A Single Dose of Ethanol Suppresses Rat Embryo Development in Vivo

In humans and animal models, maternal ethanol consumption during pregnancy results in a variety of fetal defects collectively termed the fetal alcohol syndrome (FAS). Limited follow-up studies suggest that FAS children fail to achieve normal physical or mental development despite significant postnatal intervention. Although the complete FAS appears to result only when chronic, excessive alcohol consumption occurs throughout pregnancy, several investigators have suggested that ethanol consumption at intermediate levels may induce components of FAS. The defect most consistently observed in neonates exposed to ethanol is growth retardation. Even those children whose mothers consume limited amounts of ethanol during pregnancy have a significant incidence of fetal growth deficiency. We now report that a single dose of ethanol administered to female Holtzman rats within 8 hr after mating results in a dose-dependent retardation of cell division in the fertilized ova. The growth retardation is sustained up to 42 hr after the dose and the embryos of young mothers are especially sensitive to ethanol. Animals with high blood alcohol levels (<150 mg/100 ml) show a significant increase in abnormal embryo morphology. These data suggest that maternal consumption of a single dose of ethanol near the time of conception retards embryonic growth and may be detrimental to the developing organism. Further, young female rats receiving a high dose of ethanol had significantly lower uterine weights and a lower number of corpora lutea per ovary, suggesting that a single dose of ethanol has a detrimental effect on maternal reproductive ability.     

Folgen von Alkohol und Rauchen in der Schwangerschaft

Nicotine and alcohol are legal drugs, which damage not only the health of the consumer, but also the society due to health-economic costs. In pregnancy, the consequences of alcohol consumption and smoking for the unborn life in pregnancy are dramatic. The irreversibly damaging effect of alcohol is proven in each stage of the pregnancy, whereby the phase of the organogenesis is the most sensitive period. Beside a higher incidence for deformations of all organs, the damage of the central nervous system is leading, since mental-intellectual retardation of children after alcohol consumption in pregnancy is proven. Smoking in pregnancy leads likewise to harmful effects, with the intrauterine growth retardation of the fetus being the leading smoking-induced pathology. Smoking- and alcohol-induced damages for the unborn life are irreversible with no therapeutic options. The only therapy is prevention, which means complete cessation of alcohol and smoking in pregnancy.     

Prostaglandin Synthesis Inhibitors Block Alcohol-Induced Fetal Hypoplasia

Alcohol-induced growth retardation is a fetal effect consistently associated with maternal ethanol consumption. In humans, those infants whose mothers consume even a limited amount of ethanol during pregnancy have a significant incidence of growth inhibition. The molecular mechanism responsible for this growth deficiency is unknown, and prevention depends on maternal abstinence during pregnancy. The data reported here suggest that ethanol-mediated increases in tissue prostaglandin (PG) E levels (PGE1 plus PGE2) are correlated with the growth retardation. Further, simultaneous administration of PG synthesis inhibitors with the alcohol blocks the rise in tissue PG levels and protects against the alcohol-induced hypoplasia.     

Effects of Buthionine Sulfoximine on the Outcome of the In Utero Administration of Alcohol on Fetal Development

The adverse effects of the maternal consumption of alcohol on the fetus have been recognized for centuries. Fetal alcohol syndrome is characterized by pre- and postnatal growth retardation, mental retardation, behavioral deficits, and facial deformities. Despite numerous animal studies, the biochemical mechanism(s) by which alcohol produces teratogenic effects on the developing fetus are not well understood. Several studies have shown that administration of alcohol to adult rats produces a decrease in hepatic levels of glutathione (GSH). In utero administration of alcohol has also been shown to produce a decrease in GSH levels, as well as prenatal growth retardation and intrauterine death. In an effort to determine if GSH may have a vital role in protecting the fetus against the teratogenic effects of alcohol, buthionine (SR)-sulfoximine (BSO) was used to deplete GSH levels in the mother and fetus. Timed pregnant Sprague-Dawley rats were placed on a liquid BioServ diet containing either 0%, 11 YO, =YO, 29%, 31 Yo, 33%, or 35% ethanol-derived calories, with or without BSO (888 mglkgl24 hr), starting on day 1 of pregnancy. Another set of mothers were fed lab chow and water as a control group for the liquid diet. The mothers were maintained on the diet until gestation day 21 when they were anesthetized with sodium pentobarbital and the pups delivered by cesarean section. The offspring were counted, weighed, killed, and the brain and liver weighed. The effects of BSO on the alcohol dose-response curves (body weights, brain weights, and litter number) were then determined to ascertain if a depletion in GSH potentiated the effects of alcohol. In utero administration of BSO, aside from the depletion of GSH in the liver and brain in the developing fetus, produced a shift to the left in the alcohol dose-response curve.     

