ArticleLiterature Review

Alcohol Consumption During Pregnancy

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Abstract

Alcohol is a potent teratogen in humans, and prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities. The term fetal alcohol syndrome (FAS) refers to a pattern of birth defects found in children of mothers who drank during pregnancy. FAS has four criteria: maternal drinking during pregnancy, a characteristic pattern of facial abnormalities, growth retardation, and brain damage (often manifested by intellectual difficulties or behavioral problems). As surveillance and research have progressed, it has become clear that FAS is but a rare example of a wide array of defects that can occur from exposure to alcohol in utero. At least 1 in 10 women will continue to consume alcohol during pregnancy, putting their fetuses at risk for the effects of alcohol exposure . Nurses are in a key position to provide care and conduct research that will contribute to the prevention of the adverse effects of prenatal alcohol exposure during the preconception and perinatal periods, as well as deal with the negative outcomes of exposure in the developing infant. Many areas have yet to be evaluated. Screening tools and interventions have been developed and tested, mostly in majority cultures. Culturally sensitive instruments must be generated and validated for high-risk groups such as Native Americans. Fetal alcohol biomarkers and genetic research are new and need considerably more work. Effective “no drinking during pregnancy” campaigns for high-risk groups must be created and tested. Nurses are well placed to conduct research that will describe the effects at social, behavioral, and biological levels; develop middle-range theories targeted at preventing the drinking behavior and optimizing care of affected children after birth; and generate and test effective interventions that enhance prevention strategies in the 21st century.

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... Prenatal alcohol exposure is a leading cause of central nervous system (CNS) developmental disorders i.e. intellectual disability [4] [5]. The term "fetal alcohol spectrum disorders" (FASD) refers to a pattern of birth defects found in children born from alcoholic mothers [6] [7]. FASD has four criteria: 1) maternal drinking during pregnancy; ...
... 2) a characteristic pattern of facial abnormalities; 3) intrauterine growth retardation paired to a microencephaly; 4) brain damage often manifested by intellectual disability and behavioral disorders including attention deficit, cognition, and learning inabilities [6] [8] [9]. Evidence converged on the proposal that intellectual disability was primarily due to deficiencies in neuronal network connectivity in the major cognitive centers in the brain, which secondarily would result in impaired information processing [10]. ...
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The molecular and cellular mechanisms by which alcohol produces its deleterious effects on neuronal networks are only now beginning to be understood. This review focused on alcohol-induced neurobiological alterations on neuronal network components underlying information processing, for further understanding of intellectual disability related to FASD. Abnormal neurodevelopmental events related to alcohol-damaged fetal brain included neurogenesis inhibition, aberrant migration, impaired differentiation, exacerbated apoptosis, impaired axon outgrowth and branching altering synaptogenesis and synaptic plasticity, abnormal GABAergic interneurons triggering synaptic inhibitory/excitatory imbalance, reduced myelinogenesis causing injured white matter in prefrontal lobe and atrophied corpus callosum compromising interhemispheric information transfer, the whole compromising neuronal network scaffolding which may lead to biased information processing with deficits in executive function. Added to these abnormalities are smaller gray matter and reduced hippocampus resulting in cognition and memory failures. As a whole, these developmental disorders may underlie intellectual disability related to FASD. In rodents, these neuronal network components matured mainly during the second and third trimesters equivalents of human gestation. Transferability of results from animal to human was also discussed. It was hoped that understanding of alcohol-induced neuronal networks failure mechanisms during the developing brain may lay a foundation for prospective new treatments and interventions
... U žen alkoholiček, které otěhotní, hrozí riziko poškození plodu, které se u dětí projeví růstovou retardací, postižením CNS a kraniofaciální dysmorfií (mikrocefalie, oční anomálie, plochý kořen nosu, vymizelé filtrum, tenký horní ret, nízko polože-né uši). Soubor těchto příznaků se označuje jako fetální alkoholový syndrom, jsou-li přítomny pouze poruchy chování a intelektu bez jiných známek postižení, používá se termín fetální alkoholový efekt (Kalina, 2001). ...
... To znamená, že se tyto problémy přenášejí nejen z matky na dítě, ale i do dalších generací. Podle některých studií souvisí pití alkoholu v prvních třech měsí-cích těhotenství i s výskytem náhlé smrti novorozenců ( Krulewitch, 2005). Děti matek, které během těhotenství konzumovaly i malé množ-ství alkoholu, mají později v životě zvýšené riziko problematického chování. ...
... Whereas many women either stop or reduce their alcohol consumption once they are aware that they are pregnant, some continue to drink. Estimates for prenatal alcohol consumption vary widely: around 10-12% in the United States [12] to higher rates in Europe (25-54%), particularly in the United Kingdom [13,14]. Furthermore, a significant minority of women continue to drink at problematic levels when pregnant, although accurate estimates are unavailable [7,13]. ...
... Several reviews have highlighted the importance of screening for alcohol use in pregnancy; however, none have used systematic methodology in their appraisal of available screening tools [12,[29][30][31][32][33]. ...
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Aims Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. Methods Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect 'at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. Results Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK () and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71–91%) and AUDIT-C (95%), with high specificity (71–89%, 73–83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score 3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For lifetime alcohol dependency the AUDIT at score 8 performed poorly. Conclusion T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted.
... A lcohol use during pregnancy, or prenatal alcohol exposure (PAE), is a national concern, as alcohol use can negatively impact a woman's health and can be passed across the placenta to a developing foetus. Alcohol abuse during pregnancy poses risks to the foetus (including poor growth, decreased muscle tone, delayed development, heart defects, physical/structural problems and mental retardation) known as Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Spectrum Disorder (FASD) (1). FAS is the term used to describe growth, mental and physical problems that may occur in an infant when a mother consumes alcohol during pregnancy, whereas FASD is the term used to describe the additional direct and indirect social, physical and emotional effects (2Á4). ...
... FAS is one of the most preventable causes of mental retardation in the United States (1,5). Annual long-term economic and societal costs associated with FAS and FASD are in the billions (2Á4,6). ...
Article
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Recent reports indicate a decline in rates of Fetal Alcohol Syndrome (FAS) among Alaska Native and American Indian (AN/AI) infants. Nevertheless, AN/AI infants remain disproportionately impacted by the effects of prenatal alcohol exposure. AN/AI pregnant women in their 3rd trimester completed a questionnaire on demographic data and the amount and frequency of their alcohol consumption in the month prior to conception and during pregnancy. Differences across demographics and trimesters were tested with the Chi-square, Fisher's exact or McNemar's test as appropriate. Of the 125 participants, 56% (n=71) reported no alcohol consumption in the 1st through 3rd trimesters of pregnancy; 30% (n=38) of the 125 participants also reported no alcohol consumption in the month before pregnancy. Of the 43% (n=54) who reported consuming alcohol during pregnancy (1st, 2nd and/or 3rd trimester), most (35%) reported alcohol use only in the 1st trimester. Binge drinking in the 1st or 2nd trimester was reported amongst 20% (n=25) of participants with an additional 18% (n=29) reporting binge drinking in the month prior to pregnancy. Women who reported pre-conception binge drinking were significantly more likely to report binge drinking during their 1st trimester (p<0.0001) and 2nd trimester (p<0.0001). A history of tobacco use (p=0.0403) and cigarette smoking during pregnancy (p<0.0001) were also associated with binge drinking during pregnancy. Among study participants, reported use of alcohol was primarily limited to pre-conception and the 1st trimester, with a dramatic decrease in the 2nd and 3rd trimesters. Prevention programmes, such as the Alaska FAS Prevention Project, may have contributed to observed decreases in the 2nd and 3rd trimesters. Additional study and focus on pre-conception, the 1st trimester and binge drinking, as well as tobacco use might augment Fetal Alcohol Spectrum Disorder prevention efforts.
