Proceedings of the 2008 annual meeting of the Fetal Alcohol Spectrum Disorders Study Group

The annual meeting of the Fetal Alcohol Spectrum Disorders Study Group (FASDSG) was held on June 28, 2008 in Washington DC, as a satellite to the Research Society on Alcoholism meeting. The FASDSG membership includes clinical, basic, and social scientists who meet to discuss recent advances and issues in FASD research. The main theme of the meeting was “Factors that Influence Brain and Behavioral Development: Implications for Prevention and Intervention.” Two keynote speakers, Dr. Stephen Suomi and Dr. Carl Keen addressed how early environment and nutrition may influence outcome after prenatal alcohol exposure. The final keynote speaker, Kathy Mitchell, addressed issues regarding the relationship between scientists and the families with children with FASD. Members of the FASDSG provided updates on new findings through brief (FASt) data reports and national agency representatives provided updates of activities and funding priorities. Presentations were also made by recipients of the Student Research Merit award and Rosett award.     

Proceedings of the 2010 annual meeting of the Fetal Alcohol Spectrum Disorders Study Group

The annual meeting of the Fetal Alcohol Spectrum Disorders Study Group (FASDSG) was held on June 26, 2010 in San Antonio, TX, as a satellite of the Research Society on Alcoholism meeting. The FASDSG membership includes clinical, basic, and social scientists who meet to discuss recent advances and issues in Fetal Alcohol Spectrum Disorder (FASD) research. The central theme of the meeting was “Glia and Neurons: Teamwork in Pathology and Therapy.” Alcohol disruption of neuron development and alcohol-induced neurodegeneration is central to the pathology and clinical expression of FASD. The active role of glia as perpetrator, victim, or bystander in neurotoxicology and neurodegenerative processes has emerged at the forefront of adult central nervous system (CNS) disorders and therapy. Glia- and neuron-glial interactions hold the potential to elucidate causes and offer treatment of FASD as well. Growing evidence indicates that neurons and glia are direct targets of alcohol, but may also be vulnerable to molecules produced in peripheral systems as a result of alcohol exposure. Diagnostics and therapies can take advantage of these processes and biomarkers, and these may be applicable to CNS pathology in FASD. Two keynote speakers, Howard E. Gendelman, M.D., and Ernest M. Graham, M.D, addressed the role of glia and neuroinflammation in brain development and neurodegeneration. The invited speakers and FASDSG members discussed new paradigms in CNS development and discuss new strategies for understanding and treating neurodegenerative disease. Members of the FASDSG provided updates on new findings through presentation of breaking research in the FASt data sessions. Representatives of national agencies provided updates on programs, activities, and funding priorities. The Henry Rosett Award was presented to R. Louise Floyd, R.N., D.S.N., for her career contributions to the field of fetal alcohol research. The Student and Postdoctoral Fellow Research Merit Award was presented to Shonagh O’Leary-Moore, Ph.D., for her contributions to the field as a young investigator.     

Proceedings of the 2013 Annual Meeting of the Fetal Alcohol Spectrum Disorders Study Group

The 2013 Fetal Alcohol Spectrum Disorders Study Group (FASDSG) meeting was held in Orlando (Grand Cypress), FL with the theme “Developing Brain-Based Interventions for Individuals with Fetal Alcohol Spectrum Disorders.” Children with fetal alcohol spectrum disorders have significant impairments in cognitive functioning and behavioral regulation skills, which lead to a lifetime of challenges for themselves and their families; thus, developing interventions that remediate or compensate for these deficits is of great importance. The conference included 2 keynote presentations, FASt data talks, award presentations, and updates by government agencies. In addition, a lively panel discussion addressed the challenges faced by FASDSG researchers in the translation of intervention strategies developed in preclinical studies to clinical trials and, ultimately, to clinical practice.     

