Preliminary study of the prevalence of hypotrophy and fetal alcohol syndrome in Antananarivo, Madagascar

Background: Hypotrophy is a major contributor to neonatal mortality and morbidity in underdeveloped countries. In Madagascar, efforts have been made to improve this situation, particularly with regard to prevention and early treatment. This prevention is mainly focused on the search for determining factors. Fetal Alcohol Syndrome (FAS) is not yet mentioned in Madagascar although more than 9% of Tananarivian women drink alcohol. A study was conducted in our department to determine the relationship between maternal alcohol intake and hypotrophy.Methods: The prospective study was carried out in the pediatrics department of the Joseph Raseta Befelatanana University Hospital Centre, on hospitalized hypotrophic newborns (below the 10th percentile) over a period of 3 months from December 1, 2018 to February 31, 2019. In the newborn, authors studied facial features, neurological abnormalities and associated malformations. For the mother, alcohol consumption, pregnancy information was analyzed. The character of FAS could thus be classified.Results: Author counted 21 hypotrophs among the 128 newborns hospitalized during this period. The facial abnormalities observed were: upper lip thickness abnormality (9.5%) and retrognathism (4.7%). Neurological signs described were: difficulty sucking (76.1%), hypotonia (66.6%), restlessness (9.5%), hyper-responsiveness (9.5%), hypertonia (9.5%) and tremor (4.7%). Two organ malformations (9.5%) were seen: cardiac and biliary tract malformations. Only one mother (4.7%) admitted having taken alcohol during pregnancy. Seven cases of familial alcoholism were reported. At the end of this study, we were able to identify only one case of doubtful FAS (4.7%), 2 cases of suspected FAS (9.5%) and 1 case of confirmed FAS (4.7%).Conclusions: This syndrome remains under-diagnosed in Madagascar due to the lack of staff training on FAS and the non-systematization of the search for its signs during systematic visits.

Interrelationship between family history of alcoholism and generational status in the prediction of alcohol dependence in US Hispanics

BackgroundBoth a family history of alcoholism and migration-related factors like US v. foreign nativity increase the risk for developing alcohol use disorders in Hispanic Americans. For this study, we integrated these two lines of research to test whether the relationship between familial alcoholism and alcohol dependence changes with successive generations in the United States.MethodData were from the waves 1 and 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Subjects self-identified Hispanic ethnicity (N = 4122; n = 1784 first, n = 1169 second, and n = 1169 third or later generation) and reported ever consuming ⩾12 drinks in a 1-year period. A family history of alcoholism was assessed in first- and second-degree relatives. Analyses predicting the number of alcohol dependence symptoms were path models.ResultsAlcohol dependence symptoms were associated with a stronger family history of alcoholism and later generational status. There was a significant interaction effect between familial alcoholism and generational status; the relationship of familial alcoholism with alcohol dependence symptoms increased significantly with successive generations in the United States, more strongly in women than men. Acculturation partially mediated the interaction effect between familial alcoholism and generational status on alcohol dependence, although not in the expected direction.ConclusionsFamilial alcoholism interacted with generational status in predicting alcohol dependence symptoms in US Hispanic drinkers. This relationship suggests that heritability for alcoholism is influenced by a higher-order environmental factor, likely characterized by a relaxing of social restrictions on drinking.

Maturing out of alcohol involvement: Transitions in latent drinking statuses from late adolescence to adulthood

Research has shown a developmental process of “maturing out” of alcohol involvement beginning in young adulthood, but the precise nature of changes characterizing maturing out is unclear. We used latent transition analysis to investigate these changes in a high-risk sample from a longitudinal study of familial alcoholism (N = 844; 51% children of alcoholics; 53% male, 71% non-Hispanic Caucasian, 27% Hispanic). Analyses classified participants into latent drinking statuses during late adolescence (ages 17–22), young adulthood (ages 23–28), and adulthood (ages 29–40), and characterized transitions among these statuses over time. The resulting four statuses were abstainers, low-risk drinkers who typically drank less than weekly and rarely binged or showed drinking problems, moderate-risk drinkers who typically binged less than weekly and showed moderate risk for drinking problems, and high-risk drinkers who typically binged at least weekly and showed high risk for drinking problems. Maturing out between late adolescence and young adulthood was most common among initial high-risk drinkers, but they typically declined to moderate-risk drinking rather than to nonrisky drinking statuses. This suggests that the developmental phenomenon of maturing out pertains primarily to relatively high-risk initial drinkers and that many high-risk drinkers who mature out merely reduce rather than eliminate their risky drinking.

Computer-assisted Self-infusion of Ethanol (case): New Outcome Measures may Contain Unseful Information

Oral alcohol self-administration studies limit the range of arterial blood alcohol concentrations (aBAC) due to the combination of IRB-constraints on the maximum aBAC allowed and substantial variability in idiosyncratic enteral absorption. 25 healthy young adults participated in a preliminary assessment of the influence of familial alcoholism on alcohol self-administration using CASE. CASE automates the i.v. infusion of 6% ethanol, using an individualized kinetic model to achieve identical incremental aBAC in all subjects.In two CASE sessions, the subject was instructed to request infused “drinks” in order to emulate his/her perceptions of alcohol effects obtained at a weekend party. Conventional outcome measures all correlated closely with each other, so we evaluated the basic shape of the time course of aBAC achieved and the latency to peak aBAC (Tpk).Tpk correlated with maximum aBAC on the 1st (p= 0.029), but not 2nd session. Further, Tpk did not correlate with mean aBAC on either day, but did correlate well with the number of drink requests on both days (p< 0.001). In 33 out of 47 experiments, subjects achieved and maintained stable plateaus of aBAC for at least 30 minutes during the self-infusion. Both latency to peak aBAC and the shape of the subject’s preferred time course of aBAC may represent informative new ways of examining styles of alcohol self-administration of alcohol using CASE. The additions may enrich studies of the influence of factors such as familial alcoholism on the vulnerability for alcohol future alcohol dependence.

Defining risk heterogeneity for internalizing symptoms among children of alcoholic parents

Adopting a developmental epidemiology perspective, the current study examines sources of risk heterogeneity for internalizing symptomatology among children of alcoholic parents (COAs). Parent-based factors, including comorbid diagnoses and the number of alcoholic parents in the family, as well as child-based factors, namely child gender, formed the indicators of heterogeneity. Following a novel approach to cross-study methods, we present a three-stage analysis involving measurement development using item response theory, examination of study effects on latent trajectories over time using latent curve modeling, and prediction of these latent trajectories testing our theoretically derived hypotheses in two longitudinal investigations across both mother- and self-reported symptomatology. Specifically, we replicated previous findings that parent alcoholism has a unique effect on child internalizing symptoms, above and beyond those of both parent depression and antisocial personality disorder. However, we also found important subgroup differences, explaining heterogeneity within COAs' risk profile in terms of the number of alcoholic parents in the family, comorbid diagnoses for the alcoholic parent and, for self-reported symptoms, child gender. Such factors serve to refine the definition of risk among COAs, suggesting a more severely impaired target group for preventive interventions, identifying the significance of familial alcoholism in individual differences underlying internalizing symptoms over time, and further specifying the distal risk matrix for an internalizing pathway to alcohol involvement.