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Results Show No ‘Safe’ Period For Drinking Alcohol In Pregnancy

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About the Effect of Alcohol on the Fetus

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Sandra and Joseph Jacobson, husband and wife researchers from Wayne State University in Detroit, have also been working in South Africa since the s. The Jacobsons had been using neuropsychological testing to assess the effects of prenatal alcohol exposure on intellectual function in a longitudinal cohort of children exposed at moderate-to-heavy levels in Detroit. Using timeline follow-back interviews administered repeatedly during pregnancy, mothers provided detailed information about their drinking on a daily basis.

This research has linked prenatal alcohol exposure to low IQ and problems particularly with number processing, learning and memory, working memory, and slower information processing speed.

Using the same techniques to ascertain maternal drinking during pregnancy in Cape Town, the Jacobsons and their collaborator Dr.

Christopher Molteno, a developmental pediatrician with the University of Cape Town, conducted the first prospective longitudinal study of fetal alcohol syndrome in which women were recruited during pregnancy and found a very similar neurobehavioral profile in a longitudinal cohort of children, half of whom were exposed at very heavy levels.

Given the unusually high levels of prenatal alcohol exposure in Cape Town and the consistency of the neurobehavioral profile with that seen in the U. They have been using a number of neuroimaging techniques including MRI, which measures the brain's structure, functional MRI fMRI , which documents brain activity while completing a task, and diffusion tensor imaging DTI , which assesses brain white matter integrity.

The Jacobsons initiated a collaboration with Dr. The collaborators went on to produce 19 papers from that initial Fogarty grant. Meintjes says this Fogarty fMRI grant "kick started" advanced neuroimaging research in South Africa, as well as Meintjes's neuroscience career.

Based on her training and on the first studies generated by this grant, Meintjes was awarded a prestigious research chair and Siemens contributed to the purchase of a scanner that helped launch an imaging research center that Meintjes currently directs.

With her position, came funding for students and post-docs that enabled her to expand her research group. The diagnosis of FASD can be difficult because not all alcohol-exposed children have the distinctive facial abnormalities and other physical traits associated with the condition and the neurobehavioral deficits are often similar to those seen in other conditions, such as attention deficit hyperactivity disorder.

Data from neuroimaging studies conducted by Jacobson and colleagues suggest that this deficit may be attributable, in part, to slower processing of information due to deficits in the brain's white matter, which is responsible for transmitting signals across brain regions during a task.

Children with FASD and ADHD both have problems with math, but as had been shown in the Detroit cohort, the type of problems in number processing was distinct for the two disorders. Alcohol-affected children and normal controls were each given a simple addition problem to solve while in the scanner. Both groups were able to perform the task, but there was a telling difference - children with FASD had to use more extensive brain regions to do so. Moreover, a greater amount of alcohol reported by the mother during pregnancy predicted lower levels of activation in the principal brain region known to mediate number processing in typically developing children.

Children with FASD can have a range of physical, cognitive and behavioral problems that include poor memory, diminished communication and reasoning skills, and difficulty in school, especially with math. You can choose not to answer any question, for any reason. The information you provide will be kept private to the extent allowed by law.

To protect your privacy, all records will be kept under a code number rather than under your name. Records will be kept in locked files and only senior study staff will be allowed to look at them. Your name or other facts that might point to you will not be used and will not appear when researchers present their studies or publish the results.

Filling out the survey should take only minutes, however you can use as much time as you need to finish it. You will be able to save the completed questions and return to the survey at another time.

You will be provided with a link to your partially finished questions. What information do I need to provide? When you sign up, you will need to tell us your name and provide your email address. We will use this email address to connect you with the FAS researchers in your state.

How do I start? Signing up is a simple 3-step process: Provide your name and your real email address so we can contact you. Answer some questions that will help connect you with the researchers in your state: In this trial, recruitment focuses on a high-risk population of pregnant women who are currently drinking, drank during a previous pregnancy, or drank at least one drink daily prior to current pregnancy.

