This is a competitive renewal application for U01-AA015134. The history, experience, existing infrastructure, and experienced staff and collaborators of our South African (SA) fetal alcohol spectrum disorders (FASD) research program present unique opportunities to better define population-based characteristics of children with FASD and their mothers. Furthermore, the opportunity to pursue innovative explorations into etiology of FASD in the coming five years is excellent. We will simultaneously pursue three diverse, but complementary, aims.
Aim 1 : Screen women of childbearing age drinking in prenatal clinics for high risk drinking and continuing study of maternal risk. While there are multiple reasons for screening, in Aim 1 the purpose is for selective (secondary) prevention of FASD. We will initiate a case control efficacy study (n=400) of the use of one-session motivation enhancement therapy (MET) in prenatal clinics. These prevention activities follow from findings and experience in previous prevention efforts. Continuing prevention activities in antenatal clinics will also facilitate recruitment of participants for cutting-edge biomarker studies in Aim 3.
Aim 2 : Continue longitudinal studies of the trajectory of FASD in the early years of life in two established cohorts. We will continue regularly-scheduled, follow-up evaluation of the physical growth and cognitive/behavioral trajectory in an established cohort of 197 diagnosed children ages 6-11 years and their mothers. We will also pursue similar developmental monitoring of a second maternal/child cohort (n= ~230 dyads) recruited over the past 2 years. Cohort 2 will be finalized in October, 2017. A nested study of sMRI measurement will also be undertaken in a sub-sample of Cohort 1.
Aim 3 : Collect appropriate biological samples for assessing the validity and utility of alcohol use biomarkers and markers of the role of nutrition and nutrition genetics to better assess the interactive role of nutrition and prenatal alcohol use in severity of child outcomes and the etiology of FASD. We will assess alcohol use via two biomarkers, ethyl glucuronide (EtG) and phosphatidylethanol (PEth) in antenatal clinics and prevention initiatives for accurate assessment in both longitudinal research and monitoring prevention. Self-reported alcohol use by quantity, frequency, and gestational timing (QFT) and the AUDIT will serve as comparison data. We will also collect samples and data for analyzing the role of nutritional components in affecting child outcomes via a combination of: dietary intake surveys; evaluation of multiple micronutrients in plasma samples from of pregnant women; analysis of genetic polymorphisms (SNPs) influential in metabolism, absorption, and regulation of essential nutrients.

Public Health Relevance

Program Narrative This is an application for a competitive renewal of U01-AA015134.The history, experience, existing infrastructure, and mature and skilled staff and collaborators of our South African (SA) fetal alcohol spectrum disorders (FASD) research program present unique opportunities to better define the population-based characteristics of FASD and launch innovative explorations into specific areas of etiology. We propose to simultaneously pursue: 1.) assessment of the efficacy of secondary (selective) prevention in prenatal clinics, 2.) longitudinal case control studies of life trajectories of children with FASD and those developing normally in two established maternal/child cohorts, and 3.) collection of biological samples to employ alcohol metabolic biomarkers to monitor the efficacy of prevention and study FASD etiology through dietary intake assessment, analysis of nutrients in the plasma of pregnant women, explore the genetics of nutrition, and utilize brain imaging as adjuncts to understanding epidemiologic findings and to identify new paths for basic science inquiry.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA015134-12
Application #
9789786
Study Section
National Institute on Alcohol Abuse and Alcoholism Initial Review Group (AA)
Program Officer
Balachova, Tatiana Nikolayevna
Project Start
2006-09-25
Project End
2023-06-30
Budget Start
2019-07-01
Budget End
2020-06-30
Support Year
12
Fiscal Year
2019
Total Cost
Indirect Cost
Name
University of North Carolina Chapel Hill
Department
Nutrition
Type
Schools of Public Health
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
Hoyme, H Eugene; Kalberg, Wendy O; Elliott, Amy J et al. (2016) Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders. Pediatrics 138:
May, Philip A; Marais, Anna-Susan; de Vries, Marlene M et al. (2016) The continuum of fetal alcohol spectrum disorders in a community in South Africa: Prevalence and characteristics in a fifth sample. Drug Alcohol Depend 168:274-286
Hoyme, H Eugene; Coles, Claire D (2016) Alcohol-Related Neurobehavioral Disabilities: Need for Further Definition and Common Terminology. Pediatrics 138:
Gautam, P; Nuñez, S C; Narr, K L et al. (2015) Developmental Trajectories for Visuo-Spatial Attention are Altered by Prenatal Alcohol Exposure: A Longitudinal FMRI Study. Cereb Cortex 25:4761-71
Gautam, Prapti; Lebel, Catherine; Narr, Katherine L et al. (2015) Volume changes and brain-behavior relationships in white matter and subcortical gray matter in children with prenatal alcohol exposure. Hum Brain Mapp 36:2318-29
Hoyme, H Eugene; Hoyme, Derek B; Elliott, Amy J et al. (2015) A South African mixed race lip/philtrum guide for diagnosis of fetal alcohol spectrum disorders. Am J Med Genet A 167A:752-5
May, Philip A; Hamrick, Kari J; Corbin, Karen D et al. (2014) Dietary intake, nutrition, and fetal alcohol spectrum disorders in the Western Cape Province of South Africa. Reprod Toxicol 46:31-9
Ware, Ashley L; O'Brien, Jessica W; Crocker, Nicole et al. (2013) The effects of prenatal alcohol exposure and attention-deficit/hyperactivity disorder on psychopathology and behavior. Alcohol Clin Exp Res 37:507-16
Kalberg, Wendy O; May, Philip A; Blankenship, Jason et al. (2013) A Practical Testing Battery to Measure Neurobehavioral Ability among Children with FASD. Int J Alcohol Drug Res 2:51-60
May, Philip A; Blankenship, Jason; Marais, Anna-Susan et al. (2013) Maternal alcohol consumption producing fetal alcohol spectrum disorders (FASD): quantity, frequency, and timing of drinking. Drug Alcohol Depend 133:502-12

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