... Whereas many women either stop or reduce their alcohol consumption once they are aware that they are pregnant, some continue to drink. Estimates for prenatal alcohol consumption vary widely: around 10-12% in the United States [12] to higher rates in Europe (25-54%), particularly in the United Kingdom [13,14]. Furthermore, a significant minority of women continue to drink at problematic levels when pregnant, although accurate estimates are unavailable [7,13]. ...
... Several reviews have highlighted the importance of screening for alcohol use in pregnancy; however, none have used systematic methodology in their appraisal of available screening tools [12,[29][30][31][32][33]. ...
Article
Full-text available
Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect 'at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71-91%) and AUDIT-C (95%), with high specificity (71-89%, 73-83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score >or=3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life-time alcohol dependency the AUDIT at score >or=8 performed poorly. T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted.
... So, we also determined by RT-PCR the chronic effects of bioactive substances on the expression of both RFC1 and FRa mRNA. First, we investigated the acute and chronic effects of cell exposure to ethanol because this agent is recognized as a potent teratogen in humans [39]. Indeed, prenatal alcohol exposure can give rise to alcohol-related birth defects such as spontaneous abortion, decreased immune function, attention problems, hearing impairment [40] and, as mentioned above, FASD [41]. ...
... Indeed, prenatal alcohol exposure can give rise to alcohol-related birth defects such as spontaneous abortion, decreased immune function, attention problems, hearing impairment [40] and, as mentioned above, FASD [41]. Among children with FASD, a small population presents a specific set of anomalies (specific facial abnormalities , intrauterine growth retardation and significant impairments in neurodevelopment) [39,424344, known as fetal alcohol syndrome (FAS). FAS is the major known cause of mental retardation in the western world [44] and occurs in 1.9 per 1000 live births [42]. ...
Article
Folic acid (FA) is a vitamin that acts as a coenzyme in the biosynthesis of purine and pyrimidine precursors of nucleic acids, which are critically important during pregnancy. Our group has previously shown that both reduced folate carrier (RFC1) and folate receptor alpha (FRalpha) seem to be involved in the uptake of [3H]folic acid ([3H]FA) by a human trophoblast cell line (BeWo) and by human primary cultured cytotrophoblasts. Our aim was to study the interaction between FA and some nutrients/bioactive substances. For this, we tested the acute and chronic effects of some dietary compounds on [3H]FA apical uptake and on the expression of both RFC1 and FRalpha mRNA in BeWo cells. Our results show that [3H]FA uptake was significantly reduced by acute exposure to epicatechin, isoxanthohumol (1-400 microM) or theophylline (0.1-100 microM); isoxanthohumol seemed to act as a competitive inhibitor, whereas epicatechin and theophylline caused an increase in both Km and Vmax. On the other hand, [3H]FA uptake was significantly increased by chronic exposure to xanthohumol, quercetin or isoxanthohumol (0.1-10 microM), and this increase does not seem to result from changes in the level of RFC1 or FRalpha gene expression. Moreover, [3H]FA uptake was significantly reduced by chronic exposure to ethanol (0.01%). This reduction seems to be, at least in part, due to a reduction in FRalpha expression. These results are compatible with an association between a deficient FA supply to the placenta/fetus and ethanol toxicity in pregnancy.
... Impairments are related mainly to executive function and perceptual learning among affected youth and are linked to disruptions to the growth of the corpus callosum and to myelination in adolescence. However, at least 1 in 10 women will continue to consume alcohol during pregnancy, putting their foetuses at risk for the effects of alcohol exposure [8]. ...
Article
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The world over, people drink in order to socialize, celebrate, and relax, despite the negative health effects of alcohol. Three periods of dynamic brain changes are evidenced to be particularly sensitive to the harmful effects of alcohol: gestation (from conception to birth), later adolescence (15-19 years), and older adulthood (over 65 years). This article is concentrated only on the negative effects of alcohol in children who have been exposed to alcohol before birth, known as foetal alcohol syndrome (FAS). This is a review based on published data in PubMed over the last two decades and is an analysis of more than 150 published papers. Alcohol use during pregnancy can cause miscarriage, stillbirth, and a range of lifelong physical, behavioural, and intellectual disabilities. The effects of ethanol are expressed on a set of molecules involved in neuroinflammation, myelination, neurotransmission, and neuron function. Modern neuroimaging techniques are able to specify some fine structural changes in the affected areas of the brain: volume reductions in the frontal lobe, including the middle frontal gyri in the prefrontal cortex, hippocampal structure, interhemispheric connectivity, abnormalities in glial cells, white matter deficits etc. Corpus callosum myelination is affected, resulting in a lack of the inter-hemispheric connectivity. This is known to facilitate autism, stroke, schizophrenia, as well as dementia, disrupts cognitive performance, and may lead to neurobehavioral deficits. It was pointed out that many symptoms and neuroimaging characteristics are similar in ADHD and FAS, thus the anamnesis for prenatal alcohol and nicotine exposure must be taken very seriously in order to better understand and interpret clinical symptoms.
... Alcohol consumption during pregnancy in the United States ranges from 10 to 12%. 12 In some Latin-American countries like Reliability (internal consistency) was low for all instruments, improving when optimal cut-off points were used, especially for the AUDIT, the AUDIT-C and the RAPS-QF. Conclusions In other cultural contexts, studies have concluded that T-ACE and TWEAK are the best instruments to assess pregnant women. ...
Article
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Background Considering the physical, mental and behavioral problems related to fetal alcohol exposure, prenatal clinical guides suggest a brief evaluation of alcohol consumption during pregnancy to detect alcohol intake and to adjust interventions, if required. Even if any alcohol use should be considered risky during pregnancy, identifying women with alcohol use disorders is important because they could need a more specific intervention than simple advice to abstain. Most screening tests have been developed and validated in male populations and focused on the long-term consequences of heavy alcohol use, so they might be inappropriate to assess consumption in pregnant women. Objective To analyze the internal reliability and validity of the alcohol screening instruments Alcohol Use Disorders Identification Test (AUDIT), Alcohol Use Disorders Identification Test – Consumption (AUDIT-C), Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down (TWEAK), Rapid Alcohol Problems Screen – Quantity Frequency (RAPS-QF) and Tolerance, Annoyed, Cut-Down and Eye-Opener (T-ACE) to identify alcohol use disorders in pregnant women. Methods A total of 641 puerperal women were personally interviewed during the 48 hours after delivery. The receiver operating characteristics (ROC) curves and the sensitivity and specificity of each instrument using different cut-off points were analyzed. Results All instruments showed areas under the ROC curves above 0.80. Larger areas were found for the TWEAK and the AUDIT. The TWEAK, the T-ACE and the AUDIT-C showed higher sensitivity, while the AUDIT and the RAPS-QF showed higher specificity. Reliability (internal consistency) was low for all instruments, improving when optimal cut-off points were used, especially for the AUDIT, the AUDIT-C and the RAPS-QF. Conclusions In other cultural contexts, studies have concluded that T-ACE and TWEAK are the best instruments to assess pregnant women. In contrast, our results evidenced the low reliability of those instruments and a better performance of the AUDIT in this population.
... Alcohol is a potent teratogen in humans, and prenatal alcohol exposure is a leading cause of intrauterine growth retardation and related microencephaly, brain damage often manifested by intellectual disability and behavioral disorders [1,2]. Maternal alcohol use is often concurrent with other factors that pose a risk to the developing fetal brain such as poor nutrition and nutrient factors deficits. ...
