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Khemiri L, Kuja-Halkola R, Larsson H, Butwicka A, Tideman M, D'Onofrio BM, Latvala A, Lichtenstein P. Parental substance use disorder and risk of intellectual disability in offspring in Sweden: a national register study. EClinicalMedicine 2023; 63:102170. [PMID: 37680949 PMCID: PMC10480548 DOI: 10.1016/j.eclinm.2023.102170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Background Intellectual disability (ID) is a disorder with unknown aetiology in many cases. Maternal alcohol use is a known risk factor for ID, but less is known about the importance of maternal and paternal substance use disorder (SUD) and risk of ID in offspring. Methods Data from multiple nationwide registers were used to create a cohort of children born from January 01, 1978 to December 31, 2002. All participants were born in Sweden, had available parental identification information and did not emigrate or die before age 12 (n = 1,940,820). Logistic regression modelling was performed with exposure defined as having a parent who received any SUD diagnosis, including alcohol use disorder (AUD) and drug use disorder (DUD). The outcome was registration of diagnosis of any form of ID. First, we analysed the risk of ID if parental SUD was registered prior to childbirth with stepwise adjustment of multiple covariates. Second, the effect of timing of SUD diagnosis in relation to childbirth was analysed. Findings Of 37,410 offspring with parental SUD registered prior to birth, 3.0% (n = 1110) had any form of ID compared to 1.2% (n = 23,168) of those 1,903,410 individuals without parental SUD prior birth. Parental SUD prior birth was associated with an increased risk of any form of ID (Odds Ratio [OR]: 2.3 [2.2-2.5]), with ORs similar for maternal (OR: 2.3 [2.1-2.5]) and paternal SUD (OR: 2.3 [2.1-2.5]). These ORs were reduced but remained statistically significant after adjusting for parental education, migration, psychiatric comorbidity, and co-parent SUD (OR parental SUD: 1.6 [1.5-1.8]; OR maternal SUD: 1.4 [1.2-1.5]; OR paternal SUD: 1.6 [1.5-1.7]). Parental SUD was associated with increased risk of ID in offspring irrespective of timing of diagnosis, but if mothers or fathers were diagnosed with AUD during pregnancy (OR maternal AUD: 5.0 [3.1-8.2]; OR paternal AUD: 2.8 [2.2-3.6]), the risk was significantly greater than if the AUD diagnosis was first registered after childbirth (OR maternal AUD: 1.9 [1.8-2.0]; OR paternal AUD: 1.6 [1.6-1.7]). Interpretation Both paternal and maternal SUD were associated with an increased risk of ID in offspring, with greatest risk observed when AUD was diagnosed during pregnancy. Possible mechanisms may involve shared genetic and environmental factors, including toxic effects from alcohol intake. These findings have clinical implications in suggesting that parental SUD in either parent represents a possibly modifiable risk factor to consider when developing prevention, diagnostics and treatment programs for children with ID. Funding Stockholm County Council, the Research Council of the Swedish Alcohol Retailing Monopoly, Fredrik and Ingrid Thurings stiftelse, Academy of Finland, the Swedish Research Council and the Swedish Research Council for Health, Working Life and Welfare, Nordforsk by the Nordic Council of Ministers and the Polish Medical Research Agency.
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Affiliation(s)
- Lotfi Khemiri
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Magnus Tideman
- Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Brian M. D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Antti Latvala
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Skogsdal Y, Karlsson J, Tydén T, Patil S, Backman H. The association of smoking, use of snuff, and preconception alcohol consumption with spontaneous abortion: A population-based cohort study. Acta Obstet Gynecol Scand 2022; 102:15-24. [PMID: 36222196 PMCID: PMC9780718 DOI: 10.1111/aogs.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/29/2022] [Accepted: 09/20/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION It is unclear whether tobacco in early pregnancy and alcohol use preceding pregnancy are associated with spontaneous abortion. The purpose was to investigate if use of tobacco and/or alcohol is associated with spontaneous abortion among women attending antenatal care, and if age and body mass index (BMI) attenuate the risk. MATERIAL AND METHODS A population-based cohort study based on data from the Swedish Pregnancy Register. All pregnant women having had the first antenatal visit from January 2014 to July 2018 were included (n = 525 604). The register had information about smoking and use of snuff before and in early pregnancy, as well as data on alcohol habits before pregnancy, measured by the Alcohol Use Disorders Identification Test (AUDIT), a validated questionnaire. Logistic regression analysis was used to estimate the association between lifestyle factors and spontaneous abortion, and multiple imputation was used to impute missing data. RESULTS In total, 34 867 (6.6%) pregnancies ended in a spontaneous abortion after the first visit to maternal health care. At the first maternal healthcare visit, daily smoking was reported by 24 214 (5.1%), and 6403 (1.2%) used snuff. For 19 837 (4.2%) women, a high alcohol score was reported for the year preceding pregnancy. After adjusting for potential confounders and multiple imputation, use of tobacco was associated with spontaneous abortion; smoking 1-9 cigarettes/day (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.04-1.18), smoking 10 or more cigarettes/day (aOR 1.12, 95% CI 1.-1.26), and use of snuff (aOR 1.20, 95% CI 1.06-1.37). Higher AUDIT scores were not significantly associated with spontaneous abortion (AUDIT 6-9: aOR 1.03, 95% CI 0.97-1.10 and AUDIT 10 or more: aOR 1.07, 95% CI 0.94-1.22). Increasing maternal age showed the highest risk of spontaneous abortion from the age of 35, and BMI of 30 kg/m2 or more increased the risk. There were interactions between different lifestyle factors associated with spontaneous abortion that could either increase or decrease the risk of spontaneous abortion. CONCLUSIONS Smoking and use of snuff were associated with an increased risk of spontaneous abortion. The AUDIT scores preceding pregnancy were not associated with an increased risk of spontaneous abortion, which contradicts the results from previous studies.
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Affiliation(s)
- Yvonne Skogsdal
- Maternal Health Care Unit, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Jan Karlsson
- University Health Care Research CenterFaculty of Medicine and Health, Örebro UniversityÖrebroSweden
| | - Tanja Tydén
- Department of Women's and Children's HealthAkademiska SjukhusetUppsalaSweden
| | - Snehal Patil
- Clinical Epidemiology and Biostatistics, School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
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Asp J, Bergman L, Lager S, Axelsson O, Wikström A, Hesselman S. Alcohol exposure prior to pregnancy-does hazardous consumption affect placenta- and inflammatory-mediated pregnancy outcomes? A Swedish population-based cohort study. Acta Obstet Gynecol Scand 2022; 101:1386-1394. [PMID: 36073360 PMCID: PMC9812091 DOI: 10.1111/aogs.14451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/14/2022] [Accepted: 08/24/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Alcohol consumption during pregnancy is related to severe birth complications such as low birthweight, preterm birth and birth defects. During the last decade, the Alcohol Use Disorders Identification Test (AUDIT) has been used as a screening tool in Swedish maternal healthcare units to identify hazardous, pre-pregnancy alcohol use. However, evaluation of the screening with AUDIT, as well as adverse maternal or neonatal outcomes, has not been assessed at a national level. MATERIAL AND METHODS This was a population-based cohort study of 530 458 births from 2013 to 2018 using demographic, reproductive and maternal health data from the Swedish Pregnancy Register. Self-reported alcohol consumption in the year before pregnancy, measured as AUDIT scores, was categorized into moderate (6-13 points) and high-risk (14-40 points) consumption, with low-risk (0-5 points) consumption as the reference group. Associations with pregnancy- and birth outcomes were explored with logistic regressions using generalized estimating equation models, adjusting for maternal and socioeconomic characteristics. Estimates are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS High-risk and moderate pre-pregnancy alcohol consumption was associated with preeclampsia, preterm birth and birth of an infant small for gestational age (SGA), but these associations were nonsignificant after adjustments. Prior moderate-risk (aOR 1.29, 95% CI 1.17-1.42) and high-risk consumption (aOR 1.62, 95% CI 1.17-2.25) increased the likelihood of intrapartum and neonatal infections. CONCLUSIONS Apart from identifying hazardous alcohol consumption prior to pregnancy and the offer of counseling, screening with the AUDIT in early pregnancy indicates a high risk of inflammatory-/placenta-mediated pregnancy and birth outcomes. For most outcomes, AUDIT was not an independent contributor when adjusting for confounding factors. Hazardous alcohol use prior to pregnancy was independently linked to intrapartum and neonatal infections; conditions associated with morbidity and long-term sequalae. These associations may be explained by alcohol-induced changes in the maternal or fetal immune system in early pregnancy or persistent alcohol intake during pregnancy, or may depend on unidentified confounding factors.
