FASD: Prenatal alcohol exposure alters development of brain function

fMRI scan of working memory activation in typically-developing children. 

Credit: The Saban Research Institute

In the first study of its kind, Prapti Gautam, PhD, and colleagues from The Saban Research Institute of Children's Hospital Los Angeles found that children with fetal alcohol spectrum disorders (FASD) showed weaker brain activation during specific cognitive tasks than their unaffected counterparts.

These novel findings suggest a possible neural mechanism for the persistent attention problems seen in individuals with FASD.

The results of this study will be published in Cerebral Cortex on August 4.

"Functional magnetic resonance imaging (fMRI) has been used to observe brain activity during mental tasks in children with FASD, but we are the first to utilize these techniques to look at brain activation over time," says Gautam.

"We wanted to see if the differences in brain activation between children with FASD and their healthy peers were static, or if they changed as children got older."

FASD encompasses the broad spectrum of symptoms that are linked to in utero alcohol exposure, including cognitive impairment, deficits in intelligence and attention and central nervous system abnormalities.

These symptoms can lead to attention problems and higher societal and economic burdens common in individuals with FASD.

During the period of childhood and adolescence, brain function, working memory and attention performance all rapidly improve, suggesting that this is a crucial time for developing brain networks.

To study how prenatal alcohol exposure may alter this development, researchers observed a group of unaffected children and a group of children with FASD over two years.

They used fMRI to observe brain activation through mental tasks such as visuo-spatial attention, how we visually perceive the spatial relationships among objects in our environment, and working memory.

"We found that there were significant differences in development brain activation over time between the two groups, even though they did not differ in task performance," notes Elizabeth Sowell, PhD, director of the Developmental Cognitive Neuroimaging Laboratory at The Saban Research Institute and senior author on the manuscript.

"While the healthy control group showed an increase in signal intensity over time, the children with FASD showed a decrease in brain activation during visuo-spatial attention, especially in the frontal, temporal and parietal brain regions."

These results demonstrate that prenatal alcohol exposure can change how brain signaling develops during childhood and adolescence, long after the damaging effects of alcohol exposure in utero.

The atypical development of brain activation observed in children with FASD could explain the persistent problems in cognitive and behavioral function seen in this population as they mature.

FASD: Heart defects caused by altered function, not structure?

Recent data shows that more than 500,000 women in the U.S. report drinking during pregnancy, with about 20 percent of this population admitting to binge drinking.

Even one episode of heavy drinking can lead to the collection of birth defects known as fetal alcohol syndrome (FAS).

Along with growth retardation, head and face abnormalities, and neurological problems, FAS also causes heart problems in just over half of those with this condition.

Though much research has focused on looking for the cause of these alcohol-induced heart defects, they remain largely a mystery.

To investigate this question, Ganga Karunamuni of Case Western University and her colleagues studied heart formation in quail embryos, whose heart development is very similar to that of humans.

The researchers used an innovative imaging technique, optical coherence tomography, to compare embryos exposed to a single, large dose of alcohol to those who hadn't received alcohol.

They looked both at how alcohol changed the function of the developing hearts as well as their structure.

They found that significant changes in heart function appeared to come well before changes in structure that are hallmarks of the well-known FAS heart anomalies.

These changes in function, the study authors suggest, might be the cause of the structural problems that arise later by exerting forces on the heart that change its development.

The article is entitled "Ethanol Exposure Alters Early Cardiac Function in the Looping Heart: A Mechanism for Congenital Heart Defects?"

It appears in the Articles in Press section of the American Journal of Physiology – Heart and Circulatory Physiology, published by the American Physiological Society.

Results
As expected, the researchers found that the hearts of embryos exposed to alcohol had dramatic defects close to hatching, including thinner walls separating the heart's four chambers and damaged valves.

Long before these defects formed, the researchers saw significant differences in heart blood flow between embryos that weren't exposed to alcohol and those that were.

In those whose shells weren't injected with alcohol, a small portion of the blood flowed backward through the heart circuit after each beat.

In those exposed to alcohol, a much larger portion of blood flowed backward in the circuit.

These malfunctioning hearts had smaller "cardiac cushions"—collections of cells that later become chamber walls and valves—compared to unexposed hearts.

