Breastfeeding and maternal alcohol use: Prevalence and effects on child outcomes and fetal alcohol spectrum disorders

May, Philip A.; Hasken, Julie M.; Blankenship, Jason; Marais, Anna Susan; Joubert, Belinda; Cloete, Marise; Vries, Marlene M. de; Barnard, Ronel; Botha, Isobel; Roux, Sumien; Cate, Doms,; Gossage, J. Phillip; Kalberg, Wendy O.; Buckley, David; Robinson, Luther K.; Adnams, Colleen M.; Manning, Melanie A.; Parry, Charles D. H.; Hoyme, H. Eugene; Tabachnick, Barbara G.; Seedat, Soraya

doi:10.1016/j.reprotox.2016.05.002

Cited by 66 publications

(68 citation statements)

References 49 publications

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“…These findings support and extend upon the findings of Gibson and Porter [7], who found dose-dependent reductions in children's abstract reasoning abilities at age 6-7 years. They are also consistent with the poorer grammatical comprehension observed in children of mothers who consumed alcohol while breastfeeding [39]. Furthermore, child [53] and maternal age [50], income [52], maternal education [52], birthweight [24], sex [51], tobacco smoking [1,4] and alcohol consumption during pregnancy [2,3] were all associated with academic scores in manners consistent with prior research.…”

Section: Discussionsupporting

confidence: 87%

“…No association was observed in babies who had never been breastfed. These findings were consistent with the poorer grammatical comprehension [39] and dose-dependent reduction in abstract reasoning ability observed in children of mother's who drank alcohol while breastfeeding [7]. This suggests that alcohol consumed during lactation can impact the academic achievement of children.…”

Section: Discussionsupporting

confidence: 76%

“…While Little et al [37] found reduced psychomotor scores at one year in babies whose mothers drank while breastfeeding, more recent studies found no reduction in developmental scores [17,38]. In contrast to the poorer grammatical comprehension of children whose mothers consumed alcohol during lactation [39], Gibson and Porter [7] found no dose-dependent relationship between maternal alcohol use while breastfeeding and either vocabulary or early literacy screening scores.…”

Section: Introductionmentioning

confidence: 98%

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Drinking or Smoking While Breastfeeding and Later Academic Outcomes in Children

Gibson

Porter

2020

Nutrients

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Alcohol consumed by breastfeeding mothers has been associated with reduced grammatical comprehension and cognition in children. This study examined whether drinking or smoking while breastfeeding was associated with reductions in Australian National Assessment Program–Literacy and Numeracy assessments. Data was sourced from The Growing Up in Australia Study. This is an ongoing longitudinal study of 5107 infants and mothers recruited in 2004 and followed over time every two years. Multivariable linear regression found that maternal alcohol consumption at study entry was associated with reductions in Grade 3 (age 7–10 years) National Assessment Program–Literacy and Numeracy writing (b = −1.56, 95% CI: −2.52; −0.60, p = 0.01), spelling (b = −2.06, 95% CI: −3.31; −0.81, p < 0.0001) and grammar and punctuation (b = −2.11, 95% CI: −3.59; −0.64, p = 0.01) scores, as well as Grade 5 (age 9–11 years) spelling scores (b = −1.58, 95% CI: −2.74; −0.43, p = 0.03) in children who had been breastfed at any time. This was not evident in babies who had never breastfed, or in the smaller group of infants who were actively breastfeeding at study entry. Smoking was not associated with any outcome variable. Drinking alcohol while breastfeeding may result in dose-dependent reductions in children’s academic abilities. While reductions are small, they may be of clinical significance if mothers drink large quantities. Further analyses are planned to assess developmental, physical and behavioural outcomes in children.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 98%

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Drinking or Smoking While Breastfeeding and Later Academic Outcomes in Children

Gibson

Porter

2020

Nutrients

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“…Similar questions have been used effectively and successfully in other ZA studies by our team and other experienced researchers (Jacobson et al, 2008; Viljoen et al, 2002). Proximal variables assessed included alcohol use by quantity, frequency, and timing during pregnancy and when breastfeeding (May et al, 2016c). Distal variables of maternal risk were addressed, including: maternal height, weight, and OFC; childbearing history; and demographic variables.…”

Section: Methodsmentioning

confidence: 99%

The continuum of fetal alcohol spectrum disorders in a community in South Africa: Prevalence and characteristics in a fifth sample