Is Pregnancy the Time to Change Alcohol Consumption Habits in France?

Background:  Although it is well known that France has a cultural history of alcohol use, no recent French data on alcohol consumption during pregnancy in a large sample are available.
Methods:  To determine the alcohol consumption patterns among pregnant women in France, we analyzed data from a 1-year multicenter self-survey. Sociodemographic profile, obstetrical history, neonatal data, and a self-report for assessing drinking patterns during pregnancy including AUDIT were recorded from women who delivered recently. Cases of fetal alcohol syndrome (FAS) were also reported.
Results:  A total of 837 pregnant women have described all parameters. The mean age at delivery of our sample was 29.7 years (SD = 4.8 years). A total of 52.2% of women indicated that they had consumed alcohol at least once during their pregnancy, and among abstainers 54.5% had a positive AUDIT score. Of the pregnant women who consumed alcohol, 13.7% reported at least one binge drinking episode (5 or more drinks on 1 occasion) during pregnancy. Binge drinking is significantly more frequent than regular alcohol consumption (at least 1 drink more than 1 time per week) during pregnancy. A prevalence rate of FAS of 1.8 per 1,000 live births was observed.
Conclusions:  There is a large population of women who still drink alcohol during pregnancy, particularly in binge drinking episodes. This underlines the need to clearly inform women of childbearing age about the dangers of alcohol during pregnancy as related to all types of consumption. Moreover, acting to prevent alcohol consumption prior to pregnancy may also greatly influence prenatal drinking.     

Alcohol and the Woman of Childbearing Age – A Public Health Problem

Recent work has established on a rational basis what has been understood instinctively throughout recorded history – that excessive maternal consumption of alcohol is harmful to the baby developing in utero. From conception onwards, the risk of anomalies of development (mostly minor) and retardation of intrauterine growth increases more or less in proportion to the level of alcohol consumption. Since much of the damage occurs early in pregnancy before most women realise that they are pregnant, the problem of prevention becomes one for the public health field. All professional workers concerned with women of child-bearing age should be aware, therefore, of what the facts are and how to help the woman who may become pregnant to reduce her alcohol intake. They have a dual role to play – detection of those at risk and effective counselling of the patients after their identification.     

The effects of social support on alcohol consumption during pregnancy: situational and ethnic/cultural considerations

While the effects of alcohol consumption during pregnancy have been well documented, variables associated with drinking during pregnancy have received little attention. This study sought to determine the importance of situational and ethnic/cultural-specific support on alcohol consumption during pregnancy among Black and White women in a U.S. southern urban prenatal population. A consecutive sample of 311 prenatal patients were interviewed during both the fourth month and the eighth month of pregnancy. Using standard regressions, the two components of expressive support--general support and pregnancy support--were found to be working in opposite directions, with pregnancy support showing a negative association with alcohol consumption during pregnancy. Pregnancy support was found to contribute significantly to the variance in alcohol consumption among Whites but was not found to be a significant contributor among Blacks. These findings suggest that social support, specifically pregnancy support, is a significant variable in accounting for alcohol consumption during pregnancy, but this association may not be consistent across ethnic groups.     

Alcohol consumption among low-income pregnant Latinas

BACKGROUND: Due to changing cultural norms, Latinas of childbearing age residing in the U.S. may be at increasing risk of drinking harmful levels of alcohol during pregnancy, and may also be unaware of the risks for Fetal Alcohol Spectrum Disorders associated with this behavior. We assessed the prevalence of alcohol consumption in a sample of low-income pregnant Latinas and examined risk factors for alcohol use in the periconceptional period. METHODS: As part of a larger intervention trial, a cross-sectional in-home interview study was conducted among a sample of 100 pregnant low-income Latinas receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in San Diego County, California. RESULTS: Fifty-seven percent of respondents indicated they were either life-time abstainers or had not consumed any alcohol in the periconceptional period. Forty-three percent reported some alcohol use in the three months prior to recognition of the current pregnancy, and 20% reported at least one binge episode of four or more standard drinks during that time frame. Five percent reported drinking seven or more drinks per week, and 8% continued drinking alcohol after recognition of pregnancy. Significant predictors of any alcohol use in the periconceptional period included English language/higher level of acculturation, younger maternal age, lower parity, higher level of education, younger age at first drink, and having ever smoked. Women who were aware of alcohol warning messages and /or had more knowledge of the Fetal Alcohol Syndrome (FAS) were significantly more likely to have consumed alcohol in the periconceptional period. Frequency of periconceptional use of alcohol did not differ between women who planned or did not plan the pregnancy. CONCLUSION: The prevalence and pattern of early pregnancy alcohol consumption in this sample of Latinas is similar to patterns noted in other race/ethnic groups in the U.S. Level of knowledge about FAS and awareness of warning messages was not protective for early pregnancy alcohol consumption, suggesting that specific knowledge was insufficient to prevent exposure or that other factors reinforce maintenance of alcohol consumption in early pregnancy. Selective interventions in low-income Latinas are warranted, and should be focused on women of reproductive age who are binge or frequent drinkers and who are at risk of becoming pregnant.     