A report on the Fetal Alcohol Spectrum Disorders Study Group meeting of 2012, theme title, “Biomarkers for FASD”

The 2012 meeting of the Fetal Alcohol Spectrum Disorders Study Group (FASDSG) focused on the development and ethics of biomarkers for fetal alcohol exposure. This one-day international conference brought students and trainees together with clinicians and researchers to discuss the latest research on FASD. One keynote speaker discussed the value of profiling epigenetic modifications in readily available fetal tissues to diagnose fetal exposure to environmental agents, while the second speaker discussed the ethics of biomarker development within the context of core principles of justice, autonomy, beneficence and non-maleficence. Three sessions of short data talks informed the audience of research advances with particular emphasis on the diagnosis of FASD. Other activities included updates on FASD-related activities by representatives of government agencies, a report on the implementation FASD-related diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association and a networking lunch, and the presentation of the “Merit Award” to Dr. Nathan Muraski for his work on behavioral outcomes of fetal alcohol exposure. The capstone of the meeting was the presentation of the “Henri Rosett” award to Dr. Denis Viljoen, in recognition of his role in raising awareness about the incidence of FASD in South Africa and in promoting FASD prevention and treatment programs as chairperson and chief executive officer of the Foundation for Alcohol Related Research (FARR).     

Proceedings of the 2006 annual meeting of the Fetal Alcohol Spectrum Disorders Study Group.

This article describes the proceedings of the 2006 Annual Meeting of the Fetal Alcohol Spectrum Disorders Study Group (FASDSG), which was held in Baltimore, Maryland on June 24, 2006. The meeting was held in conjunction with the annual meeting of the Research Society on Alcoholism and was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism. The 2005-2006 FASDSG officers, Daniel J. Bonthius (President), Heather Carmichael Olson (Vice-President), and Jennifer Thomas (Secretary-Treasurer), organized the meeting. Nationally prominent speakers delivered plenary lectures on topics of newborn screening, ethics, and neuroscience. Selected members of the FASDSG provided brief scientific data (FASt) reports, describing new research findings. Representatives from national agencies involved in fetal alcohol syndrome (FAS) research, treatment, and prevention provided updates regarding priorities, funding, and agency activities. Presentations were also made by the 2006 Student Merit Award recipient and by the 2006 Rosett Award recipient. The meeting served as a forum for clinicians, neuroscientists, psychologists, social scientists, and other professionals to discuss recent advances in FAS research and to identify the most important gaps in the understanding of alcohol-induced teratology.     

Developmental age strengthens barriers to ethanol accumulation in zebrafish

Fetal Alcohol Spectrum Disorders (FASD) describes a wide range of phenotypic defects affecting facial and neurological development associated with ethanol teratogenicity. It affects approximately 1 in 100 children born in the United States each year. Genetic predisposition along with timing and dosage of ethanol exposure are critical in understanding the prevalence and variability of FASD. The zebrafish attributes of external fertilization, genetic tractability, and high fecundity make it a powerful tool for FASD studies. However, a lack of consensus of ethanol treatment paradigms has limited the interpretation of these various studies. Here we address this concern by examining ethanol tissue concentrations across timing and genetic background. We utilize headspace gas chromatography to determine ethanol concentration in the AB, fli1:EGFP, and Tu backgrounds. In addition, we treated these embryos with ethanol over two different developmental time windows, 6–24 h post fertilization (hpf) and 24–48 hpf. Our analysis demonstrates that embryos rapidly equilibrate to a sub-media level of ethanol. Embryos then maintain this level of ethanol for the duration of exposure. The ethanol tissue concentration level is independent of genetic background, but is timing-dependent. Embryos exposed from 6 to 24 hpf were 2.7–4.2-fold lower than media levels, while embryos were 5.7–6.2-fold lower at 48 hpf. This suggests that embryos strengthen one or more barriers to ethanol as they develop. In addition, both the embryo and, to a lesser extent, the chorion, surrounding the embryo are barriers to ethanol. Overall, this work will help tighten ethanol treatment regimens and strengthen zebrafish as a model of FASD.     

Development of a media campaign on fetal alcohol spectrum disorders for northern plains american Indian communities

Alcohol-exposed pregnancies are especially of concern for American Indians. The Indian Health Service reported that 47% to 56% of pregnant patients admitted to drinking alcohol during their pregnancy. In addition, rates of Fetal Alcohol Syndrome are estimated to be as high as 3.9 to 9.0 per 1,000 live births among American Indians in the Northern Plains, making prevention of alcohol-exposed pregnancies an important public health effort for this population. The goal of this article is to add to the literature on universal prevention of Fetal Alcohol Spectrum disorders by describing the development, dissemination, and evaluation of a media campaign on Fetal Alcohol Spectrum Disorders that was created by and for American Indian communities in the Northern Plains.     