Article
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Find a full-text view-only of the enhanced PDF version on the following journal site: http://rdcu.be/rli0 Accumulating evidence has shown that binge-type alcohol intake in mothers interferes with thiamine deficiency (TD) to promote the fetal alcohol syndrome (FAS). Developmental alcohol or TD exposures act either synergistically or separately to reproduce FAS features e.g. intrauterine growth retardation and related microcephaly characterized by extensive cellular death induced by one another neurotoxicant. However molecular and cellular mechanisms underlying apoptosis in both alcohol and TD toxicities are unknown. The current review addresses mechanisms of apoptosis underlying alcohol and TD toxicities for further understanding FAS pathology. This study indicates two different mitochondria pathways regulating cellular death: The first mechanism may engage alcohol which activates the c-subunit ring of the F0-ATP synthase to form MPT pore-dependent apoptosis; following the second mechanism, TD activates CyP-D translocation from mitochondrial matrix towards the mitochondrial inner membrane to form MPT pore-dependent necrosis. These studies shed light upon molecular and cellular mechanisms underlying apoptosis and necrosis in developemental brain disorders related to alcohol and thiamine deficiency, in hopes of developing new therapeutic strategies for FAS medication.
... While not ignoring the potency of psychopathology and cognitive approaches, our attempt at explaining the relationship between marital dissatisfaction and drinking among pregnant women places this paper in the perspectives of three learning paradigms which would direct the course of our discussion: the operant conditioning model [8] and the classical conditioning [9], social learning theory [10] and the psychodynamic model [11]. ...
Article
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A convenient sampling technique was used to draw a sample of 110 pregnant women reporting for antenatal clinical checks in both private and public medical facilities in Uyo, Nigeria to investigate marital satisfaction and age as predictors of alcohol use during pregnancy. Kansas Marital Satisfaction Scale was used in dichotomizing respondents into satisfied and dissatisfied pregnant women in marriage, while an item in Alcohol Use Disorder Identification Test (AUDIT) delineated our cohorts into users and non-users of alcohol. A 2 × 2 factorial design was adopted as regards the plan of the study while a 2-way analysis of variance was used for the analysis of data collected. Results confirmed the first hypothesis which predicted that pregnant women who are satisfied in their marriages would report less alcohol use than their dissatisfied counterparts {F (1,104)=4.70; p<0.05}. Findings also confirmed our second hypothesis which stated that pregnant women who are younger would report more alcohol use than their elderly counterparts {F (5,104)=11.833; p<0.05}. Discussion of findings centered on the theories of learning which formed the nucleus of this paper and it was recommended that intervention would benefit from effective and affordable psychological counselling and treatment services for women exposed to harmful and/or hazardous alcohol use predicated by marital distress, violence, depression as well as those with limited coping skills.
... FASD is often described as a preventable disease (Medina and Krahe, 2008;Ripabelli et al., 2006;Payne et al., 2005;Krulewitch, 2005), and indeed efforts to heighten awareness about the consequences of EtOH consumption during pregnancy have had some limited success (Abel, 1998). In spite of this, a substantial portion of women drink during pregnancy (Muhuri and Gfroerer, 2009). ...
... Alcohol consumption has been reported to impair fertility, although the level of consumption associated with the risk is unclear. A high level of alcohol consumption is known to affect the fetus (Goransson et al., 2003;Krulewitch, 2005), but the effect on fertility at lower levels is still unknown. The mechanisms by which alcohol could impair conception are unclear but may include an alcohol-induced rise in oestrogen, which reduces FSH secretion, suppressing folliculogenesis (Homan et al., 2007). ...
Article
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The aim of this study was to evaluate the influence of patients' lifestyle factors and eating habits on embryo development. A total of 2659 embryos recovered from 269 patients undergoing intracytoplasmic sperm injection cycles were included. The frequency of intake of food items and social habits were registered and its influences on embryo development evaluated. The consumption of cereals, vegetables and fruits positively influenced the embryo quality at the cleavage stage. The quality of the embryo at the cleavage stage was also negatively correlated with the consumption of alcoholic drinks and smoking habits. The consumption of fruits influenced the likelihood of blastocyst formation, which was also positively affected by the consumption of fish. Being on a weight-loss diet and consumption of red meat had a negative influence on the likelihood of blastocyst formation. The likelihood of blastocyst formation was also negatively influenced by the consumption of alcoholic drinks and by smoking habits. The consumption of red meat and body mass index had a negative effect on the implantation rate and the likelihood of pregnancy. In addition, being on a weight-loss diet had a negative influence on implantation rate. Our evidence suggests a possible relationship between environmental factors and ovary biology. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
... Recently attention has turned to paternal age as a possible predictor of congenital malformations (9, 10, 11) even though previous reports did not regard paternal age as a significant contributor in the overall prevalence of CMs (1) . Maternal smoking (12,13) and alcohol use (14,15,16,17) during pregnancy has been associated with certain CMs as well. Furthermore, ethnic differences in the prevalence of CMs have also been reported (18). ...
Article
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Aim: Congenital Malformations (CMs) represent a challenge especially for developing countries. Data about CMs in Albania are rather scarce. In this context, our aim was to assess the prevalence and factors associated with CMs in Tirana, the capital of Albania. Methods: Information on all CMs at birth during 2011-2013 was retrieved from the National CM Surveillance System. For each CM case, three controls (babies born without CM) were retrieved as well. Overall, 831 cases and 2522 controls were included in this study. The prevalence was calculated using the total number of live births in Tirana during the same period. Binary logistic regression was used to determine the factors associated with CMs adjusting for a number of covariates. Results: The three-year prevalence of CMs was 23.41 per 1,000 live births. The most affected body systems were the musculoskeletal, cardiovascular and genital systems. CMs were more prevalent among male babies. Advanced mothers’ age, lower education, unemployment status and lower gestational age were all positively associated with increased likelihood of CMs. Conclusions: Socio-demographic factors of mothers are linked to CMs in Albania. Future surveys are needed in Albania in order to establish determinants of CMs at a national level.
... Sie kann ausreichend sein, um im Rahmen von Abstinenzkontroll-programmen für den aktuell verwendeten Alkoholkonsummarker Äthylglukuronid (EtG) im Urin positive Ergebnisse zu generieren [1,2,8,9,10]. Der Konsum von alkoholfreiem Bier in der Schwangerschaft und in der Stillzeit wird kontrovers diskutiert [4,5,6]. Eine weitere Personengruppe, der aus dem Konsum "alkoholfreier" Getränke Probleme erwachsen könnten, sind Fahranfänger, für die seit 2007 in Deutschland die "0,0-Promil- ...
Article
In den letzten Jahren stieg der Absatz von alkoholfreiem Bier stetig an. Dieses „alkoholfreie“ Getränk darf nach deutschem Lebensmittelrecht einen maximalen Alkoholgehalt von < 0,5 Vol.-% enthalten. Für manche Personengruppen könnte bereits diese geringe Äthanolmenge zu Problemen führen. So sind z. B. Fahranfänger nach § 24c des Straßenverkehrsgesetzes (StVG) mit einem strikten Alkoholverbot belegt. Da bislang noch keine verlässlichen Daten zur Blutalkoholkonzentration (BAK) nach dem Konsum von „alkoholfreiem Bier“ zur Verfügung stehen, wurde ein entsprechender Trinkversuch durchgeführt: Nach 5-tägiger Alkoholabstinenz wurden insgesamt 78 Probanden aufgefordert, innerhalb von 1 h 1,5 l alkoholfreies Bier mit einem Alkoholgehalt in Höhe von 0,41–0,42 Vol.-% zu trinken. In viertel- bzw. halbstündlichen Intervallen erfolgten Blutentnahmen. Die Blutproben wurden mithilfe der Headspace-Gaschromatographie-Flammenionisationsdetektion (HS-GC-FID) auf Äthanol untersucht. Bei 20 von 67 in die Auswertung aufgenommenen Testpersonen war eine BAK bestimmbar [“limit of detection“ (LOD) 0,0005 g/l]. Die maximal festgestellte Konzentration betrug 0,0056‰. Selbst bei forciertem Konsum von alkoholfreiem Bier sind demnach für Fahranfänger keine negativen rechtlichen Konsequenzen zu erwarten. Auch im Zusammenhang mit anderen forensischen Fragestellungen geben die ermittelten Alkoholkonzentrationen keinen Anlass, eine psychophysische Alkoholwirkung in Erwägung zu ziehen.
