Category Archives: Research

BBC: Why alcohol affects women more than men

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OOEC6SBKLVEDNKIPQMHWPMWZQQIt used to be that men were the outsized alcohol drinkers in Western society – perhaps best depicted in popular culture by Don Draper’s Mad Men cronies, who swilled from office stashes of brown liquor, knocked back three-martini lunches and imbibed Old Fashioneds in an after-work pub culture where few women dared tread.

But epidemiologists have noted that the rise of marketing alcohol to women and the changing of gender roles have gradually shifted the booze imbalance. Overall, men are still almost twice as likely as women to binge drink. But that isn’t true for younger people, specifically. In fact, women born between 1991 and 2000 now drink just as much as their male counterparts – and their drinking rates could eventually surpass them.

Women’s bodies are affected differently by alcohol than men’s bodies – for reasons that go beyond mere size

Women are increasingly suffering from the ill effects of alcohol, too. National data show that the cirrhosis death rate shot up by 57% among women aged 45-64 from 2000-2015 in the US, compared to 21% among men. And it rose 18% in women aged 25-44, despite decreasing by 10% among their male peers. Adult women’s visits to hospital emergency departments for overdosing on alcohol also are rising sharply. And risky drinking patterns are escalating among women in particular.

But the problem isn’t just that women are drinking more. Researchers are finding that women’s bodies are affected differently by alcohol than men’s bodies – for reasons that go beyond mere size.

Scientists have discovered that women produce smaller quantities of an enzyme called alcohol dehydrogenase (ADH), which is released in the liver and breaks down alcohol in the body.

Meanwhile, fat retains alcohol, while water helps disperse it. So thanks to their naturally higher levels of body fat and lower levels of body water, women experience an even more dramatic physiological response to alcohol.

“That vulnerability is why we see increases in medical problems in women with alcohol-use disorders, compared to men,” says Dawn Sugarman, a psychology professor at Harvard Medical School and addiction psychologist at McLean Hospital in Belmont, Massachusetts. (Find out more about how different bodies react to alcohol differently in our recent story Why do only some people get blackout drunk?)

Women who drink excessively also tend to develop addiction and other medical issues more quickly than men. It’s a phenomenon called ‘telescoping’: women with alcohol struggles tend to start drinking later in life than men, but it takes them much less time to develop alcohol addiction. Women are also faster to experience liver disease and damage to their hearts and nerves.

Many of these gender-based differences in alcohol’s effects on the body weren’t discovered until recent decades. The earliest study on gender-based differences in ADH, for example, was published in 1990.

In fact, almost all clinical studies on alcohol were done entirely on men until the 1990s. This was partly because scientists were encouraged to eliminate as many variables as possible that might influence an experiment’s results – one of which was gender. And because alcoholism was assumed to be a mostly male problem, no-one wondered what not studying women and alcoholism might miss.

That changed when government institutions like the US National Institutes of Health mandated that women and minorities had to be included as clinical research subjects, and critical gender gaps in medical research began to be addressed.

Scientists just assumed, well, you could study men and it could apply to women – Sharon Wilsnack

“People just didn’t think about women,” says Sharon Wilsnack, a psychiatry and behavioural science professor at the University of North Dakota’s School of Medicine and Health Sciences. “To the extent that they did, they just assumed, well, you could study men and it could apply to women.”

For her PhD at Harvard University in the early 1970s, Wilsnack wrote her graduate dissertation about women and alcohol; her literature review then yielded only seven studies at Harvard’s Widener Library. With her husband, a sociologist, Wilsnack went on to lead the first long-term national study on women’s drinking habits. Among their many findings was the discovery that women who abuse alcohol often have been sexually abused as children, a gender difference that has since been deemed as crucial in helping women with addiction.

Gender-based alcohol research since then has turned up a variety of other sex-specific results.