Reduction of Alcohol Consumption During Pregnancy with Benefits to the Newborn

Among a group of 69 pregnant women who drank heavily, 25 reduced alcohol consumption before the third trimester. Infants born to these women showed less growth retardation than did infants born to 44 women who continued to drink heavily throughout the pregnancy. Analysis of other risk factors showed little effect on outcome when third trimester drinking patterns were held constant. Identification and counseling of heavy-drinking pregnant women should provide benefits for both the mother and her newborn.     

Prenatal Alcohol Exposure and Development at Preschool Age: Main Results of a French Study

Very high levels of alcohol consumption during pregnancy are harmful for the central nervous system of the child and affect morphogenesis and growth. The aim of this study was to investigate the effects of moderate prenatal alcohol exposure on development at preschool age in a longitudinal study. Pregnant women were interviewed on their alcohol consumption during pregnancy at their first visit to the maternity hospital of Roubaix, France. The development of their 160 children was assessed at the age of 4½. Multiple regression analyses indicated that consumption of 1.5 oz of absolute alcohol (approximately 3 drinks) or more during pregnancy was significantly related to a decrease of 7 points on the general cognitive index of the McCarthy scales, after controlling for confounders. This level of consumption was also related to a higher score on minor neurological anomalies, a lower height of the child, and a higher score on facial features. This level of 1.5 oz of absolute alcohol/day should not be interpreted as a biological threshold, because the study does not allow conclusions to be drawn regarding the effects of lower levels of alcohol consumption. Alcohol consumption during pregnancy can affect the development of the child, at levels well below those associated with fetal alcohol syndrome.     

Clinical practice characteristics and preconception counseling strategies of health care providers who recommend alcohol abstinence during pregnancy

OBJECTIVE: National initiatives on fetal alcohol syndrome in Canada and the United States aimed at prevention, identification, and treatment of individuals who are affected by alcohol exposure in utero recommend that women abstain from consuming alcohol during pregnancy. Health care providers are key educators regarding appropriate alcohol use. The objective of this study was to describe characteristics of physicians who recommend alcohol abstinence during pregnancy with regard to knowledge of fetal alcohol syndrome and preconception counseling strategies. METHODS: A survey was mailed to Canadian physicians and midwives between 2001 and 2002. Participants consisted of a national random sample of 1090 Canadian obstetricians and gynecologists, midwives, and family physicians who were current members of provincial and national professional organizations. The main outcome measure was questionnaire responses to knowledge, prevention, and diagnosis of issues related to alcohol use during pregnancy. RESULTS: Response rates ranged from 31.1% among family physicians to 63.5% among midwives. Overall, 91.2% of providers recommended abstinence from alcohol during pregnancy. These providers were significantly more likely to believe that there is sufficient information about alcohol use and that clients were interested in discussing alcohol (p < 0.05). They were also significantly more likely to discuss depression, personal alcohol use, partner's use of alcohol, and family history of alcohol misuse with women of childbearing age (p < 0.05). Once a patient became pregnant, fewer practice differences were noted, although those who recommended alcohol abstinence were significantly more likely to take clinical action when pregnant patients were consuming moderate amounts of alcohol (p < 0.05). CONCLUSIONS: It is encouraging that almost 90% of Canadian health care providers recommend abstinence from alcohol during pregnancy. However, differences in clinical practice exist between providers who recommend alcohol abstinence during pregnancy as compared with those who recommend a "glass in moderation."     