In this study, the investigators, led by Chang, are comparing the results of an assessment-only condition with an enhanced brief intervention that involves a support partner chosen by the pregnant woman.

Handmaker and colleagues piloted a study to evaluate the results of motivational interviewing with 42 pregnant problem drinkers. Women reporting any recent drinking were randomly assigned either to the experimental group that received a 1-hour motivational interview focused on weighing drinking against the risk of birth defects, or to a control group that received a letter explaining the risks of drinking during pregnancy and recommending the woman talk to her obstetrical provider about the risks.

Women in both groups had significantly reduced their alcohol intake at followup 2 months later. Women who self-reported the highest levels of blood alcohol concentrations had the greatest decrease in alcohol consumption if they were in the experimental group compared with the control group. Blood alcohol concentrations were estimated using computer projections that were based on self-reports of estimated number of drinks, alcohol content of drinks, length of drinking episodes, the woman's weight, and an average rate of alcohol metabolism for women.

Another selective prevention approach that was part of the Developing Effective Educational Resources DEER project examined the exposure and reactions to warnings about drinking during pregnancy in samples of pregnant Native Americans and African Americans living in the Northern California Bay area and Los Angeles. In this study, Kaskutas found that although the women were frequently exposed to warning messages, they were uncertain about the impact of FAS.

Specifically, only about a quarter of the women could name at least one birth defect associated with FAS and only one-fifth knew that FAS was related to alcohol consumption. Furthermore, the women did not understand the benefits of quitting drinking at any time during pregnancy, and they had the misconception that wine, beer, and wine coolers are safer to drink during pregnancy than liquor. Finally, most of the women underestimated their drinking.

Thus, when the investigator compared alcohol intake using standard drink sizes 5 5 A standard drink frequently is defined as 12 ounces of beer, 5 ounces of wine, or 1.

Ongoing research is extending this methodology and testing a novel prevention program for pregnant women enrolled in a health maintenance organization Kaskutas and Graves In this randomized clinical trial, the investigators use models of alcoholic beverage containers beverage containers of various sizes, such as ounce versus ounce beer bottles or beer cans, or liquor bottles that range from milliliters, milliliters, and 1 liter or drinking vessels shot glasses, wine glasses, or drinking glasses with lines marked off with letters so women could tell the investigators how high they filled the glass and a computer program to help pregnant women understand how much they actually drink.

After the women identify the bottle or glass they typically drink from, the computer program calculates the absolute ounces of alcohol consumed. These nonconfrontational approaches of using drinking vessels and beverage containers and talking about drinking in a nonthreatening way help the women discuss their drinking habits while pregnant. Indicated prevention efforts are directed toward the population at highest risk of having children with FAS or alcohol- related effects-that is, women who have a history of drinking during pregnancy or have previously delivered a child affected by alcohol.

Several studies have assessed prevention approaches directed at this population to prevent the birth of further alcohol-affected children. Handmaker and Wilbourne [] thoroughly review motivational interventions in prenatal clinics, describing additional approaches not mentioned here.

One of these approaches was the Protecting the Next Pregnancy project, which targeted women who had been identified as drinking heavily during the last pregnancy called the index pregnancy.

The goal of the intervention being tested was to reduce the women's drinking during their next pregnancies Hankin and Sokol ; Hankin et al. All women consuming at least four drinks per week i.

The women's average alcohol consumption was 1. Four weeks after giving birth, the women were randomly assigned to an experimental group that received an intensive brief intervention or a control group that received standard clinical care.

The study included women, who were followed up to 5 years. The brief intervention involved a one-on-one method, which was based on a cognitive behavioral approach, and included 5 sessions beginning at 1 month after giving birth and continuing for 12 months.

In those sessions, the counselor reviewed the definition of a standard drink, helped the women set the goal of abstention or reduction of alcohol use, established limits on consumption if not abstaining , and taught ways to reduce drinking.