... Our summary here largely draws from studies utilizing acute developmental ethanol exposure. By comparison, chronic exposure models are indeed more commonly utilized, and are more reality-based in that they more accurately simulate habitual drinking patterns known to occur in affected human populations [55,56]. We however, highlight specific purposes for which acute exposure possesses key advantages, particularly for examining long-lasting effects of exposure on neural circuit function from specific developmental time points of insult. ...
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Fetal Alcohol Spectrum Disorder (FASD) is a general diagnosis for those exhibiting long-lasting neurobehavioral and cognitive deficiencies as a result of fetal alcohol exposure. It is among the most common causes of mental deficits today. Those impacted are left to rely on advances in our understanding of the nature of early alcohol-induced disorders toward human therapies. Research findings over the last decade have developed a model where ethanol-induced neurodegeneration impacts early neural circuit development, thereby perpetuating subsequent integration and plasticity in vulnerable brain regions. Here we review our current knowledge of FASD neuropathology based on discoveries of long-lasting neurophysiological effects of acute developmental ethanol exposure in animal models. We discuss the important balance between synaptic excitation and inhibition in normal neural network function, and relate the significance of that balance to human FASD as well as related disease states. Finally, we postulate that excitation/inhibition imbalance caused by early ethanol-induced neurodegeneration results in perturbed local and regional network signaling and therefore neurobehavioral pathology.
... Sie kann ausreichend sein, um im Rahmen von Abstinenzkontrollprogrammen für den aktuell verwendeten Alkoholkonsummarker Äthylglukuronid (EtG) im Urin positive Ergebnisse zu generieren [1, 2, 8, 9, 10]. Der Konsum von alkoholfreiem Bier in der Schwangerschaft und in der Stillzeit wird kontrovers diskutiert [4, 5, 6] . Eine weitere Personengruppe , der aus dem Konsum " alkoholfreier " Getränke Probleme erwachsen könnten, sind Fahranfänger, für die seit 2007 in Deutschland die " le-Grenze " ( § 24c des Straßenverkehrsgesetzes , StVG) gilt. ...
Article
In recent years sales of non-alcoholic beer have constantly increased. In Germany, so-called non-alcoholic beer may still have an ethanol content of up to 0.5% (by volume). This marginal amount of ethanol might have negative implications for certain groups of persons such as novice drivers. So far no reliable data regarding the blood ethanol concentration after consumption of non-alcoholic beer have been published. Therefore, a drinking experiment was performed as follows: after 5 days of abstinence from ethanol 78 test persons were asked to drink 1.5 l of non-alcoholic beer (ethanol content 0.41-0.42%) within 1 h. Blood samples were taken on a regular basis and analyzed for ethanol by headspace gas chromatography-flame ionization detection (HS-GC-FID). A total of 67 data sets could be interpreted and in 20 test persons ethanol was detected in blood with a limit of detection (LOD) of 0.0005 g/l. The maximum blood ethanol concentration was 0.0056aEuro degrees. The results of the study suggest that even after consumption of unrealistically high amounts of non-alcoholic beer negative forensic implications are not to be expected.
... These behaviors have been repeatedly identified as dangerous during pregnancy to the unborn child. [33][34][35] Therefore, it is less likely that pregnant women would engage in such behaviors. Given the high risk of DM2 in women who have had GDM, it is important that health professionals support ongoing management of negative health habits related to nutrition and physical activity post-partum in women with GDM. ...
Article
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Lifestyle related diseases associated with physical inactivity and poor diet quality, represent a major health burden. This study assessed negative and positive health habits and health care utilization in healthy women (n = 50) and women with lifestyle related diseases such as polycystic ovary syndrome (PCOS) (n = 50), gestational diabetes mellitus (GDM) (n = 44) and type 2 diabetes (DM2) (n = 43). A significant difference existed across groups for negative health habits (P = .012) with a trend for positive health habits (P = .06) elevated in women with PCOS. Women with DM2 had the highest amount of health care utilization including doctors office visits (P < .001), overnight hospital treatments (P < .001) and emergency room treatments (P = .01). Health practitioners would benefit from both encouraging positive health habits and addressing negative health habits. Furthermore, self-management and emphasizing the pivotal role patients' have in managing their illness is important for optimizing health outcomes. Elevated health care utilization rates were observed in women with DM2 but there were no differences in positive health habits across sub-groups. Encouraging lifestyle modification in women with precursor diseases such as GDM and PCOS is vital in order to prevent progression to DM2.
... Alcohol has been excluded from this review because it is not recommended during pregnancy and, on that basis, many studies do not report its consumption, although it has also been reviewed elsewhere. 27 Nutrient values, including supplements, were excluded. Supplement intake was treated as not included if no details about it were provided. ...
Article
Research reporting diet during pregnancy in nationally representative samples is limited. This review summarizes the dietary intakes of pregnant women in developed countries and compares them with national recommendations. A systematic search without date limits was conducted. All studies reporting the macronutrient intakes of pregnant women were considered, irrespective of design. Two authors independently identified the studies to be included and assessed the methodological quality. Nutritional adequacy was summarized, with confounding factors considered. Meta-analysis data are reported for developed countries collectively, by geographical region, and by dietary methodology. Energy and macronutrient intakes of pregnant women do not match national recommendations. Energy and fiber intakes were consistently below recommendations, while total fat and saturated fat intakes were generally above recommendations and carbohydrate and polyunsaturated fat intakes were below to borderline low compared with recommendations. A mismatch between dietary practices and macronutrient recommendations in pregnant women is widespread and not well quantified. The implications of these practices are unknown until further research compares maternal diet with short-term and long-term maternal and offspring health outcomes.
... It is important to note that all these drugs were tested in concentration ranges comprising their known recreational blood levels [63,64]. Alcohol abuse during pregnancy is known to produce severe brain damage and behavioral dysfunction to the fetus and is also known to be associated with the fetal alcohol syndrome (FAS)6566676869. The results obtained in the present work suggest that impairment of FA placental uptake may be one of the mechanisms involved in ethanol placento-and fetotoxicity. ...
Article
Folic acid (FA) is crucial for fetal development. We aimed to study the modulation of FA placental uptake by: hyperserotoninemia and hyperglycaemia, anti-hypertensives, insulin and drugs of abuse. For this, we characterized 3H-FA uptake by primary cultures of human cytotrophoblasts (TB cells) and tested the effects of these compounds upon 3H-FA uptake, TB cell viability and gene expression. Our results show that: (a) acutely, 3H-FA uptake was decreased by labetalol (0.1–1000 μM), ecstasy and amphetamine (0.025–25 μM); and (b) chronically, 3H-FA uptake was decreased by high glucose (30 mM), atenolol, nicotine (0.1 and 10 μM), ethanol (0.01 and 10 mM), ecstasy, amphetamine (0.25 and 1 μM) and tetrahydrocannabinol (1 and 100 nM). Moreover, many of these drugs were cytotoxic and they differentially modulated the mRNA expression of FA placental transport systems. Our results suggest that inhibition of FA placental uptake may constitute one of the mechanisms involved in the fetotoxicity of many of the compounds tested.
