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Alcohol is made from ethanol and is present in a variety of alcoholic beverages such as beer, wine, vodka, etc. Alcohol is classified as a depressant that can result in slurred speech, unsteady movement, and altered perception.

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What happens if your baby is exposed to alcohol during your pregnancy?

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What happens if your baby is exposed to alcohol during your pregnancy?

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Alcohol is also classified as a teratogen because when consumed during pregnancy, it can increase the risk of the baby to form fetal alcohol syndrome. When your drink while pregnant, the alcohol can flow pass through the placenta to the baby. Fetal alcohol syndrome can cause intellectual disabilities, facial malformation, delayed growth, and learning difficulties. If the mother is addicted to alcohol, the fetus can also experience dependence on alcohol as well. When the baby is born, the dependence on alcohol continues, however the baby could go through withdrawal since it is no longer available.

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A study conducted by the Collaboration on Fetal Alcohol Spectrum Disorders Prevalence (CoFASP) consortium on 6,000 children determined that the frequency of fetal alcohol syndrome ranged from 1.1% to 5%. The study showed that the children who had the syndrome experienced growth deficiencies, facial abnormalities, and even organ damage, especially to the brain. Fetal alcohol syndrome could cause a variety of neurological defects that can contribute to physical, behavioral, cognitive, and social challenges to the baby.

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NIH-funded research examined over 6,000 children to determine prevalence of FASD ranged from 1.1 to 5 percent.

A study of more than 6,000 first-graders across four U.S. communities has found that a significant number of the children have fetal alcohol spectrum disorders (FASD), with conservative rates ranging from 1 to 5 percent in community samples. The new findings represent more accurate prevalence estimates of FASD among general U.S. communities than prior research. Previous FASD estimates were based on smaller study populations and did not reflect the overall U.S. population. The study was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health.

FASD is an umbrella term for a range of health effects caused by prenatal alcohol exposure. Individuals with FASD may experience growth deficiencies, facial abnormalities, and organ damage, including to the brain. The effects of prenatal alcohol exposure on the brain can result in a range of neurobiological deficits that contribute to physical, cognitive, behavioral, and social challenges throughout life.

"Prenatal alcohol exposure is a leading preventable cause of developmental disabilities worldwide," said NIAAA Director George F. Koob, Ph.D. "Estimating the prevalence of FASD in the United States has been complex due to the challenges in identifying prenatally exposed children. The findings of this study confirm that FASD is a significant public health problem, and strategies to expand screening, diagnosis, prevention, and treatment are needed to address it."

The study was conducted by the Collaboration on Fetal Alcohol Spectrum Disorders Prevalence (CoFASP) consortium, which studies the prevalence of FASD among U.S. school children. Before the study began, consortium members established standardized classification criteria for FASD based on facial features, growth, and neurodevelopmental performance. Co-led by Philip May, Ph.D., of the University of North Carolina Nutrition Research Institute, Kannapolis, and Christina Chambers, Ph.D., of the University of California San Diego School of Medicine, the findings are reported online in the Journal of the American Medical Association.

Researchers collected data between 2010 and 2016 on 6,639 children in four communities in the Midwest, Rocky Mountain, Southeast and Pacific Southwest, sites that were selected to be more reflective of U.S. community populations than previous studies. At each site, first-graders in public and private schools were recruited across two academic years and evaluated based on the FASD criteria. Prenatal alcohol exposure was assessed by interviewing mothers or other close relatives.

The researchers found that the prevalence estimates for FASD among the selected sites ranged from 1.1 to 5 percent. This was the most conservative estimate and assumed that no additional cases of FASD would be found in first-graders who did not participate in the study. Using a "weighted prevalence" approach that assumed that the rate of FASD in children who were evaluated would be the same in all eligible first-grade children in each community, the estimated prevalence of FASD was higher-ranging from 3.1 to 9.8 percent among the study sites. Of the 222 children diagnosed with FASD in the study, only two had been previously diagnosed with FASD, although many parents and guardians were aware of the children's learning and behavioral challenges. This finding suggests that children with FASD often go undiagnosed or misdiagnosed.

"We believe our study is the first to use school-based assessments, a common methodology and classification system, and expert in-person evaluations for the full range of FASD on many children from communities across the United States," said May.

"This comprehensive approach should reflect estimates that more closely resemble the prevalence of FASD in the United States, and further highlights the public health burden of FASD," added Chambers.