Additional booster sessions were conducted over the 5-year followup period. The control group was simply advised that "You can have a healthier baby if you cut back or stop drinking during pregnancy.

Of the participants, 96 women delivered 1 or more infants during the followup period. The investigators found that women in the experimental group drank significantly less than did women in the control group during the subsequent pregnancies. While 25 percent of the women in the control group drank at least 0.

Furthermore, among women who drank during subsequent pregnancies, those from the experimental group drank about half as much as did women from the control group i. This reduced alcohol consumption resulted in improved birth outcomes among women from the experimental group, including fewer low-birth weight babies and fewer premature births.

In addition, children born to women from the experimental group exhibited better neurobehavioral performance at 13 months of age compared with the children of women from the control group.

These findings indicate that the brief intervention protected the next pregnancy by reducing alcohol consumption and improving infant outcomes. In another indicated prevention effort called Project TrEAT Trial for Early Alcohol Treatment researchers screened almost 6, women ages 18 to 40 for problem drinking and then randomly assigned problem drinkers to a brief intervention program or to a control group Manwell et al. The two groups did not differ significantly with respect to various factors, such as alcohol use, age, socioeconomic status, smoking, various psychiatric disorders, lifetime drug use, or health care utilization.

The brief intervention in this study consisted of two minute counseling sessions conducted by physicians and including a review of the woman's current health behavior, a discussion of the adverse effects of alcohol, a drinking agreement, and cards to record alcohol intake.

The control group received a booklet on general health issues. Participants were followed for 48 months. Women in the brief intervention group successfully reduced their mean alcohol intake by 48 percent, and the proportion of women reporting any binge drinking in this group decreased from 93 percent to 68 percent.

The control group also exhibited modest declines in alcohol use. During the followup period, 41 women became pregnant, including 22 in the brief intervention group and 19 in the control group. For these women, the brief intervention seemed to result in better outcomes in terms of decreased consumption because women in the brief intervention group reduced their alcohol consumption from Another example of a treatment program targeting women who have already given birth to alcohol- or drug-exposed infants was the Seattle Birth to 3 Advocacy Project Streissguth This program was designed for women who were heavy users of alcohol or other drugs, had no prenatal care, and were not connected to service providers during their pregnancy.

The 65 women in the program, most of whom were unemployed or on welfare, learned how to set goals, connect with other providers, and acquire new skills. After 2 years, 80 percent of the women had received alcohol and other drug abuse treatment, and 60 percent had remained abstinent from alcohol and other drugs. Moreover, 62 percent of the women were using long-term birth control methods, thereby reducing the risk for another alcohol- or drug-exposed pregnancy.

Several other programs are studying different FAS prevention efforts in a variety of target populations and settings. These populations include women in a jail, in a substance abuse center, or in clinics as well as a group of women with concerns about problem drinking who were recruited through media announcements. Another recently funded study is aimed at college students, encouraging them to abstain from alcohol or to use contraception if they drink. The goal of this program is to reduce alcohol use and promote effective contraception among women who are not currently pregnant.

The program uses a brief intervention that educates women about the consequences of problem drinking, the benefits and costs of changing drinking and contraception behavior, setting goals, keeping a daily diary, and followup support. An ongoing prevention effort on Native American reservations is based on the Institute of Medicine model and incorporates universal, selective, and indicated prevention activities May The study includes four prevention communities and two "research only" communities.

The selective prevention component consists of a screening program for women in clinics and Women, Infant, and Children WIC sites to identify high-risk drinkers. The indicated prevention component involves case management using motivational interviewing and community reinforcement approaches to help women who are drinking during pregnancy.

The two sets of communities will be compared on a variety of outcome measures. NIAAA is funding several other prevention studies of interventions designed to reduce drinking among pregnant women. Most of these efforts use brief interventions with motivational interviewing.

Another program that is based at WIC clinics seeks to increase the detection of alcohol use during pregnancy, identify maternal characteristics contributing to the success of a brief intervention, identify characteristics of the intervention itself that contribute to its effectiveness, and evaluate the impact of the program on infant outcome. Finally, NIAAA is funding a study that is based on a more environmentally focused perspective and that examines the impact of alcohol server education in FAS prevention.