... Exposure to ethanol (EtOH) during development is the leading preventable cause of mental retardation in the United States (Krulewitch, 2005). Studies report the prevalence of individuals meeting the full criteria for fetal alcohol syndrome (FAS) at 0.2-1.5 per 1000 births (Astley et al., 2002;Bertrand et al., 2004). ...
Article
Current therapies for attention deficit hyperactivity disorder (ADHD) have varying efficacy in individuals with fetal alcohol spectrum disorders (FASD), suggesting that alternative therapeutics are needed. Developmental exposure to ethanol produces changes in dopamine (DA) systems, and DA has also been implicated in ADHD pathology. In the current study, lobeline, which interacts with proteins in dopaminergic presynaptic terminals, was evaluated for its ability to attenuate neonatal ethanol-induced locomotor hyperactivity and alterations in dopamine transporter (DAT) function in striatum and prefrontal cortex (PFC). From postnatal days (PND) 1-7, male and female rat pups were intubated twice daily with either 3 g/kg ethanol or milk, or were not intubated (non-intubated control) as a model for "third trimester" ethanol exposure. On PND 21 and 22, pups received acute lobeline (0, 0.3, 1, or 3 mg/kg), and locomotor activity was assessed. On PND 23-25, pups again received an acute injection of lobeline (1 or 3 mg/kg), and DAT kinetic parameters (Km and V(max)) were determined. Results demonstrated that neonatal ethanol produced locomotor hyperactivity on PND 21 that was reversed by lobeline (1 and 3 mg/kg). Although striatal DAT function was not altered by neonatal ethanol or acute lobeline, neonatal ethanol exposure increased the V(max) for DAT in the PFC, suggesting an increase in DAT function in PFC. Lobeline ameliorated this effect on PFC V(max) at the same doses that decreased hyperactivity. Methylphenidate, the gold standard therapeutic for ADHD, was also evaluated for comparison with lobeline. Methylphenidate decreased DAT V(max) and Km in PFC from ethanol-treated pups. Thus, lobeline and methylphenidate differentially altered DAT function following neonatal ethanol exposure. Collectively, these findings provide support that lobeline may be a useful pharmacotherapy for some of the deficits associated with neonatal ethanol exposure.
... In utero and early life environmental exposure programming may be critical to the onset of many diseases and dysfunctions in adulthood (Barker, 2007;Heindel, 2006), such as an increased risk of hypertension, cardiovascular disease (Palinski et al. 2007), diabetes (Armitage et al. 2008), and breast cancer (Xue and Michels, 2007). Some in utero and early life environmental exposures have demonstrated unequivocal harmful effects to children, such as thalidomide (Speirs, 1962), ionizing radiation (Doll and Wakeford, 1997), methylmercury (Watanabe and Satoh, 1996), lead (Gardella, 2001), environmental tobacco smoke (Herrmann et al. 2008), cigarette smoking and high alcohol consumption during pregnancy (Krulewitch, 2005;Shea and Steiner, 2008). Whereas other in utero and early life environmental exposures have come under scrutiny without consensus as to the degree of infl uence on child or adult health, such as exposure to pesticides (Eskenazi et al. 1999), polybrominated biphenyls (PCBs) (Guo et al. 1995), nitrates (Mueller et al. 2004), bisphenol A (vom Saal andHughes, 2005), and phytoestrogens (Damgaard et al. 2002). ...
... Over the past century, many case reports and hospital-based studies have been Because of its rare occurrence, little is known about the role of maternal health behaviors during pregnancy in the etiology of choanal atresia. For example, women may engage in high risk behaviors, such as cigarette smoking or alcohol use, during the initial months of their pregnancies [11][12][13] . Both animal and human studies have shown that such exposures during reproductive years can trigger potential teratogenic effects in the fetus [14][15][16][17][18] . ...
Article
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Choanal atresia is a well-defined congenital malformation; however, little is known about its prevalence and risk factors. Data from the Iowa Registry for Congenital and Inherited Disorders were used to examine prevalence, infant, and maternal characteristics of choanal artesia. Data from the National Birth Defects Prevention Study (NBDPS) were used to examine selected risk factors for choanal atresia. Overall prevalence was estimated as number of choanal atresia cases per 10,000 live births with 95% confidence intervals (CI)s. Crude and adjusted odds ratios (OR)s and 95% CIs were estimated to investigate selected risk factors. The overall prevalence of choanal atresia among live born deliveries in Iowa from January, 1998 through December, 2005 was 0.46 (95% CI=0.27, 0.78) per 10,000 live births. Using data from the NBDPS, choanal atresia cases were compared to unaffected control infants for births from October 1997 through December 2005. Overall, case infants compared to control infants were more likely to be female, preterm, and a multiple birth. For all choanal atresia cases combined, odds of high maternal zinc (OR=2.1; 95% CI=1.2, 3.9) and vitamin B-12 (OR=2.4; 95% CI=1.4, 4.3) intake in the year prior to pregnancy, and maternal periconceptional (one month before through three months after conception) exposure to anti-infective urinary tract medications (OR=3.3; 95% CI=1.3, 8.4) were significantly elevated among case compared to control mothers. For isolated choanal atresia cases (those with no additional major malformations), odds of maternal periconceptional exposure to passive cigarette smoke (OR=2.3; 95% CI=1.0, 5.3) as well as maternal intake of 3 or more cups of coffee per day one-year prior to pregnancy were increased (OR=2.9; 95% CI=1.3, 6.4) for case compared to control mothers. The reverse was found for low maternal intake of pantothenic acid (OR=0.4; 95% CI=0.2,0.9) and vitamin A (OR=0.3; 95% CI=0.1, 0.8) one-year prior to pregnancy. The current study provided support for potential associations between maternal health behaviors before and during pregnancy and choanal atresia; however, the findings were based on a modest number of cases. The study needs to be replicated in a larger case sample, also examining the role of genetics in choanal atresia.
... Alcohol is a known teratogen (Randall, 1987; Chaudhuri, 2000) and its consumption has been reported to decrease fertility, although the level of consumption associated with risk is unclear. Alcohol consumption at the extreme level is known to be dangerous to the unborn child (Astley et al., 2000; Goransson et al., 2003; Krulewitch, 2005) but the effect at lower levels is less certain. The mechanisms by which alcohol could impair conception are unclear but may include an alcohol-induced rise in estrogen, which reduces FSH secretion suppressing folliculogenisis and ovulation. ...
Article
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This evidence-based review focuses on the impact of potentially modifiable, non-communicable lifestyle factors on reproductive performance in the general population and the infertile population undergoing assisted reproductive technology (ART) treatment. The impact of several lifestyle factors including; age, weight, smoking, diet, exercise, psychological stress, caffeine consumption, alcohol consumption and exposure to environmental pollutants are included in the review. The databases of Medline, PubMed and Cinahl were searched to identify relevant publications. There is strong evidence that age, weight and smoking impact on general health and adversely on reproductive performance. However there is a need for further research focusing specifically on the relationship between diet and various levels of exercise on reproductive performance. There are several other factors such as psychological stress, caffeine consumption, alcohol consumption and exposure to environmental pollutants that have been implicated but the evidence is equivocal. It is concluded that lifestyle modification can assist couples to conceive spontaneously or optimize their chances of conception with ART treatment.
