Download Investigators

Fetal Alcohol Syndrome:
Alcohol and Pregnancy
Nancy L. Day, PhD
School of Medicine, Department of
Psychiatry, University of Pittsburgh
Investigators
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Nancy Day, PHD, Epidemiology
Gale Richardson, PHD, Developmental Psychology
Marie Cornelius, PHD, Epidemiology
Christopher Ryan, PHD, Neuropsychology
John Donovan, PHD, Social Psychology
Nadine Robles, PHD, Anthropology
David Stoffer, PHD, Statistics
Paul Taylor, MD, Pediatrics
Mark Scher, MD, Neurology
Cynthia Larkby, PHD, Epidemiology
Lidush Goldschmidt, PHD, Statistics
Maternal Health Practices and Child
Development Project
Alcohol use
during prignancy
N. Day
Prenatal
Cocaine Use
G. Richardson
Teenage prenatal
tobacco and
marijuana use
M. Cornelius
Prenatal Marijuana
Exposure N. Day
Data Instruments
Administration
Personnel Analysis
Alcohol Research
Training Program
Childhood Abuse,
Alcohol Use,
and PTSD
C. Larkby
Tobacco Prenatal Effects
and Adolescent Use
N. Day, M. Cornelius
Psychiatric
Epidemiology
Training Program
Diagnosis of Fetal Alcohol
Syndrome
Minimal Criteria:
Abnormalities in each of three areas
1. Prenatal and/or postnatal growth retardation
2. Central nervous system involvement
3. Characteristic facial dysmorphology
Predictive Value of Head Circumference
and One Facial Anomaly
Head
Sircumference
<10th Percentile
and One Facial
Anomaly
All remaining
subjects
N=29
N=713
85.5
95.9
Math Subtest
80.9
WRAT-R
Spelling Subtest 79.0
WRAT-R
93.3
Reading Subtest 89.2
WRAT-R
93.9*
IQ Score at Age 6
89.2
All comparisons are significant at P<.01; *significant at p=.09
Predictive Value of Head Circumference
and One Facial Anomaly
Head Sircumference
<10th Percentile and One
Facial Anomaly
Average Daily Volume
(ADV) Frist Trimester
ADV Third Trimester
Weight at Age 6 (kg)
Height at Age 6 (cm)
Head Circumference at Age
6 (mm)
All remaining
subjects
N=29
1.37
N=713
0.57
1.28
20.9
113.8
513.4
0.1
23.2
119.5
521.2
All comparisons are significant at P<.0005
Study Design
16 years
14 years
10 years
6 years
3 years
18 months
8 months
delivery
7th prenatal month
4th prenatal month
Study Follow-Up rates
Inter
Vied
Birth
8 month
18
month
3 year
6 year
10 year
14 year
595
465
509
526
522
490
460
81%
91%
95%
94%
90%
84%
Rate 96%
Time Investment
7.7 contacts to schedule a
subject
The range was 1 to 43 times
Time-II
On Average, each appointment
is rescheduled two times
Range 1 to 13
From the time that you got pregnant to
the time that you realized that you
were pregnant……… was your
drinking was more like what you told
me you did prior to your pregnancy, or
more like you told me you drank
during the first trimester?
PERCENTAGE OF DRINKERS WHO
MISREPORTED FIRST TRIMESTER
DRINKING
CONCEPTION
RECOGNITION
61%
DIAGNOSIS
30%
DOMAINS OF DATA: MATERNAL
DEMOGRAPHIC FACTORS
RACE
AGE
MARITAL STATUS
EDUCATION
MEDICAL FACTORS
PREGNANCY AND LOBOR
CURRENT HEALTH STATUS
MEDICATION
PSYCHOLOGICAL FACTORS
DEPRESSION
ANXIETY
HOSTILITY
SELF-ESTEEM
MATERNAL FACTORS
SOCIAL FACTORS
DYADIC ADJUSTMENT
SOCIAL SUPPORT
LIFE EVENT
RELIGION
COGNITIVE MEASURES
MATERNAL IQ
ENVIRONMENTAL
FACTORS
FAMILY ENVIRONMENT
HOUSEHOLD STRUCTURE
PARENTAL WARMTH
SUPERVISION
DISCIPLINE
SUBSTANCE ABUSE
PRENATAL DRUG AND ALCOHOL ABUSE
MARIJUANA, TOBACCO, OTHER ILLICIT DRUGS, ALOCOHOL
EACH TRIMESTER AND EACH MONTH OF THE FIRST
TRIMESTER
POSTNATAL DRUG AND ALCOHOL USE
DRUG AND ALCOHOL USE OF THE FATHER AND THE MALE IN
THE HOUSEHOLD
HISTORY OF USE AND ABUSE
CURRENT USE
CHILD DOMAINS
PHYSICAL STATUS
MEDICAL HISTORY
GROWTH
PUBERTAL DEVELOPMENT
NEUROPSYCHOLOGICAL DEVELOPMENT
CPT
WRAML