All of these prevention efforts are ongoing, and researchers are still waiting for data on the results of these programs. Furthermore, many of the women who continue to drink during pregnancy are at highest risk for having children with fetal alcohol syndrome and related problems.

Thus, finding potent new ways to reach populations at risk and to influence changes in their behavior remains a challenge for alcohol research" NIAAA b , p. Researchers and clinicians already have made some progress in the efforts to prevent FAS.

For example, universal prevention approaches have increased the general public's knowledge about the results of drinking during pregnancy.

Studies on awareness of the alcohol beverage warning label showed an increase in awareness over time. In addition, a larger proportion of the public knows about the relationships between drinking during pregnancy and birth defects.

However, knowledge is not enough to change norms and actual behavior, as indicated by recent data that almost 13 percent of pregnant women drink during pregnancy CDC a. Numerous questions remain to be answered. For example, although the alcohol beverage warning label had a modest impact on drinking during pregnancy for a short time, the public has become habituated to its message.

Future analyses need to clarify why this habituation occurred and whether new labels or a system of rotating labels can prevent habituation. Additional research must identify the most effective ways to educate the public about FAS e. Systematic studies are needed that compare various universal prevention efforts and their impacts across various social groups. Several researchers have examined the effects of selective and indicated prevention efforts using randomized clinical trials.

The results described in this article suggest that brief interventions for pregnant women can successfully reduce alcohol intake during pregnancy. Additional studies using experimental designs i. Other unanswered questions concern the most appropriate contents for the brief intervention. Finally, it is important to understand whether the intervention results in clinically significant results across a variety of outcomes, including drinking during pregnancy, infant birth weight, length of gestation, and infant neurobehavioral outcomes.

Although the research on the success of FAS prevention programs is still in its infancy, ongoing studies may help researchers and clinicians discover the best methods for separating alcohol from pregnancy and thus preventing FAS and alcohol-related effects.

Morbidity and Mortality Weekly Reports, April 5, 51 Morbidity and Mortality Weekly Reports, May 24, 51 A brief intervention for alcohol use in pregnancy:

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Fetal Alcohol Syndrome Prevention Research Janet R. Hankin, Ph.D. Alcohol consumption during pregnancy can have numerous adverse health consequences for the developing fetus, including fetal alcohol syndrome (FAS) and alcohol-related effects, and therefore is a significant public health problem.

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Feb 09,  · Amanda Dreasher, a public health nurse, measures a boy's eyes in , in Emporia, Kan., at the Fetal Alcohol Syndrome Clinic. (David Doemland/AP) Fetal alcohol syndrome, which can be physically, emotionally and intellectually disabling, is quite common, and most sufferers are not being diagnosed, according to new research.

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Alcohol can disrupt fetal development at any stage during a pregnancy — including at the earliest stages and before a woman knows she is pregnant. Research shows that binge drinking, which means consuming four or more drinks per occasion, and regular heavy drinking put a fetus at the greatest risk. National Organization on Fetal Alcohol Syndrome / Volunteer for CIFASD Research Prenatal alcohol exposure can harm a baby’s body or brain, and can cause challenges that can last a lifetime. However, not enough is known about Fetal Alcohol Spectrum Disorders (FASD).

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Fetal Alcohol Spectrum Syndrome Research (FASDs), Prenatal Substance Exposure, and Prevention Research Fetal Alcohol Spectrum Disorders (FASDs), Prenatal Substance Exposure, and Prevention Research Preventing FAS/ARND in Russian Children (NIH, National Institute on Alcohol and Alcoholism (NIAAA) and Fogarty International Center). Fetal alcohol spectrum disorder is an umbrella phrase that includes the more well known ‘fetal alcohol syndrome,’ which can be fatal. FASD also can cause severe complications with learning ability and behavior, stunted development, and facial abnormalities.