About the National Institute on Alcohol Abuse and Alcoholism (NIAAA): The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, diagnosis, prevention, and treatment of alcohol use disorder. NIAAA also disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at: https://www.niaaa.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIH...Turning Discovery Into Health®
Reference

May, P.A., et al. Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities. JAMA. Online February 6, 2018.

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Study of first-graders shows fetal alcohol spectrum disorders prevalent in U.S. communities

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NIH-funded research examined over 6,000 children to determine prevalence of FASD ranged from 1.1 to 5 percent. A study of more than 6,000 first-graders across four U.S. communities has found that a significant number of the children have fetal alcohol spectrum disorders (FASD), with conservative rates ranging from 1 to 5 percent in community samples.

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Caffeine is a natural stimulant, and the most consumed stimulant, that is most commonly found in tea, coffee, and soda. Caffeine stimulants the central nervous system to help you stay alert and awake. Caffeine can also increase your blood pressure and heart rate, so it is not recommended to be consumed while pregnant.

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Cocaine is a stimulant drug that is highly addictive. It is usually snorted, smoked, or injected. Cocaine can cause increased heart rate, muscle spasms, and decreased appetite. Using cocaine for a short period of time can still increase the risk of dependence.

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Isotretinoin is a prescription medication used to treat severe acne. Isotretinoin is an oral medication that is taken usually once or twice a day. It is classified as a retinoid that is made from a synthetic form of vitamin A.

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What happens if your baby is exposed to caffeine during your pregnancy?

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What happens if your baby is exposed to caffeine during your pregnancy?

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Consumption of caffeine during pregnancy can increase the chances of miscarriage and can cause low birth weight. It can also cause birth defects, premature labor, and reduced fertility. Drinking caffeine can pass through the placenta and reach the fetus; however, the fetus is not fully matured and cannot metabolize the caffeine. The caffeine can also hinder the baby's normal sleep pattern or movement pattern.

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Ling-Wei Chen, researcher at University College Dublin in Ireland, studied 941 mothers and their children born in Ireland. Chen saw that a high caffeine consumption led to a lower birth weight, as well as "lower gestational age, birth length and head circumference."

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(Reuters Health) - Pregnant women who consume caffeine - whether it's from coffee or tea - have smaller babies than those who abstain from the stimulant during pregnancy, new research suggests.

Even women who took in less than 200 milligrams of caffeine, the safe cutoff during pregnancy according to the American College of Obstetricians and Gynecologists (ACOG), had a significantly increased risk of delivering prematurely or having a low-birthweight baby.

"Based on the consistent associations we observed, and because many pregnancies are unplanned, we would recommend women who are pregnant or seeking to become pregnant to at least limit their intakes of caffeinated coffee and tea," lead study author Ling-Wei Chen, a researcher at University College Dublin in Ireland, said in an email.

The study cannot prove cause and effect, he cautioned. But several previous studies have linked caffeine exposure in the womb to negative effects, Chen and his colleagues write in The American Journal of Clinical Nutrition.

In most of those studies, coffee was the main caffeinated beverage consumed.

For the current study, Chen's team looked at 941 mother-child pairs born in Ireland, where people drink more tea than coffee. Nearly half of the mothers in the study drank tea, while about 40 percent drank coffee.

Every additional 100 milligrams of caffeine consumed daily during the first trimester of pregnancy was associated with a 72-gram (2.5 ounce) lower birth weight, as well as significantly lower gestational age, birth length and head circumference.

Women who took in the most caffeine had babies weighing about 170 grams (6 ounces) less than those who consumed the least, the researchers found. Whether the caffeine came from coffee or tea made no difference to the results.

"High caffeine intake can result in restricted blood flow in the placenta which may subsequently affect fetal growth," Chen explained. "Caffeine can also cross the placenta readily, and because caffeine clearance slows as pregnancy progresses, caffeine accumulation may occur in fetal tissues."

One 12-ounce cup (355 ml) of brewed coffee contains about 200 mg of caffeine, but tea generally contains less caffeine and the amount can vary by type of tea and how long it was brewed. The Lipton Tea company, for example, says its black tea contains about 83 mg caffeine in a 12-ounce cup.

The public doesn't seem to recognize tea's caffeine content, said the study's senior author, Catherine Phillips, a researcher at University College Dublin. "Thus, maternal intake of both tea and coffee need to be taken into account when trying to minimise overall caffeine intake during pregnancy. This is especially important where tea is the predominant caffeine source," she told Reuters Health by email.

ACOG states that consuming less than 200 milligrams of caffeine per day in pregnancy "does not appear to be a major contributing factor in miscarriage or preterm birth." The World Health Organization recommends that women consume less than 300 mg of caffeine daily in pregnancy.

