Fetal Alcohol Syndrome Alcohol and Pregnancy Nancy L

Fetal Alcohol Syndrome: Alcohol and Pregnancy Nancy L. Day, Ph. D School of Medicine, Department of Psychiatry, University of Pittsburgh

Investigators • • • Nancy Day, PHD, Epidemiology Gale Richardson, PHD, Developmental Psychology Marie Cornelius, PHD, Epidemiology Christopher Ryan, PHD, Neuropsychology John Donovan, PHD, Social Psychology Nadine Robles, PHD, Anthropology David Stoffer, PHD, Statistics Paul Taylor, MD, Pediatrics Mark Scher, MD, Neurology Cynthia Larkby, PHD, Epidemiology Lidush Goldschmidt, PHD, Statistics

Maternal Health Practices and Child Development Project Alcohol use during prignancy N. Day Prenatal Cocaine Use G. Richardson Teenage prenatal tobacco and marijuana use M. Cornelius Prenatal Marijuana Exposure N. Day Data Instruments Administration Personnel Analysis Alcohol Research Training Program Childhood Abuse, Alcohol Use, and PTSD C. Larkby Tobacco Prenatal Effects and Adolescent Use N. Day, M. Cornelius Psychiatric Epidemiology Training Program

Diagnosis of Fetal Alcohol Syndrome Minimal Criteria: Abnormalities in each of three areas • Prenatal and/or postnatal growth retardation • Central nervous system involvement • Characteristic facial dysmorphology

Predictive Value of Head Circumference and One Facial Anomaly Head Sircumference <10 th Percentile and One Facial Anomaly All remaining subjects N=29 N=713 IQ Score at Age 6 85. 5 95. 9 Math Subtest WRAT-R 80. 9 93. 3 Spelling 79. 0 Subtest WRAT -R 89. 2 Reading 89. 2 93. 9* Subtest WRAT All comparisons are significant at P<. 01; *significant at p=. 09

Predictive Value of Head Circumference and One Facial Anomaly Head Sircumference <10 th Percentile and One Facial Anomaly All remaining subjects N=29 1. 37 N=713 0. 57 ADV Third Trimester 1. 28 0. 1 Weight at Age 6 (kg) Height at Age 6 (cm) 20. 9 23. 2 113. 8 119. 5 Average Daily Volume (ADV) Frist Trimester Head Circumference at All comparisons Age 6 (mm) 513. 4 521. 2 are significant at P<. 0005

Study Design 16 years 14 years 10 years 6 years 3 years 18 months delivery 7 th prenatal month 4 th prenatal month

Study Follow-Up rates Birth 8 18 3 mont year h h 6 year 10 year 14 year Inte 595 465 509 526 522 490 460 r Vie d Rat 96 81 91 95 94 90 84 e % % % %

Time Investment 7. 7 contacts to schedule a subject The range was 1 to 43 times

Time-II On Average, each appointment is rescheduled two times Range 1 to 13

From the time that you got pregnant to the time that you realized that you were pregnant……… was your drinking was more like what you told me you did prior to your pregnancy, or more like you told me you drank during the first trimester?

PERCENTAGE OF DRINKERS WHO MISREPORTED FIRST TRIMESTER DRINKING CONCEPTION RECOGNITION 61% DIAGNOSIS 30%

DOMAINS OF DATA: MATERNAL DEMOGRAPHIC FACTORS RACE AGE MARITAL STATUS EDUCATION MEDICAL FACTORS PREGNANCY AND LOBOR CURRENT HEALTH STATUS MEDICATION PSYCHOLOGICAL FACTORS DEPRESSION ANXIETY HOSTILITY SELF-ESTEEM

MATERNAL FACTORS SOCIAL FACTORS DYADIC ADJUSTMENT SOCIAL SUPPORT LIFE EVENT RELIGION COGNITIVE MEASURES MATERNAL IQ ENVIRONMENTAL FACTORS FAMILY ENVIRONMENT HOUSEHOLD STRUCTURE PARENTAL WARMTH SUPERVISION DISCIPLINE

SUBSTANCE ABUSE PRENATAL DRUG AND ALCOHOL ABUSE MARIJUANA, TOBACCO, OTHER ILLICIT DRUGS, ALOCOHOL EACH TRIMESTER AND EACH MONTH OF THE FIRST TRIMESTER POSTNATAL DRUG AND ALCOHOL USE OF THE FATHER AND THE MALE IN THE HOUSEHOLD HISTORY OF USE AND ABUSE CURRENT USE