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Affiliation(s)
- Joline Asp
- Center for Clinical Research SörmlandUppsala UniversityEskilstunaSweden,Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Lina Bergman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden,Department of Obstetrics and GynecologyInstitute of Clinical Science, Sahlgrenska Academy, University of GothenburgGothenburgSweden,Department of Obstetrics and GynecologyStellenbosch UniversityStellenboschSouth Africa
| | - Susanne Lager
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Ove Axelsson
- Center for Clinical Research SörmlandUppsala UniversityEskilstunaSweden,Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | | | - Susanne Hesselman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden,Center for Clinical Research DalarnaFalunSweden
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Periconceptual and prenatal alcohol consumption and neurodevelopment at age two and five years. Eur J Obstet Gynecol Reprod Biol 2022; 274:197-203. [PMID: 35667175 DOI: 10.1016/j.ejogrb.2022.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Examine the association between alcohol consumption before and during pregnancy and neurodevelopmental outcomes in the offspring at two and five years. STUDY DESIGN Retrospective analysis of a prospective longitudinal cohort; SCOPE-BASELINE. Data on pre-conception and prenatal alcohol consumption were obtained at 15 weeks' gestation and categorised as abstinent, occasional-low (1-7units/week) and moderate-heavy (≥8units/week). Binge drinking was defined as ≥6 units/session. Outcome measures (Child Behaviour Checklist and Kaufman Brief Intelligence Test) were obtained at two and five years. Linear regression examined an alcohol consumption and Child Behaviour Checklist and Kaufman Brief Intelligence Test relationship, adjusting for several potential confounders. RESULTS Data on alcohol consumption was available for 1,507 women. Adjusted linear regression suggested few associations: pre-pregnancy occasional-low alcohol consumption was associated with lower log externalizing Child Behaviour Checklist scores (-0.264, 95% CI: -0.009, -0.520), while pre-pregnancy moderate-high levels of alcohol consumption was associated with lower Kaufman Brief Intelligence Test verbal standard scores (-0.034, 95% CI: -0.001, -0.068) and composite IQ scores (-0.028, 95% CI: -0.056, -0.0004) at five-years. In the first trimester, moderate-high levels of alcohol consumption was associated with lower internalizing Child Behaviour Checklist scores at two-years (-0.252, 95% CI: -0.074, -0.430). No significant associations were observed between number of binge episodes pre-pregnancy or binge drinking in the first trimester and Child Behaviour Checklist or Kaufman Brief Intelligence Test. CONCLUSIONS We did not find strong evidence of associations between pre-pregnancy and early pregnancy maternal alcohol consumption and adverse neurodevelopmental outcomes at age two and five years overall. Further research examining alcohol consumption (including binge drinking) beyond 15 weeks' gestation and subsequent neurodevelopmental outcomes is needed to examine the potential effect of alcohol consumption in later pregnancy.
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Peltonen K, Kurki M, Reedtz C, Kaiser S, Rasmussen LMP, Merikukka M, Rye M, Laajasalo T, Kyrrestad H, Karjalainen P, Pettersen SD, Eng H, Breivik K, Martinussen M. Psychological tests for expectant parents and young children in the Nordic countries: A review of the evidence. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2022. [DOI: 10.1080/17405629.2022.2067141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Kirsi Peltonen
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
| | - Marjo Kurki
- Department of Psychology, Itla Children’s Foundation, Helsinki, Finland
| | - Charlotte Reedtz
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sabine Kaiser
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Lene-Mari P. Rasmussen
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marko Merikukka
- Department of Psychology, Itla Children’s Foundation, Helsinki, Finland
| | - Marte Rye
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Henriette Kyrrestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Piia Karjalainen
- Department of Psychology, Itla Children’s Foundation, Helsinki, Finland
| | - Susann Dahl Pettersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Helene Eng
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kyrre Breivik
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Monica Martinussen
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
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Alcohol and illicit and non-medical prescription drug use before and during pregnancy in Stockholm, Sweden: A cross-sectional study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100622. [PMID: 34010729 DOI: 10.1016/j.srhc.2021.100622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/13/2020] [Accepted: 04/07/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To provide current estimates of alcohol and drug use among pregnant women attending antenatal care lectures in preparation for childbirth in Stockholm, Sweden. STUDY DESIGN A cross-sectional study. Data was collected anonymously among women attending lectures in preparation for childbirth. MAIN OUTCOME MEASURES The prevalence of alcohol and illicit and non-medical prescription drug use among pregnant women attending antenatal care lectures in preparation for childbirth. RESULTS Nine hundred and thirty-six pregnant women attending lectures in preparation for childbirth participated. Among those answering all questions about alcohol use during pregnancy, 4.2 percent reported use (95% confidence interval (CI), 3.0-5.7%) and among those answering all questions about illicit or non-medical prescription drug use during pregnancy, 0.5 percent reported such use (95% CI, 0.1-1.3%). The prevalences of binge drinking during pregnancy and alcohol and drug use before pregnancy are presented. Comparisons of anonymously and non-anonymously collected data are included. CONCLUSIONS Approximately one in 25 women reported using alcohol and approximately one in 200 reported using illicit or non-medical prescription drugs while pregnant. Alcohol use during pregnancy may have decreased in Stockholm, Sweden.
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Adler J, Rissmann A, Kropf S, Mohnicke K, Taneva E, Ansorge T, Zenker M, Wex T. Estimated Prevalence of Harmful Alcohol Consumption in Pregnant and Nonpregnant Women in Saxony-Anhalt (NorthEast Germany) Using Biomarkers. Alcohol Clin Exp Res 2021; 45:819-827. [PMID: 33547677 DOI: 10.1111/acer.14567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/27/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Alcohol consumption is commonly accepted in Western societies and is a known risk factor in pregnancy, which could lead to fetal alcohol spectrum disorders (FASDs). Prevalence of alcohol consumption during pregnancy is mostly unknown. Prevalence estimates in publications based on questionnaires are limited by possible underreporting due to social stigmatization. The aim of this study was to estimate the prevalence of harmful alcohol consumption in a large cohort of pregnant women using different biomarkers related to alcohol consumption and compare the findings with those of non-pregnant women METHODS: Routine parameters known to be influenced by alcohol consumption (γ-glutamyltransferase, GGT; carbohydrate-deficient transferrin, CDT/%CDT; mean corpuscular/cell volume, MCV; combined parameter of GGT and %CDT, GGT-CDT) were analyzed in serum samples of 2,182 pregnant women and 743 non-pregnant, age-matched females. Data were tested for (i) differences between pregnant and non-pregnant women and (ii) changes across the 3 trimesters of pregnancy. RESULTS Prevalence rates differ greatly according to the parameter and cutoff, which reflects the limitations of assessing alcohol consumption with biomarkers. The prevalence of harmful alcohol consumption on the basis of a single or several elevated parameters was 13.8% (95% CI: 12.4 to 15.2) in pregnant women and 18.6% (95% CI: 15.8 to 21.4) in non-pregnant women, though 85.0% of the elevated measurements were attributable to an isolated elevation in %CDT only. Using GGT-CDT as the parameter with the highest specificity according to the literature, the estimated prevalence of harmful alcohol consumption in pregnancy is 0.5% (95% CI: 0.2 to 0.7). CONCLUSION Estimated prevalence rates differ greatly with respect to the biomarkers and cutoffs used. The use of CDT/%CDT alone appears to overestimate harmful alcohol consumption during pregnancy.
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Affiliation(s)
- Jakob Adler
- Medical Laboratory for Clinical Chemistry, Microbiology, Infectious Diseases and Genetics "Prof. Schenk/Dr. Ansorge & Colleagues, Magdeburg, Germany
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Siegfried Kropf
- Institute for Biometry and Medical Informatics, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Klaus Mohnicke
- Department of Pediatrics, Pediatric Endocrinology, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Elina Taneva
- Medical Laboratory for Clinical Chemistry, Microbiology, Infectious Diseases and Genetics "Prof. Schenk/Dr. Ansorge & Colleagues, Magdeburg, Germany
| | - Thomas Ansorge
- Medical Laboratory for Clinical Chemistry, Microbiology, Infectious Diseases and Genetics "Prof. Schenk/Dr. Ansorge & Colleagues, Magdeburg, Germany
| | - Martin Zenker
- Institute of Human Genetics, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Thomas Wex
- Medical Laboratory for Clinical Chemistry, Microbiology, Infectious Diseases and Genetics "Prof. Schenk/Dr. Ansorge & Colleagues, Magdeburg, Germany
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McKeague M, Norton S, Canfield M. A review of factors associated with patterns of drinking during pregnancy. ADVANCES IN DUAL DIAGNOSIS 2019. [DOI: 10.1108/add-08-2019-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose
The purpose of this paper is to identify factors associated with drinking patterns during pregnancy.
Design/methodology/approach
A rapid evidence assessment was undertaken, scanning multiple databases for studies examining factors associated with alcohol consumption in pregnancy. Studies were included if they stratified data according to quantity of alcohol consumed and identified relevant associated factors. Drinking patterns were classified as light/moderate and heavy/binge.
Findings
In total, 15 studies were included (N=7 light/moderate; N=15 heavy/binge drinking). Factors associated with alcohol consumption during pregnancy included: smoking, age, SES, marital status, pre-pregnancy substance use and parity. While few studies reported an association between heavy/binge drinking and maternal mental health, none of the studies included explored the association between mental health and light/moderate drinking.
Research limitations/implications
Relatively few studies have looked at the association between psychological characteristics of women and their drinking patterns. There is a lack of articles examining light/moderate drinking in pregnancy compared to heavy/binge drinking. Moreover, there is marked variation in how alcohol use is measured. Further studies are needed to increase understanding of the association between psychological factors and patterns of drinking during pregnancy, and how health professionals might support women in this context.
Originality/value
The authors expand on previous work by examining two different patterns of alcohol consumption in pregnancy, rather than alcohol use simply as an isolated concept. The two groups were found to differ in a number of demographic and social factors. This information could be used to aid healthcare professionals in targeting specific interventions to those women most at risk.