Alcohol consumption during pregnancy in nonindigenous west Australian women

BACKGROUND: High alcohol intake in pregnancy has been linked to abnormal fetal development. There are limited published data in Australia on standard drinks of alcohol consumed on a typical occasion during the periconceptional period or pregnancy. METHODS: During 1995 to 1997, a 10% random sample of all nonindigenous women giving birth in Western Australia was surveyed 12 weeks after delivery (N=4,839). Women were asked questions about alcohol consumption in each of the 4 time periods: the 3 months before pregnancy and each trimester of pregnancy. Questions were framed to measure volume, frequency, and type of alcoholic beverage. RESULTS: 46.7% of the women had not planned their pregnancy. Most women (79.8%) reported drinking alcohol in the 3 months before pregnancy, with 58.7% drinking alcohol in at least 1 trimester of pregnancy. The proportion of women consuming 1 to 2 drinks on a typical occasion did not change much during pregnancy, but the number of occasions declined. Although the proportion of women consuming more than 2 standard drinks on a typical occasion declined after the first trimester, 19.0% of women consumed this amount in at least 1 trimester of pregnancy and 4.3% of women consumed 5 or more standard drinks on a typical occasion in at least 1 trimester of pregnancy. In the first trimester of pregnancy, 14.8% of women drank outside the current Australian guideline for alcohol consumption in pregnancy, decreasing to 10% in the second and third trimesters. CONCLUSIONS: Women generally reduced their average alcohol consumption and the number of standard drinks on a typical occasion as their pregnancy progressed, although 10 to 14% were drinking outside current guidelines for pregnancy. It is important that all women of child-bearing age are aware, well before they consider pregnancy, of the risks of drinking alcohol during pregnancy so they can make informed decisions about their alcohol consumption in pregnancy.     

Use of record linkage to examine alcohol use in pregnancy

BACKGROUND: To date, no population-level data have been published examining the obstetric and neonatal outcomes for women with an alcohol-related hospital admission during pregnancy compared with the general obstetric population. This information is critical to planning and implementing appropriate services. METHODS: Antenatal and delivery admissions to New South Wales (NSW) hospitals from the NSW Inpatient Statistics Collection were linked to birth information from the NSW Midwives Data Collection over a 5-year period (1998-2002). Birth admissions were flagged as positive for maternal alcohol use where a birth admission or any pregnancy admission for that birth involved an alcohol-related International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) code. Key demographic, obstetric, and neonatal variables were compared for births to mothers in the alcohol group with births where no alcohol-related ICD10-AM was recorded. RESULTS: A total of 416,834 birth records were analyzed over a 5-year period (1998-2002). In this time, 342 of these were coded as positive for at least 1 alcohol-related ICD-10-AM diagnosis. Mothers in the alcohol group had a higher number of previous pregnancies, smoked more heavily, were not privately insured, and were more often indigenous. They also presented later on in their pregnancy to antenatal services and were more likely to arrive at hospital unbooked for delivery. Deliveries involved less epidural and local and more general anesthesia. Cesarean sections were more common to women in the alcohol group and were performed more often for intrauterine growth retardation. Neonates born to women in the alcohol group were smaller for gestational age, had lower Apgar scores at 5 minutes, and were admitted to special care nursery more often. CONCLUSIONS: This study shows that linked population-level administrative data provide a powerful new source of information for examining the maternal and neonatal outcomes associated with alcohol use in pregnancy.     

Screening for Down's syndrome

Down's syndrome (DS) is the commonest single cause of severe mental retardation in children. It can be diagnosed antenatally by chorionic villus sampling (CVS) or amniocentesis followed by karyotyping. At one time the sole indication for these invasive procedures was maternal age: typically women above age 35. However, this led to the detection of only some 30% of cases of DS at best. In the past ten years a series of biochemical and other abnormalities have been noted in Down's pregnancies and these form the basis for new screening programmes. The most familiar of the biochemical abnormalities are elevated levels of maternal serum human chorionic gonadotrophin (hCG), and reduced levels of α-fetoprotein (AFP) and oestriol (E₃). Changes are also noted in a number of other fetoplacental products. The underlying mechanism of these changes is unknown: suggestions include the possibility that a Down's syndrome pregnancy is relatively 'immature', or that there is a fetal–placental imbalance.     

Women's alcohol consumption and risk for alcohol-exposed pregnancies in Russia

Aims Alcohol‐exposed pregnancies (AEP) are the direct cause of fetal alcohol spectrum disorders (FASD). This study examines drinking patterns among pregnant and non‐pregnant women of childbearing age in Russia, a country with one of the highest levels of alcohol consumption in the world. Design Cross‐sectional survey. Setting Seven public women's clinics in two locations: St Petersburg (SPB) and the Nizhny Novgorod region (NNR). Participants A total of 648 pregnant and non‐pregnant childbearing‐age women. Measurements A face‐to‐face structured interview assessed alcohol consumption, pregnancy status/possibility of becoming pregnant and consumption before and after pregnancy recognition. Findings Eighty‐nine per cent of non‐pregnant women reported consuming alcohol and 65% reported binge drinking in the past 3 months; 47% in NNR and 28% in SPB reported binges at least monthly. Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant, and 32% of women in SPB and 54% in NNR were categorized as at risk for AEP. There was a significant decline in drinking after pregnancy identification. Twenty per cent of pregnant women reported consuming alcohol and 6% in SBP (none in NNR) reported binge drinking; however, a high prevalence of binge drinking was found among women who might become pregnant or who were trying to conceive. Conclusions Russian women substantially reduce drinking after pregnancy recognition compared to pre‐pregnancy levels. No reductions were found prior to pregnancy recognition, either when a woman might become pregnant or when she was trying to conceive. The pre‐conception period presents a risk window and, therefore, a prevention opportunity.     

