Children Of Alcoholic Mothers Research Articles

USO ABUSIVO DE ÁLCOOL DURANTE A GESTAÇÃO: UMA REVISÃO INTEGRATIVA DA LITERATURA

Introdução: o consumo de álcool durante a gestação tem sido tema de pesquisa razoavelmente bem documentada, embora, ainda, muitas das consequências do mesmo sobre o desenvolvimento infantil em filhos de mães alcoolistas, sejam pouco conhecidas em sua extensão e gravidade. Objetivo: descrever as repercussões maternas e fetais decorrentes do abuso de álcool durante a gestação. Método: trata-se de revisão integrativa da literatura. A busca bibliográfica foi realizada através dos descritores: Gestação; Alcoolismo; Abuso de álcool, na base de dados Scientific Electronic Library Online (SciELO), respeitando os limites de publicação entre 2009 e 2014, no idioma português. Resultados: após a combinação dos descritores na base citada, foram identificadas 50 referências. Dentre estas, após seleção por título e resumo condizente com o objetivo do estudo, foram analisados os artigos na íntegra e incluídos 8 artigos, excluindo, assim, 42 artigos, seja por repetição nas bases de dados, seja por não contemplarem os critérios de inclusão. Conclusão: A gestação é um período facilitador de sensibilização ao tratamento. Se houver preparo por parte da equipe, é exatamente nesta fase que se consegue uma abstinência do álcool.

The effects of maternal alcohol use disorders on childhood relationships and mental health.

Despite millions of children living in the turmoil of their parents' active alcoholism or the aftermath of past abuse, research to date has not (1) provided a comprehensive examination of the effects of maternal alcohol use disorders (AUDs) on children's social ties outside of their relationships with parents, or (2) considered whether the number and quality of childhood social ties alter the effects of maternal AUDs on children's mental health. Using data from the National Longitudinal Surveys of Youth 1979 Children and Young Adults, analysis examined the influence of maternal AUDs on the number and quality of children's ties with siblings, extended family and family friends, peers, and neighborhood members. The analysis also considered how children's social ties influenced the association between maternal AUDs and children's internalizing and externalizing problems. Children of alcoholic mothers had similarly sized networks but more distant relationships with siblings and friends, negative interactions with classmates, and isolating neighborhoods. Controlling for these aspects of children's social ties substantially reduced mental health disparities between children of alcoholic mothers and other children. Findings support the view that maternal alcohol use disorders have the potential to damage children's mental health while also setting into motion long-term relationship problems. Future research should examine the networks of children who experience parental AUDs to further clarify the social processes that link parental AUDs to children's mental health.

Fetal/neonatal ethanol exposure irreversibly alters dendritic cell function in adult mice

Children born to alcoholic mothers are known to have increased incidence and severity of infections.We have developed a model of fetal/neonatal alcohol exposure (FAE) in which female mice are maintained on 10% EtOH in the drinking water during breeding and gestation, and then on 12% EtOH during lactation.Pups have successfully been weaned and showed no significant difference in weights from controls through 12 weeks of age.These pups have been studied at 20 d (weaning) and 12 weeks (young adult) for DC function.Splenic DC numbers did not change. FAE decreased the ability of these DC to stimulate allogeneic T cells,changes that persisted following cessation of EtOH exposure.In addition, antigen‐specific Foxp3+ regulatory T cells were induced following antigen presentation by FAE DC at a higher rate than by control DC. IL‐10 production by OTII T cells increased and IL‐2 production decreased following stimulation with OVA peptide‐pulsed FAE DC relative to control DC.These results indicate that mice born to EtOH‐consuming mothers have deficiencies in DC function that are persistent following cessation of EtOH exposure, and provide a mechanism, which could at least partially explain the increased incidence and severity of infection in children of alcoholic mothers.

Message in a Bottle: The Making of Fetal Alcohol Syndrome

Janet Golden, Message in a Bottle: The Making of Fetal Alcohol Syndrome , Cambridge, MA: Harvard University Press, 2005. Pp. 240. £16.95. ISBN 0–674–01485–5. For generations women have been drinking alcohol while pregnant. In the nineteenth and early twentieth centuries, physicians prescribed ale, sparkling wine, brandy and other alcohol-based tonics (but not degenerate gin) for all sorts of pregnancy-related discomforts and maladies. We now know that alcohol, not debauchery or disorderly lives, affects the developing foetus and the physical, developmental and behavioural signs of alcohol's teratogenic effects must have been present for all to see. With the long history of drinking while pregnant and its evident results, the ‘discovery’ of Fetal Alcohol Syndrome (FAS) in June 1973 by a team of researchers in Seattle, USA, is a historical curiosity. Why then? After all, this ‘discovery’ was predated in 1968 when a French paediatrician, Paul Lemoine, described many of the same characteristics in the children of alcoholic mothers, a condition named Lemoine syndrome. This ‘discovery’ was mostly ignored in France and elsewhere. Does another event in 1973 explain the identification of FAS? After all, this was the year of the Roe vs. Wade legal case in which the US Supreme Court made a decision that defined (and limited) a woman's right to decide to end her pregnancy. Whether historical accident or the result of the focus on the foetus brought on by the abortion controversy, the timing of the discovery of FAS would shape its political and cultural meaning. Research documented the poisonous effects of significant and sustained doses of alcohol on the developing foetus, although little of the data supported a link between one or two drinks a day and FAS. Nonetheless, without evidence of a safe level of drinking, pregnant women in the USA were advised to stop consuming alcohol altogether. Women who drank before discovering that they were pregnant now worried that their foetuses were irreparably harmed. FAS became a ‘medical’ justification for abortion, further linking it to Roe vs. Wade.

