August 14, 2017

119,000 Children With FAS Born Each Year

Worldwide, an estimated 119,000 children are born with Fetal Alcohol Syndrome (FAS) each year, a new study from the Centre for Addiction and Mental Health (CAMH) shows. The study, published in The Lancet Global Health, provides the first-ever estimates of the proportion of women who drink during pregnancy, as well as estimates of FAS by country, World Health Organization (WHO) region and worldwide.

Globally, nearly 10 per cent of women drink alcohol during pregnancy, with wide variations by country and WHO region. In some countries, more than 45 per cent of women consume alcohol during pregnancy. In Canada, which has clinical guidelines advising abstinence during pregnancy, an estimated 10 per cent of pregnant women still drink, which is close to the estimated world average.

Prevalence of FAS Increasing

Nearly 15 per 10,000 people around the world are estimated to have FAS, the most severe form of Fetal Alcohol Spectrum Disorder (FASD). FAS is characterized by mental, behavioural and learning problems, as well as physical disabilities. In Canada, the estimate is 10.5 cases of FAS per 10,000 people.

Not every woman who drinks while pregnant will have a child with FAS. "We estimated that one in 67 mothers who drink during pregnancy will deliver a child with FAS," says lead author Dr. Svetlana Popova, Senior Scientist in CAMH's Institute for Mental Health Policy Research.

She notes that this figure is very conservative and does not include other types of FASD that may occur from alcohol consumption during pregnancy, including partial FAS (pFAS) and Alcohol-related Neurodevelopmental Disorders (ARND).

Safest to Completely Abstain

Although it's well established that alcohol can damage any organ or system in the developing fetus, particularly the brain, it's still not known exactly what makes a fetus most susceptible, in terms of the amount or frequency of alcohol use, or timing of drinking during pregnancy. Other factors, such as the genetics, stress, smoking and nutrition also contribute to the risk of developing FASD.

"The safest thing to do is to completely abstain from alcohol during the entire pregnancy," says Dr. Popova.

The study involved comprehensive literature reviews and statistical analyses to determine the estimates, which are intended to help countries plan public health initiatives and policies, such as FAS surveillance systems and educational efforts on the risks of alcohol use during pregnancy, the researchers note.

Rates Highest in Europe

The five countries with the highest alcohol use in pregnancy were in Europe: Russia, United Kingdom, Denmark, Belarus and Ireland. As a region, Europe also had a 2.6 higher prevalence of FAS than the global average. The lowest levels of drinking and FAS were found for the Eastern Mediterranean and South East Asia regions, as there are high rates of alcohol abstinence in these regions.

The predictive model that the research team developed in this study could also be used to estimate the prevalence of other disease conditions, notes Dr. Popova. Her team is currently extending this work to study the global scale of all fetal alcohol spectrum disorders (FASD). An earlier study by Dr. Popova and her team, published in The Lancet last year, showed that more than 400 disease conditions co-occur with FASD.

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August 13, 2017

Over 400 Conditions Co-Occur With FASD

Researchers at the Centre for Addiction and Mental Health (CAMH) have identified 428 distinct disease conditions that co-occur in people with Fetal Alcohol Spectrum Disorders (FASD), in the most comprehensive review of its kind.

The results were published in The Lancet.

"We've systematically identified numerous disease conditions co-occurring with FASD, which underscores the fact that it isn't safe to drink any amount or type of alcohol at any stage of pregnancy, despite the conflicting messages the public may hear," says Dr. Lana Popova, Senior Scientist in Social and Epidemiological Research at CAMH, and lead author on the paper. "Alcohol can affect any organ or system in the developing fetus."

Severity and Symptoms Vary

FASD is a broad term describing the range of disabilities that can occur in individuals as a result of alcohol exposure before birth. The severity and symptoms vary, based on how much and when alcohol was consumed, as well as other factors in the mother's life such as stress levels, nutrition and environmental influences. The effects are also influenced by genetic factors and the body's ability to break down alcohol, in both the mother and fetus.

Different Canadian surveys suggest that between six and 14 per cent of women drink during pregnancy.