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Alcohol consumption during pregnancy and risk of small-for-gestational-age newborn. Women Birth 2018; 32:284-288. [PMID: 30119966 DOI: 10.1016/j.wombi.2018.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Contradictory results have been published on the association of alcohol consumption during pregnancy with perinatal outcomes, including the risk of small for gestational age newborn. AIM To determine whether alcohol consumption during pregnancy is associated with the risk of small for gestational age newborn. METHOD A case-control study with 518 pairs of pregnant Spanish women in five hospitals was conducted; cases were women with small for gestational age newborn and age-matched (±2years) controls were women with non-small for gestational age newborn. Data were gathered on demographic characteristics, socioeconomic status, toxic habits, and diet. Alcohol intake was recorded with a self-administered 137 food frequency questionnaire and with a personal interview, Alcohol intake was categorized -. Agreement in alcohol intake results between direct interview and frequency food questionnaire was evaluated with the Kappa index. Crude and adjusted odds ratios and their 95% confidence intervals were estimated by conditional logistic regression. FINDINGS Poor agreement was observed between food frequency questionnaire and personal interview results for both cases (κ=0.23) and controls (κ=0.14). A food frequency questionnaire-recorded intake of less than 4g/day was associated with a significantly lower odds ratios for small for gestational age newborn (odds ratios=0.62, 95% confidence intervals, 0.43-0.88), whereas an interview-recorded intake of <4g/day was not related to small for gestational age newborn (odds ratios=0.86, 95% confidence intervals, 0.49-1.54). CONCLUSIONS A very moderate alcohol intake during pregnancy may have a negative association with the risk of having a small for gestational age newborn.
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Comasco E, Rangmar J, Eriksson UJ, Oreland L. Neurological and neuropsychological effects of low and moderate prenatal alcohol exposure. Acta Physiol (Oxf) 2018; 222. [PMID: 28470828 DOI: 10.1111/apha.12892] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/17/2017] [Accepted: 04/27/2017] [Indexed: 01/18/2023]
Abstract
Several explanations for the diverse results in research on foetal alcohol spectrum disorders or alcohol-related neurodevelopmental disorder might be at hand: timing, amount and patterns of alcohol exposure, as well as complex epigenetic responses. The genetic background of the offspring and its interaction with other prenatal and post-natal environmental cues are likely also of importance. In the present report, key findings about the possible effects of low and moderate doses of maternal alcohol intake on the neuropsychological development of the offspring are reviewed and plausible mechanisms discussed. Special focus is put on the serotonergic system within developmental and gene-environment frameworks. The review also suggests guidelines for future studies and also summarizes some of to-be-answered questions of relevance to clinical practice. Contradictory findings and paucity of studies on the effects of exposure to low alcohol levels during foetal life for the offspring's neuropsychological development call for large prospective studies, as well as for studies including neuroimaging and multi-omics analyses to dissect the neurobiological underpinnings of alcohol exposure-related phenotypes and to identify biomarkers. Finally, it remains to be investigated whether any safe threshold of alcohol drinking during pregnancy can be identified.
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Affiliation(s)
- E. Comasco
- Department of Neuroscience; Uppsala University; Uppsala Sweden
| | - J. Rangmar
- Department of Psychology; University of Gothenburg; Gothenburg Sweden
| | - U. J. Eriksson
- Department of Medical Cell Biology; Uppsala University; Uppsala Sweden
| | - L. Oreland
- Department of Neuroscience; Uppsala University; Uppsala Sweden
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11
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Chiandetti A, Hernandez G, Mercadal-Hally M, Alvarez A, Andreu-Fernandez V, Navarro-Tapia E, Bastons-Compta A, Garcia-Algar O. Prevalence of prenatal exposure to substances of abuse: questionnaire versus biomarkers. Reprod Health 2017; 14:137. [PMID: 29070078 PMCID: PMC5657059 DOI: 10.1186/s12978-017-0385-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/12/2017] [Indexed: 01/18/2023] Open
Abstract
Alcohol and drugs of abuse consumption in young adults, including women of childbearing age, has experienced significant increase over the past two decades. The use of questionnaires as the only measure to investigate prenatal alcohol and drugs of abuse exposure underestimates the real prevalence of exposure and could mislead to wrong conclusions. Therefore, the aim of this article was to compare reported rates of prenatal alcohol and drugs of abuse consumption with biomarkers of exposure by a comprehensive review of the available literature. We searched MEDLINE and EMBASE databases for articles catalogued between 1992 and 2015. We identified relevant published studies that assessed the comparison between prenatal exposure to alcohol and drugs of abuse assessed by self-reported questionnaire of consumption versus biomarkers of exposure. Thirteen studies were included regarding alcohol consumption, and seven of them about drugs of abuse. Women who admitted consumption during pregnancy by questionnaire varied from 0 to 37% for alcohol, from 0 to 4.3% for cocaine, and 2.9% for tetrahydrocannabinol (THC). Positive biomarkers results ranged from 16 to 44% for alcohol, 15.4% for cocaine, and from 4 to 12.4% for THC. Biomarkers should always complement questionnaires, as it has been shown that self-report may underestimate prenatal exposure to substances of abuse.
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Affiliation(s)
- Antonella Chiandetti
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain.,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Gimena Hernandez
- Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Grup de Recerca en Farmacologia (GRF), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - María Mercadal-Hally
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain.,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Airam Alvarez
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain.,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Vicente Andreu-Fernandez
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain
| | - Elisabet Navarro-Tapia
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain
| | - Adriana Bastons-Compta
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain
| | - Oscar Garcia-Algar
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain. .,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Dumas A, Toutain S, Simmat-Durand L. Alcohol Use During Pregnancy or Breastfeeding: A National Survey in France. J Womens Health (Larchmt) 2017; 26:798-805. [DOI: 10.1089/jwh.2016.6130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Agnès Dumas
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
- Université Paris-Sud, Orsay, France
| | - Stéphanie Toutain
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société (CERMES3), UMR CNRS 8211, INSERM U988, EHESS, Paris, France
| | - Laurence Simmat-Durand
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société (CERMES3), UMR CNRS 8211, INSERM U988, EHESS, Paris, France
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Socioeconomic Status, Alcohol Use, and Pregnancy Intention in a National Sample of Women. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016. [PMID: 26220497 DOI: 10.1007/s11121-015-0578-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Using data from the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional study was conducted to explore the role of socioeconomic status as a potential modifier on the relationship between a woman's intention to become pregnant and her drinking behaviors. The analytic sample included 37,777 fertile women aged 18-44 years. The primary outcomes were any, heavy, or binge drinking. The analysis included three separate multivariable logistic regression models to account for the complex survey methodology utilized in the BRFSS. In the unadjusted models, women intending a pregnancy were less likely to drink at heavy (OR = 0.68, CI = 0.50, 0.93) or binge (OR = 0.80, CI = 0.67, 0.96) levels compared to those not intending a pregnancy. Adjusted regression models indicated that both education and income modified the relation between pregnancy intention and any drinking and binge drinking. After performing a multivariable regression model stratified by education, women who had more than a high school education and were intending to become pregnant were 28 % less likely to binge drink than those not intending a pregnancy (OR = 0.72, CI = 0.57, 0.90). Stratification by income indicated that women intending to become pregnant within the middle income categories were less likely to drink any alcohol compared to those not intending a pregnancy. Pregnancy intention and binge drinking were associated among women with more than a high school education, with those intending a pregnancy being less likely to binge drink. Generally, as education increased, the association between income and binge drinking weakened.
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Kesmodel US. Risks and guidelines for the consumption of alcohol during pregnancy. World J Obstet Gynecol 2016; 5:162-174. [DOI: 10.5317/wjog.v5.i2.162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/13/2015] [Accepted: 01/22/2016] [Indexed: 02/05/2023] Open
Abstract
Daily average intake of alcohol during pregnancy has consistently been associated with short term adverse outcomes such as miscarriage, preterm birth and intrauterine growth restriction, a large variety of malformations, as well as long term adverse outcomes such as foetal alcohol syndrome, mental retardation and general impairment of cognitive functions including intelligence, attention, learning abilities as well as social and behavioural functions. Weekly average consumption and alcohol binge drinking (usually defined as ≥ 5 drinks on a single occasion) independently of high daily average intake has not been consistently associated with short and long term adverse outcomes. Health authorities in most countries recommend that pregnant women completely abstain from alcohol. Even so, many health professionals including doctors, midwives and nurses do not provide information to pregnant women in accordance with the official recommendations, although a large proportion of women of child bearing age and pregnant women drink alcohol, especially before recognition of pregnancy. The discrepancy between guidelines and the information practice of health personnel is likely to continue to exist because guidelines of abstinence are not clearly evidence-based and not in line with current focus on autonomy and informed choice for patients, and because guidelines do not consider the everyday clinical communication situation.