Behavioural and emotional problems in children of alcoholic mothers and fathers.

The Child Behavior Check List (CBCL) was used to compare a sample of 103 Danish children of alcoholics (CoA) to a Danish population-based sample (N = 780). The CoA had a significantly greater incidence of symptoms on 17 of the 118 CBCL items. Compared to the reference population, daughters of alcoholics were more impaired than sons of alcoholics on most CBCL measures. In families with maternal alcoholism daughters had higher internalising and depression scores than sons, and in families with paternal alcoholism, sons had higher internalising and depression scores than daughters. The CoA also had a significantly greater risk of scoring above the 95th percentile on internalising behaviour, depression symptoms and socially deviant behaviour. On all CBCL dimensions, almost half of the CoA samples functioned as well as the average of the reference population. The results from this study suggest that CoA should be regarded as a risk group but with very heterogeneous consequences in response to parental alcoholism.

Children's health and child-parent relationships as predictors of problem-drinking mothers' and fathers' long-term adaptation.

This study examined the extent to which children's health status and child-parent relationships affected the severity of problem-drinking parents' alcohol use disorders, as well as the parents' psychological states and marital stressors and resources. These issues were examined using data from an 8-year study of problem-drinking women and men. Generally, over the 8-year period, the children of alcoholic mothers and fathers were comparable on their health status and relationships with their parents. The severity of mothers' and fathers' drinking problems were also generally comparable over this period. Better children's health and child-parent relationships at baseline and 1- and 3-year follow-ups were consistent predictors of mothers' reduced drinking and better psychological states on the subsequent follow-ups. Associations between children's functioning and fathers' adaptation were few and inconsistent. The results support the possibility that an undesirable cycle might be established in which maternal drinking and children's dysfunction coexist in an ever worsening reciprocal relationship.

Are children of alcoholic mothers more psychologically damaged compared with children of mothers from the general population?

Matched pairs of 40 women from the general population and 40 female alcoholic inpatients living in Stockholm were examined and found to fulfil the alcoholism criteria of DSM‐III‐R. They comprised 40 inpatient women consecutively admitted to an Alcohol Clinic and staying at least one week for treatment. The examination included a general medical examination, a psychiatric and social history, blood tests, ECG, computed tomography of the brain and neuropsychological testing. The aim of the study was to determine if children of alcoholic mothers were more psychologically damaged compared with children of mothers from the general population. The subjects’ and their families’ possibilities of creating a good upbringing environment and their own childhood were studied. The female alcoholics and the women from the general population and their offspring were followed from the registers of the child welfare committees, temperance boards, social service departments, the Social Insurance Office and the Medical Information System of the Medical Services Board of Stockholm County Council. The children of the female alcoholics had, during their childhood, more often had contact with an educational welfare officer, a psychologist or a physician for various problems and also had a significantly higher rate of registration in the childrens welfare committee registers than children of women from the general population. Fourteen per cent of the boys and 6% of the girls in the group from the general population and 35% of the sons and 20% of the daughters of the female alcoholics were registered by the Temperance Board. Eighteen per cent of the boys and 0% of the girls from the general population and 40% of the sons and 25% of the daughters of the female alcoholics were registered in the Criminal Offenders Register. No girl in the group from the general population was registered in the Criminal Offenders Register. Of the girls with an alcoholic home background, 25% were registered and all these had been sentenced to fines. Eight per cent of the children from the general population and 40% of the sons and 25% of the daughters of the female alcoholic inpatients had had hospital treatment on at least one occasion for underlying physical illness or injury. Eight per cent of the children in the general population and 40% of the sons and 25% of the daughters of alcoholic women were registered at children's psychiatric wards and outpatient clinics and counselling clinics. None of the children of the women of the general population, but 30% of the sons and 20% of the daughters of the female alcoholics abused alcohol or drugs. It was concluded that children of female alcoholics have a more psychologically disturbed childhood than children of women from the general population.