Click to read full article by Marisa Taylor 

Retrieved from http://www.bbc.com/future/story/20180618-why-alcohol-affects-women-more-than-men

 

Research: Addressing the public health concerns of Fetal Alcohol Spectrum Disorder, Impact of stigma and health literacy

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Stigma concept.

Abstract

Background

Fetal alcohol spectrum disorders (FASD) are a group of developmental disabilities that may result from the mother’s consumption of alcohol during pregnancy. The present study examined the effects of health literacy and stigma on the public health agenda for preventing FASD.

Methods

Three hundred and forty-one participants were sampled to ascertain levels of endorsement of the public health priorities of FASD, and FASD health literacy. Stigma towards women who consume alcohol during pregnancy, and towards biological mothers of children with FASD were operationalized using ratings of difference and disdain.

Results

Public stigma towards women who consume alcohol during pregnancy was greater than stigma towards biological mothers of children with FASD. Research participants with higher FASD literacy were more likely to endorse the prevention priorities of FASD, but also more likely to endorse greater stigma towards biological mothers of children with FASD. Interestingly, those who endorsed greater stigma supported the public health priorities of FASD more strongly. Female research participants more strongly supported the prevention priorities of FASD than male participants. Male participants were more likely to endorse stigma than female participants.

Conclusions

Stigma experienced by biological mothers of children with FASD generalizes to women who consume alcohol while pregnant. Some results were contrary to expectations: stigma was positively associated with health literacy and endorsement of prevention priorities of FASD. Reasons for these findings are speculated and should be tested in future research.

(Health literacy is defined as the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.)

Retrieved from https://www.sciencedirect.com/science/article/pii/S0376871618300851

Research: Substance Use in Pregnant Women Using the Emergency Department: Undertested And Overlooked?

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C. Leigh Moyer, BA, Sean Johnson, BS, Marilyn G. Klug, PhD, and Larry Burd, PhD

West J Emerg Med. 2018 May; 19(3): 579–584.
Published online 2018 Apr 5. doi:  10.5811/westjem.2018.1.35630

Introduction

The objective was to determine if pregnant women visiting the emergency department (ED) are tested for substance use as frequently as non-pregnant women.

Methods

We captured all ED visits over a six-year period (2010–2016) from a single community hospital and identified women of childbearing age, defined for our study as 11–50 years old. We collected demographic data including age in years, ethnicity, body mass index, marital status, disposition, last encounter department, method of arrival, and day of week. An independent binary variable was created based on whether the woman was tested for alcohol or drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, opioids) during her visit. We then compared rates of testing for substance use by pregnancy status.

Results

We identified 61,222 ED visits by women of childbearing age (range 11–50, mean 30.5, standard deviation 9.6) over a six-year period from 2010–2016. Of the 57,360 non-pregnant women, 4.14% were tested compared to 1.04% of the 3,862 pregnant women tested with a relative risk of 0.25 (p<0.001, 95% confidence interval [CI] [0.183–0.341]). The most highly tested chief complaints for all women – psychiatric or substance use concerns – showed pregnant women were still 37% and 54% less likely to be tested, respectively (risk ratio [RR] 0.46, 95% CI [0.19–1.13]; RR 0.63, 95% CI [0.41–0.96]). Beyond pregnancy status, we found no significant interaction between patient demographics and substance use testing.

Conclusion

Pregnant women presenting to the ED were 75% less likely to be tested for drug or alcohol use than non-pregnant women. Our study showed only pregnancy status as a statistically significant variable in drug- and alcohol-screening rates when pregnant and non-pregnant patient chief complaints and demographics were compared. Increased attention to the screening of pregnant women for substance use may be necessary to provide adequate care and intervention to this population.

To access research please visit https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5942028/

Kids Brain Health Network, Mental Health Across Generations: the role of antidepressants in maternal and child wellbeing

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Existing evidence on the impact of antidepressant use during pregnancy on child development is often too mixed to offer women concrete answers about the implications for their children.