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15
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Claesson IM, Hultgren E, Blomberg M. Lifestyle habits and women's attitudes towards discussing them at a visit for contraceptive advice. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 6:114-8. [PMID: 26842632 DOI: 10.1016/j.srhc.2014.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 08/06/2014] [Accepted: 08/15/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aims of this study was to use visits for contraceptive counselling as opportunities for examining women's actual life style habits with the main focus being placed on alcohol consumption but also to evaluate the women's opinions about discussing their alcohol and tobacco habits and their weight status. METHODS A total of 535/802 (67%) women completed a study-specific anonymous questionnaire after a contraceptive counselling visit with a midwife. RESULTS A majority of the women thought that a discussion concerning alcohol habits at a contraceptive counselling session was important (85.5%) and not intrusive (86.4%) neither embarrassing (81.7%). Women with high-risk drinking habits were younger, more often tobacco users and more often planning for childbirth in the future, compared with women who did not display high-risk drinking behaviour. A significantly higher percentage of women who practiced high-risk drinking thought that a discussion of alcohol was intrusive (10.9%) and embarrassing (46.7%), compared with women not practicing high-risk alcohol consumption. Most women (72.9%) stated that no other caregiver during the preceding year except the midwife had discussed drinking habits with them. The weight was a good thing that the midwife brought up for discussion according to 82.5% of the women but the discussions about weight was more often found embarrassing (18.4%) than the discussion about alcohol habits. CONCLUSION Women who came for contraceptive counselling found the discussion concerning alcohol habits important, not intrusive or embarrassing and a good thing to be brought up by the midwife.
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Affiliation(s)
- Ing-Marie Claesson
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping University, Linköping, Sweden.
| | - Eva Hultgren
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping University, Linköping, Sweden
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El Ammouri A, Sabir M, Ahid S, Toufiq J, El Omari F. [Non-drug psycho-active substance use and pregnancy]. Encephale 2015; 41:302-8. [PMID: 26383617 DOI: 10.1016/j.encep.2014.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 03/26/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND The consumption of psycho-active substances (PAS) by pregnant women is in a growing increase around the world. It is a major problem of public health in some countries due to serious and negative consequences for children and society as well as for pregnant women. This problem has also increased among women in Morocco. However, it is still neglected and underrated in the absence of any official statistical data. This is the first study leading to a better profiling of pregnant women who may consume psycho-active substances during their pregnancy; it would permit better medical and psychosocial care of both women and children. OBJECTIVES To determine the prevalence and the factors associated with the psycho-active substances used by pregnant women and describe their socio-demographic characteristics. METHODS AND PATIENTS A trans-sectional study was carried out from September to October 2010, including pregnant women consulting at the obstetrical service of the provincial hospital Moulay Abdellah in the city of Salé. The study included women who were pregnant or had recently given birth, and not having any serious mental disorders that could have upset their cognitive abilities. The data was collected through a straight questionnaire of 25 items specifying the socio-demographic characteristics, data about pregnancy and habits of using psycho-active substances. RESULTS One hundred and fifty pregnant women were included in the study. The majority of them (83.2%) were aged 20 to 40 years old, 94.6% were married, 96% were unemployed and depended on their spouses for their financial resources and 80% had normal domestic relationships (from average to good quality). Among the women, 31.3% of them reported traumatic events in the past. The prevalence of psycho-active substance consumption by the pregnant women of our sample was 11.3%. The used substances were tobacco (9.3%) and cannabis (4%). These women were more likely to have a low level of education (47.1 vs 16.5). They were victims of abuse or neglect in their past (82.3 vs 24.9), and their relationships with their spouses were bad (70.6 vs 13.5) with a lack of desired pregnancy (47.1 vs 27.8) and poor follow-up (47.1 vs 3.8). The results show statistically significant differences. CONCLUSION Not only should decision-makers draw attention to the seriousness of the problem because of the relatively high rate of psycho-active substance consumption, but also they should increase obstetric team's awareness to look systematically for psycho-active substance use.
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Affiliation(s)
- A El Ammouri
- Hôpital psychiatrique universitaire Ar-razi, CHU Rabat-Salé, rue Ibn-Rochd, 11010 Salé, Maroc.
| | - M Sabir
- Hôpital psychiatrique universitaire Ar-razi, CHU Rabat-Salé, rue Ibn-Rochd, 11010 Salé, Maroc
| | - S Ahid
- Équipe de recherche en pharmaco-épidémiologie & pharmaco-économie, faculté de médecine et de pharmacie, université Mohammed V Souissi, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Maroc
| | - J Toufiq
- Hôpital psychiatrique universitaire Ar-razi, CHU Rabat-Salé, rue Ibn-Rochd, 11010 Salé, Maroc
| | - F El Omari
- Hôpital psychiatrique universitaire Ar-razi, CHU Rabat-Salé, rue Ibn-Rochd, 11010 Salé, Maroc
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Braga DPAF, Halpern G, Setti AS, Figueira RCS, Iaconelli A, Borges E. The impact of food intake and social habits on embryo quality and the likelihood of blastocyst formation. Reprod Biomed Online 2015; 31:30-8. [DOI: 10.1016/j.rbmo.2015.03.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 03/03/2015] [Accepted: 03/17/2015] [Indexed: 01/18/2023]
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Strengell P, Väisänen I, Joukamaa M, Luukkaala T, Seppä K. Psychiatric comorbidity among substance misusing mothers. Nord J Psychiatry 2015; 69:315-21. [PMID: 25426622 DOI: 10.3109/08039488.2014.978892] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Approximately half of patients suffering from a significant drug or alcohol related disorder also match the criteria of some other psychiatric disorder. Yet, little is known about comorbidity among substance misusing pregnant women. AIMS To estimate the prevalence of psychiatric diseases among mothers with substance misuse severe enough to end up in an assessment at a specialized addiction clinic and to compare their backgrounds to the controls. METHODS Between 1 June 2003 and 31 December 2005, the maternity clinics in Pirkanmaa health district were asked to refer mothers with possible substance misuse to Tampere University Addiction Psychiatric Clinic, where 119/217 patients were considered misusers. Of these, 49/119 (41.2%) participated in the whole study. At baseline, the assessment was made using the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and at the end of the study, 6-12 months after delivery, with the Structured Clinical Interview for DSM-IV (SCID). The comparison group (n = 74) filled a postal survey concerning their background and substance use. RESULTS 57% of substance misusing pregnant women had psychiatric illnesses; 6-12 months after delivery the number of substance use-related diagnoses was 40%. However, the number, spectrum and severity of psychiatric diagnoses were high in this group. CONCLUSIONS Psychiatric comorbidity is common among substance misusing mothers. Their social situation is often very difficult and support needs vary a lot. In order to offer them best possible treatment, diagnosing these disorders should be a routine part of evaluation during pregnancy.
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Affiliation(s)
- Paula Strengell
- Paula Strengell, Medical School, University of Tampere; Department of Psychiatry, Tampere University Hospital , Tampere , Finland
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Kydd RM, Connor J. Inconsistency in reporting abstention and heavy drinking frequency: associations with sex and socioeconomic status, and potential impacts. Alcohol Alcohol 2015; 50:333-45. [PMID: 25648932 DOI: 10.1093/alcalc/agu106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 12/22/2014] [Indexed: 01/18/2023] Open
Abstract
AIMS To describe inconsistencies in reporting past-year drinking status and heavy drinking occasions (HDOs) on single questions from two different instruments, and to identify associated characteristics and impacts. METHODS We compared computer-presented Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) with categorical response options, and mental health interview (MHI) with open-ended consumption questions, completed on the same day. Participants were 464 men and 459 women aged 38 (91.7% of surviving birth cohort members). Differences in dichotomous single-item measures of abstention and HDO frequency, associations of inconsistent reporting with sex, socioeconomic status (SES) and survey order, and impacts of instrument choice on associations of alcohol with sex and SES were examined. RESULTS The AUDIT-C drinking frequency question estimated higher past-year abstention prevalence (AUDIT = 7.6%, MHI = 5.4%), with one-third of AUDIT-C abstainers being MHI drinkers. Only AUDIT-C produced significant sex differences in abstainer prevalence. Inconsistencies in HDO classifications were bidirectional, but with fewer HDOs reported on the MHI than AUDIT-C question. Lower SES was associated with inconsistency in abstention and weekly+ HDOs. Abstention and higher HDO frequency were associated with lower SES overall, but sex-specific associations differed by instrument. CONCLUSIONS In this context, data collection method affected findings, with inconsistencies in abstention reports having most impact. Future studies should: (a) confirm self-reported abstention; (b) consider piloting data collection methods in target populations; (c) expect impacts of sex and SES on measurements and analyses.