... Chronic alcohol (ethanol) consumed during pregnancy causes a wide spectrum of physical and mental alterations in the offspring, which can lead to the appearance of the fetal alcohol syndrome. Fetal alcohol syndrome is characterized by pre-and/or post-natal growth deficiencies, microcencephaly, characteristic facial anomalies and mental retardation in neonates (Floyd et al. 2005;Krulewitch 2005;Martínez and Egea 2007 for recent reviews). The alteration of essential cellular processes has been proposed to explain the teratogenicity of ethanol (Martínez and Egea 2007). ...
Article
Long-term ethanol treatment substantially impairs glycosylation and membrane trafficking in primary cultures of rat astrocytes. Our previous studies indicated that these effects were attributable to a primary alteration in the dynamics and organization of the actin cytoskeleton, although the molecular mechanism(s) remains to be elucidated. As small Rho GTPases and phosphoinositides are involved in the actin cytoskeleton organization, we now explore the effects of chronic ethanol treatment on these pathways. We show that chronic ethanol treatment of rat astrocytes specifically reduced endogenous levels of active RhoA as a result of the increase of in the RhoGAP activity. Furthermore, ethanol-treated astrocytes showed reduced phosphoinositides levels. When lysophosphatidic acid was added to ethanol-treated astrocytes, it rapidly reverted actin cytoskeleton reorganization and raised active RhoA levels and phosphoinositides content to those observed in untreated astrocytes. Overall, our results indicate that the harmful effects of chronic exposure to ethanol on a variety of actin dynamics-associated cellular events are primarily because of alterations of activated RhoA and phosphoinositides pools.
... Interestingly, several metabolic and growth effects of elevated IGFBP-1 levels such as fetal growth deficiency and erosion of lean body mass are reminiscent of the toxic consequences observed during chronic alcohol abuse [17,18]. This led to the hypothesis that IGFBP-1 induction during alcohol intoxication could mediate some of the effects of alcohol. ...
Article
Insulin-like growth factor-binding protein-1 (IGFBP-1) modulates cell growth and metabolism in a variety of physiopathological conditions. The aim of this study was to determine the molecular mechanisms involved in IGFBP-1 upregulation by ethanol. We studied IGFBP-1 regulation by ethanol at the protein, mRNA and gene promoter levels in the human hepatocarcinoma cell line, HepG2, which does not express significantly ethanol-metabolizing enzymes. Ethanol (35-150mM) induced the IGFBP-1 mRNA and protein up to 5-fold in a dose-dependent manner. A similar effect was observed using primary cultures of human hepatocytes. Various inhibitors of ethanol metabolism and the antioxidant N-acetylcysteine did not prevent ethanol effects. While ethanol did not modify the IGFBP-1 gene promoter activity, it elicited a 2- to 3-fold increase in IGFBP-1 mRNA half-life and this stabilization required the 5' and the 3' untranslated mRNA region. Ethanol triggered a rapid activation of c-Jun N-terminal Kinase (JNK) in HepG2 cells and IGFBP-1 induction was significantly decreased by a specific inhibitor of JNK. This study reveals a novel pathway of gene regulation by alcohol which involves the activation of JNK and the consequent mRNA stabilization.
... No gender differences in the identification of hazardous or harmful drinking were reported, but female dependent drinkers were more likely to be identified than their male counterparts. The higher identification in females is relevant, as women who drink heavily or are alcoholdependent suffer more physical health-related consequences than men [28], including higher mortality rates293031, an accelerated rate of progression to severe liver injury [32] and a range of negative reproductive health consequences333435, including the risk of fetal alcohol syndrome [36]. However, as general population studies find higher prevalence rates of alcohol dependence in males, our findings suggest under-identification of AUDs in the male general practice population, although they may be more likely to present with alcohol-related problems to other primary care services such as accident and emergency (A&E). ...
Article
The prevalence of alcohol use disorders (AUDs) in the United Kingdom is estimated at 25%, and primary care has been identified as the first line of treatment for this population. However, there is a paucity of evidence regarding the current rates of identification of AUDs in primary care. The aim of the present study was to compare the observed rates of AUDs in general practice with expected rates, which are based on general population prevalence rates of AUDs. DESIGN, PARTICIPANTS AND MEASUREMENTS: Epidemiological data on individuals aged 16-64 years with an AUD was obtained from the General Practice Research Database. General population prevalence rates of AUDs were obtained from the Psychiatric Morbidity Survey. Chi(2) tests and identification ratios were used to analyse the data. There was a significant relationship between type of AUD and identification (chi(2)=1466.89, P<0.001), and general practitioners were poorer at identifying harmful/hazardous drinkers when compared with dependent drinkers. No gender differences in the identification of hazardous/harmful drinking were found, but female dependent drinkers were significantly more likely to be identified than males (identification ratio 0.07; 95% confidence interval 0.06-0.07). The identification of AUDs was significantly lower for the 16-24-year age group compared with all other age groups. Despite attempts at targeting hazardous/harmful drinkers for brief interventions in primary care, the present findings suggest that this group are still under-identified. Furthermore, this under-identification is even more apparent in men and in young people who have high general population prevalence rates for AUDs. In conclusion, increasing identification rates could be incorporated into brief intervention strategies in primary care.
... This agent is recognized as a potent teratogen in humans (41), and alcohol abuse during pregnancy can give rise to alcohol-related birth defects such as spontaneous abortion, decreased immune function, attention problems, hearing impairment (42), permanent fetal brain damage and a wide variety of manifestations, known as fetal alcohol spectrum disorder (FASD) (43). Among children with FASD, a small population present a specific set of anomalies [specific facial abnormalities, intrauterine growth retardation and significant impairments in neurodevelopment (41,(44)(45)(46)]. One of the factors involved in the toxic effect of ethanol is the formation of its metabolite acetaldehyde at the maternal, placental and fetal level (47,48). ...
Article
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The aim of this work was to investigate the putative modulation of glucose uptake in trophoblast cells by several dietary compounds and by drugs of abuse. For this, the acute (26 min) and chronic (48 h) effect of these substances on the apical uptake of 3H-2-deoxy-d-glucose (3H-DG) by a human choriocarcinoma cell line (BeWo) was determined. 3H-DG apical uptake by BeWo cells was time dependent, displayed saturable kinetics (Vmax = 1210 ± 29 nmol mg protein−1 6 min−1 and Km = 13.4 ± 0.5 mM) and was insulin-insensitive and cytochalasin B-sensitive (by up to 60%). Acutely, acetaldehyde (30–100 mM), resveratrol, xanthohumol, epigallocatechin-3-gallate (100 μM), chrysin and quercetin (10–100 μM) decreased 3H-DG apical uptake, whereas rutin, catechin (10–100 μM), epicatechin (100 μM) and ethanol (10 mM) increased it. Quercetin and xanthohumol seem to be non-competitive inhibitors of 3H-DG apical uptake, whereas both epigallocatechin-3-gallate and acetaldehyde decreased both the Km and Vmax values. Chronically, rutin and myricetin increased the apical uptake of 3H-DG both isolated (0.1–1 μM) and in combination (both at 1 μM), whereas theophylline (0.1–1 μM) and amphetamine, 3,4-methylenedioxymethamphetamine (0.25–1 μM) and Δ9-tetrahydrocannabinol (1 nM) decreased it. In conclusion, 3H-DG apical uptake by BeWo cells is differentially modulated by different compounds present in drinks and by drugs of abuse.
