addiction and drug reinforcement studies and is believed to be the central processing component of the reward circuit. In this study, we used a well-established rat model to expose mother dams to alcohol, nicotine-alcohol, and saline perinatally. DA and non-DA neurons collected from the VTA of the rat pups were used to study expression profiles of miRNAs and mRNAs. miRNA pathway interactions, putative miRNA-mRNA target pairs, and downstream modulated biological pathways were analyzed. In the DA neurons, 4607 genes were differentially upregulated and 4682 were differentially downregulated following nicotine-alcohol exposure. However, in the non-DA neurons, only 543 genes were differentially upregulated and 506 were differentially downregulated. Cell proliferation, differentiation, and survival pathways were enriched after the treatments. Specifically, in the PI3K/AKT signaling pathway, there were 41 miRNAs and 136 mRNAs differentially expressed in the DA neurons while only 16 miRNAs and 20 mRNAs were differentially expressed in the non-DA neurons after the nicotine-alcohol exposure. These results depicted that chronic nicotine and alcohol exposures during pregnancy differentially affect both miRNA and gene expression profiles more in DA than the non-DA neurons in the VTA. Understanding how the expression signatures representing specific neuronal subpopulations become enriched in the VTA after addictive substance administration helps us to identify how neuronal functions may be altered in the brain.
Maternal alcohol consumption is closely associated with alcohol-related birth defects and neurodevelopment,¹ and therefore, it is widely recommended for women to quit consuming alcohol before and during pregnancy.² Paternal alcohol exposure biologically increases the risk of genetic and epigenetic sperm abnormalities.³ The epidemiological association is less evident and likely interfered with by maternal confounders, such as a maternal alcohol consumption rate as high as 30% in Western countries.⁴,5 Our previous preconception care project showed that among Chinese married couples, who were a unique study population, nearly one-third of fathers and only 3% of mothers consumed alcohol before pregnancy,⁴,5 suggesting minor effects of maternal alcohol consumption on offspring, and the Chinese population is a good model to analyze the association of preconception paternal drinking and birth defect. Thus, this study aimed to investigate the association between paternal drinking before pregnancy and birth defects to provide supportive evidence for paternal alcohol cessation in preconception health care.
Objectives Early pregnancy detection is important for improving pregnancy outcomes as the first trimester is a critical window of fetal development; however, there has been no description of trends in timing of pregnancy awareness among US women. Methods We examined data from the 1995, 2002, 2006–2010 and 2011–2013 National Survey of Family Growth on self-reported timing of pregnancy awareness among women aged 15–44 years who reported at least one pregnancy in the 4 or 5 years prior to interview that did not result in induced abortion or adoption (n = 17, 406). We examined the associations between maternal characteristics and late pregnancy awareness (≥7 weeks’ gestation) using adjusted prevalence ratios from logistic regression models. Gestational age at time of pregnancy awareness (continuous) was regressed over year of pregnancy conception (1990–2012) in a linear model. Results Among all pregnancies reported, gestational age at time of pregnancy awareness was 5.5 weeks (standard error = 0.04) and the prevalence of late pregnancy awareness was 23 % (standard error = 1 %). Late pregnancy awareness decreased with maternal age, was more prevalent among non-Hispanic black and Hispanic women compared to non-Hispanic white women, and for unintended pregnancies versus those that were intended (p < 0.01). Mean time of pregnancy awareness did not change linearly over a 23-year time period after adjustment for maternal age at the time of conception (p < 0.16). Conclusions for Practice On average, timing of pregnancy awareness did not change linearly during 1990–2012 among US women and occurs later among certain groups of women who are at higher risk of adverse birth outcomes.
In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposures and conditions. Consequently, attributing poor birth outcomes to prenatal alcohol exposure is a complicated and ongoing task, requiring continued attention to validated methodology and to identifying specific biological mechanisms.
The consequences of maternal alcohol use during pregnancy on the outcome of offspring depend, among other factors, on the amount and pattern of alcohol consumption. Animal studies found that bingelike drinking patterns, in which the fetus is exposed to high blood alcohol concentrations (BACs) over relatively short periods of time, are particularly harmful, even if the overall alcohol amount consumed is less than those of more continuous drinking patterns. Long-term studies in humans have confirmed that children of binge-drinking mothers exhibited especially severe cognitive and behavioral deficits. Binge drinking may be particularly harmful because it results in high BACs, may occur during critical periods of brain development, and may be associated with repeated withdrawal episodes.
To determine the prevalence, patterns, and predictors of alcohol consumption prior to and during various intervals of pregnancy in the U.S.
Alcohol-related, pregnancy-related, and demographic data were derived from computer-assisted telephone interviews with 4,088 randomly selected control mothers from the National Birth Defects Prevention Study who delivered live born infants without birth defects during 1997-2002. Alcohol consumption rates and crude and adjusted odds ratios (OR) were calculated.