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Affiliation(s)
- Robyn M Kydd
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Bortes C, Geidne S, Eriksson C. Preventing Alcohol Consumption during Pregnancy: A Randomized Controlled Trial. Health (London) 2015. [DOI: 10.4236/health.2015.73033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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The effectiveness of a brief intervention to reduce alcohol consumption in pregnancy: a controlled trial. Ir J Psychol Med 2014; 31:175-189. [PMID: 30189489 DOI: 10.1017/ipm.2014.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Alcohol consumption during pregnancy potentially has significant effects on both mother and baby. The aim of the study was to determine the effectiveness of a brief intervention to reduce alcohol consumption during pregnancy. METHODS This study was performed at the outpatient antenatal clinics of a large academic maternity teaching hospital in Dublin city centre. Six hundred and fifty-six women who drank alcohol before pregnancy were recruited at their first antenatal clinic visit. Drinking patterns before pregnancy, since becoming pregnant, and in later pregnancy (at ~32 weeks of gestation) were assessed using the Alcohol Use Disorders Identification Test (AUDIT). A controlled study was conducted - participants were allocated to either the brief intervention group (screening and 5 minutes of non-directive discussion of their drinking pattern) or a control group (screening and treatment as usual). RESULTS Before pregnancy, 57% of women consumed five or more units of alcohol per drinking occasion (i.e. binge drinking); during pregnancy, the rate of binge drinking fell to 4.8%. Sixty per cent of women who drank before pregnancy ceased drinking when pregnant, and a further 9% reduced their intake substantially. Four hundred and ninety-nine women were followed up in later pregnancy. The brief intervention did not produce any significant reduction in alcohol consumption above that attributable to pregnancy and comprehensive screening in antenatal care. Larger reductions in alcohol intake during pregnancy were associated with younger age, non-Irish nationality and greater intake of alcohol before first antenatal clinic visit. CONCLUSION Pregnancy itself produces abstinence and large reductions in alcohol consumption, even among women who drink relatively heavily. Consequently, a universal screening and brief intervention programme is not warranted but screening and targeted interventions could be appropriate such as repeated interventions for those who continue to binge drink. Future research could include evaluating interventions for those women who continue to binge drink during pregnancy and exploring ways of maintaining reductions in alcohol consumption among women who decreased consumption during pregnancy.
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Osterman RL, Carle AC, Ammerman RT, Gates D. Single-session motivational intervention to decrease alcohol use during pregnancy. J Subst Abuse Treat 2014; 47:10-9. [PMID: 24637202 PMCID: PMC4012014 DOI: 10.1016/j.jsat.2014.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 01/08/2014] [Accepted: 01/21/2014] [Indexed: 01/29/2023]
Abstract
This randomized clinical trial tested the effectiveness of a single-session of motivational interviewing (MI) to decrease alcohol use during pregnancy, while examining theory-based mechanisms of the intervention. Eligible pregnant women who drank any amount of alcohol in the previous year (n=122) were randomized to an intervention or comparison group. Drinking behaviors, basic psychological need satisfaction, and autonomous motivation to decrease prenatal alcohol use were measured at baseline, 30 day postbaseline, and 30 day postpartum follow-ups. Poisson and linear regression with generalized estimating equations were used to evaluate treatment effects over time. Although MI was not found effective in decreasing alcohol use, low levels of reported alcohol use by the women at baseline left little room for improvement due to the intervention. To prevent fetal alcohol spectrum disorders, future studies will use self-report and biomarkers to more accurately identify women in need of interventions to reduce their risk of alcohol-exposed pregnancies.
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Affiliation(s)
- Robin L Osterman
- University of Cincinnati College of Nursing, Cincinnati, OH 45221, USA.
| | - Adam C Carle
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Robert T Ammerman
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Donna Gates
- University of Cincinnati College of Nursing, Cincinnati, OH 45221, USA
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[Pregnancy and substance use in France: a literature review]. ACTA ACUST UNITED AC 2014; 43:649-56. [PMID: 24930726 DOI: 10.1016/j.jgyn.2014.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/08/2014] [Accepted: 05/14/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Substance use during pregnancy is an important public health issue. It requires identifying at-risk populations and risk perception among women. MATERIALS AND METHODS A literature review was conducted. It included French studies conducted since 2000 on substance use during pregnancy (tobacco, alcohol, marijuana, psychotropic drugs) and risk perception. RESULTS In France, in 2010, 24% of pregnant women smoke--17% in the 3rd trimester. Depending on studies, the prevalence of alcohol use ranged from 12 to 63% and binge drinking ranged from 1 to 7%; daily drinking was below 0.5%. Marijuana use ranged from 1 to 3%, and psychotropic drugs ranged from 2 to 4%. Little research has been dedicated to risk perception. Studies show a lack of awareness about the equivalence of risks between fermented and distilled beverages and about the risks of moderate smoking during pregnancy. CONCLUSION Data is lacking to characterize at-risk populations and mechanisms underlying risky behaviors.
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Association between maternal alcohol consumption in early pregnancy and pregnancy outcomes. Obstet Gynecol 2013; 122:830-837. [PMID: 24084541 DOI: 10.1097/aog.0b013e3182a6b226] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To investigate the association between alcohol consumption and binge drinking before and during early pregnancy and adverse pregnancy outcomes. METHODS We used data from 5,628 nulliparous pregnant participants recruited to the Screening for Pregnancy Endpoints (SCOPE) study, a prospective cohort study. Participants were interviewed at 15 weeks of gestation and information on alcohol intake before pregnancy and until the time of interview was obtained using a standardized questionnaire. Alcohol intake was classified as occasional (1-2 units per week), low (3-7 units per week), moderate (8-14 units per week), and heavy (greater than 14 units per week). Binge alcohol consumption was defined as consumption of 6 or more alcohol units in one session. RESULTS Of the 5,628 participants, 1,090 (19%) reported occasional alcohol consumption, 1,383 (25%) low alcohol consumption, 625 (11%) moderate alcohol consumption, and 300 (5%) heavy alcohol consumption. Overall, 1,905 (34%) participants reported binge alcohol consumption in the 3 months before pregnancy, and 1,288 (23%) of these participants reported binge alcohol consumption during the first 15 weeks of pregnancy. Participants who consumed occasional to heavy amounts of alcohol in early pregnancy did not have altered odds of a small-for-gestational-age neonate, reduced birth weight, preeclampsia, or spontaneous preterm birth. Similarly, those who binge drank in early pregnancy did not have altered odds of these adverse pregnancy outcomes. CONCLUSION Alcohol consumption in early pregnancy was prevalent in this nulliparous cohort. There was no association between alcohol consumption before 15 weeks of gestation and small for gestational age, reduced birth weight, preeclampsia, or spontaneous preterm birth. LEVEL OF EVIDENCE : II.
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Skagerström J, Alehagen S, Häggström-Nordin E, Årestedt K, Nilsen P. Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden. BMC Public Health 2013; 13:780. [PMID: 23981786 PMCID: PMC3765772 DOI: 10.1186/1471-2458-13-780] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/12/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There is a paucity of research on predictors for drinking during pregnancy among women in Sweden and reported prevalence rates differ considerably between studies conducted at different antenatal care centres. Since this knowledge is relevant for preventive work the aim of this study was to investigate these issues using a multicenter approach. METHODS The study was conducted at 30 antenatal care centers across Sweden from November 2009 to December 2010. All women in pregnancy week 18 or more with a scheduled visit were asked to participate in the study. The questionnaire included questions on sociodemographic data, alcohol consumption prior to and during the pregnancy, tobacco use before and during pregnancy, and social support. RESULTS Questionnaires from 1594 women were included in the study. A majority, 84%, of the women reported alcohol consumption the year prior to pregnancy; about 14% were categorized as having hazardous consumption, here defined as a weekly consumption of > 9 standard drinks containing 12 grams of pure alcohol or drinking more than 4 standard drinks at the same occasion. Approximately 6% of the women consumed alcohol at least once after pregnancy recognition, of which 92% never drank more than 1 standard drink at a time. Of the women who were hazardous drinkers before pregnancy, 19% reduced their alcohol consumption when planning their pregnancy compared with 33% of the women with moderate alcohol consumption prior to pregnancy. Factors predicting alcohol consumption during pregnancy were older age, living in a large city, using tobacco during pregnancy, lower score for social support, stronger alcohol habit before pregnancy and higher score for social drinking motives. CONCLUSIONS The prevalence of drinking during pregnancy is relatively low in Sweden. However, 84% of the women report drinking in the year preceding pregnancy and most of these women continue to drink until pregnancy recognition, which means that they might have consumed alcohol in early pregnancy. Six factors were found to predict alcohol consumption during pregnancy. These factors should be addressed in the work to prevent alcohol-exposed pregnancies.
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Affiliation(s)
- Janna Skagerström
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, SE-581 83, Sweden.
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Shaheen SO, Rutterford C, Zuccolo L, Ring SM, Davey Smith G, Holloway JW, Henderson AJ. Prenatal alcohol exposure and childhood atopic disease: a Mendelian randomization approach. J Allergy Clin Immunol 2013; 133:225-32.e1-5. [PMID: 23806636 PMCID: PMC3884122 DOI: 10.1016/j.jaci.2013.04.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Alcohol consumption in western pregnant women is not uncommon and could be a risk factor for childhood atopic disease. However, reported alcohol intake may be unreliable, and associations are likely to be confounded. OBJECTIVE We aimed to study the relation between prenatal alcohol exposure and atopic phenotypes in a large population-based birth cohort with the use of a Mendelian randomization approach to minimize bias and confounding. METHODS In white mothers and children in the Avon Longitudinal Study of Parents and Children (ALSPAC) we first analyzed associations between reported maternal alcohol consumption during pregnancy and atopic outcomes in the offspring measured at 7 years of age (asthma, wheezing, hay fever, eczema, atopy, and total IgE). We then analyzed the relation of maternal alcohol dehydrogenase (ADH)1B genotype (rs1229984) with these outcomes (the A allele is associated with faster metabolism and reduced alcohol consumption and, among drinkers, would be expected to reduce fetal exposure to ethanol). RESULTS After controlling for confounders, reported maternal drinking in late pregnancy was negatively associated with childhood asthma and hay fever (adjusted odds ratio [OR] per category increase in intake: 0.91 [95% CI, 0.82-1.01] and 0.87 [95% CI, 0.78-0.98], respectively). However, maternal ADH1B genotype was not associated with asthma comparing carriers of A allele with persons homozygous for G allele (OR, 0.98 [95% CI, 0.66-1.47]) or hay fever (OR, 1.11 [95% CI, 0.71-1.72]), nor with any other atopic outcome. CONCLUSION We have found no evidence to suggest that prenatal alcohol exposure increases the risk of asthma or atopy in childhood.