428 Co-Occurring Conditions

The 428 co-occurring conditions were identified from 127 studies included in The Lancetreview. These disease conditions, coded in the International Classification of Disease (ICD-10), affected nearly every system of the body, including the central nervous system (brain), vision, hearing, cardiac, circulation, digestion, and musculoskeletal and respiratory systems, among others.

While some of these disorders are known to be caused by alcohol exposure - such as developmental and cognitive problems, and certain facial anomalies - for others, the association with FASD does not necessarily represent a cause-and-effect link.

Problems range from communications disorders to hearing loss

However, many disorders occurred more often among those with FASD than the general population. Based on 33 studies representing 1,728 individuals with Fetal Alcohol Syndrome (FAS), the most severe form of FASD, the researchers were able to conduct a series of meta-analyses to establish the frequency with which 183 disease conditions occurred.

More than 90 per cent of those with FAS had co-occurring problems with conduct. About eight in 10 had communications disorders, related to either understanding or expressing language. Seven in 10 had developmental/cognitive disorders, and more than half had problems with attention and hyperactivity.

Cause May Be Overlooked

Because most studies were from the U.S., the frequency of certain co-occurring conditions was compared with the general U.S. population. Among people with FAS, the frequency of hearing loss was estimated to be up to 129 times higher than the general U.S. population, and blindness and low vision were 31 and 71 times higher, respectively.

"Some of these other co-occurring problems may lead people to seek professional help," says Dr. Popova. "The issue is that the underlying cause of the problem, alcohol exposure before birth, may be overlooked by the clinician and not addressed."

The benefits of screening and diagnosis

Improving the screening and diagnosis of FASD has numerous benefits. Earlier access to programs or resources may prevent or reduce secondary outcomes that can occur among those with FASD, such as problems with relationships, schooling, employment, mental health and addictions, or with the law.

"We can prevent these issues at many stages," says Dr. Popova. "Eliminating alcohol consumption during pregnancy or reducing it among alcohol-dependent women is extremely important. Newborns should be screened for prenatal alcohol exposure, especially among populations at high risk. And alerting clinicians to these co-occurring conditions should trigger questions about prenatal alcohol exposure."

Stay Away From Alcohol If Pregnant

"It is important that the public receive a consistent and clear message - if you want to have a healthy child, stay away from alcohol when you're planning a pregnancy and throughout your whole pregnancy," she says.

It's estimated that FASD costs $1.8 billion annually in Canada, due largely to productivity losses, corrections and health care costs, among others.

In addition to this review, Dr. Popova has been part of an expert group of leading FASD researchers and clinicians working with the Ontario Ministry of Children and Youth Services on its new FASD strategy. Her team is also undertaking a study to determine how common FASD is in Canada, as well as in other countries in Eastern and Central Europe and Africa.

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Alcohol's Effects on Women's Sleep More Pronounced

Researchers have known for decades that alcohol can initially deepen sleep during the early part of the night but then disrupt sleep during the latter part of the night; this is called a "rebound effect." A study of the influence of gender and family history of alcoholism on sleep has found that intoxication can increase feelings of sleepiness while at the same time disrupt actual sleep measures in healthy women more than in healthy men.

Results will be published in the May 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

Alcohol Disrupts Later Sleep


"It's clear that a substantial portion of the population uses alcohol on a regular basis to help with sleep problems," said J. Todd Arnedt, assistant professor of psychiatry and neurology at the University of Michigan and lead author of the study. "This perception may relate to the fact that alcohol helps people fall asleep quickly and they may be less aware of the disruptive effects of alcohol on sleep later in the night."

Arnedt said that his group decided to examine gender differences in the effects of alcohol on sleep because very few alcohol administration studies have included female participants and, since women metabolize alcohol differently than men, it seemed reasonable to expect differences by gender.

"Our decision to examine family history was based on some observational studies showing different sleep characteristics among family-history positive participants compared to family-history negative participants," he explained. "Family-history positive individuals also seem to be more resistant to the acute intoxicating effects of alcohol than individuals without a family history of alcoholism."

