The impact of maternal adiposity specialization on infant birthweight: upper versus lower body fat.

BACKGROUND: The specialization of human fat deposits is an inquiry of special importance in the study of fetal growth. It has been theorized that maternal lower-body fat is designated specifically for lactation and not for the growth of the fetus. OBJECTIVE: Our goal was to compare the contributions of maternal upper-body versus lower-body adiposity to infant birth weight. We hypothesized that upper-body adiposity would be strongly associated with infant birth weight and that lower-body adiposity would be weakly or negligibly associated with infant birth weight-after adjusting for known determinants. STUDY DESIGN: In this prospective cohort study, 355 women initiated medical pre-natal care during the first trimester of pregnancy at The University of Oklahoma Health Sciences Center during 1990-1993. Maternal anthropometric measurements were assessed at the first clinic visit: (a) height; (b) weight; (c) circumferences of the upper arm, forearm, and thigh; and, (d) skin-fold measurements of the bicep, subscapular region, and thigh. RESULTS: Infant birth weight was regressed on known major determinants to create the foundational model. Maternal anthropometric variables subsequently were added one at a time into this multiple regression model. The highest contribution by a single anthropometric variable to infant birthweight was, in order: subscapular skin-fold, forearm circumference, and thigh circumference. With one upper-body (subscapular skin-fold) and one lower-body (circumference of the thigh) adiposity measure in the model, the z-score regression coefficient (s.e.) was 85.7g (30.8) [p=0.0057] for maternal subscapular skin-fold and 19.0g (31.6) [p=0.5477] for circumference of the thigh. When the second-best upper-body contributor to infant birthweight (circumference of the forearm) was entered with one lower-body measure into the model, the z-score regression coefficient (s.e.) was 77.5g (38.5) [p=0.0451] for maternal forearm circumference and 14.1g (38.5) [p=0.7146] for circumference of the thigh. When both subscapular skinfold and forearm circumference were added to the model in place of BMI, the explained variance (r2=0.5478) was similar to the model using BMI (r2=0.5487). CONCLUSION: Upper-body adiposity - whether operationalized by subscapular skin-fold or circumference of the forearm - was a markedly larger determinant of infant birth weight than lower-body adiposity.

Make your office alcohol-exposed pregnancy prevention friendly.

This article is third in a series on fetal alcohol spectrum disorders (FASD), and centers on preventing an alcohol exposed pregnancy (AEP). FASDs are 100% preventable if a woman does not drink alcohol during pregnancy. As many pregnancies are unintended, Arkansas providers would best serve childbearing women if they would routinely screen for alcohol use in all childbearing-aged women and encourage women to consider drinking reduction or elimination, or use of an effective method of contraception if they continue to drink alcohol. A systematic process in the clinical setting involving all office personnel enables screening to be a feasible process, otherwise busy clinicians alone often do not have the time to provide these services. A provider other than a physician, such as a trained nurse, can conduct brief interventions after a positive screen while the patient is in the clinic. These brief interventions have been shown to reduce the risk of an AEP. Additionally, there are multiple resources in Arkansas for women who need further treatment for an alcohol use disorder.

Fetal alcohol spectrum disorders: flying under the radar.

Alcohol exposure during pregnancy has been shown to result in a spectrum of birth defects known as Fetal Alcohol Spectrum Disorders (FASD) that can negatively impact a child's growth, development, cognition, behavior and physical appearance over his or her entire lifespan. FASD is not a diagnostic term, unlike Fetal Alcohol Syndrome (FAS), which is the most serious disorder within the spectrum. Despite warnings by the U.S. Surgeon General and others, childbearing age women continue to drink at high levels, even in pregnancy. As there is no cure for an FASD, preventive activities are currently the only successful approach to reduce the risk of an Alcohol-Exposed Pregnancy (AEP) through screening, education, or brief interventions of childbearing age women. The Midwest Region Fetal Alcohol Syndrome Training Center (MRFASTC) has established teams in 8 states in the Midwest, including Arkansas, with the goal of training health care professionals in FASD recognition, diagnosis, treatment, and prevention.

A web-based intervention to reduce alcohol-exposed pregnancies in the community.