Incidence of cytomegalovirus infection among the general population and pregnant women in the United States

Background  

Cytomegalovirus (CMV) is a common opportunistic infection among HIV-infected individuals, a major source of serious complications among organ-transplant recipients, and a leading cause of hearing loss, vision loss, and mental retardation among congenitally infected children. Women infected for the first time during pregnancy are especially likely to transmit CMV to their fetuses. More children suffer serious disabilities caused by congenital CMV than by several better-known childhood maladies such as Down syndrome or fetal alcohol syndrome     

Perception of Pregnancy and Social Support as Predictors of Alcohol Consumption during Pregnancy

Although an association between alcohol consumption during pregnancy and adverse fetal outcomes has been well documented, variables related to alcohol consumption during pregnancy have remained neglected. Since pregnancy has been considered a time of crisis and stress for pregnant women, this study sought to determine the association of perceptions of pregnancy and social support to alcohol consumption during pregnancy. The 311 Southern metropolitan prenatal patients sampled were interviewed twice during pregnancy. Perception of pregnancy was not found to be correlated with either social support or alcohol consumption during pregnancy. Social support was significantly associated with decreased alcohol consumption during pregnancy. Using standard multiple regressions, two components of social support, general support and pregnancy support, were found to be working in opposite directions prior to pregnancy, with general support showing a positive association with alcohol consumption. Only pregnancy support continued to account for a significant amount of the variance in alcohol consumption during the first 4 months of pregnancy. Pregnancy support, additionally, showed a significant negative association with high maximum drinking (consuming five or more drinks on occasion) prior to pregnancy. These findings suggest that social support may be an important predictor of alcohol consumption both prior to and during pregnancy and merits further investigation.     

Independent Associations among Maternal Alcohol Consumption and Infant Thyroxine Levels and Pregnancy Outcome

Studies with animal models of alcohol-related birth defects (ARBDs) suggest that reductions in circulating thyroid hormones, including thyroxine (T₄), may be a persistent postnatal effect of fetal alcohol exposure. The few clinical reports of children with fetal alcohol syndrome (FAS) that address thyroid system function generally reported that FAS children have thyroid hormone levels within normal limits. For the current study, data bases from the Fetal Alcohol Research Center and the Michigan Department of Public Health Newborn Screening Program were assessed to correlate measures of maternal drug use during pregnancy and infant outcome (gestational age at birth, birthweight, “fetal growth”), with infant whole-blood T₄ levels. Multiple regression analyses accounted for demographic factors, infant age at testing, and variation in the T₄ assay. As expected, alcohol intake and smoking each had a substantial negative impact on birthweight, gestational age at birth, and fetal growth, assessed as birthweight corrected for gestational age. Infant T₄ levels were positively related to birthweight and gestational age and were more strongly related to fetal growth. Infant T₄ levels were not influenced significantly by either maternal smoking or alcohol consumption. Smoking- and alcohol-related reductions in birthweight, gestational age, or fetal growth were not associated significantly with variations in infant T₄. Interesting questions remain regarding species differences and the influences of maternal alcohol consumption on T₄ metabolism as a mechanism for ARBDs. However, the current data do not support the hypothesis that maternal alcohol consumption, or smoking, during pregnancy leads to compromised thyroid system function in newborn humans. Therefore, newborn screens for T₄ are not likely to be effective in helping to detect infants with ARBDs or FAS.     

Antiphospholipid syndrome in pregnancy

Antiphospholipid syndrome (APS) is frequently associated with complications during pregnancy. Miscarriage and maternal thrombosis are the most common problems, but prematurity, intrauterine growth retardation, pregnancy-induced hypertensive disorders, and pulmonary hypertension can complicate pregnancy as well. The correct treatment of these women requires an accurate preconceptual counseling and a close collaboration between obstetricians and physicians. Doppler studies of the umbilical and uterine arteries play an important role in predicting APS-related complications during pregnancy.