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Affiliation(s)
- Seif O Shaheen
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
| | - Clare Rutterford
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Luisa Zuccolo
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Medical Research Council Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, United Kingdom
| | - Susan M Ring
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Medical Research Council Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, United Kingdom
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - A John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Mellingen S, Torsheim T, Thuen F. Changes in alcohol use and relationship satisfaction in Norwegian couples during pregnancy. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:5. [PMID: 23356958 PMCID: PMC3565924 DOI: 10.1186/1747-597x-8-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 01/24/2013] [Indexed: 01/18/2023]
Abstract
Background Numerous studies have documented a profound reduction in alcohol use among pregnant women, whereas research on expectant fathers has been scarce. The aim of this study was to measure changes in alcohol consumption from before pregnancy to 17 weeks in gestation for mothers and fathers, differentiating between parents with and without any previous children, and to measure how level and change in alcohol consumption into early pregnancy was associated with relationship satisfaction. Methods The data collection was conducted as part of the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. This cohort now includes 108 000 children, 90 700 mothers and 71 500 fathers recruited from 1999 to 2008. The present study comprises 82 362 couples. Alcohol consumption was assessed using a questionnaire including items about usual drinking frequency, quantities, and number of occasions with heavy episodic drinking (HED). Relationship satisfaction was measured by five items scored on a Likert agreement scale. Results The findings indicate that both mothers and fathers reduce their drinking significantly during pregnancy. Reduction was apparent for all three measures of alcohol consumption. First-time fathers reduced their alcohol consumption more than experienced fathers, from initially higher levels. The gap between the fathers and their pregnant partner was greater for first-time parents compared to parents with previous children. Drinking pre-pregnancy and relationship satisfaction during pregnancy were weakly related within each partner, whereas no association across partners was observed. Conclusions Both expectant mothers and fathers changed their alcohol consumption patterns when expecting a child. Almost all mothers stopped drinking, whereas fathers reduced their drinking to a considerable degree. Relationship satisfaction was only slightly related to their drinking patterns. The findings may have important policy implications, mainly with regard to developing alcohol preventive strategies.
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Affiliation(s)
- Sonja Mellingen
- Centre for Evidence-Based Practice, Bergen University College, Møllendalsveien 6, 5009, Bergen, Norway.
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Mallard SR, Connor JL, Houghton LA. Maternal factors associated with heavy periconceptional alcohol intake and drinking following pregnancy recognition: a post-partum survey of New Zealand women. Drug Alcohol Rev 2013; 32:389-97. [PMID: 23305204 DOI: 10.1111/dar.12024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 11/25/2012] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIMS Alcohol consumption during pregnancy places the foetus at risk of Foetal Alcohol Spectrum Disorders. Little is known about the current prevalence and patterns of alcohol consumption before and following pregnancy recognition in New Zealand. DESIGN AND METHODS A retrospective survey of 723 post-partum women resident in maternity wards located across New Zealand was conducted using a self-administered questionnaire. Maternal sociodemographic and obstetric characteristics and alcohol intake before and after pregnancy recognition were assessed. RESULTS Of the 968 women invited to participate, 78% agreed. Eighty-two percent of women reported consuming alcohol prior to pregnancy and 20% reported typically consuming >4 New Zealand standard drinks per occasion. Overall, 34% of women reported drinking at some time during pregnancy. Twelve percent of pregnancies were at high risk of heavy alcohol exposure in early gestation. In fully adjusted analysis, pregnancies most at risk were those of indigenous Māori women, Pacific women, smokers and drug users. Almost one-quarter (24%) of drinkers continued to drink following pregnancy recognition, and in fully adjusted analysis, continuing to drink was positively associated with frequency of alcohol consumption before pregnancy (P < 0.001 for linear trend). DISCUSSION AND CONCLUSIONS To reduce the burden of alcohol-related harm to the foetus, these findings suggest that New Zealand alcohol policy should be focused not only on promoting total abstinence when planning a pregnancy and when pregnant, but also on reducing 'binge drinking' culture and the frequent consumption of lower levels of alcohol.
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Pfinder M, Feldmann R, Liebig S. Alcohol During Pregnancy from 1985 to 2005: Prevalence and High Risk Profile. SUCHT 2013. [DOI: 10.1024/0939-5911.a000248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Aims: This study aimed 1. to examine the prevalence of German children born with prenatal alcohol exposure (PAE) from 1985 to 2005, and asked 2. whether it differed on levels of socioeconomic status (SES) and 3. whether there are differences between abstainers and drinkers during pregnancy in regard to physical, behavioural and sociodemographic features. Methods: 16 978 German mothers, enrolled in the German Health Interview and Examination Survey (KiGGS) were studied. Results: Between 1985 and 2005 13.5 percent of the children were born with PAE. No stable decrease was found over time. Over 20 years, the prevalence of children born with PAE was highest in the upper class. Drinkers differed from abstainers in regard to physical, behavioural and sociodemographic characteristics. High SES women were on a higher risk of alcohol intake during pregnancy. Conclusions: The prevalence of children born with PAE over time indicates that alcohol intake during pregnancy needs further interventions and prevention as no long-lasting decrease was found in the years from 1985 to 2005. Alcohol intake during pregnancy was and still is an issue in women from the upper class. Future research should therefore aim to explain the social gradient.
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Affiliation(s)
- Manuela Pfinder
- Bielefeld Graduate School in History and Sociology, Faculty of Sociology, University of Bielefeld, Germany
- Department of Pediatrics, University Hospital Munster, Germany
| | | | - Stefan Liebig
- Sonderforschungsbereich (SFB 882) “From Heterogeneities to Inequalities”, Faculty of Sociology, University of Bielefeld, Germany
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Leis JA, Heron J, Stuart EA, Mendelson T. Associations between depressive and anxious symptoms and prenatal alcohol use. Matern Child Health J 2012; 16:1304-11. [PMID: 21971680 DOI: 10.1007/s10995-011-0892-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Symptoms of depression and anxiety are prevalent during pregnancy and may influence women's health behaviors. The impact of women's mental health on alcohol use may be particularly important to consider as prenatal alcohol use is common and may have serious negative consequences for the developing fetus. The objectives of this study were to investigate the relationships between elevated symptoms of depression and anxiety and subsequent likelihood of any alcohol use and binge drinking during pregnancy. The sample consisted of 12,824 women from a prospective, population-based study from the United Kingdom, the Avon Longitudinal Study of Parents and Children. Participants completed questionnaires assessing alcohol use and depressive and anxious symptoms during the first and third trimesters of pregnancy. A series of multivariable regression models was fit using multiply imputed data. Thirty four percent of women reported having at least one alcoholic drink at 32 weeks' gestation and 17% reported binge drinking. We found a weak association between elevated symptoms of anxiety and any alcohol use but not between elevated symptoms of depression and any alcohol use. Modest associations were found between both elevated symptoms of depression and anxiety at 18 weeks' gestation and binge drinking at 32 weeks' gestation. Elevated symptoms of depression and anxiety may increase risk for binge drinking during pregnancy. Further research into the impact of symptoms of depression and anxiety on binge drinking during pregnancy is needed as this could represent an opportunity for public health intervention.
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Affiliation(s)
- Julie A Leis
- Department of Pediatrics, Johns Hopkins University, School of Medicine, 200 North Wolfe Street, Baltimore, MD 21287, USA.
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Determinants of pregnant women's compliance with alcohol guidelines: a prospective cohort study. BMC Public Health 2012; 12:777. [PMID: 22971176 PMCID: PMC3511880 DOI: 10.1186/1471-2458-12-777] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/31/2012] [Indexed: 02/08/2023] Open
Abstract
Background In 2009, Australian alcohol guidelines for pregnancy changed from low to no alcohol intake. Previous research found a high proportion of pregnant Australian women drank during pregnancy; however, there has been limited investigation of whether pregnant women comply with 2009 alcohol guidelines. The purpose of this study was to provide an assessment of pregnant women’s compliance with 2009 Australian alcohol guidelines and identify predictors of such compliance, including previous drinking behaviour. Methods Cross-sectional analysis of prospective data from the 1973–1978 cohort of the Australian Longitudinal Study on Women’s Health was conducted. Women aged 30–36 years who were pregnant at the 2009 survey and had data on alcohol use were included (n = 837). Compliance with 2009 alcohol guidelines for pregnancy was defined as no alcohol intake. Predictors of compliance were analysed using multivariate logistic regression, controlling for area of residence, in three separate models to account for multicollinearity between measures of previous alcohol intake (compliance with 2001 guidelines; frequency and quantity; bingeing). Private health insurance, household income, and illicit drug use were entered into all models and retained if significant. Results 72% of pregnant women did not comply with the 2009 alcohol guidelines and 82% of these women drank less than seven drinks per week, with no more than one or two drinks per drinking day. The odds of complying with abstinence increased by a factor of 3.48 (95% CI 2.39-5.05) for women who previously complied with the 2001 alcohol guidelines and decreased by a factor of 0.19 (95% CI 0.08-0.66) if household incomes were $36,400 or more. In other models the odds of complying were lower for women who consumed alcohol before pregnancy at least weekly (OR = 0.40, 95% CI 0.25-0.63) or binged (OR ≥ 0.18, 95% CI 0.10-0.31) and were higher for those who abstained (OR = 45.09; 95% CI 8.63-235.49) prior to pregnancy. Conclusion Most pregnant women did not comply with alcohol guidelines promoting abstinence. Prior alcohol behaviour was the strongest predictor of compliance during pregnancy, suggesting alcohol use should be addressed in women of child-bearing age. The study is limited by the relatively short timeframe between the official introduction of the 2009 guidelines and the date the surveys were sent out. Widespread dissemination of the guidelines may be necessary to help increase guideline compliance by pregnant women.