Despite warnings that drinking during pregnancy is unsafe, many women are still at risk for an alcohol-exposed pregnancy (AEP). This article describes the outcomes of a web-based, self-guided change intervention designed to lower the risk for AEPs in a community. A sample of 458 women, between the ages of 18 and 44 years and at risk for an AEP (i.e., any drinking in the past 30 days and not using reliable contraception), participated in the study. A total of 58% of the women enrolled in the self-guided change intervention were no longer at risk for an AEP at the 4-month follow-up. Sublevel analysis revealed that mail and online versions of the intervention were equally successful at reducing risk for an AEP. This study represents a successful implementation of a web-based, self-guided change intervention to reduce risk for an AEP, an intervention with community-wide reach due to the Internet platform.

Exploring pregnancy-related changes in alcohol consumption between black and white women.

BACKGROUND: Although epidemiological data indicate that White women are more likely to drink and binge drink before pregnancy, fetal alcohol syndrome (FAS) is more common in the Black population than among Whites in the United States. Differences in drinking cessation between Black and White women who become pregnant may help explain the disparity in FAS rates. METHODS: The study sample was comprised of 280,126 non-Hispanic Black and White women, ages 18 to 44, from the Behavioral Risk Factor Surveillance System (BRFSS) 2001 to 2005 data sets. Predictors of reduction in alcohol consumption (in drinks per month) and binge drinking (>4 drinks on one occasion) by pregnant and non-pregnant women were identified with logistic regression. The effect of interactions of pregnancy status with age, education, and Black or White race on drinks per month and binge occasions were explored using analysis of variance (ANOVA). RESULTS: Pregnant White women averaged 79.5% fewer drinks per month than non-pregnant White women (F = 1250.1, p < 0.001), and 85.4% fewer binge drinking occasions (F = 376, p < 0.001). Pregnant Black women averaged 58.2% fewer drinks per month than non-pregnant Black women (F = 31.8, p < 0.001) and 64.0% fewer binge occasions (F = 13.8, p < 0.001). Compared to Black women, White women appear to make a 38% greater reduction in drinks per month, and a 33% greater reduction in binge occasions. CONCLUSIONS: Non-Hispanic White women appear more likely to reduce drinks per month and binge drinking occasions than non-Hispanic Black women during pregnancy. These findings may help explain disparities in FAS in the United States, though this cross-sectional sample does not permit claims of causation. To better describe the impact of differential drinking reduction on FAS rates, future studies of longitudinal data should be done.

Knowledge and attitudes about fetal alcohol syndrome, fetal alcohol spectrum disorders, and alcohol use during pregnancy by occupational therapists in the Midwest.

Fetal Alcohol Syndrome (FAS) occurs in approximately 3 of 1,000 live births in the general population of the U.S. and is the leading known cause of mental retardation. The Midwest Regional Fetal Alcohol Syndrome Training Center (MRFASTC) surveyed 1,000 licensed occupational therapists (OT) of the American Occupational Therapists Association in a six-state Midwest region, including Missouri, Iowa, Nebraska, Kansas, Oklahoma, and Arkansas to assess knowledge and attitudes regarding FAS. Nearly 20% of the OTs responded. Of the respondents, nearly 94% regarded at least 1 drink per day as being 'heavy' in a pregnant woman. There was an increase in the number of respondents who thought it was acceptable to consume 1 drink or more with each advancing trimester of pregnancy. 92% of the OTs indicated a willingness to counsel a mother of a child having FAS, but 96% indicated a poor to fair ability to select valid and reliable assessment instruments for screening a child for FAS. Only 6% of the OT respondents indicated a good-excellent ability to conduct brief interventions on alcohol cessation for women. The data collectively indicate OTs possess similarities to other health care providers, including physicians and psychologists, in the misunderstanding or deficits of knowledge and skills associated with FAS and that they are largely unprepared to provide intervention for women 'at risk' for FAS, or to recognize correctly FAS in children. There is a demonstrated need, and desire, by the practicing OTs for continued education related to alcohol abuse associated with FAS.

Pediatricians' knowledge, training, and experience in the care of children with fetal alcohol syndrome.