Women's knowledge and attitudes regarding alcohol consumption in pregnancy: a national survey

Background  

Alcohol exposure in pregnancy is a common and modifiable risk factor for poor pregnancy and child outcomes. Alcohol exposure in pregnancy can cause a range of physical and neurodevelopmental problems in the child including the Fetal Alcohol Spectrum Disorders (FASD). In order to improve prevention strategies, we sought to describe the knowledge and attitudes of women of childbearing age regarding alcohol consumption during pregnancy and its effects on the fetus.     

Predictors of alcohol use prior to pregnancy recognition among township women in Cape Town, South Africa

South Africa has the highest prevalence of Fetal Alcohol Spectrum Disorders (FASDs) in the world. The purpose of this study was to identify high risk factors associated with drinking alcohol prior to pregnancy recognition in 24 neighborhoods in the Cape Flats outside Cape Town, South Africa. An interviewer assessed risk among 619 pregnant Black/African women between the ages of 18 and 41 years. Logistic regression analyses explored factors associated with drinking alcohol post conception but prior to pregnancy recognition. Forced multiple logistic regression analysis revealed that drinking prior to pregnancy recognition was associated with being younger, single, having better living conditions, smoking, having a longer gestation prior to pregnancy recognition, having a greater number of sexual partners, and a higher incidence of intimate partner violence. Depressive symptoms tended to be higher among alcohol users. These risk factors were consistent with other research on the characteristics of South African women having children with a diagnosis of Fetal Alcohol Spectrum Disorders and/or of non pregnant women at high risk for an alcohol-exposed pregnancy. These findings highlight the need for women of child-bearing age to be routinely screened for alcohol use and its associated risk factors. Intervention efforts could be integrated into health initiatives already present in South Africa including the prevention and treatment of HIV/AIDS, tuberculosis, and malnutrition. Preconception care is particularly important since pregnancy recognition often occurs several weeks to months following conception and could be implemented by South African community health workers. These endeavors should facilitate national goals of healthier pregnancies and the elimination of FASDs in South Africa.     

Young Investigator Award Symposium

This article highlights the research presented at the inaugural meeting of Alcoholism and Stress: A Framework for future Treatment Strategies. This meeting was held on May 6-8, 2008 in Volterra, Italy. It is an international meeting dedicated to developing preventive strategies and pharmacotherapeutic remedies for stress- and alcohol-related disorders. For the first time, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conferred a Young Investigator Award to promote the work of young researchers and highlight their outstanding achievements in the fields of addiction medicine and stress disorders. The awardees were Dr. Katie Witkiewitz (University of Washington), Dr. Andrew Holmes (NIAAA), Dr. Lara A. Ray (Brown University), Dr. James Murphy (University of Memphis), and Dr. Heather Richardson (The Scripps Research Institute). The symposium was chaired by Drs. Fulton Crews and Antonio Noronha.     

Recent research on the effects of alcohol policy changes

As the agenda of alcohol problems prevention has broadened, new traditions of research have emerged: of experimental studies at the community or the societal level, of natural experiment studies of the effects of sudden changes such as strikes or new legislation, and of sophisticated time-series analyses of the effects of sudden and of long-term changes. While it has been shown that control measures can influence alcohol problems rates, substantial change seems to require changes in the political status quo, often also involving popular movements. Except for taxes, raising the drinking age and drinking-driving countermeasures, the political will to restrict availability has been lacking in market-oriented industrial societies in the modern era, so that the modern experience of the effects of other control measures is based on centrally-planned or non-industrial economies.Preparation of this paper was supported by a National Alcohol Research Center grant (AA-05595) from the U.S. National Institute on Alcohol Abuse and Alcoholism to the Alcohol Research Group, Medical Research Institute of San Francisco, 2000 Hearst Avenue, Berkeley CA 94709. Revised from papers presented at a meeting on Alcohol Policies: Perspectives from the USSR and Some Other Countries, October 31-November 4, 1988, Baku, USSR, and at a NIMHANS-ADAMHA Symposium on Alcohol and Drug Abuse, Bangalore, India, November 18–21, 1986.     