"This paper and other papers show that this is likely too high," said Dr. De-Kun Li, a senior scientist at the Kaiser Permanente Northern California division of research in Oakland, who wasn't involved in the study. "Epidemiological findings based on self-reported caffeine consumption are usually not very precise. Thus, any cutoffs chosen by ACOG and WHO can only be considered as rough reference points. Biologically, it is unlikely that 300 mg is risky while 299 mg is safe," Li said in a phone interview.

"The message to women I would prefer would be 'the less the better,'" Li said. "Then the women can choose for themselves."

Reports touting the health benefits of caffeine also need to include a caveat stating that it may be harmful in pregnancy, added Li, whose own research has linked caffeine consumption in pregnancy to miscarriage and childhood obesity. "My advice would be try to reduce as much as you can, if you can totally quit that would be even better."

ACOG told Reuters Health that it reviews all of its recommendations every 18 to 24 months, includes all new research in its reviews, and makes adjustments to recommendations as needed. "Until that time, ACOG's current guidance still stands."

SOURCE: bit.ly/2KpXsIg The American Journal of Clinical Nutrition, online October 19, 2018.

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Caffeine in tea, coffee may be equally risky to fetus

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(Reuters Health) - Pregnant women who consume caffeine - whether it's from coffee or tea - have smaller babies than those who abstain from the stimulant during pregnancy, new research suggests.

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What happens if your baby is exposed to isotretinoin during your pregnancy?

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What happens if your baby is exposed to isotretinoin during your pregnancy?

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Isotretinoin causes birth defects in over 35% of infants who were exposed to the drug during pregnancy. Most of the babies with birth defects will have small or absent ears, hearing and eyesight problems, and life-threatening heart defects. Some can have facial abnormalities such as small jaw, small head, and cleft palate. The use of isotretinoin during pregnancy can also lead to brain malformations and intellectual disabilities. The risk for having a miscarriage or premature delivery increases when isotretinoin is taken during the pregnancy.

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In a research study, out of 115 pregnancies who had isotretinoin exposed to their fetus, 26 had congenital malformations. The study also showed that the main abnormalities that isotretinoin caused were 'craniofacial, central nervous system, cardiovascular, and thymic."

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Recently, one of our patients who was taking isotretinoin became pregnant. This occurred despite appropriate counseling, a negative pregnancy test result before commencing treatment, and use of the combined oral contraceptive pill Microgynon 30 (Schering Health Care, West Sussex, England) (levonorgestrel, 150 μg, ethinylestradiol, 30 μg). The patient did not want to terminate her pregnancy. The aim of this Critically Appraised Topic is to explore the literature to determine the chance of delivering a healthy child after fetal exposure to isotretinoin; the types of fetal malformations associated with it; and what monitoring should be performed.

Since introduction of the drug in 1982, over 2000 pregnancies in the United States have been affected by fetal exposure to isotretinoin, most resulting in spontaneous or elective abortions.

We searched the Medline and EmBase databases from 1966 to March 2007 using the terms isotretinoin or Accutane or Roaccutane and pregnancy or birth defect.

Appraisal of the Evidence

We found 469 articles in the literature search and chose 2 case series that prospectively identified and followed up pregnancies in which the fetus was exposed to isotretinoin for which abortion was not elected. We extracted data from these 2 prospective studies to develop our clinical bottom line because these studies are likely to be less biased than the retrospective studies. These 2 studies collected data from a combined total of 151 pregnant women in the United States aged 14 years to older than 35 years whose fetuses were exposed to isotretinoin.

In one study of 115 pregnancies, there were 21 spontaneous abortions (18%). Of the 94 live births, 61 were healthy infants (65% of births, 53% of pregnancies), 26 had congenital malformations consistent with isotretinoin embryopathy (28% of births, 23% of pregnancies), and 7 had other problems (7% of births). Therefore, 28% of live births had congenital malformations consistent with isotretinoin embryopathy (95% confidence interval, 19%-37%).

In the second study of 36 pregnancies, there were 8 spontaneous abortions (22%). Of the 28 live births, 23 were healthy infants (82% of births, 64% of pregnancies), and 5 had congenital malformations (18% of births, 14% of pregnancies).

The main abnormalities found in isotretinoin embryopathy are craniofacial, central nervous system, cardiovascular, and thymic.