More information: ajpheart.physiology.org

FASD: Alcohol during pregnancy causes impaired social skills in children

A recent study published in Child Neuropsychology has found that drinking alcohol while pregnant means your child is more likely to develop issues with social skills as they grow older.

The results of the study indicate that children with prenatal alcohol exposure (PAE) who do not have a global intellectual disability are at high risk of developing significant problems in a broad array of cognitive, emotional, behavioral, and social domains.

125 children aged between 6 and 12 participated in the study, 97 of whom met diagnostic criteria for a Fetal Alcohol Spectrum Disorder (FASD).

The children underwent a comprehensive multi-informant assessment of neurocognitive, emotional, social, behavioural, and adaptive functioning.

The results of the study indicated that the children who had prenatal alcohol exposure (PAE), returned significantly poorer scores compared to the non-exposed group on tests measuring executive functioning (the processes that help us connect past experience with present action, the skills we use for organization and planning), attention, working /visuospatial memory, linguistic abstraction, adaptive behaviour, emotional/behavioural functioning, and social cognition (understanding of why people do the things that they do).

The study showed that while the children with PAE and the non-exposed children attributed hostile intentions towards provocative behaviors by their peers, e.g. pushing and shoving, the children affected by PAE were more likely to attribute hostile intentions to situations that did not involve physical provocation e.g. asking if they can play and being told 'no'.

The parents of children with PAE also gave greater reports of inattentive and hyperactive/impulsive behavior and the children were shown to also be more likely to show depressive symptoms.

The group of children with PAE were also shown to have more social problems according to assessments involving parents and teachers. These results maintained their significance past controlling for IQ, demonstrating that relying on IQ alone to guide parental, peer, and school expectations may be misleading.

The study also notes that this may also suggest that the negative effects of PAE are above and beyond the control of intelligence.

The study concludes by suggesting that the results mean it is becoming increasingly more evident that there is a pressing need for early identification of social issues related to prenatal alcohol exposure and intervention in order to take advantage of the developing brain's plasticity and to maximise the likelihood of effecting meaningful functional improvement.

More information: Justin L. Quattlebaum & Mary J. O'Connora "Higher functioning children with prenatal alcohol exposure: Is there a specific neurocognitive profile?" Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence Volume 19, Issue 6, 2013 DOI: 10.1080/09297049.2012.713466

Fetal Alcohol Syndrome (FASD): Prenatal exposure to alcohol disrupts brain circuitry

Prenatal exposure to alcohol severely disrupts major features of brain development that potentially lead to increased anxiety and poor motor function, conditions typical in humans with Fetal Alcohol Spectrum Disorders (FASD), according to neuroscientists at the University of California, Riverside.

In a groundbreaking study, the UC Riverside team discovered that prenatal exposure to alcohol significantly altered the expression of genes and the development of a network of connections in the neo-cortex—the part of the brain responsible for high-level thought and cognition, vision, hearing, touch, balance, motor skills, language, and emotion—in a mouse model of FASD.

Prenatal exposure caused wrong areas of the brain to be connected with each other, the researchers found.

These findings contradict the recently popular belief that consuming alcohol during pregnancy does no harm.

"If you consume alcohol when you are pregnant you can disrupt the development of your baby's brain," said Kelly Huffman, assistant professor of psychology at UC Riverside and lead author of the study that appears in the Nov. 27 issue of The Journal of Neuroscience, the official, peer-reviewed publication of the Society of Neuroscience.

Study co-authors are UCR Ph.D. students Hani El Shawa and Charles Abbott.

"This research helps us understand how substances like alcohol impact brain development and change behavior," Huffman explained.

"It also shows how prenatal alcohol exposure generates dramatic change in the brain that leads to changes in behaviour.

Although this study uses a moderate- to high-dose model, others have shown that even small doses alter development of key receptors in the brain."

Researchers have long known that ethanol exposure from a mother's consumption of alcohol impacts brain and cognitive development in the child, but had not previously demonstrated a connection between that exposure and disruption of neural networks that potentially leads to changes in behaviour.

Huffman's team found dramatic changes in intra-neocortical connections between the frontal, somato-sensory and visual cortex in mice born to mothers who consumed ethanol during pregnancy.