This difficult, but urgent area of research has been a long-term research interest for Network Investigator Dr. Tim Oberlander, and the focus of a Brain Canada-KBHN postdoctoral fellowship for Dr. Sarah Hutchison, who presented findings on the effects of SSRIs, on children 12 years following prenatal exposure to the common antidepressant at the Pediatric Academic Societies 2018 Meeting in May.

The KBHN-funded study found the children scored higher than controls on a task that measures thinking and attention skills. The work builds on Oberlander and colleagues’ earlier work following 51 children and their mothers since 26 weeks of pregnancy.

“The impact of prenatal antidepressant exposure is not a simple cause and effect,” says Dr. Oberlander. “When it comes to assessing the long-term impact of SSRI exposure before birth, genes and family-life also play a powerful role in influencing how a child grows and develops.

“At the core of this whole story is mother’s mental health,” adds Dr. Oberlander. “We have to talk about what it is about mother’s mental health during pregnancy that influences not only her health, but the health of her fetus and her child.”

While the full picture of antidepressants’ effect during pregnancy is far from complete, “no treatment is not an option,” observes Dr. Hutchison. “It’s important that women who are pregnant and making decisions about whether to take antidepressants or not have a discussion with their physician or midwife. That’s really the key message.”

“I want to emphasize that this is a big public health issue, and the medication part is a subset of the bigger story about pregnancy-related maternal mood disorders,” adds Dr. Oberlander. “Depression during pregnancy and after is a major public health problem that affects mothers and their children.

“The impact of maternal mental health and related medication treatment during pregnancy go on long after birth,” he adds, “and in that sense, represent an influence of mental health across two generations.”

“Further research is needed to examine whether ‘better’ cognitive skills in children with antidepressant exposure reflect a developmental advantage in some ways but also perhaps a risk in other ways, such as perhaps increased anxiety (Hanley et al, 2015),” reflects Dr. Oberlander. “Our findings when the children were 3 and 6 years of age indicated increased levels of anxiety, though the absence of this at 12 years might indicate that as executive functioning improves, children are able to help calm themselves.

“At this point we are fairly cautious in interpreting these results because data collection is ongoing,” agrees Dr. Hutchison. This is just a preliminary sample that we’ve examined so far,” adding that more research is needed before we can confidently comment on the long term consequences or benefits of this prenatal exposure.

In the end, says Dr. Oberlander, the story of this research is not one of the drugs being good or bad, or depression being good or bad. “This is must be a story of how can we support and optimize children’s developmental and mental health, even under adverse circumstances, regardless of what the particular exposure is. That’s the important thing. At a clinical level as a developmental pediatrician, my focus is really on how does this child think, act, and behave, and how can we support their development in the best ways possible, rather than saying ‘this is a population of kids that got exposed to a drug, we have to treat them in this way.’ It doesn’t work like that. It is not one size fits all.

“I hope that my work will provide a much more nuanced story that tell us about a variety of developmental outcomes and that should help us make much more precise and personal interventions for therapy.”

For more information on the SSRI  study, click here for the press release from PAS.

Retrieved from http://kidsbrainhealth.ca/index.php/2018/06/11/mental-health-across-generations-the-role-of-antidepressants-in-maternal-and-child-wellbeing/

Research: Human Drug Addiction Behaviors Tied to Specific Impairments in 6 Brain Networks

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Summary: A new study reports impairments in six brain networks are associated with addiction behaviors. The findings may pave the way for developing more targeted treatments for addiction.

Source: Mount Sinai Hospital.

Specific impairments within six large-scale brain networks during drug cue exposure, decision-making, inhibitory control, and social-emotional processing are associated with drug addiction behaviors, according to a systematic review of more than 100 published neuroimaging studies by experts at the Icahn School of Medicine at Mount Sinai and published Wednesday, June 6 in the journal Neuron.