Neonatal screening for prenatal alcohol exposure: Assessment of voluntary maternal participation in an open meconium screening program

Meconium fatty acid ethyl esters (FAEEs) are validated biomarkers of fetal alcohol exposure. Meconium FAEE testing can potentially be used as a screen by health-care professionals to identify neonates at-risk for Fetal Alcohol Spectrum Disorder, thereby permitting diagnostic follow-up of these children and early intervention in those who develop disabilities. The purpose of this study was to assess whether women would willingly partake in a screening program of this nature. This was determined by launching a pilot screening program for prenatal alcohol exposure in a high-risk obstetric unit previously shown to have a high prevalence of FAEE-positive meconium via anonymous meconium testing. The program involved voluntary testing of meconium for FAEEs and long-term developmental follow-up of positive cases through an existing public health program. The participation rate in the screening program was significantly lower than when testing was conducted anonymously (78% vs. 95%, respectively; p < 0.05), and the positivity rate was 3% in contrast to 30% observed under anonymous conditions (p < 0.001). These low rates suggest that the majority of mothers who consumed alcohol in pregnancy refused to participate. We conclude that despite the potential benefits of such screening programs, maternal unwillingness to consent, likely due to fear, embarrassment, and guilt, may limit the effectiveness of meconium testing for population-based open screening, highlighting the need for public education and social marketing efforts for such programs to be of benefit.     

Fetal Alcohol Spectrum Disorders: understanding the effects of prenatal alcohol exposure and supporting students

BACKGROUND: Fetal Alcohol Spectrum Disorders (FASD) affect a significant number of children in this country. This article addresses diagnostic issues related to fetal alcohol syndrome (FAS) and other alcohol-related disabilities, discusses associated features and behaviors of FASD, and introduces interventions to support children with FASD in school settings. METHODS: A comprehensive review of FAS and FASD literature as it relates to school functioning was conducted. RESULTS: Prenatal alcohol exposure can result in a broad range of negative developmental consequences, including deficits in cognitive and academic functioning, psychological disorders, behavioral problems, and difficulties with independent living. Children with prenatal alcohol exposure are at risk for a spectrum of difficulties at school. CONCLUSIONS: This topic is of considerable relevance to all professionals in a school setting, including teachers, administrators, school psychologists, special education providers, special service providers, and school nurses who interact with children who may be prenatally exposed to alcohol. Successful interventions will need to balance the use of environmental modifications, immediate and meaningful positive and negative consequences for behaviors, and opportunities to teach children skills to monitor and modify their behavior.     

Fetal alcohol syndrome prevention in Washington State: evidence of success

Fetal alcohol syndrome (FAS) is a permanent birth defect syndrome caused by maternal consumption of alcohol during pregnancy. It is characterised by growth deficiency, central nervous system damage/dysfunction, and a unique cluster of minor facial anomalies. To assess the effectiveness of fetal alcohol syndrome prevention efforts, one must be able to estimate accurately the prevalence of fetal alcohol syndrome over time in population-based samples. With the establishment of the Washington State Fetal Alcohol Syndrome Diagnostic and Prevention Network of clinics, the development of the Fetal Alcohol Syndrome Facial Photographic Analysis Software, the creation of the Fetal Alcohol Spectrum Disorders (FASD) 4-Digit Diagnostic Code, the establishment of the Foster Care Fetal Alcohol Syndrome Screening Program, and the collection of Pregnancy Risk Assessment Management System data on maternal use of alcohol during pregnancy, the tools, methods and infrastructure for assessing the effectiveness of fetal alcohol syndrome primary prevention efforts in Washington State are in place. A cross-sectional study was conducted to determine whether the prevalence of fetal alcohol syndrome among children in a foster care population, born between 1993 and 1998, decreased with the documented decrease in prevalence of maternal use of alcohol during pregnancy from 1993 and 1998 in Washington State. The prevalence of maternal drinking during pregnancy in Washington State declined significantly (P < 0.001) from 1993 to 1998 as did the prevalence of fetal alcohol syndrome among foster children born 1993-98 (P < 0.03). These observations support the likelihood that fetal alcohol syndrome prevention efforts in Washington State are working successfully.     