The changes were especially severe in the frontal cortex, which regulates motor skill learning, decision-making, planning, judgment, attention, risk-taking, executive function and sociality.

FASD: Association found between poor academic achievement and maternal drinking

Education records from the WA Literacy and Numeracy Assessment statewide testing program were compared with maternal alcohol consumption data. Credit: iStock

Researchers from WA and the UK have linked heavy drinking and binge drinking, even occasionally during pregnancy, to children's academic achievement in reading, writing and spelling; and this impact is related to the trimester in which the exposure occurred.

These results lend further support to other international studies which have found prenatal alcohol exposure increases the risk of a range of neurodevelopmental disorders, including Fetal Alcohol Spectrum Disorder (FASD).

Lead author Colleen O'Leary, from Curtin's Centre for Population Health Research, says this study is a first.

"This is the first population-based study that utilises linked cohort and state-wide education test data to examine the effect of prenatal alcohol exposure on educational achievement," Dr O'Leary says.

The cohort of 4056 children aged 8-9 years-old were from the Randomly Ascertained Sample of Children born in Australia's Largest State study; a 10 per cent random sample of infants born in WA between 1995 and 1997.

FASD Indications

Information about maternal alcohol consumption was catergorised into dosage and pattern; low (1-2 standard drinks on occasion, less than 7 per week), moderate (3-4 standard drinks on occasion, 7 per week), binge drinking (more than 50g per occasion), and heavy drinking (more than 7 standard drinks per week).

They then matched this data with education records from the WA Literacy and Numeracy Assessment statewide testing program, and also examined absenteeism at these tests.

Resulting learning problems varied depending on the dose, timing, and drinking pattern of the prenatal alcohol exposure.

"Children exposed to heavy prenatal alcohol exposure during the first trimester were over twice as likely as comparison children to not achieve the reading benchmark," Dr O'Leary says.

"Prenatal exposure to occasional binge drinking in late pregnancy [second and/or third trimester] increased the risk of not achieving the benchmark for writing.

"Children of mothers binge drinking occasionally or drinking heavily at any stage during pregnancy were more likely to have been absent for the spelling test."

Dr O'Leary says results are particularly pertinent given the high rate of pregnancies reported to be unplanned – around 50 per cent – and thus associated risk of unintentional prenatal alcohol exposure.

While low or moderate levels of prenatal alcohol exposure was not associated with academic underachievement, Dr O'Leary stresses that other studies have demonstrated adverse offspring effects, even at very low doses.

As such, "we cannot conclusively state that any amount of alcohol is 'safe'."

She recommends exploring the impact of whether supportive family and school systems can improve academic achievement of children exposed prenatally to alcohol.

More information: www.ncbi.nlm.nih.gov/pubmed/23837182

Fetal Alcohol Spectrum Disorders (FASD) - South Africa study

Two recently published studies report prevalence data about fetal alcohol spectrum disorders (FASD) in South Africa and find that negative consequences of prenatal exposure to alcohol may be lessened if a child is provided with adequate nutrition and appropriate cognitive and behavioral stimulation in his or her first seven years of life.

Dr. Philip A. May

Dr. Philip A. May, faculty member at the University of North Carolina's Nutrition Research Institute (NRI), research professor of nutrition at the Gillings School of Global Public Health and Principal Investigator at the University of New Mexico's Center on Alcoholism, Substance Abuse, and Addictions (CASAA), is lead author of both papers.

At the NRI, May is conducting a comprehensive study of South African mothers and their children who are affected by FASD.

The work is funded through a $5.3 million grant from the National Institutes of Health's National Institute on Alcohol Abuse and Alcoholism.

The study, titled "Approaching the Prevalence of the Full Spectrum of Fetal Alcohol Spectrum Disorders in a South African Population-Based Study," appeared in the May issue of Alcoholism: Clinical and Experimental Research.

"This is the first population-based study of the prevalence of FASD to diagnose a significant number of alcohol-related disabilities, which are at the mild end of the continuum," Dr. May said of the study.

Employing newly refined diagnostic criteria, the researchers were able to better indicate the scope of the problem.

"There is evidence of advances in diagnosis of the milder effects of alcohol exposure in the prenatal period," Dr. May said. "The rate of FASD is greater than we ever thought in human populations."