Drug addiction is a disorder that encompasses not only excessive drug-seeking and taking, but also fundamental changes in cognition and emotional processing. It comprises core clinical symptoms and behavioral manifestations including a chronically relapsing cycle of intoxication, bingeing, withdrawal, and craving that propels uncontrollable drug use despite adverse consequences and a reduction in the pleasure derived from the drug. While much of the early research on drug addiction focused on understanding the rewarding properties of the drug, recent research has made it increasingly clear that cognitive and emotional impairments support the initiation, escalation, and maintenance of the cycle of addiction. A better understanding of the underlying impaired neural mechanisms in human drug addiction is critical to paving the way for the development of more targeted, evidence-based treatment interventions and timely prevention approaches.

The Impaired Response Inhibition and Salience Attribution (iRISA) model, first published in 2002 by Rita Goldstein, PhD, Professor of Psychiatry and Neuroscience and Director of the Neuropsychoimaging of Addiction and Related Conditions research program at the Icahn School of Medicine at Mount Sinai, and Nora Volkow, Director of NIDA, proposed that impairments of two broad neuropsychological functions–response inhibition (a cognitive process that permits individuals to inhibit their impulses) and salience attribution (the property of tagging something as valuable or important)–and their underlying neural substrates contribute to the cycle of addiction across a broad range of substances of abuse.

The iRISA model uses multiple neuroimaging modalities including magnetic resonance imaging, electroencephalogram (EEG) and derived event-related potentials, positron emission tomography, and neuropsychological testing to explore the underlying neurobiology of human drug addiction and the shift to excessive salience attributed to the drug and drug-related cues at the expense of other salient reinforcers as associated with impaired self-control (especially in a drug related context) and increased drug taking in drug addicted individuals.

“We conducted the current review to update the iRISA model with the most recent evidence from the neuroimaging literature by systematically reviewing 105 task-related neuroimaging studies published since 2010,” says Dr. Goldstein, last and senior author of the paper. “We found consistent impairments in brain function in six large-scale brain networks during performance of different tasks. While the involvement of these specific brain networks was task-specific, we generally observed that in a drug-related context (e.g., during exposure to drug cues) drug addicted individuals had increased engagement of the brain networks underlying decision making, inhibitory control, and social-emotional processing, but a blunted response during non-drug related tasks, as predicted by the iRISA model.”

Please click to read the full article https://neurosciencenews.com/addiction-brain-networks-9273/

Journal of Fetal Alcohol Spectrum Risk & Prevention

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The Journal of Fetal Alcohol Spectrum Risk & Prevention strives to serve as an international resource for scientific publications on the epidemiology, neurobiology, psychology and sociology of fetal alcohol toxicity. A strong emphasis will be placed on prevention and risk reduction. 

Message From The Editor: Tom Leibson, MD

The recent decade has fostered an amazing advancement in addiction research, yet we are still far from understanding the entire spectrum of consequences associated with fetal exposure to addictive substances and how to prevent them from happening. This knowledge gap exists despite global multi-disciplinary research and millions of dollars invested in addiction biochemistry, neurology and psychology. Cognizant of the matter, our new journal is designed to attract and showcase novel data regarding the most common teratogenic drug of abuse – alcohol.

This dedicated publication venue is not meant to replace existing journals but rather allow the community of clinicians and scientists who are interested in the clinical implications of fetal alcohol research findings to prioritize discussions concerning risk stratification and prevention of fetal alcohol harm.

Over the years several key assumptions had been challenged in our field and one that is most fascinating addresses the role of parental contribution to the fetal alcohol spectrum of clinical findings and outcomes. Once attributed solely to the molecular toxicity of alcohol, it is now becoming more evident that FASD has strong associations to parental mental health and the early years exposure to parental behaviours. As the pendulum swings, we may see a gradual shift from defining alcohol as a toxin exclusively to viewing it also as a biomarker of parental distress so profound that its impact crosses from generation to generation.