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Jones SC, Telenta J. What influences Australian women to not drink alcohol during pregnancy? Aust J Prim Health 2012; 18:68-73. [PMID: 22394665 DOI: 10.1071/py10077] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 05/26/2011] [Indexed: 01/18/2023]
Abstract
There is a strong social norm against consuming alcohol during pregnancy. However, many women do not realise they are pregnant until the sixth week and are not provided with information about the risks of consuming alcohol until they visit a health professional in the second trimester. We conducted semi-structured interviews with 12 midwives and 12 pregnant women from two regions in NSW in 2008-09 to explore attitudes towards alcohol consumption during pregnancy, and the factors that may encourage or inhibit women from following the recommendation to abstain from drinking while pregnant. Both groups noted the social issues around pregnant women consuming alcohol due to perceived social norms and the challenges in not revealing early pregnancy status at social events.
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Affiliation(s)
- Sandra C Jones
- Centre for Health Initiatives, Innovation Campus, University Of Wollongong, Wollongong, NSW 2522, Australia.
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Towards improved alcohol prevention in Swedish antenatal care? Midwifery 2012; 28:314-20. [DOI: 10.1016/j.midw.2011.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 04/15/2011] [Accepted: 04/22/2011] [Indexed: 01/18/2023]
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DUNCAN EILIDHM, FORBES-MCKAY KATRINAE, HENDERSON SARAHE. Alcohol Use During Pregnancy: An Application of the Theory of Planned Behavior1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2012. [DOI: 10.1111/j.1559-1816.2012.00923.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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NILSEN PER, SKAGERSTRÖM JANNA, RAHMQVIST MIKAEL, HULTGREN EVA, BLOMBERG MARIE. Alcohol prevention in Swedish antenatal care: effectiveness and perceptions of the Risk Drinking project counseling model. Acta Obstet Gynecol Scand 2012; 91:736-43. [DOI: 10.1111/j.1600-0412.2012.01402.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Comasco E, Hallberg G, Helander A, Oreland L, Sundelin-Wahlsten V. Alcohol consumption among pregnant women in a Swedish sample and its effects on the newborn outcomes. Alcohol Clin Exp Res 2012; 36:1779-86. [PMID: 22486280 DOI: 10.1111/j.1530-0277.2012.01783.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 01/17/2012] [Indexed: 01/18/2023]
Abstract
BACKGROUND Little is known about the effects of low levels of maternal alcohol intake on the neuropsychological development of the child. This study is part of an ongoing investigation on maternal drinking and presents data on demographic variables, maternal alcohol use, and birth outcomes from that study. METHODS The sample comprised 2,264 women from a Swedish antenatal clinic. Retrospective self-report data were collected on alcohol consumption before and during pregnancy, using the Alcohol Use Disorders Identification Test (AUDIT), and on nicotine use. Specific alcohol biomarkers for excessive drinking, carbohydrate-deficient transferrin (CDT) in serum and phosphatidylethanol (PEth) in whole blood, were determined during mid-pregnancy in a subsample of the women. Data on labor and early characteristics of the child were also assessed. RESULTS Before pregnancy, 89% of the women regularly consumed alcohol and 49% reported occasional or frequent binge drinking. Nicotine was used by 15% before and by 5% during pregnancy. During pregnancy, 12% continued using alcohol and 5% also admitted binge drinking. However, all alcohol biomarker values were below the reporting limits (CDT ≤ 1.7% disialotransferrin; total PEth < 0.1 μmol/L). Self-reported drinking during pregnancy was associated with a higher AUDIT score before pregnancy, nicotine use at the time of the first prenatal visit, older age, and previous legal abortions. CONCLUSIONS The AUDIT questionnaire and 2 specific alcohol biomarkers were used in routine maternity care to collect information about drinking during pregnancy and thereby to identify children at risk for alcohol-related complications. While the AUDIT results suggested that a significant number of women continued using alcohol during pregnancy, implying a risk for fetal disorders, the biomarkers showed negative test values thus indicating only modest drinking levels.
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Affiliation(s)
- Erika Comasco
- Department of Neuroscience, Unit of Pharmacology, Uppsala University, Uppsala, Sweden
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Bakhireva LN, Wilsnack SC, Kristjanson A, Yevtushok L, Onishenko S, Wertelecki W, Chambers CD. Paternal drinking, intimate relationship quality, and alcohol consumption in pregnant Ukrainian women. J Stud Alcohol Drugs 2012; 72:536-44. [PMID: 21683035 DOI: 10.15288/jsad.2011.72.536] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Maternal alcohol consumption during pregnancy and fetal alcohol spectrum disorders (FASDs) represent a significant public health problem. The influence of the male partner's alcohol consumption patterns and the quality of the partner's intimate relationship might be important factors to consider in the design of successful FASD prevention programs. METHOD As part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, 166 pregnant women in two regions in Ukraine participated in an in-person interview at an average gestational age of 18-19 weeks. Subjects were classified cross-sectionally as abstainers/light drinkers (n = 80), defined as low or no consumption of alcohol in the periconceptional period and none in the most recent 2 weeks of pregnancy; discontinuers (n = 43), defined as moderate to heavy alcohol use in the periconceptional period but none during the most recent 2 weeks of pregnancy; or continuing drinkers (n = 43), defined as continued moderate to heavy alcohol use within the most recent 2 weeks of pregnancy. Women also reported on their partner's drinking behavior and on the quality of their intimate relationship. RESULTS Heavy paternal drinking was significantly associated with both continuing maternal drinking in the most recent 2 weeks (adjusted odds ratio [OR] = 34.1; 95% CI [5.9, 195.8]) and being a risky drinker only around conception (adjusted OR = 27.0; 95% CI [5.0, 147.7]). In addition, women who consumed alcohol during pregnancy had lower mean scores for satisfaction with partners' relationship and ability to discuss problems (p < .05) compared with light drinkers/abstainers. CONCLUSIONS This study suggests that development of partner-based interventions, as opposed to those solely focused on maternal drinking, might be warranted as a strategy to prevent FASD.
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Affiliation(s)
- Ludmila N Bakhireva
- Department of Pediatrics, University of California, San Diego, La Jolla, 92093, USA
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Balachova T, Bonner B, Chaffin M, Bard D, Isurina G, Tsvetkova L, Volkova E. Women's alcohol consumption and risk for alcohol-exposed pregnancies in Russia. Addiction 2012; 107:109-17. [PMID: 21752144 PMCID: PMC3229961 DOI: 10.1111/j.1360-0443.2011.03569.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Tatiana Balachova
- University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA.
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Skagerstróm J, Chang G, Nilsen P. Predictors of drinking during pregnancy: a systematic review. J Womens Health (Larchmt) 2011; 20:901-13. [PMID: 21671775 DOI: 10.1089/jwh.2010.2216] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Many pregnant women continue to drink alcohol despite clinical recommendations and public health campaigns about the risks associated with alcohol use during pregnancy. This review examines the predictors of prenatal alcohol use, with the long-term goal of developing more effective preventive efforts. METHODS A literature search of several databases for relevant articles was undertaken. Studies were included if they occurred in the context of antenatal care, collected data during the woman's pregnancy (between 1999 and 2009), investigated predictors of any drinking, had a population-based orientation (e.g., did not focus only on high-risk drinkers), and were published in English in a scientific peer-reviewed journal between 1999 and 2009. RESULTS Fourteen studies published between 2002 and 2009 fulfilled the inclusion criteria (United States, 4; Europe, 4; Australia and New Zealand, 3; Japan, 2; and Uganda, 1). The predictors of prenatal alcohol use most consistently identified were prepregnancy alcohol consumption and having been abused or exposed to violence. Less consistent predictors of drinking during pregnancy were high income/social class and positive dependence screen. Unemployment, marital status, and education level were examined in many studies but found to be predictive only infrequently. CONCLUSIONS Women's prepregnancy alcohol consumption (i.e., quantity and frequency of typical drinking) and exposure to abuse or violence were consistently associated with drinking during pregnancy. Antenatal care providers should assess these factors for improved detection of women at risk for alcohol-exposed pregnancies.
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Affiliation(s)
- Janna Skagerstróm
- Department of Medical and Health Sciences, Division of Social Medicine and Public Health Science, Linköpings Universitet, Linköping, Sweden.