Fluctuating odontometric asymmetry and maternal alcohol consumption.

Fluctuating asymmetry was evaluated in the dental arcades of 112 children (60 male, 52 female) of alcoholic mothers. Only individuals who showed no signs of the fetal alcohol syndrome were included. When these results were compared with those of a control group of 120 normal children, the former group was found to be significantly more asymmetric. The present study showed that canines were the least asymmetric whilst lateral incisors showed the greatest levels of asymmetry. It is suggested that the elevated levels of fluctuating odontometric asymmetry in children of alcoholic mothers may be ascribed to prenatal stress, especially during the soft tissue stage of odontogenesis.

Alcohol, pregnancy, and prostaglandins.

Basic scientists and clinicians alike are in agreement that children of alcoholic mothers are at risk for a variety of birth defects. These defects have been labeled fetal alcohol syndrome or, in a milder form, fetal alcohol effects. Prevention or therapeutic intervention of this disorder requires an understanding of the mechanism of action of alcohol on the developing fetus. This paper addresses the possible role of prostaglandins as biochemical mediators of the teratogenic actions of alcohol.

Disorganization of attachment in relation to maternal alcohol consumption.

The relation between maternal alcohol consumption and Infant behavior at one year was investigated in this study. Alcohol consumption was estimated by self-report questionnaires filled out by mothers over 30 vears of age, regarding the amount of alcohol they consumed prior to, during, and following pregnancy. Alcohol level was computed using the Jessor, Graves, Hanson and Jessor AA score (absolute alcohol/day). The behavior of infants was observed at one year of age using the Ainsworth Strange-Situation Procedure. Infants were classified as: Lft2ILL1 (group B); insecureavoitant (group A); or insecure-ambiv_alemt/resistent (group C). Additionally, a new classification of.insecurejisorganized/dtsoriemteA (group D), developed by Main and Solomon, was used. This classification is thought to include infants *who may have more serious disturbances. Findings were that the majority of infants of mothers who consumed more -altohol prior to pregnancy and during pregnancy were-insecure in comparison to a minority of insecure infants of mothers who were abstinent or light drinkers during those time periods. Other results were that the classification of infants as insecure-Vsocganized/ IllatialIAA helped to identify a large number of infants who were insecure in the group of heavy drinking mothers. Disorganization of Attachment 3 Disorganization of Attachment in Relation to Maternal Alcohol Consumption Heavy alcohol use during pregnancy has been documented as a casual agent in a of growth deficiency, mental retardation and abnormal morphogenesis called fetal alcohol syndrome (Jones & Smith, 1973; Smith, 1979; Streissguth, Landesman-Dwyer, Martin, & Smith, 1980). Results from the Seattle Longitudinal Prospective Study on Alcohol and Pregnancy suggest that even moderate consumption of alcohol or social drinking during early pregnancy may have an adverse effect on the fetus as reflected in abnormalities in newborn physical status and behavior (Hanson, Streissguth, & Smith, 1978; Landesman-Dwyer, Keller, & Streissguth, 1978; Martin, Martin, Lund, & Streissguth, 1977; Martin, Martin, Streissguth, & Lund, 1979; Streissguth, Martin, Martin, & Barr, 1981). The Seattle group has reported smaller infant size, lower Apgar scores, poorer neonatal habituation and conditioning, increased tremulousness, decreased activity and sucking, and increased minor dysmorphic features (Streissguth, Martin, Martin, & Barr, 1981, for summary). Studies of older infants reveal lower mental development (O'Connor, Brill & Sigman, 1986; Streissguth, Barr, Martin, & Herman, 1980). Disorganization of Attachment 4 While the literature shows that children of alcoholic mothers are at risk for suffering the negative consequences of caretaking casualty (Sameroff & Chandler, 1975), no studies have been designed to examine social maladjustment in infants of these mothers. The importance of studying the effects of maternal drinking behavior on infant emotional development is underscored by the demonstration that an infant's early relationship with the mother has significant and long-term effects on development. (Mahler, Pine & Bergman, 1975). Bowlby (1973,1980,1982) eloquently described how the infant's relationship with the mother lays the foundation for later social/ emotional development. The patterning of the early relationship is the base on which later representation of self and the figure is constructed. The relationship may strongly influence the ways in which the child relates to others and resolves interpersonal issues later in life. Fortunately, an investigative technique for characterizing infant behavior with the mother is provided by the Ainsworth Strange Situation Procedure (Ainsworth, Blehar, Waters & Wall, 1978); Based upon the theory of Bowlby (1973,1980, 1982)4_Ainsworth and colleagues developed a brief, structured laboratory procedure designed to elicit Disorganization of Attachment 5 infant behavior toward a particular caregiver (generally the mother). Individual differences in infant response to the situation allows for the classification of infants into one of three major attachment categories, as secure (group B), illaauLgavoidant (group A), or tnsecure-ambivalent/resistant

Perception of maternal behavior by elementary school children of alcoholic mothers.