Craniofacial: ear defects, dysmorphism, cleft palate, depressed nasal bridge, hypertelorism;

Central nervous system: hydrocephalus, microcephaly, facial nerve palsy, cortical and cerebellar defects;

Cardiovascular: Fallot's tetralogy, transposition of great vessels, septal defects, aortic arch hypoplasia;

Thymic: ectopia, hypoplasia, aplasia; and

Miscellaneous: spina bifida, limb reduction.

In addition, fetal exposure to isotretinoin is associated with high risk of adverse outcome with respect to mental functioning. The United Kingdom National Teratology Information Service estimates that in fetal exposure to isotretinoin, 30% of infants with no gross malformations have mental retardation, and up to 60% have impaired neuropsychological function.

The National Teratology Information Service recommends that women who wish to continue their pregnancy after fetal exposure to isotretinoin should have alpha-fetoprotein testing at 16 to 19 weeks' gestation and undergo a targeted ultrasound scan and echocardiography at 20 to 21 weeks' gestation. These investigations would give some indication of the risks of structural malformations so that parents can plan support services and, in rare instances, in utero intervention could be performed, if appropriate.

The high rate of fetal exposure to isotretinoin and its serious teratogenicity are clearly illustrated. The US Food and Drug Administration has recently approved the "iPLEDGE" risk management program, which is designed to reduce the risk of fetal exposure to isotretinoin. However, it is also important that dermatologists prevent pregnant women from taking the medication (document proof of no pregnancy) and prevent women who are taking it from getting pregnant (use of 2 forms of birth control).

There is no dose of oral isotretinoin that is safe for use in pregnant women and, consequently, there are no published studies of women who took isotretinoin throughout pregnancy. Therefore, information about safety must be obtained from studies in which isotretinoin was taken for acne during some portion of pregnancy.

Reported outcomes of retrospectively and prospectively ascertained cases differ considerably. Therefore, we have based our conclusions on data from prospective studies because of the strong likelihood of bias (especially reporting bias) associated with retrospective studies. Published prospective outcome data are available for only a small proportion of pregnancies in which the fetus was exposed to isotretinoin because most of these pregnancies are not reported in the literature.

The level of fetal exposure to isotretinoin varies from pregnancy to pregnancy so it is possible that isotretinoin-related problems may be higher for women who continue taking isotretinoin for a longer duration before discovering that they are pregnant. However, there is insufficient data to address this issue. There is little information about the timing of spontaneous abortions, either in weeks or trimesters. There is little follow-up data on infants with no gross malformation to determine the risk of developmental disabilities later in life.

In pregnancies in which the fetus is exposed to isotretinoin,

The risk of spontaneous abortion is approximately 20%;

In pregnancies that progress, 65% to 82% of neonates appear normal at birth, but there is insufficient data to determine how many will later develop isotretinoin-related problems;

There is an 18% to 28% risk of isotretinoin embryopathy;

There is no safe level of exposure: any exposure can cause malformation;

The main abnormalities are craniofacial, cardiac, central nervous system, and thymic; and

Women who choose to continue their pregnancy require careful support and monitoring.

Finally, it is important that dermatologists prevent pregnant women from taking isotretinoin and prevent women who are taking it from getting pregnant.

What Happened to Our Patient?

Our patient ceased taking isotretinoin as soon as she discovered that she was pregnant, at approximately 6 to 7 weeks' gestation. We discussed with her the evidence regarding isotretinoin and birth defects. She elected to continue with her pregnancy and underwent regular ultrasound scans, performed by her obstetrician. She delivered a healthy baby girl, with no apparent birth defect. At age 18 months, her daughter was developing normally.

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What Is the Chance of a Normal Pregnancy in a Woman Whose Fetus Has Been Exposed to Isotretinoin?

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Recently, one of our patients who was taking isotretinoin became pregnant. This occurred despite appropriate counseling, a negative pregnancy test result before commencing treatment, and use of the combined oral contraceptive pill Microgynon 30 (Schering Health Care, West Sussex, England) (levonorgestrel, 150 μg, ethinylestradiol, 30 μg).

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What happens if your baby is exposed to cocaine during your pregnancy?

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What happens if your baby is exposed to cocaine during your pregnancy?

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Using cocaine while pregnant can lead to serious consequences for babies such as behavioral problems and impaired language development. It can also increase the chance for babies to develop cognitive and brain damage.

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A research study showed that consuming cocaine while pregnant increased the risk of congenital malformations. The study also showed that pregnant women who used cocaine had a higher frequency of their babies having abnormal behavior and getting an abortion.

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Cocaine as a Teratogen | The Embryo Project Encyclopedia