Research-based interventions for children and youth with a Fetal Alcohol Spectrum Disorder: revealing the gap

BACKGROUND: Alcohol use during pregnancy can result in a continuum of effects including growth deficits, dysmorphology and/or complex patterns of behavioural and cognitive difficulties that influence an individual's functioning throughout their lifespan. We conducted a systematic review to identify research-based interventions for children and youth with a Fetal Alcohol Spectrum Disorder and areas for future study. METHODS: We identified the substantive literature by searching 40 peer-reviewed and 23 grey literature databases, as well as reference lists. We hand-searched eight relevant journals, and undertook a systematic search of Internet sites and review of reports and documents received from key stakeholders. Two reviewers independently assessed eligibility and quality, and extracted data. Given the small number of studies that met all inclusion criteria, both experimental and quasi-experimental studies were included. RESULTS: Ten intervention studies were identified, of which three were experimental or quasi-experimental, and four were non-experimental. Despite multiple attempts, three studies (two in foreign languages and one unpublished) could not be acquired. A meta-analysis could not be undertaken because the included studies examined different interventions or outcomes. Interventions targeted in the included studies were as follows: (i) psychostimulant medications (methyphenidate, pemoline and dextroamphetamine); and (ii) Cognitive Control Therapy. The identified studies were limited by very small sample sizes and weak designs. CONCLUSION: There is limited scientific evidence upon which to draw recommendations regarding efficacious interventions for children and youth with a Fetal Alcohol Spectrum Disorder. Clinicians, researchers, service providers, educators, policy makers, affected children and youth and their families, and others need to urgently collaborate to develop a comprehensive research agenda for this population.     

Binge drinking in alcohol-preferring sP rats at the end of the nocturnal period

Sardinian alcohol-preferring (sP) rats have been selectively bred for high alcohol preference and consumption using the standard 2-bottle “alcohol (10%, v/v) vs. water” choice regimen with unlimited access; under this regimen, sP rats daily consume 6–7 g/kg alcohol. The present study assessed a new paradigm of alcohol intake in which sP rats were exposed to the 4-bottle “alcohol (10%, 20%, and 30%, v/v) vs. water” choice regimen during one of the 12 h of the dark phase of the daily light/dark cycle; the time of alcohol exposure was changed daily in a semi-random order and was unpredictable to rats. Alcohol intake was highly positively correlated with the time of the drinking session and averaged approximately 2 g/kg when the drinking session occurred during the 12th hour of the dark phase. Alcohol drinking during the 12th hour of the dark phase resulted in (a) blood alcohol levels averaging approximately 100 mg% and (b) severe signs of alcohol intoxication (e.g., impaired performance at a Rota-Rod task). The results of a series of additional experiments indicate that (a) both singular aspects of this paradigm (i.e., unpredictability of alcohol exposure and concurrent availability of multiple alcohol concentrations) contributed to this high alcohol intake, (b) alcohol intake followed a circadian rhythm, as it decreased progressively over the first 3 h of the light phase and then maintained constant levels until the beginning of the dark phase, and (c) sensitivity to time schedule was specific to alcohol, as it did not generalize to a highly palatable chocolate-flavored beverage. These results demonstrate that unpredictable, limited access to multiple alcohol concentrations may result in exceptionally high intakes of alcohol in sP rats, modeling – to some extent – human binge drinking. A progressively increasing emotional “distress” associated to rats' expectation of alcohol might be the neurobehavioral basis of this drinking behavior.     

The Marulu Strategy 2008–2012: overcoming Fetal Alcohol Spectrum Disorder (FASD) in the Fitzroy Valley

Objective: Aboriginal leaders concerned about high rates of Fetal Alcohol Spectrum Disorder (FASD) in the Fitzroy Valley, remote north‐western Australia, introduced restrictions on access to take‐away full‐strength alcohol. Following this, Aboriginal leaders engaged strategic partners in a broader strategy to address FASD in the region. The aim of this study was to develop and implement a community‐led, researcher‐supported, FASD strategy. Methods: A review of literature focusing on community‐led FASD strategies identified key components that informed the Marulu FASD strategy. These included strategy ownership, leadership, and governance by participating communities, and a research framework. Results: Community meetings and workshops led to the development of The Marulu FASD Strategy (2008). Feasibility and community consent to conduct a FASD prevalence study (the Lililwan Project) was confirmed, and implementation was progressed (2010–2013). Concurrent FASD prevention activities were conducted. In 2012, the Marulu FASD Unit was established within a local Aboriginal organisation to sustain and coordinate ongoing strategy activities. Conclusions: Community control of public health initiatives can be achieved when Aboriginal communities prioritise issues of significant concern, and engage strategic partners to overcome them. Implications for public health: The Marulu Strategy forms a template for action to address FASD and other public health issues in Aboriginal communities in Australia and internationally.     