CHILD DOMAINS PHYSICAL STATUS MEDICAL HISTORY GROWTH PUBERTAL DEVELOPMENT NEUROPSYCHOLOGICAL DEVELOPMENT CPT WRAML TRAIL MAKING PARTS A AND B GROOVED PEGBOARD STROOP WISCONSIN CARD SORTING TEST

CHILD MEASURES COGNITIVE DEVELOPMENT STANFORD-BINET SCHOOL PERFORMANCE WRAT-R PIAT-R GRADES ATTENDANCE BEHAVIOR ACTIVITY ATTENTION BEHAVIOR PROBLEMS DELINQUENCY

CHILD MEASURES SUBSTANCE USE ALOCOHOL TOBACCO MARIJUANA OTHER ILLICIT DRUGS

NEUROPSYCHOLOGICAL ASSESSMENT CONTINUOUS PERFORMANCE TASK IMPULSIVITY TRAIL MAKING A INATTENTION STROOP COLOR/WORD INTERFERENCE TEST DIFFICULTY WITH FLEXIBLE THINKING AND PLANNING

ACADEMIC PERFORMANCE WRAT-R SIGNIFICANT EFFECTS AT 6 AND 10 PIAT-R READING DECREASED RECOGNITION DECREASED COMPREHENSION TOTAL SCORE TEACHER’S REPORT POORER ATTENDANCE POORER PERFORMANCE

PATTERN OF MARIJUANA USE

PATTERN OF TOBACCO USE

PATTERN OF COCAINE USE

Alcohol Use at First Trimester at 10 Years Use at 10 years First Trimester Use

ANALYTIC MODEL FOR THE TERATOGENIC EFFECTS OF PRENATAL ALCOHOL EXPOSURE RISK FACTORS MATERNAL REARING ALCOHOL ENVIRONMENT USE PRENATAL EXPOSURE CHILD OUTCOME

Figure 2 Offspring Weight by First Trimester Alcohol Exposure Weight (lb)

Figure 4. Offspring Head Circumference by First Trimester Alcohol Exposure Circum ference (mm)

Figure 5. Offspring Skinfold Thickness by Second Trimester Alcohol Exposure Thick ness (mm)

Neuropsychological Tests Memory and Learning Scores on the WRAML Attention Errors of Omission on a CPT Impulsivity Errors of Commission on CPT

Deficits in Executive Function at Age 14 Predicted By Prenatal Alcohol Use By Trimester ( Willford J, 2001)

Temperament Emotionality Shyness

BEHAVIOR 10 YEARS • Child Behavior Checklist (Teacher Report) Anxiety

BEHAVIOR • Child Report Anxiety

ANXIETY AS A MEDIATOR FOR THE EFFECTS OF PRENATAL ALCOHOL EXPOSURE DAMAGE . 14 THEFT . 19 PRENATAL ALCOHOL . 09 ANXIETY . 24. 14 -. 12 RACE VIOLENCE . 18 . 08 SUBSTANCE USE STATUS OFFENSES

PRENATAL ALCOHOL . 10 . 08 ANXIETY -. 15 CHILD IQ SUBSTANCE USE -. 15 RACE Data are presented As standardized Coefficients. indicates a Correlation. . 07 . 16 . 30 MOTHER’S IQ . 16 HOME SCORE -. 10 MOTHER’S DEPRESSION

SCHOOL ACHIEVEMENT Wide Range Achievement Test-Revised Reabody Individual Achievement Test-Revised

AGE 10 YEARS AGE 3 YEARS ENVIRON . 12 ENVIRON . 26. 25 . 24. 17 SES. 26. 16 . 26 ACTIVITY ATTEN . 14 . 45 . 16 ENVIRON MOM PSYCH . 54 MOM PSYCH . 32 . 20. 17 . 50 SES PRENATAL ALCOHOL SECOND ? ? ? PROBLEM BEHAVIROS . 12 ALC DRUG . 29 RACE . 20 . 26 CHILD PSYCH. 42 . 30 ALC DRUG . 19. 14. 15 GENDER . 23. 13 . 09 . 17

SUMMARY PRIMARY OUTCOMES SECONDARY OUTCOMES • Concept Formation • Ability to Learn New Information • Memory • Attention • Mood • Behavior Problems • Academic Achievement • Delinguency