May

Marais

Vries

et al. 2016

Drug and Alcohol Dependence

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Background The prevalence and characteristics of the continuum of diagnoses within fetal alcohol spectrum disorders (FASD) were researched in a fifth sample in a South African community. Methods An active case ascertainment approach was employed among all first grade learners in this community (n=862). Following individual examination by clinical geneticists/ dysmorphologists, cognitive/behavioral testing, and maternal interviews, final diagnoses were made in multidisciplinary case conferences. Results Physical measurements, cardinal facial features of FAS, and total dysmorphology scores clearly differentiated diagnostic categories in a consistent, linear fashion, from severe to mild. Neurodevelopmental delays and behavioral problems were significantly worse for each of the FASD diagnostic categories, although not as consistently linear across diagnostic groups. Alcohol use was documented by direct report from the mother in 71% to 100% of cases in specific diagnostic groups. Significant distal maternal risk factors in this population are: advanced maternal age at pregnancy; low height, weight, and body mass index (BMI); small head circumference; low education; low income; and rural residence. Even when controlling for socioeconomic status, prenatal drinking correlates significantly with total dysmorphology score, head circumference, and five cognitive and behavioral measures. In this community, FAS occurs in 59 – 79 per 1,000 children, and total FASD in 170 – 233 per 1,000 children, or 17% to 23%. Conclusions Very high rates of FASD continue in this community where entrenched practices of regular binge drinking co-exist with challenging conditions for childbearing and child development in a significant portion of the population.

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“…In our study, we found notable differences in facial dysmorphology caused by prenatal alcohol exposure between the Cape Coloured and Caucasian cohorts related to midline and nonmidline structures. May and colleagues (, ) addressed the role of nutrition in FASD in the South African population (both in Reproductive Toxicology ). In the 2014 article, all of the mothers of both FASD and controls were found to be undernourished, but the mothers of children with FASD were more malnourished especially in calcium, docosapentaenoic acid, riboflavin, and choline, all nutrients important to growth and development and therefore could influence brain (head) and facial development.…”

Section: Discussionmentioning

confidence: 99%

Facial Curvature Detects and Explicates Ethnic Differences in Effects of Prenatal Alcohol Exposure

Suttie

Wetherill

Jacobson

et al. 2017

Alcoholism Clin & Exp Res

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Background Our objective is to help clinicians detect the facial effects of prenatal alcohol exposure (PAE) by developing computer based tools for screening facial form. Methods All 415 individuals considered were evaluated by expert dysmorphologists and categorized as 1) healthy control (HC), 2) fetal alcohol syndrome (FAS) or 3) heavily prenatally alcohol exposed (HE) but not clinically diagnosable as FAS. 3D facial photographs were used to build models of facial form to support discrimination studies. Surface curvature based delineations of facial form were introduced. Results Facial growth in FAS, HE and control subgroups is similar in both cohorts. Cohort consistency of agreement between clinical diagnosis and HC-FAS facial form classification is lower for mid-line facial regions and higher for non-mid-line regions. Specific HC-FAS differences within and between the cohorts include: for HC, a smoother philtrum in Cape Coloured individuals;for FAS, a smoother philtrum in Caucasians;for control-FAS philtrum difference, greater homogeneity in Caucasians;for control-FAS face difference, greater homogeneity in Cape Coloured individuals; Curvature changes in facial profile induced by prenatal alcohol exposure are more homogeneous and greater in Cape Coloureds than in Caucasians. The Caucasian HE subset divides into clusters with control-like and FAS-like facial dysmorphism. The Cape Coloured HE subset is similarly divided for non-mid-line facial regions but not clearly for mid-line structures. The Cape Coloured HE subset with control-like facial dysmorphism shows orbital hypertelorism. Conclusions Facial curvature assists the recognition of the effects of prenatal alcohol exposure and helps explain why different facial regions result in inconsistent control-FAS discrimination rates in disparate ethnic groups. Heavy prenatal alcohol exposure can give rise to orbital hypertelorism, supporting a long-standing suggestion that prenatal alcohol exposure at a particular time causes increased separation of the brain hemispheres with a concomitant increase in orbital separation.

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Breastfeeding and maternal alcohol use: Prevalence and effects on child outcomes and fetal alcohol spectrum disorders

Cited by 66 publications

References 49 publications

Drinking or Smoking While Breastfeeding and Later Academic Outcomes in Children

Drinking or Smoking While Breastfeeding and Later Academic Outcomes in Children

The continuum of fetal alcohol spectrum disorders in a community in South Africa: Prevalence and characteristics in a fifth sample

Facial Curvature Detects and Explicates Ethnic Differences in Effects of Prenatal Alcohol Exposure

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