Chambers CD1 and Coles CD2
1Department of Pediatrics, University of California San Diego, La Jolla CA USA
2Department of Psychiatry, Emory University, Atlanta GA USA
A better understanding of potential mediators or moderators of fetal, infant and subsequent lifelong consequences of heavy prenatal alcohol exposure can help both to identify infants at highest risk and to inform prevention and intervention activities. Of particular interest are those potentially modifiable factors that seem to confer resilience despite exposure to risky levels of alcohol. As part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD) consortium, a longitudinal cohort of pregnant women and their offspring have been followed at two sites in Ukraine from 2009-2015. A total of 285 women were recruited into a risky alcohol exposure group based on frequent heavy episodic drinking in the month around conception and/or in the most recent month of pregnancy. Demographic, social, health and lifestyle characteristics were collected on the mothers, and their nutritional status was measured at the time of enrollment. Outcomes including gestational age at delivery, birth size, and neurobehavioral measures on the Bayley Scales of Infant Development II were assessed up through one year of age.
Despite the fact that women in the sample consumed similar amounts of alcohol, several factors were associated with better outcomes for the children. Maternal use of vitamin/mineral supplements was associated with longer length of gestation. Mothers who were more educated and vitamin users were significantly more likely to have a higher birth weight infant (+63 grams for each level of education, p <0.001; +128 grams for vitamin use, p <0.001). Better status on selected micronutrients, e.g. higher choline levels in mid-pregnancy, was associated with higher birth weight infants (p=0.015). Mothers with higher socioeconomic status, vitamin users, and those who were not depressed had infants who scored better on the Bayley Scales of Infant Development.
Postnatal follow-up of children in this longitudinal sample continues. Elements in the postnatal environment that contribute to cumulative family stress will be combined with measures/markers of prenatal stressors to develop a cumulative risk index/resiliency profile that is associated with better child outcomes even in the presence of substantial prenatal alcohol exposure. Factors in the pre- and postnatal environment that are modifiable are potential targets for intervention.