Chapter
Human behavior is an indefeasible part of economic and industrial systems. Mathematical modelling of human’s behavior and evaluation of its characteristics is a part of the system’s risk assessment. There are situations when one can only ask a person about his behavior. The most reliable data on behavior that can be obtained through an interview is the data on last episodes of this behavior. In this paper we propose a non-parametric Bayesian Belief network to estimate the intensity of episode-like behavior when only limited interview data is available — the data on times of the three last episodes of the behavior. The NPBN (non-parametric Bayesian Belief Network) model takes into account all peculiarities of the problem: it uses continuous variables directly and may incorporate expert knowledge. The proposed model is illustrated with UNINET software.
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With nearly 10% of women consuming alcohol during pregnancy, fetal alcohol spectrum disorders (FASDs) are becoming an increasing concern for clinicians and policymakers interested in the field of healthcare. Known as the range of mental and/or physical disabilities that occur among individuals with prenatal alcohol exposure, FASDs can result in dysmorphic features, problems with physical growth, neurobehavioral and cognitive problems that not only increase risk of various diseases, but also premature mortality. We investigated whether the diagnosis of FASDs result in increased risk of hospitalizations and mortality, with respect to FASD domains and relative diseases, when age effects are controlled for. The data for this study was taken from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) between 2003 and 2013. The population attributable risk (PAR) statistic was used to estimate the percentage of hospitalizations and mortality attributable to FASDs and other factors. A time-dependent Cox proportional hazards model with age of diagnosis as the timescale was employed to calculate adjusted hazard ratios and 95% CIs for hospitalizations and mortality among FASD populations compared to their general population peers. Among the 3,103 FASD cases, 27.5% experienced hospitalizations and 12.5% died. Overall, FASDs accounted for 853 FASD-attributable hospitalizations (51.0% of all hospitalizations in the study population) and 387 mortality events (34.5% of all deaths in the study population). 20.52% of hospitalizations and 21.35% of mortalities were attributable to FASDs in this population. Compared to the control group, FASD patients had a 1.25-fold (HR: 1.25, 95% CI: 1.05-1.49, p = 0.0114) increased risk of hospitalizations and a 1.33-fold (HR: 1.33, 95% CI: 1.07-1.67, p = 0.0118) increased risk of all-cause mortality. The most common cause for hospitalization was diseases of the nervous system, which accounted for 450 FASD-attributable hospitalizations (96.2% of all nervous system hospitalizations in the study population). In fact, FASD patients were 52 times more likely to be hospitalized for nervous system diseases than their peers (HR: 51.78, 95% CI: 29.09-92.17, p < .0001). The most common cause for mortality was neoplasms, which accounted for 94 FASD-attributable deaths (28.7% of all neoplasm deaths in the study population). However, FASD patients did not have increased risk of neoplasm mortality than the general population (HR: 0.88, 95% CI: 0.59-1.32, p < .0001). Overall, this study found that individuals diagnosed with FASDs have increased risk of both hospitalizations and mortality, compared to their general population peers. This is particularly so for diseases of the nervous system, which showed a 52-fold increase in hospitalizations and four-fold increase in mortality for FASD patients in our study. Likewise, while the association between FASDs and neoplasm mortality was not significant in our investigation, more attention by neurologists and related healthcare providers regarding the link between these two factors is necessary.
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A convenient sampling technique was used to draw a sample of 110 pregnant women reporting for antenatal clinical checks in both private and public medical facilities in Uyo, Nigeria to investigate marital satisfaction and age as predictors of alcohol use during pregnancy. Kansas Marital Satisfaction Scale was used in dichotomizing respondents into satisfied and dissatisfied pregnant women in marriage, while an item in Alcohol Use Disorder Identification Test (AUDIT) delineated our cohorts into users and non-users of alcohol. A 2x2 factorial design was adopted as regards the plan of the study while a 2-way analysis of variance was used for the analysis of data collected. Results confirmed the first hypothesis which predicted that pregnant women who are satisfied in their marriages would report less alcohol use than their dissatisfied counterparts {F (1, 104) = 4.70; p < .05}. Findings also confirmed our second hypothesis which stated that pregnant women who are younger would report more alcohol use than their elderly counterparts {F (5, 104) = 11.833; p, <.05}. Discussion of findings centered on the theories of learning which formed the nucleus of this paper and it was recommended that intervention would benefit from effective and affordable psychological counseling and treatment services for women exposed to harmful and/or hazardous alcohol use predicated by marital distress, violence, depression as well as those with limited coping skills.
Chapter
Use of substances including alcohol, tobacco and drugs is common in people of reproductive age, can lead to dependence and is a major global health concern. Despite targeted public health policies and campaigns, population surveys (National Institute on Drug Abuse (NIH) 2020; European Drug Report 2019) continue to highlight widespread use of substances, often in combination, which have substantial negative implications for health in general and the potential to harm future generations (Stephenson et al. 2018). Healthcare professionals need to be aware of the complex psychological, physiological and social factors that may be linked to substance use and be prepared to offer counselling and referral for specialist services. Pregnancy, however, can be a ‘window of opportunity’ and a motivating factor for women and their partners to change their behaviour and minimise risk with help to quit or cut down on substance use (Solomon and Quinn 2004). Preconception care offers the opportunity to further reduce risk by helping to modify consumption prior to pregnancy.
Article
Prenatal ethanol exposure induces developmental toxicities of multiple organs in offspring. Here, we investigate the effects of prenatal ethanol exposure on bone mass in postnatal offspring and explore its intrauterine programming mechanism. We found that prenatal ethanol exposure could induce bone dysplasia in fetuses and postnatal osteopenia in female offspring, accompanied by the sustained activation of the local renin-angiotensin systems (RAS) and inhibition of bone formation. Additionally, we also found that histone 3 lysine 9 acetylation (H3K9ac) and H3K27ac levels in the promoter region of angiotensin-converting enzyme (ACE) were increased in female offspring exposed to ethanol during pregnancy. In vitro, ethanol suppressed the formation of mineralized nodules and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs), which was blocked by enalapril. Furthermore, ethanol promoted the expression and nuclear translocation of early growth response factor 1 (Egr1), which participated in the promotion of histone acetylation of ACE and subsequent RAS activation, by recruiting p300 and binding to the ACE promoter region directly. These findings indicate that the sustained activation of the local RAS might participate in bone dysplasia in fetus and postnatal osteopenia in the female offspring, while the Egr1/p300/ACE signal might be a key promoter of the sustained activation of the local RAS of the long bone.
Article
Background: The evidence of important problems related to prenatal alcohol exposure has faced researchers with the problem of understanding and screening alcohol use in this population. Although any alcohol use should be considered risky during pregnancy, identifying alcohol-drinking problems (ADPs) could be especially important because women with ADPs could not benefit from a simple advice of abstinence and because their offsprings are subjected to a higher risk of problems related with prenatal alcohol exposure. In this context, we aim to study the prevalence and characteristics of ADPs in pregnant women, evaluating the performance of different diagnostic systems in this population. Objectives: The aims of the study were to describe the prevalence of ADPs obtained with the criteria of the Diagnostic and Statistical Manual of Mental Disorders in its fourth (DSM-IV) and fifth edition (DSM-5), and the International Classification of Diseases (ICD)-10, in Argentinean females aged 13 to 44 years, 12 months before delivery; to evaluate the level of agreement between these classification systems; and to analyze the performance of each diagnosis criterion in this population. Methods: Data were collected through personal interviews of a probability sample of puerperal women (N = 641) in the city of Santa Fe (Argentina), between October 2010 and February 2011. Diagnoses compatible with DSM-IV, DSM-5, and ICD-10 were obtained through the Composite International Diagnostic Interview. Agreement among diagnostic systems was measured through Cohen kappa. Diagnosis criteria performance were analyzed considering their prevalence and discriminating ability (D value). Results: Total ADP prevalence was 6.4% for DSM-IV (4.2% abuse and 2.2% dependence), 8.1% for DSM-5 (6.4% mild, 0.8% moderate, and 0.9% severe alcohol use disorder), and 14.1% for the ICD-10 (11.9% harmful use and 2.2% dependence). DSM-5 modifications improved agreement between DSM and ICD. The least prevalent and worst discriminating ability diagnostic criterion was "legal problems." The most prevalent and 1 of the best discriminating ability diagnostic criterion was '"health issues." Conclusions: DSM-IV and ICD-10 dependence prevalence was similar to that of previous studies in pregnant women, whereas abuse prevalence was surprisingly higher. Our results indicate a better performance of the DSM-5 alcohol use disorder category relative to the DSM-IV dual categorization. Nevertheless, the poor diagnostic performance of some DSM-5 criteria in this population could evidence their intercultural variability.