OBJECTIVES: Prenatal exposure to alcohol interferes with fetal development and is the leading preventable cause of birth defects and developmental disabilities. The purpose of this study was to identify current knowledge, diagnosis, prevention, and intervention practices related to fetal alcohol syndrome and related conditions by members of the American Academy of Pediatrics. METHODS: This study was developed collaboratively by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Questionnaires were mailed to a 3% random sample (n = 1600) of American Academy of Pediatrics members in the United States. General pediatricians, pediatric subspecialists, and pediatric residents were included. RESULTS: Participation rate was 55% (n = 879). Respondents almost universally knew the teratology and clinical presentation of fetal alcohol spectrum disorders. However, they were less likely to report comfort with routine pediatric care of these children. Whereas 62% felt prepared to identify and 50% felt prepared to diagnose, only 34% felt prepared to manage and coordinate the treatment of children with fetal alcohol spectrum disorders. Even fewer (n = 114 [13%]) reported that they routinely counsel adolescent patients about the risks of drinking and pregnancy. CONCLUSIONS: The survey confirms that pediatricians are knowledgeable about fetal alcohol syndrome but do not feel adequately trained to integrate the management of this diagnosis or prevention efforts into everyday practice. Furthermore, the respondents were not active in routine anticipatory guidance with adolescents for prevention of alcohol-affected pregnancies. The development, dissemination, and implementation of best practice tools for prevention, diagnosis, and referral of fetal alcohol syndrome that are specific for general and subspecialist pediatricians are recommended.

Preventing alcohol-exposed pregnancies.

Fetal alcohol exposure affects approximately 1% to 3% of live births in the United States. Family physicians are in a unique position to reduce the incidence of alcohol-exposed pregnancy. Fetal alcohol exposure can be minimized through 2 general approaches: reducing alcohol consumption or increasing effective contraception among childbearing-aged women who engage in "at-risk" drinking and encouraging pregnant women to abstain from alcohol. Although no safe level of alcohol consumption during pregnancy is established, women who binge drink are more likely to deliver infants with physical and cognitive-developmental anomalies. Screening tools, such as quantity/frequency questions, the TWEAK and the T-ACE, developed specifically for prenatal care, are more useful with women than the CAGE and Michigan Alcohol Screening Test (MAST). Screening alone seems to reduce alcohol use among pregnant women. Brief interventions, including education about alcohol's effects on the developing fetus, are effective among women not responding to screening. Unfortunately, many barriers exist to effective implementation of alcohol-exposed pregnancy (AEP) prevention in the clinical setting. Designing effective office base systems so the entire burden of implementing AEP prevention activities does fall solely on the family physician is critical.

Report from the CDC. Physician and allied health professionals' training and fetal alcohol syndrome.

Maternal prenatal alcohol use is one of the leading preventable causes of birth defects and developmental disabilities. On the severe end of the spectrum of conditions related to drinking during pregnancy is fetal alcohol syndrome (FAS). Physicians and other health practitioners play a critical role in diagnosing FAS and in screening women of childbearing age for alcohol use during pregnancy. The Fetal Alcohol Syndrome Prevention Team at CDC's National Center on Birth Defects and Developmental Disabilities awarded funds to four medical school partners (Meharry and Morehouse Medical Colleges, St. Louis University, the University of Medicine and Dentistry of New Jersey, and the University of California at Los Angeles) to develop FAS regional training centers (RTCs). The RTCs are developing, implementing, evaluating, and disseminating educational curricula for medical and allied health students and practitioners that incorporate evidence-based diagnostic guidelines for FAS and other prenatal alcohol-related disorders.

Medicina ambulatoria: atención primaria de la familia

Analiza las principales afecciones y enfermedades crónicas con que se enfrentan los médicos de familia y presenta para las 66 afecciones más frecuentes -como ser , , , , , , , , y -, su fisiopatologia, síntomas, signos, pruebas de laboratorio y tratamiento. También, para las enfermedades crónicas como enfermedad de , , , , , , , , y otras , y para aspectos relacionados con la . Finalmente, se detiene en distintos aspectos de la medicina preventiva, como ser el asesoramiento del paciente

Medicina ambulatoria: atención primaria de la familia

Analiza las principales afecciones y enfermedades crónicas con que se enfrentan los médicos de familia y presenta para las 66 afecciones más frecuentes -como ser , , , , , , , , y -, su fisiopatologia, síntomas, signos, pruebas de laboratorio y tratamiento. También, para las enfermedades crónicas como enfermedad de , , , , , , , , y otras , y para aspectos relacionados con la . Finalmente, se detiene en distintos aspectos de la medicina preventiva, como ser el asesoramiento del paciente