I congratulate the authors who have joined us for this exciting journey and have contributed their science to the launching issue of the Journal of Fetal Alcohol Syndrome Risk and Prevention. I expect to see an ongoing involvement and interest of the entire medical community in this rapidly growing research area, and most importantly I am sincerely hoping that our joint effort will have a positive impact on the lives of our patients and their families.

For more information on the journal and to sign up for the publishing notification service for this journal, please click Register link. This registration will result in the reader receiving the Table of Contents by email for each new issue of the journal. 

Umbilical Cord Tissue: A Better Way to Test for Prenatal Drug Exposure?

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baby-in-womb

Maureen A. O’Reilly, DNP, NNP-BC

Clinicians are searching for quicker and easier collection methods and more accurate toxicology testing for infants affected by intrauterine substance exposure. Umbilical cord testing offers some striking advantages over the “gold standard” of meconium testing, making the switch to cord testing increasingly attractive.

Pregnancy and Drugs of Abuse

Women in their reproductive years are at high risk for substance use disorder.[1] Unfortunately, many women continue unhealthy and addictive substance use behaviors throughout their pregnancies.[2] In a 2012 national survey,[2]5.9% of pregnant women admitted to illicit drug use, 8.5% drank alcohol, and 15.9% smoked cigarettes.[2] The opioid crisis and increased substance use in pregnancy have triggered a national debate,[3] politicizing both detection and treatment for women and their infants. This mix of politics, money, science, and social opinion pressures healthcare clinicians to constantly re-examine how they detect and treat substance use in pregnancy.

The Impact on Newborns

As many as 400,000-440,000 newborns (10%-11% of all births) are exposed to tobacco, alcohol, or illicit drugs each year.[4] In-utero substance exposure is associated with birth defects, premature delivery, fetal alcohol spectrum disorders, and developmental, behavioral, and cognitive problems in affected children.[5,6]

Neonatal abstinence syndrome is a disorder of central and autonomic nervous and gastrointestinal systems that occurs when intrauterine substance exposure causes the newborn to experience withdrawal after birth.[7] Rapid, accurate newborn toxicology testing is crucial in identifying affected newborns, allowing timely initiation of treatment.

Toxicology Testing Matrices

Meconium toxicology has long been the “gold standard” in detecting newborn exposure to drugs of abuse.[8,9] Meconium samples can be difficult to collect. Fetal stressors during labor or delivery can induce meconium passage,[6] or it can be delayed up to a week, depending on gestational age.[9,10] Alternatively, meconium may be passed but not collected because drug use is neither suspected nor reported until after the sample is no longer available, or a parent may discard a diaper with meconium to avoid illicit drug detection.[10]

Other sample matrices for newborn testing have drawbacks. Cutting a hair sample from a newborn is protested by parents for cosmetic reasons and frequently results in inadequate sample size.[6] Fingernails are small and inadequate for sampling in newborns.[6] Vernix caseosa can be used to detect maternal drug use after 24 weeks of gestation; however, the volume is often inadequate for testing.[6] The window of drug detection in urine is narrow.[9]Newborns often void at the time of birth and may not void again for hours. Furthermore, urine samples can be difficult to obtain in the newborn.[11]

A New Method: Umbilical Cord Toxicology

Dianne Montgomery, a neonatal nurse practitioner, was debating the pros and cons of various tissues and waste products for drug detection in newborns, while also trying to address nursing complaints about sample collection difficulties. She approached the United States Drug Testing Laboratory in 2001 to suggest the umbilical cord as an alternative tissue for infant toxicology.[11]Cord toxicology testing first became available commercially in 2012 and is now offered by several US laboratories.[12]

References:

  1. Forray A. Substance use during pregnancy. F1000Res. 2016;5.
  2. Reitan T. Substance abuse during pregnancy: a 5-year follow-up of mothers and children. Drugs Educ Prev Policy. 2018 Feb 15. [Epub ahead of print]
  3. Bodenner C. How to treat pregnant drug addicts? Your thoughts. Atlantic. May 21, 2015. Source Accessed May 4, 2018.
  4. National Center on Substance Abuse and Child Welfare. Substance-exposed infants: state responses to the problem. January 31, 2018. Source Accessed May 4, 2018.
  5. Interrante JD, Ailes EC, Lind JN, et al; National Birth Defects Prevention Study 1997-2011. Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997-2011. Ann Epidemiol. 2017;27:645-653. Abstract
  6. Wabuyele SL, Colby JM, McMillin GA. Detection of drug-exposed newborns. Ther Drug Monit. 2018;40:166-185. Abstract
  7. McQueen K, Murphy-Oikonen J. Neonatal abstinence syndrome. N Engl J Med. 2016;375:2468-2479. Abstract
  8. Colby JM. Comparison of umbilical cord tissue and meconium for the confirmation of in utero drug exposure. Clin Biochem. 2017;50:784-790. Abstract
  9. Concheiro-Guisan A, Concheiro M. Bioanalysis during pregnancy: recent advances and novel sampling strategies. Bioanalysis. 2014;6:3133-3153. Abstract
  10. Montgomery DP, Plate CA, Jones M, et al. Using umbilical cord tissue to detect fetal exposure to illicit drugs: a multicentered study in Utah and New Jersey. J Perinatol. 2008;28:750-753. Abstract
  11. United States Drug Testing Laboratory. CordStat origin with Dianne Montgomery . September 20, 2013. Source Accessed May 4, 2018.
  12. United States Drug Testing Laboratory. Umbilical cord drug tissue testing. Source Accessed May 6, 2018.
  13. Plate C. Identifying alcohol exposed newborns. United States Drug Testing Laboratory. 2012. Source Accessed May 8, 2018.
  14. Marin SJ, Christensen RD, Baer VL, Chantry CJ, McMillin GA. Nicotine and metabolites in paired umbilical cord tissue and meconium specimens. Ther Drug Monit. 2011;33:80-85. Abstract
  15. Wright TE, Milam KA, Rougee L, Tanaka MD, Collier AC. Agreement of umbilical cord drug and cotinine levels with maternal self-report of drug use and smoking during pregnancy. J Perinatol. 2011;31:324-329. Abstract
  16. ARUP Consult®. Newborn drug testing – meconium and umbilical cord tissue. SourceAccessed May 7, 2018.
  17. McMillin GA, Wood KE, Strathmann FG, Krasowski MD. Patterns of drugs and drug metabolites observed in meconium: what do they mean? Ther Drug Monit. 2015;37:568-580. Abstract
  18. ARUP Laboratories. Drug detection panel, umbilical cord tissue, qualitative. SourceAccessed May 8, 2018.
  19. United States Drug Testing Laboratory. Universal umbilical cord collection chain of custody procedure. Source Accessed May 9, 2018.
  20. Hudak ML, Tan RC; COMMITTEE ON DRUGS; COMMITTEE ON FETUS AND NEWBORN; American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics. 2012;129:e540-e560. Abstract
  21. American College of Obstetricians and Gynecologists. Opioid use and opioid use disorder in pregnancy. ACOG Committee Opinion 711. August 2017. Source Accessed May 10, 2018.
  22. Palmer KL, Wood KE, Krasowski MD. Evaluating a switch from meconium to umbilical cord tissue for newborn drug testing: a retrospective study at an academic medical center. Clin Biochem. 2017;50:255-261. Abstract
  23. Cotten SW. Drug testing in the neonate. Clin Lab Med. 2012;32:449-466. Abstract

 

Cite this article: Umbilical Cord Tissue: A Better Way to Test for Prenatal Drug Exposure? – Medscape – Jun 05, 2018.

Retrieved from https://www.medscape.com/viewarticle/897494

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