Article
Policymakers are political system elites that may respond to, or even help lead, community sentiment. For any specific policy question, community sentiment may include preferences expressed by the mass public or may be limited to the relevant community of experts and insiders. In 2003, the North Dakota state legislature unanimously added alcohol abuse during pregnancy to the existing laws against child abuse and neglect and allowed for involuntary civil commitment to treat women who violate the law. Alcohol use by pregnant women can be very costly to a state because of the risk of fetal alcohol spectrum disorders (FASD), and one strategy for alcohol control is to punish expectant mothers as criminals. This chapter presents a policy analysis of North Dakota’s approach to reducing prenatal alcohol use. Searches for community sentiment in media reports and in legislative history suggested that the policy subsystem of insider stakeholders was the impetus for this policy change. Stunted public discourse driven by unanimously positive, neutral, or uninformed sentiment leads to a variety of negative outcomes for mothers and society. The policy analysis highlights the negative effects of this law and suggests better alternatives.
Article
Our previous study demonstrated prenatal ethanol exposure (PEE) enhances the sensitivity of the hypothalamic-pituitary-adrenal (HPA) axis in adult offspring rats. This study was aimed to investigate the underlying mechanisms. Intrauterine growth retardation (IUGR) rat model was established by PEE. The female offspring were fed with high-fat diet (HFD) after weaning and subjected to the unpredictable chronic stresses (UCS) in adulthood. For adult offspring, PEE group exhibited increased expression levels of both hypothalamic corticotrophin-releasing hormone (CRH) and arginine vasopressin (AVP) as well as elevated gain rates of serum adrenocorticotropic hormone (ACTH) and corticosterone after UCS. Meanwhile, the expression ratios of hypothalamic vesicular glutamate transporter 2/glutamic acid decarboxylase 65 (VGluT2/GAD65) were also enhanced in the PEE females. Furthermore, these changes were also accompanied by the enhanced expression levels of glucocorticoid receptor (GR), N-methyl-D-aspartate-subtype glutamate receptor 2B (NR2B) and the decreased expression ratio of mineralocorticoid receptor (MR)/GR in hippocampus of PEE offspring. The abnormal hippocampus neurons were observed especially in the cornu ammonis 3 (CA3) and dentate gyrus subfields. For PEE fetuses, both VGluT2/GAD65 expression ratios and GR expression were increased while the mineralocorticoid receptor (MR)/GR expression ratios were decreased. PEE also caused ultrastructural injury in CA3. Our findings suggest that PEE induced both functional and structural programming of fetal hippocampus, which not only results in attenuated feedback regulation on the HPA axis but also enhances the excitatory potential of fetal hypothalamus and consequently stimulates sensitivity of the HPA axis in PEE adult offspring.
Article
The goal of this study was to investigate low to moderate intrauterine exposure to alcohol and tobacco and possible behavioral consequences for children. A sample of ninety-eight young mothers were interviewed and their self-reports of substance use during pregnancy and perceived problem behaviors in their children (ages infancy to 12) were examined. Findings suggest significant differences between perceived problem behaviors by children of mothers who used low to moderate amounts of alcohol and tobacco while pregnant and children of mothers who had not used these substances. This offers important implications for prevention programs for young women.
Article
Background: During lactation, the consumption of ethanol is discussed controversially. After women drink alcoholic beverages, ethanol can be found in breastmilk with a time lag. To abstain from ethanol, but not from the taste of alcoholic beverages, in particular, non-alcoholic beer has become popular in recent years. According to regulations in the United States and most European countries, these "alcohol-free" beverages may still contain ethanol up to 1.2% by volume. To determine how much of this ethanol may reach the breastfed child, a drinking experiment with non-alcoholic beer was performed. Subjects and methods: Fifteen healthy breastfeeding women participated in the study. After at least 5 days of abstinence from ethanol and the donation of a void breastmilk sample, they were asked to drink 1.5 L of non-alcoholic beer within 1 hour. Breastmilk samples were collected using electronic breast pumps immediately after the end of drinking as well as 1 and 3 hours later. The milk was analyzed for ethanol by headspace-gas chromatography-flame ionization detection using a fully validated method. Results: In two women, trace amounts of ethanol (up to 0.0021 g/L) were found in the samples gained immediately after the drinking period. In the other samples ethanol could not be detected (limit of detection=0.0006 g/L). Conclusions: The mother's consumption of non-alcoholic beer is likely innocuous for the breastfed infant.
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Objective: In this study, the 4(th), 5(th), 6(th) and 7(th) babies born with different anomalies that had been described in the Sumerian myth of "Enki and Nimnah: Creation of Man", have been evaluated. Material and Methods: The myth was evaluated with the help of archeological sources, online museum catalogues, reviews written on this subject and getting opinions of various experts. Results: In the first part of the myth, a feast given by the gods to celebrate the creation of the perfect man had been described. In the second part, the Goddess Nimnah, had become jealous of Enki's success and created 6 defective, crippled babies out of mud. As Enki had got angry with Nimnah's act, he had created the 7(th) defective baby. Based on the descriptions of the babies in the myth, the 4(th) one had urinary continence, the 5(th) one was an infertile girl, the 6(th) one had ambigious genitalia, and the 7(th) one had probably Wolf-Hirschhorn syndrome. The creations of these seven babies were done during above-mentioned feast under the influence of alcohol. To the best of our knowledge, this myth presented on the Sumerian clay tablets has an importance as they are the first written documents describing urinary incontinence, infertility and ambigiuous genitalia. Conclusion: It can be speculated that, Sumerians, who had pioneered various fields of science and technology might have observed the teratogenic effects of parental use of alcohol and wanted to send a message to the following generations by this myth.
Article
Fetal alcohol syndrome is the leading cause of mental retardation worldwide and is also the foremost preventable cause of neurobehavioral and developmental abnormalities. In this paper, we discuss those aspects of fetal alcohol syndrome relevant to the clinician: its clinical characteristics, assessment, diagnosis, and prevention.
Article
This interpretive ethnographic study describes the experiences of northern British Columbian Aboriginal mothers raising adolescents with fetal alcohol spectrum disorder (FASD) and provides an understanding of how the mothers interpreted and responded to their adolescents' FASD. The all-encompassing theoretical perspectives of postcolonialism provided the conceptual guide for this study. This ontological stance facilitates discourse on the social and historical context of this research focused on northern British Columbian Aboriginal mothers. Using semistructured interviews and participant observation, eight participants were interviewed three times over a period of several months. Data were analyzed using an interpretive analysis to generate an overarching cultural theme, Mothering from the Margins. The theme conveyed how study participants understood FASD and how they were raising their adolescents within the social and historical context unique to postcolonial societies.
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