In "Maternal Factors Predicting Cognitive and Behavioral Characteristics of Children with Fetal Alcohol Spectrum Disorders," which appeared in the Journal of Developmental and Behavioral Pediatrics in June, May and his colleagues found evidence that good health and nutrition of the pregnant mother provides her child with an advantage for cognitive and behavioral development by age seven.

"In the first seven years of life environmental advantages of cognitive and behavioral stimulation and adequate nutrition can, in many cases, serve to minimize any negative consequences of prenatal alcohol exposure on the children's social, behavioral, and intellectual functioning," May said.

The NIAAA grant is funding a study for children as young as 12 months to improve their development with nutritional supplements and a regimen of cognitive and behavioral interventions.

"There is hope that a good postnatal environment in the early years of life can mitigate some, if not most, of the damage that occurs from alcohol exposure in the prenatal period," May said.

Conclusions
High rates of specific diagnoses within FASD were well documented in this new cohort of children. FASD persists in this community. The data reflect an increased ability to provide accurate and discriminating diagnoses throughout the continuum of FASD.

More information: Approaching the Prevalence of the Full Spectrum of Fetal Alcohol Spectrum Disorders in a South African Population-Based Study

FASD impacts brain development throughout childhood and adolescence

Highlighted areas are some of the white matter tracts the research group studied. Credit: U of A

Medical researchers at the University of Alberta recently published findings showing that brain development is delayed throughout childhood and adolescence for people born with Fetal Alcohol Spectrum Disorder (FASD).

Christian Beaulieu and Carmen Rasmussen, the two primary investigators in the research study, recently published the results of their work in the peer-reviewed journal, The Journal of Neuroscience.

Carmen Rasmussen

Their team scanned 17 people with FASD, and 27 people without the disorder, who were between 5 and 15 years old.

Each participant underwent two to three scans, with each scan taking place two to four years apart.

This is the first research study involving multiple scans of the same FASD study participants.

Researchers used an advanced MRI method that examines white matter in the brain. White matter forms connections between various regions of the brain and usually develops significantly during childhood and adolescence.

Those who took part in the study were imaged multiple times, to see what kinds of changes occurred in brain development as the participants aged.

Those without the disorder had marked increases in brain volume and white matter – growth that was lacking in those with FASD.

However, the advanced MRI method revealed greater changes in the brain wiring of white matter in the FASD group, which the authors suggest may reflect compensation for delays in development earlier in childhood.

Sarah Treit

"These findings may suggest that significant brain changes happened earlier in the study participants who didn't have FASD," says the study's first author, Sarah Treit, who is a student in the Centre for Neuroscience at the U of A.

"This study suggests alcohol-induced injury with FASD isn't static – those with FASD have altered brain development, they aren't developing at the same rate as those without the disorder. And our research showed those with FASD consistently scored lower on all cognitive measures in the study."

Treit said the research team also made other important observations. Children with FASD who demonstrated the greatest changes in white matter development also made the greatest gains in reading ability – "so the connection seems relevant."

Christian Beaulieu

And those with the most severe FASD showed the greatest changes in white matter brain wiring. Scans also confirmed those with FASD have less overall brain volume – this issue neither rectified itself nor worsened throughout the course of the study.

The team is continuing their research in this area, in hopes of finding a biomarker for FASD, and to examine how the brain changes from adolescence into adulthood in those with the disorder.

The advanced MRI imaging the team used can pinpoint brain damage present in those with FASD, and could one day guide medical interventions for those with the disorder, which affects one in every 100 Canadians.

What is Foetal Alcohol Spectrum Disorder (FASD)

FASD - Foetal Alcohol Spectrum Disorder, is a term used to describe the range of birth defects, which can occur in a child whose mother drinks high levels of alcohol during pregnancy.

Currently in the UK, information and resources for supporting children affected by FASD, are very limited. The Sunfield Research Institute, in consultation with the National Organisation for Fetal Alcohol Syndrome UK (NOFAS-UK), have worked together to create a toolkit of resources which we hope will provide early years practitioners with the necessary knowledge and skills to support children who may have FASD.

Below are 4 Links to FASD information articles, in PDF format;
















Strategies for supporting children with FASD
















Information Sheets
















Case studies
















Things to Remember - Communicating with Children


Further information can also be found on the Sunfield website.