TRAIL MAKING PARTS A AND B
GROOVED PEGBOARD
STROOP
WISCONSIN CARD SORTING TEST
CHILD MEASURES
COGNITIVE DEVELOPMENT
STANFORD-BINET
SCHOOL PERFORMANCE
WRAT-R
PIAT-R
GRADES
ATTENDANCE
BEHAVIOR
ACTIVITY
ATTENTION
BEHAVIOR PROBLEMS
DELINQUENCY
CHILD MEASURES
SUBSTANCE USE
ALOCOHOL
TOBACCO
MARIJUANA
OTHER ILLICIT DRUGS
NEUROPSYCHOLOGICAL ASSESSMENT
CONTINUOUS PERFORMANCE TASK
IMPULSIVITY
TRAIL MAKING A
INATTENTION
STROOP COLOR/WORD INTERFERENCE TEST
DIFFICULTY WITH FLEXIBLE THINKING AND
PLANNING
ACADEMIC PERFORMANCE
WRAT-R
SIGNIFICANT EFFECTS AT 6 AND 10
PIAT-R READING
DECREASED RECOGNITION
DECREASED COMPREHENSION
TOTAL SCORE
TEACHER’S REPORT
POORER ATTENDANCE
POORER PERFORMANCE
PATTERN OF MARIJUANA USE
90
80
70
60
None
Light
Moderate
Heavy
50
40
30
20
10
0
1st Trim
2nd Trim
3rd Trim
10 Years
PATTERN OF TOBACCO USE
50
45
40
35
30
25
20
15
10
5
0
None
Light
Moderate
Heavy
1st Trim
2nd Trim
3rd Trim
10 years
PATTERN OF COCAINE USE
7
6
5
4
3
2
1
0
1st Trim
2nd Trim
3rd Trim
10 years
Alcohol Use at First Trimester at 10 Years
0.6
Use
at 10
years
0.5
0.4
None
Light/nod
Heavy
0.3
0.2
0.1
0
None
Light/Mod
First Trimester Use
Heavy
ANALYTIC MODEL FOR THE TERATOGENIC
EFFECTS OF PRENATAL ALCOHOL EXPOSURE
RISK
RISK
FACTORS
FACTORS
MATERNAL
REARING
ALCOHOL
ENVIRONMENT
USE
PRENATAL
EXPOSURE
CHILD
OUTCOME
Figure 2 Offspring Weight by First
Trimester Alcohol Exposure
155
150
Weight
(lb)
151.72
149.44
142.59
145
140
135.71
135
130
125
Level of Alcohol Use
Abstainer: No use
Moderate > 1.5 /week and < 1 /day
Light: > 0 and < 1.5 / week
Heavy: 1 or more /day
Figure 4. Offspring Head Circumference by
First Trimester Alcohol Exposure
564
562.74
562
560
Circum
ference
(mm)
558
558.12
556.95
556.12
556
554
552
Level of Alcohol Use
Abstainer: No Use
Moderate: > 1.5 drinks/wk and < 1/day
Light: >0 and < 1.5 drinks/week
Heavy: 1 or more/day
Figure 5. Offspring Skinfold Thickness by
Second Trimester Alcohol Exposure
20
15.82
15
14.34
13.69
10.06
Thick
10
ness
(mm)
5
0
Level of Alcohol Use
Abstainer: No use
Moderate: > 1.5 drinks/wk and <1/day
Light: >0 and < 1.5 drinks/week
Heavy: 1 or more/day
Neuropsychological Tests
Memory and Learning
Scores on the WRAML
Attention
Errors of Omission on a CPT
Impulsivity
Errors of Commission on CPT
Deficits in Executive Function at Age 14
Predicted By Prenatal Alcohol Use By Trimester (
Willford J, 2001)
EF Test
1st Trimester
Trail Making
Alcohol
CCT
Alcohol
Mazes
Alcohol
Block Design
Coding
Picture
Arrangement
2nd
Trimester
3rd
Trimester
Alcohol
Temperament
Emotionality
Shyness
BEHAVIOR 10 YEARS
• Child Behavior Checklist (Teacher Report)
Anxiety
BEHAVIOR
• Child Report
Anxiety
ANXIETY AS A MEDIATOR FOR THE
EFFECTS OF PRENATAL ALCOHOL
EXPOSURE
DAMAGE
.14
THEFT
.19
PRENATAL
ALCOHOL
.09 ANXIETY
.24
.14
-.12
RACE
VIOLENCE
.08
.18
SUBSTANCE
USE
STATUS
OFFENSES
PRENATAL
ALCOHOL
.10
.08 ANXIETY
-.15
CHILD
IQ
SUBSTANCE
USE
-.15
RACE
Data are presented
As standardized
Coefficients.
indicates a
Correlation.
.07
.16
.30
MOTHER’S
IQ
-.10
.16
HOME
SCORE
MOTHER’S
DEPRESSION
SCHOOL ACHIEVEMENT
Wide Range Achievement Test-Revised
Reabody Individual Achievement Test-Revised
AGE 10 YEARS
AGE 3 YEARS
ENVIRON
.12
ENVIRON
.26
.25
.24 .17
SES .26
.16
.26
ACTIVITY
ATTEN
.14
.45
.16
ENVIRON
MOM
PSYCH
.54
MOM
PSYCH
.32
.20 .17
.50
SES
PRENATAL ALCOHOL
SECOND ???
PROBLEM
BEHAVIROS
.12
ALC
DRUG
.29
RACE
.20
.26
CHILD
PSYCH .42
.30
ALC
DRUG
.19
.14
.15 GENDER
.23
.13
.09
.17
SUMMARY
PRIMARY
OUTCOMES
SECONDARY
OUTCOMES
• Concept Formation
• Ability to Learn
New Information
• Memory
• Attention
• Mood
• Behavior Problems
• Academic
Achievement
• Delinguency