Date of Award

8-11-2015

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Daniel Whitaker, PhD

Second Advisor

Claire D. Coles, PhD

Abstract

Objectives

Prenatal alcohol exposure can lead to fetal alcohol spectrum disorders (FASD), which include a broad range of cognitive, growth, behavior, and physical abnormalities. Early detection of the teratogenic effects of prenatal alcohol exposure is necessary to identify early interventions. The aim of this study is to identify the effects of prenatal alcohol exposure on growth and infant development, to determine if ultrasound imaging can be used as an early identification tool, and to determine if maternal folate supplementation can mitigate the detrimental effects on growth and infant development.

Methods

A prospective cohort study and randomized trial from 2008 to 2014 conducted in two sites of Western Ukraine was analyzed. A sample of pregnant women who reported moderate-to-heavy alcohol consumption during pregnancy, and a sample reporting little-to-no alcohol use during pregnancy participated in a comprehensive maternal interview and screening process. Women were further randomized into micronutrient supplementation groups. Standard ultrasound examinations during pregnancy including study specific brain growth measurements, along with blood and urine samples were obtained during follow-up visits. A biometric screening was conducted at birth, along with Bayley Scales of Infant Development-II Mental Development Index (MDI) and Psychomotor Development Index (PDI) assessments at 6 and 12 months of age.

Results

Estimated fetal weight (EFW), abdominal circumference (AC), biparietal diameter (BPD), transverse cerebellar diameter (TCD), occipitofrontal diameter (OFD), caval-calvarial distance (CCD), and orbital diameter (OD) were significantly reduced by alcohol exposure at third trimester ultrasound (p2(7)=18.044, p=0.012), AC at third trimester (X2(5)=17.955, p=0.003), and birth weight (X2(6)=75.058, p2(11)=63.051, p

Conclusions

Significant reductions in fetal growth measurements during third trimester ultrasound suggest that the effects of prenatal alcohol exposure may be detectable in late pregnancy. Significant associations between multivitamin supplementation and specific growth measurements suggest that micronutrient supplementation during pregnancy, including high doses of folate, may be an early intervention to reduce the harmful effects of prenatal alcohol exposure. Further studies are needed to identify the specific micronutrients producing these effects, and to assess the appropriate level of these micronutrients necessary to provide the greatest benefit without exceeding the safe limit.

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