Women More Effected Than Men


Arnedt and his colleagues recruited 93 healthy adults (59 women, 34 men) in their twenties through advertisements in the Boston area, 29 of whom had a positive family history of alcoholism. Between 8:30 and 10:00 p.m., participants consumed either a placebo beverage or alcohol to the point of intoxication as determined by breath alcohol concentration (BrAC). Their sleep was then monitored with polysomnography between 11:00 p.m. and 7:00 a.m. Participants also completed questionnaires at bedtime and upon awakening.

"Alcohol increased self-reported sleepiness and disrupted sleep quality more in women than men," said Arnedt. "Sleep quality following alcohol did not differ between family-history positive and family-history negative subjects. Morning ratings of sleep quality were worse following alcohol than placebo. Findings also confirmed results from other studies that a high dose of alcohol solidifies sleep in the first half of the night, meaning more deep sleep, but disrupts it in the second part of the night, meaning more wakefulness."

With respect to gender differences, women objectively had fewer hours of sleep, woke more frequently and for more minutes during the night, and had more disrupted sleep than men.

Metabolism May Be Key


"These differences may be related to differences in alcohol metabolism," explained Arnedt, "since women show a more rapid decline in BrAC following alcohol consumption than men. It is important to note that the peak BrACs were equivalent between men and women in our study so the findings are not due to higher BrACs among the female subjects. We also do not believe that the differences were due to differences in alcohol experience because the prior alcohol use was also equivalent between the men and women."

In summary, said Arnedt, this study's primary contribution was to demonstrate that the effects of alcohol on objectively measured sleep quality are different between men and women at equivalent BrACs.

"These findings may have implications for future studies examining the relationship between sleep quality and risk for the development of alcohol use disorders, as well as studies evaluating how sleep quality relates to relapse among recovering alcoholic individuals," he said.

Posted by Webmaster at 11:34 AM

Alcohol Ups Risk of Breast Cancer Recurrence

A study of early-stage breast cancer patients who were light drinkers found an increased risk for recurrence of breast cancer and mortality. In the Life After Cancer Epidemiology (LACE) study, 1,897 participants diagnosed with early-stage breast cancer between 1997 and 2000 and recruited on average 2 years post-breast cancer diagnosis were evaluated for the association between alcohol intake and breast cancer recurrence and death.

The women, who were generally light drinkers, were followed for an average of 7.4 years. The study reported an increase in risk of breast cancer recurrence and breast cancer death, but no effect on total mortality, to be associated with consumption of 3 to 4 or more drinks per week when compared with women not drinking following their cancer diagnosis.

Alcohol and Breast Cancer

Previous research has been mixed on this topic. Almost all large studies have shown no increase in all-cause mortality for women who drink moderately following a diagnosis of breast cancer (as does this study).

As for recurrence of breast cancer, most have shown no increase in risk, although one previous study of women with estrogen-receptor + tumors found an increased risk of a primary cancer developing in the contralateral breast to be associated with alcohol intake of more than 7 drinks per week.

Because of conflicting results among studies on this topic, further research will be needed to determine the extent to which alcohol following a diagnosis of breast cancer may relate to subsequent disease and death.

Posted by Webmaster at 10:53 AM

Women Beer Drinkers Likely to Develop Psoriasis

Regular beer—but not light beer or other types of alcohol—appears to be associated with an increased risk of developing psoriasis, according to a report posted online that will be published in the Archives of Dermatology.

"Psoriasis is a common immune-mediated skin disease," the authors write as background information in the article. "The association between alcohol consumption and increased risk of psoriasis onset and psoriasis worsening has long been suspected. For example, individuals with psoriasis drink more alcohol than individuals without psoriasis, and alcohol intake may exacerbate psoriasis severity."

Alcohol and Psoriasis

For other diseases, type of alcoholic beverage has been shown to influence risk—for instance, beer confers a larger risk for gout than wine or spirits. To evaluate the association between different types of alcohol and psoriasis risk, Abrar A. Qureshi, M.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, assessed data from 82,869 women who were age 27 to 44 years in 1991. The women, participants in the Nurses' Health Study II, reported the amount and type of alcohol they consumed on biennial questionnaires. They also reported whether they had received a diagnosis of psoriasis.