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Osterman R. Feasibility of Using Motivational Interviewing to Decrease Alcohol Consumption During Pregnancy. J Addict Nurs 2011. [DOI: 10.3109/10884602.2011.585723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Osterman RL. Decreasing Women's Alcohol Use During Pregnancy. ALCOHOLISM TREATMENT QUARTERLY 2011. [DOI: 10.1080/07347324.2011.608589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Copeland WE, Magnusson A, Göransson M, Heilig MA. Genetic moderators and psychiatric mediators of the link between sexual abuse and alcohol dependence. Drug Alcohol Depend 2011; 115:183-9. [PMID: 21193270 PMCID: PMC3083494 DOI: 10.1016/j.drugalcdep.2010.10.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 09/24/2010] [Accepted: 10/11/2010] [Indexed: 01/18/2023]
Abstract
BACKGROUND/OBJECTIVE This study used a case-control female sample to test psychiatric mediators and genetic moderators of the effect of sexual abuse on later alcohol dependence. The study also tested differences between alcohol dependent women with or without a history of sexual abuse on variables that might affect treatment planning. METHODS A case-control design compared 192 treatment-seeking alcohol dependent women with 177 healthy population controls. All participants were assessed for alcohol-related behaviors, sexual abuse history, psychiatric problems, and personality functioning. Markers were genotyped in the CRHR1, MAO-A and OPRM1 genes. RESULTS The association of sexual abuse with alcohol dependence was limited to the most severe category of sexual abuse involving anal or vaginal penetration. Of the five psychiatric disorders tested, anxiety, anorexia nervosa, and bulimia met criteria as potential mediators of the abuse-alcohol dependence association. Severe sexual abuse continued to have an independent effect on alcohol dependence status even after accounting for these potential mediators. None of the candidate genetic markers moderated the association between sexual abuse and alcohol dependence. Of alcohol dependent participants, those with a history of severe abuse rated higher on alcoholism severity, and psychiatric comorbidities. CONCLUSION Sexual abuse is associated with later alcohol problems directly as well as through its effect on psychiatric problems. Treatment-seeking alcohol dependent women with a history of abuse have distinct features as compared to other alcohol dependent women.
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Affiliation(s)
- William E Copeland
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Osterman RL, Dyehouse J. Effects of a motivational interviewing intervention to decrease prenatal alcohol use. West J Nurs Res 2011; 34:434-54. [PMID: 21540353 DOI: 10.1177/0193945911402523] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study determined the effectiveness of motivational interviewing (MI) to decrease prenatal alcohol use, while examining mechanisms of behavior change based on self-determination theory that may have evoked decreases in drinking behaviors. In all, 67 pregnant women who reported previous-year alcohol use were randomly assigned to an MI intervention or comparison group, with 56 women completing all study procedures. Both groups were assessed at baseline and 4- to 6-week follow-up for alcohol use and mechanisms of behavior change (basic psychological needs satisfaction and autonomous motivation). Only the MI group received the intervention after baseline assessments. Although MI was not found effective in decreasing prenatal drinking behaviors in this study, nonspecific factors were identified, such as treatment structures, participant motivation for improvement, and provider qualities, which may have influenced these results. More research is needed to determine theory-based specific and nonspecific factors that drive effective nursing interventions to decrease alcohol use during pregnancy.
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Affiliation(s)
- Robin L Osterman
- University of Cincinnati, College of Nursing, Cincinnati, OH 45221-0038, USA.
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Guelinckx I, Devlieger R, Vansant G. Alcohol during pregnancy and lactation: recommendations versus real intake. Arch Public Health 2011. [PMCID: PMC3436706 DOI: 10.1186/0778-7367-68-4-134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction Even though total abstinence of alcohol for pregnant and lactating women is recommended, consumption prevalences ranging from 12% up to 30% have been reported. No Belgian data on alcohol consumption in pregnant women were recently published. Methods First, a literature search on the effects of alcohol consumption during pregnancy and lactation was performed in the MEDLINE database using Pubmed. Secondly, in a prospective study the alcohol consumption of 215 Belgian women was evaluated every trimester through 7-day food records. The international standard unit for alcohol or 1 standard glass equals 13.5 g pure ethanol. Binge drinking was defined as drinking more than 50 g on one occasion. Results Prenatal exposure of the foetus to alcohol can lead to a broad range of anomalies, including pre- and postnatal growth retardation, preterm delivery, central or craniofacial dysmorphia, neurological and behavioural disorders and disorders of cognitive function, which can persist throughout adulthood. In the Belgian study population, total abstinence of alcohol was seen in 76% of the women. Of the 24% of women who consumed alcohol, 13.9% consumed alcohol during 1 of the 3 weeks. These women were considered to be low consumers. Five women (2.5%) reported drinking during all 3 weeks of recording. This could suggest that these women drink more regularly. No binge drinking was recorded. The maximum amount was 5 consumptions per week. Conclusion Even though total abstinence of alcohol for pregnant and lactating women is recommended, at least 25% of pregnant women still consumes alcohol. Health care providers have to be aware of the underreporting of alcohol use by pregnant women, especially if they drink heavily since they fear of being stigmatised.
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Abstract
The impact of prenatal alcohol exposure is far reaching and transgenerational but is largely under diagnosed. This has been a major public health concern but remains an area that has lacked attention with regards service development and research in Ireland. There is a need for mental health professionals to have a good working knowledge of the range of deficits associated with prenatal alcohol exposure. Knowledge of these deficits will facilitate identification of affected children for early diagnosis and intervention. This paper reviews available literature on this topic using broad search criteria. The aim of this article is to create greater awareness among professionals working with children in Ireland considering the high rates of alcohol consumption and the fact that most cases of FASD present with chronic undiagnosed mental health problems.
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Jones SC, Telenta J, Shorten A, Johnson K. Midwives and pregnant women talk about alcohol: what advice do we give and what do they receive? Midwifery 2010; 27:489-96. [PMID: 20471731 DOI: 10.1016/j.midw.2010.03.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 03/18/2010] [Accepted: 03/20/2010] [Indexed: 01/18/2023]
Abstract
BACKGROUND the Australian National Health and Medical Research Council (NHMRC) recently revised its guidelines for alcohol consumption during pregnancy and breast feeding, moving from a recommendation of minimising intake to one of abstinence. Women are potentially exposed to a variety of messages about alcohol and pregnancy, including from the media and social contacts, and are likely to see midwives as the source of expert advice in understanding these contradictory messages. OBJECTIVE to explore the advice that midwives believe they give to pregnant women about alcohol consumption, and the advice that pregnant women believe they receive; the knowledge and attitudes of both groups regarding alcohol consumption and the consistency with the NHMRC guidelines; and the receptivity and comfort of both groups in discussing alcohol consumption in the context of antenatal appointments. DESIGN individual semi-structured interviews with midwives and pregnant women. SETTING face-to-face interviews with midwives and telephone interviews with pregnant women were conducted in two regional areas of New South Wales in 2008-2009. PARTICIPANTS 12 midwives and 12 pregnant women. FINDINGS midwives and pregnant women consistently agreed that conversations about alcohol are generally limited to brief screening questions at the first visit, and the risks are not discussed or explained (except for high-risk women). KEY CONCLUSIONS both groups expressed comfort with the idea of discussing alcohol consumption, but lacked knowledge of the risk and recommendation, and it appears that this opportunity to provide women with information is under-utilised. IMPLICATIONS FOR PRACTICE there is a need to provide midwives with accurate information about the risks of alcohol consumption during pregnancy and effective communication tools to encourage them to discuss the risks and recommendations with their patients.
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Affiliation(s)
- Sandra C Jones
- Centre for Health Initiatives, University of Wollongong, NSW 2522, Australia.
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Burns E, Gray R, Smith LA. Brief screening questionnaires to identify problem drinking during pregnancy: a systematic review. Addiction 2010; 105:601-14. [PMID: 20403013 DOI: 10.1111/j.1360-0443.2009.02842.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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 (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. 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.
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Affiliation(s)
- Ethel Burns
- School of Health and Social Care, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, UK
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Magnusson A, Göransson M, Heilig M. Early onset alcohol dependence with high density of family history is not "male limited". Alcohol 2010; 44:131-9. [PMID: 20193873 DOI: 10.1016/j.alcohol.2010.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 01/18/2010] [Accepted: 01/18/2010] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Based on classical adoption studies, early onset type II alcoholism was originally described as "male limited." We examined the possible expression of this subtype in present day alcohol-dependent women. Detailed systematic assessment was obtained from 200 treatment-seeking alcohol-dependent women and 189 healthy population controls. Women fulfilling type II alcoholism criteria had higher alcoholism severity as measured by The Alcohol Use Disorders Identification Test and markedly higher use of illicit drugs. Both alcoholism subtypes scored higher than normal on anxiety and impulsivity traits, but type II women scored markedly higher on aggression subscales than either of the other groups. Importantly, density of family history was markedly higher in type II women, suggesting a higher heritability. Despite its original description as male limited, early onset alcoholism with high density of family history is likely to be a valid construct in women. Its recognition has important implications for diagnosis, treatment, and research.
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Affiliation(s)
- Asa Magnusson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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50
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État des lieux de la consommation de substances psychoactives par les femmes enceintes. Encephale 2010; 36:33-8. [DOI: 10.1016/j.encep.2008.12.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 12/01/2008] [Indexed: 01/18/2023]
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