Conceptualizing withdrawal-induced escalation of alcohol self-administration as a learned,plasticity-dependent process

This article represents one of five contributions focusing on the topic “Plasticity and neuroadaptive responses within the extended amygdala in response to chronic or excessive alcohol exposure” that were developed by awardees participating in the Young Investigator Award Symposium at the “Alcoholism and Stress: A Framework for Future Treatment Strategies” conference in Volterra, Italy on May 3–6, 2011 that was organized/chaired by Drs. Antonio Noronha and Fulton Crews and sponsored by the National Institute on Alcohol Abuse and Alcoholism. This review discusses the dependence-induced neuroadaptations in affective systems that provide a basis for negative reinforcement learning and presents evidence demonstrating that escalated alcohol consumption during withdrawal is a learned, plasticity-dependent process. The review concludes by identifying changes within extended amygdala dynorphin/kappa-opioid receptor systems that could serve as the foundation for the occurrence of negative reinforcement processes. While some evidence contained herein may be specific to alcohol dependence-related learning and plasticity, much of the information will be of relevance to any addictive disorder involving negative reinforcement mechanisms. Collectively, the information presented within this review provides a framework to assess the negative reinforcing effects of alcohol in a manner that distinguishes neuroadaptations produced by chronic alcohol exposure from the actual plasticity that is associated with negative reinforcement learning in dependent organisms.     

Hepatitis B vaccination: A completed schedule enough to control HBV lifelong?: Milan,Italy, 17–18 November 2011

The Viral Hepatitis Prevention Board (VHPB) organized an international meeting in Milan in November 2011 on the question of whether completing a course of hepatitis B vaccination confers lifelong protection against hepatitis B virus infection and its complications. Presentations covered vaccine efficacy including factors influencing long-term protection; breakthrough infections; the immunological effect of natural boosting; the effectiveness of universal hepatitis B vaccination in different countries, and issues relating to national, regional and global policies on booster vaccination. Findings from four continents were presented at the meeting, with data now extending to follow-up for nearly 30 years after full primary vaccination. The results reported add to the extensive and growing body of knowledge, demonstrating that in spite of subsequent decline and ultimate loss of detectable serum anti-HBs, a full primary course of hepatitis B vaccine confers complete protection against acute clinical disease and chronic hepatitis B infection for long periods of time. Our understanding of the role and functions of T and B cells in protective immunity deepens, although the picture is still complex. A framework for future work in several areas emerged from the meeting, including monitoring and surveillance of vaccination programmes, breakthrough infections, hepatitis B in immigrant populations, and vaccine-escape viral mutants. One further concrete recommendation is the setting up of a working group to standardize definitions on terms such as “immunity”, “protection”, “immune memory”, “non-responders”, “long-term”, “anamnestic response”, “breakthrough” and “vaccine failure”.     

Sex differences,environmental complexity,and mother-infant relations

Differential handling of male and female infants by their mothers and differential behavior of male and female infants independent of maternal behavior is a critical research issue with significant implications for understanding human development. This report describes mother-infant interaction in the squirrel monkey as a function of the infant's sex in a variety of laboratory environments. In a complex social environment, males move away from their mothers at a younger age than do females. The mothers then attempt to keep the males physically close. This maternal effort at continuing mother-son closeness is not successful, indicating greater infant-activated autonomy in the male.This research was supported by Grant No. MH-15965 from the National Institute of Mental Health.This paper was presented at the symposium, Male and Female Behavior in Primate Societies, at the Fourth International Congress of Primatology, Portland, Oregon, August 1972.This research was conducted while Dr. Rosenblum was the recipient of Research scientist Development Award No. K5, MH-23685.