Through 2005, 1,150 cases of psoriasis developed, 1,069 of which were used for analysis. Compared with women who did not drink alcohol, the risk of psoriasis was 72 percent greater among women who had an average of 2.3 drinks per week or more. When beverages were assessed by type, there was an association between non-light beer drinking and psoriasis, such that women who drank five or more beers per week had a risk for the condition that was 1.8 times higher. Light beer, red wine, white wine and liquor were not associated with psoriasis risk.

When only confirmed psoriasis cases—those in which women provided more details about their condition on a seven-item self-assessment—were considered, the risk for psoriasis was 2.3 times higher for women who drank five or more beers per week than women who did not drink beer.

Increased Risk of Psoriasis

"Non-light beer was the only alcoholic beverage that increased the risk for psoriasis, suggesting that certain non-alcoholic components of beer, which are not found in wine or liquor, may play an important role in new-onset psoriasis," the authors write. "One of these components may be the starch source used in making beer. Beer is one of the few non-distilled alcoholic beverages that use a starch source for fermentation, which is commonly barley." Barley and other starches contain gluten, to which some individuals with psoriasis show a sensitivity. Lower amounts of grain are used to make light beer as compared with non-light beer, potentially explaining why light beer was not associated with psoriasis risk, they note.

"Women with a high risk of psoriasis may consider avoiding higher intake of non-light beer," the authors conclude. "We suggest conducting further investigations into the potential mechanisms of non-light beer inducing new-onset psoriasis."

Posted by Webmaster at 10:31 AM

Couples Therapy Best for Alcohol Dependent Women

Barbara McCrady and Elizabeth Epstein wanted to know whether cognitive behavior therapy worked better for alcohol-dependent women when delivered as couples therapy than when delivered as individual therapy. They reported recently that both treatment methods worked well, but women treated in couples therapy maintained their gains a bit better than those in individual therapy. Also, women suffering from depression in addition to alcohol-dependence did better in couples therapy. Their paper appeared in the Journal of Consulting and Clinical Psychology.

Epstein is an associate research professor at the Center of Alcohol Studies. McCrady, formerly a professor of psychology at Rutgers, now directs the University of New Mexico’s Center on Alcoholism, Substance Abuse and Addictions.

Women Less Likely to Seek Treatment

Alcohol use disorders hit women particularly hard, physically and psychologically. Epstein and McCrady cite earlier studies’ findings that between 4 and 8 percent of women under age 44 are alcohol-dependent, that as many as 65 percent of alcohol-dependent women have some additional psychiatric disorder, and that women are less likely to seek treatment for alcoholism than men. Alcohol-dependent women have high rates of distressed marriages and not much support from members of their social networks when they try to break that dependence. Until recently, there has not been much research on unique treatments for alcohol use disorders in women.

McCrady and Epstein recruited 102 women with newspaper ads and referrals from other alcohol treatment programs. They were looking for women who were alcohol-dependent, married or in a committed relationship with a man for at least six months, and whose male partners were willing to participate in therapy.

Couples Therapy Helps

Both groups received 20 out-patient sessions of cognitive behavioral therapy over six months, for which the goal was abstinence from alcohol. Seven therapists, all trained both in individual and couples therapy, saw the clients. After the 20 sessions,, each participant received follow-up interviews on the phone and in person for another year. For each woman in each of the 18 months of the study, researchers calculated the percentage of days abstinent and the percentage of days of heavy (more than three drinks in a day) drinking.

Nearly half the women started abstaining before the first treatment session, the researchers wrote. For the first month of treatment, the abstinence rate for women still drinking in both groups rose sharply – more sharply for women in couples therapy, perhaps because they had a slightly lower rate of abstention to start with. During the year following treatment, the women in couples treatment reported fewer heavy drinking days than women in individual treatment.

Social Support Important

The researchers concluded that there is a widespread need for specific treatments for alcohol- dependent women, and that social support for change is important. However, not all women have spouses, and not all spouses are supportive. Epstein and McCrady are currently recruiting women for another study comparing individual and group therapy. Participants needn’t be married or in a committed relationship for this study. Interested participants can call 732 445- 0900 visit womenandalcohol.rutgers.edu. Learn more about other aspects of the research program and current opportunities for participating by clicking here.

These studies are funded by the National Institute of Alcohol Abuse and Alcoholism of the National Institutes of Health.

Posted by Webmaster at 09:20 AM