30.3% of all women reported drinking alcohol at some time during pregnancy, of which 8.3% reported binge drinking (4+ drinks on one occasion). Drinking rates declined considerably after the first month of pregnancy, during which 22.5% of women reported drinking, although 2.7% of women reported drinking during all trimesters of pregnancy and 7.9% reported drinking during the 3rd trimester. Pre-pregnancy binge drinking was a strong predictor of both drinking during pregnancy (adjusted OR = 8.52, 95% CI = 6.67-10.88) and binge drinking during pregnancy (adjusted OR = 36.02, 95% CI = 24.63-52.69). Other characteristics associated with both any drinking and binge drinking during pregnancy were non-Hispanic white race/ethnicity, cigarette smoking during pregnancy, and having an unintended pregnancy.
Our study revealed that drinking during pregnancy is fairly common, three times the levels reported in surveys that ask only about drinking during the month before the survey. Women who binge drink before pregnancy are at particular risk for drinking after becoming pregnant. Sexually active women of childbearing ages who drink alcohol should be advised to use reliable methods to prevent pregnancy, plan their pregnancies, and stop drinking before becoming pregnant.
Importance
Excessive alcohol use is one of the most common causes of premature mortality in the United States. From 2006 to 2010, an estimated 88 000 alcohol-attributable deaths occurred annually in the United States, caused by both acute conditions (eg, injuries from motor vehicle collisions) and chronic conditions (eg, alcoholic liver disease). Alcohol use during pregnancy is also one of the major preventable causes of birth defects and developmental disabilities.
Objective
To update the US Preventive Services Task Force (USPSTF) 2013 recommendation on screening for unhealthy alcohol use in primary care settings.
Evidence Review
The USPSTF commissioned a review of the evidence on the effectiveness of screening to reduce unhealthy alcohol use (defined as a spectrum of behaviors, from risky drinking to alcohol use disorder, that result in increased risk for health consequences) morbidity, mortality, or risky behaviors and to improve health, social, or legal outcomes; the accuracy of various screening approaches; the effectiveness of counseling interventions to reduce unhealthy alcohol use, morbidity, mortality, or risky behaviors and to improve health, social, or legal outcomes; and the harms of screening and behavioral counseling interventions.
Findings
The net benefit of screening and brief behavioral counseling interventions for unhealthy alcohol use in adults, including pregnant women, is moderate. The evidence is insufficient to assess the balance of benefits and harms of screening and brief behavioral counseling interventions for unhealthy alcohol use in adolescents.
Conclusions and Recommendation
The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening and brief behavioral counseling interventions for alcohol use in primary care settings in adolescents aged 12 to 17 years. (I statement)
Importance
Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples.
Objective
To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States.
Design, Setting, and Participants
Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled.
Exposures
Alcohol consumption during pregnancy.
Main Outcomes and Measures
Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95% CIs were calculated using the eligible first-grade population as the denominator. Weighted prevalences and 95% CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation.
Results
A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3%). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95% CI, 7.8-15.8) to 50.0 (95% CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95% CI, 16.1-54.0) to 98.5 (95% CI, 57.5-139.5) per 1000 children.
Conclusions and Relevance
Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach. These findings may represent more accurate US prevalence estimates than previous studies but may not be generalizable to all communities.
Excessive alcohol use is risk factor for a wide range of health and social problems including liver cirrhosis, certain cancers, depression, motor vehicle crashes, and violence. Alcohol use during pregnancy can lead to fetal alcohol spectrum disorders (FASDs) and other adverse birth outcomes . Community studies estimate that as many as 2% to 5% of first grade students in the United States might have an FASD, which include physical, behavioral, or learning impairments. In 2005, the Surgeon General reissued an advisory urging women who are or might be pregnant to abstain from alcohol consumption to eliminate the risk for FASDs or other negative birth outcomes. To estimate current prevalences of any alcohol use and binge drinking (consuming four or more drinks on an occasion) among pregnant and nonpregnant women aged 18-44 years in the United States, CDC analyzed 2011-2013 Behavioral Risk Factor Surveillance System (BRFSS) data. Among pregnant women, the prevalences of any alcohol use and binge drinking in the past 30 days were 10.2% and 3.1%, respectively. Among nonpregnant women, the prevalences of any alcohol use and binge drinking in the past 30 days were 53.6% and 18.2%, respectively. Among binge drinkers, pregnant women reported a significantly higher frequency of binge drinking than nonpregnant women (4.6 and 3.1 episodes, respectively); the largest amount consumed during binge drinking was also higher among pregnant women than nonpregnant women (7.5 versus 6.0 drinks), although this difference was not statistically significant. Implementation of evidence-based clinical and community-level strategies would be expected to reduce binge drinking among pregnant women and women of childbearing age, and any alcohol consumption among women who are or might be pregnant. Healthcare professionals can support these efforts by implementing alcohol screening and brief interventions in their primary care practices, and informing women that there is no known safe level of alcohol consumption when they are pregnant or might be pregnant.
