Reinhold Feldmann

Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? results from two large Western-European studies

BackgroundInconsistent data on the association between prenatal alcohol exposure and a range of pregnancy outcomes, such as preterm birth (PTB) and small for gestational age (SGA) raise new questions. This study aimed to assess whether the association between low-moderate prenatal alcohol exposure and PTB and SGA differs according to maternal education, maternal mental distress or maternal smoking.MethodsThe Amsterdam Born Children and their Development (ABCD) Study (N = 5,238) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (N = 16,301) are both large studies. Women provide information on alcohol intake in early pregnancy, 3 months postpartum and up to 17 years retrospectively. Multivariate logistic regression analyses and stratified regression analyses were performed to examine the association between prenatal alcohol exposure and PTB and SGA, respectively.ResultsNo association was found between any level of prenatal alcohol exposure (non-daily, daily, non-abstaining) and SGA. The offspring of daily drinkers and non-abstainers had a lower risk of PTB [ABCD: odds ratio (OR) 0.31, 95% confidence interval (CI) 0.13, 0.77; KiGGS: OR 0.75, 95% CI 0.57, 0.99]. Interactions with maternal education, maternal distress or maternal smoking were not significant.ConclusionsAlthough these results should be interpreted with caution, both studies showed no adverse effects of low-moderate prenatal alcohol exposure on PTB and SGA, not even in the offspring of women who were disadvantaged in terms of low education, high levels of distress, or smoking during pregnancy.

Adolescents' Use of Alcohol, Tobacco and Illicit Drugs in Relation to Prenatal Alcohol Exposure: Modifications by Gender and Ethnicity

AIMS The study aimed to investigate (a) the association between low to moderate prenatal alcohol exposure (PAE) and the use of alcohol, tobacco and illicit drugs in adolescence and (b) whether the associations are modified by gender and ethnicity. METHODS The subjects of the study were 5922 children and adolescents, aged from 11 to 17 years, enrolled in the cross-sectional German Health Interview and Examination Survey for Children and Adolescents (the KiGGS study). Information on PAE is based on parental self-report questionnaires. Use of alcohol, tobacco and illicit drugs was assessed through self-report questionnaires for adolescents. RESULTS Low to moderate PAE was associated with an increased risk of drinking alcohol (adjusted odds ratio (OR) 1.73, 95% confidence interval (CI) 1.34, 2.18) and also of illicit drug use (adjusted OR 1.62, 95% CI 1.23, 2.14). The associations between PAE and the use of alcohol, tobacco and illicit drugs differed according to gender and ethnicity. Gender-stratified analyses resulted in adverse effects of PAE on drinking alcohol, smoking and illicit drug use in females; however, in German males, the associations disappeared. Stronger associations between PAE and the outcome measures were found in non-Germans. CONCLUSIONS Our findings indicate that low to moderate levels of maternal alcohol intake during pregnancy are a risk factor for use of alcohol, tobacco and illicit drugs by the offspring, with stronger associations in females and non-Germans.

Malocclusion Can Give Additional Hints for Diagnosis of Fetal Alcohol Spectrum Disorder

Aims Fetal alcohol spectrum disorder (FASD) is a developmental disorder caused by maternal alcohol intake (prevalence: 0.77%). Malocclusion has been described in case reports of patients with FASD, but reliable evidence for associations between FASD and malocclusion is not documented. Malocclusion is defined as tooth irregularity (prevalence: 14.6%) or incorrect relationship between the jaws such as lateral crossbites (prevalence: 3.1%). The purpose of this study was to investigate possible associations between malocclusion and FASD. Short summary FASD prevalence is high and diagnosis is very difficult; Malocclusions can give additional hints for FASD diagnosis; Patients with FASD show growth deficits concerning the maxilla; Early and consistent orthodontic supervision and therapy can prevent facial asymmetries in FASD patients. Methods Thirty patients with FASD and 30 patients of a healthy control group were examined. Inclusion criteria were mixed dentition, verified FASD/absence of FASD (control group), exclusion criteria were orthodontic treatment and disorders other than FASD. The extent and type of malocclusion were quantified with the peer assessment rating (PAR) index based on an analysis of orthodontic plaster models. In addition, anthropometric data such as gestational age, body weight and height at birth as well as present body weight, height and head circumference at examination date were assessed. Results The PAR index showed a significant increase in malocclusions in FASD patients compared to the group that were not diagnosed with FASD (P = 0.002). FASD patients showed particular differences in the upper transversal dimension with a higher prevalence of crossbites (P = 0.018) and a lower head circumference (P < 0.001). Body weight (P < 0.001) and height (P < 0.001) were significantly lower for FASD patients at time of birth, but not at the present examination date (weight: P = 0.329; height: P = 0.496). When relating weight and height measures to age using percentile curves of physiological growth, clinically relevant discrepancies could be found for FASD patients. Conclusions Our results show that malocclusion can provide additional evidence for FASD diagnosis. When FASD is diagnosed in a child, early referral to an orthodontist is advisable to stimulate maxillary growth and consequently prevent further malocclusions.