Elementary-school-aged children of alcoholic mothers more often perceive their mothers to be using guilt as a means of psychological control and using lax disciplinary methods than similar children with nonalcoholic mothers. This outcome is discussed as a unique profile resulting from denial in the alcoholic family and the possible projection of guilt felt by the alcoholic mother. Implications for prevention programming and further areas for empirical investigation are suggested.

Academic achievement in elementary school children of alcoholic mothers

Elementary school aged children (N = 40) of alcoholic mothers when compared to similar children (N = 40) with nonalcoholic mothers scored significantly lower on several subtests of an academic achievement test. This result replicated and extended previous findings to a middle-class, well-educated population. Suggestions are made for future examination of critical antecedent causes and covariates within the context of both environmental and cognitive domains.

Children of alcoholic mothers. Growth and motor performance compared to matched controls.

Twenty-one children born 1970-76, selected from 103 children of 30 alcoholic women, were paired to controls matched for sex, age, birth weight and gestational age. The sample (10 girls, 11 boys) was representative of the whole group with regard to weight, length and head circumference at birth. At follow-up (mean age 70 months) the study group was significantly leaner, shorter and had smaller mean head circumference than the control group. The controls had significant catch-up growth from birth to follow-up of weight, height and head circumference to the mean for Swedish children. The study group had no catch-up growth. Compared to controls the study group had significantly lower fine and gross motor age test scores and inferior coordination. One child had cerebral palsy (spastic hemiplegia) and in 6 other children slight tremor and ataxia were observed. Malformations and/or other signs of the fetal alcohol syndrome (FAS) were found in 10 cases. Study group children with FAS had significantly slower growth of head circumference than others without FAS. Children placed in foster home care (n = 11) were found to have significantly (p less than 0.05) lower birth weight, birth length and head circumference than children raised at home (n = 10). There were no significant differences at follow up between study group children raised in foster homes or in homes of their biological mother.

Children of alcoholic mothers. Developmental, perceptual and behavioural characteristics as compared to matched controls.

From a retrospective material including all the 103 children of 30 alcoholic women, the 21 youngest born 1970-76, were paired to controls matched for sex, age, birth weight, gestational age and living area. IQ scores were measured with Griffiths and WISC scales. Controls tested within the normal range for Swedish children, while the study group scored 15-19 IQ points below controls (p less than 0.01), the means of the study group corresponding to -1.6 SD below means of the controls. Significant differences between the groups were found in all subscales. Visual perception was measured with Frostig's test. Perceptual age was generally equal to mental age except in the most severely affected cases where perceptional age was lower than mental age. A marked perceptual delay exceeding 1 year was found in 8/17 tested cases in the study group, while all controls were normal. Developmental levels evaluated from Human Figure Drawings according to Koppitz was in accordance with IQ test results. Indicators of emotional instability were found significantly more often in the study group than in controls. Hyperactivity, distractability and short attention span were found in 12/21 cases and perseveration in 6/21 cases but not among controls. Members of the study group with traits of the fetal alcohol syndrome (10/21) had significantly lower IQ and perceptual delay was more pronounced than in members without such signs. No significant IQ difference was found between subjects reared in foster homes and in biological homes.

MODERATE DRINKING DURING PREGNANCY AND FOETAL OUTCOME

Although there are many reports of the adverse effects of alcohol on the infant in ancient literature the first modern report was by Sullivan, Physician to Liverpool gaol. He showed an increased incidence of growth retardation and stillbirth in children of alcoholic mothers using their non-drinking relatives as a control. The literature on moderate drinking is contradictory and suffers from poor control of factors known to confound pregnancy outcome such as social class, parity and smoking habit. The other major problem in assessing the effect of moderate drinking is the difficulty in obtaining accurate drinking histories and the many and varied ways in which these are taken. All histories however, should be regarded as an underestimate. Moderate drinking (less than 40 g alcohol/day before and during pregnancy) has been related to growth retardation, a higher incidence of congenital abnormality, poorer behavioural and neurological scores in the newborn. Recent American surveys have shown an increased relative risk of mid-trimester abortion in women who drink more than three times a week in early pregnancy. Recent work in this country has demonstrated a trend toward smaller head circumference and reduced weight in the babies born to mothers consuming more than 100 g alcohol a week in very early pregnancy. The interaction between smoking and drinking is particularly important for this effect. Using logistic regression analysis the effect of drinking and smoking on birth weight can be clearly seen together with the effect of social class. For any impact to be made on this problem educational intervention is necessary before pregnancy is planned, and thus should be directed at pre-conception clinics, family planning clinics and the general practitioner's surgery.