Assess long-term trends of the correlation between alcohol sales data and survey data.
Analyses of state alcohol consumption data from the US Alcohol Epidemiologic Data System based on sales, tax receipts or alcohol shipments. Cross-sectional, state annual estimates of alcohol-related measures for adults from the US Behavioral Risk Factor Surveillance System using telephone surveys.
United States. Participants State alcohol tax authorities, alcohol vendors, alcohol industry (sales data) and randomly selected adults aged > or = 18 years 1993-2006 (survey data).
State-level per capita annual alcohol consumption estimates from sales data. Self-reported alcohol consumption, current drinking, heavy drinking, binge drinking and alcohol-impaired driving from surveys. Correlation coefficients were calculated using linear regression models.
State survey estimates of consumption accounted for a median of 22% to 32% of state sales data across years. Nevertheless, state consumption estimates from both sources were strongly correlated with annual r-values ranging from 0.55-0.71. State sales data had moderate-to-strong correlations with survey estimates of current drinking, heavy drinking and binge drinking (range of r-values across years: 0.57-0.65; 0.33-0.70 and 0.45-0.61, respectively), but a weaker correlation with alcohol-impaired driving (range of r-values: 0.24-0.56). There were no trends in the magnitude of correlation coefficients.
Although state surveys substantially underestimated alcohol consumption, the consistency of the strength of the association between sales consumption and survey data for most alcohol measures suggest both data sources continue to provide valuable information. These findings support and extend the distribution of consumption model and single distribution theory, suggesting that both sales and survey data are useful for monitoring population changes in alcohol use.
To examine the prevalence and correlates of substance use during pregnancy among women in the United States.
We analyzed data from pregnant (n=1800) and non-pregnant women (n=37,527) aged 15-44 years who participated in the 2002 or 2003 National Survey on Drug Use and Health, a nationally representative epidemiologic survey. Study variables included demographics, any substance use in the prior 30 days, and possible current psychopathology. Data were analyzed using weighted chi-square and multiple logistic regressions that accounted for the complex survey design.
The overall prevalence of any past month substance use during pregnancy was 25.8%; the prevalence rates of past month illicit drug, cigarette and alcohol use were 4.7%, 18.9% and 10%, respectively. Compared to the prevalence of substance use among women in their first trimester, use was significantly lower among women in their second or third trimesters. Women who reported using substances during pregnancy were significantly more likely to meet the criteria for possible current psychopathology and be White. Additionally, women who were employed, married, and in their second or third trimester compared to the first were significantly less likely to have used any substance during pregnancy, adjusting for age, ethnicity and income.
Although the prevalence of substance use among pregnant women was significantly lower than non-pregnant women, some groups of women remain vulnerable to continued use, including those who are unemployed, unmarried, and experiencing possible current psychopathology. Prevention and intervention programs aimed at high-risk populations are warranted to reduce the deleterious effects of substance use on pregnancy outcomes.
To assess the relationship between unintended pregnancy resulting in a live birth and binge drinking (having 5 or more alcoholic beverages on 1 occasion) in the 3 months before pregnancy (the preconception period) and to characterize women who are of childbearing age and binge drink.
A case-control study was conducted of women with pregnancies that resulted in a live birth, comparing those with unintended pregnancies with those with intended pregnancies. Data analyzed were from the 15 states that participated in the Pregnancy Risk Assessment Monitoring System from 1996-1999.
Of 72 907 respondents, 45% of pregnancies were unintended. Compared with women with intended pregnancy, women with unintended pregnancy were more likely to be young and black and to report preconception binge drinking (16.3% vs 11.9%; odds ratio [OR]: 1.43; 95% confidence interval [CI]: 1.13-1.54). After adjusting for potential confounders, preconception binge drinking was associated with unintended pregnancy for white women (adjusted OR: 1.63; 95% CI: 1.47-1.80) but not for black women (adjusted OR: 0.96, 95% CI: 0.77-1.20). Overall, 14% of women reported preconception binge drinking. Women who binge drank in the preconception period were more likely to be white and unmarried; to smoke and be exposed to violence in the preconception period; and to consume alcohol, binge drink, and smoke during pregnancy.
Binge drinking in the preconception period was associated with unintended pregnancies resulting in a live birth among white women but not among black women. Preconception binge drinkers were more likely to engage in other risky behaviors, including drinking during pregnancy. Comprehensive interventions to reduce binge drinking may reduce unintended pregnancies, as well as other adverse maternal and pediatric health outcomes.