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Native WYSE CHOICES adapted an Alcohol Exposed Pregnancy (AEP) prevention curriculum for mobile health delivery for young urban American Indian and Alaska Native (AIAN) women. This qualitative study explored the relevance of culture in adapting a health intervention with a national sample of urban AIAN youth. In total, the team conducted 29 interviews across three iterative rounds. Participants expressed interest in receiving culturally informed health interventions, were open to cultural elements from other AIAN tribes, and highlighted the importance of culture in their lives. The study underscores why community voices are central in tailoring health interventions for this population.

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Ethanol exposure and early life stress during brain development are associated with an increased risk of developing psychiatric disorders. We used a third-trimester equivalent model of fetal alcohol spectrum disorders combined with a maternal separation (MS) protocol to evaluate whether these stressors cause sexually dimorphic behavioral and hippocampal dendritic arborization responses in adolescent rats. Wistar rat pups were divided into four experimental groups: 1) Control; 2) MS (MS, for 3 h/day from postnatal (PND) 2 to PND14); 3) EtOH (EtOH, 5 g/kg/day, i.p., PND2, 4, 6, 8, and 10); 4) EtOH + MS. All animals were divided into two cohorts and subjected to a battery of behavioral tests when they reached adolescence (PND37-44). Animals from cohort 1 were submitted to: 1) the open field test; 2) self-cleaning behavior (PND38); and 3) the motivation test (PND39-41). Animals from cohort 2 were submitted to: 1) the novel object recognition (PND37-39); 2) social investigation test (PND40); and 3) Morris water maze test (PND41-44). At PND45, the animals were euthanized, and the brains were collected for subsequent dendritic analysis. Postnatal ethanol exposure (PEE) caused anxiety-like behavior in females and reduced motivation, and increased hippocampal dendritic arborization in both sexes. MS reduced body weight, increased locomotor activity in females, and increased motivation, and hippocampal dendritic arborization in both sexes. We found that males from the EtOH + MS groups are more socially engaged than females, who were more interested in sweets than males. Altogether, these data suggest that early life adverse conditions may alter behavior in a sex-dependent manner in adolescent rats.

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OBJECTIVE: To study the utility of genetic evaluation and testing in patients with suspected fetal alcohol spectrum disorder (FASD). STUDY DESIGN: We performed a retrospective chart review of all patients (n = 36) referred for evaluation for suspected FASD to the genetics clinic at Boston Children's Hospital between January 2006 and January 2013. Records of all patients were reviewed to obtain the medical history, family history, examination findings, and investigations, including genetic testing. RESULTS: Of the 36 patients, definite prenatal exposure was documented in 69%. Eight patients did not fulfill clinical criteria for FASD. Chromosomal microarray analysis (CMA) detected 19 copy number variants (CNVs) in 14 patients. Among patients who fulfilled criteria for FASD and underwent CMA, pathogenic CNVs were detected in 3 patients (2q37del, 22q11.22dup, and 4q31.21del syndromes), giving a yield of 14.3%. All 3 patients had overlapping features between FASD and the genetic syndrome. CONCLUSION: Genetic testing, especially CMA, should be considered in patients referred for evaluation of FASD, as a significant proportion have a clinically significant CNV even when they fulfill diagnostic criteria for FASD spectrum.

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RESUMO Objetivo Investigar e comparar a narrativa oral de indivíduos com Transtorno do Espectro Alcoólico Fetal (TEAF) e de indivíduos com desenvolvimento típico de linguagem (DTL) e correlacionar o desempenho na narrativa oral com a pontuação do "4-Digit Diagnostic Code". Método Participaram 20 indivíduos com TEAF, de ambos os gêneros, com idade cronológica entre seis e 16 anos e 20 indivíduos com DTL, semelhantes quanto ao gênero, idade e nível socioeconômico aos do grupo TEAF. A narrativa oral foi eliciada por meio do livro "Frog, where are you?" e analisada quanto aos aspectos macroestruturais, microestruturais e nível de coerência global. Os aspectos macroestruturais incluíram elementos típicos de história e os microestruturais incluíram palavras (total, palavras diferentes), unidades comunicativas (C-Units), diversidade lexical e extensão média dos C-Units. Resultados Desempenho inferior foi encontrado para o grupo TEAF em todos os aspectos macroestruturais, exceto para os marcadores linguísticos. Dentre os aspectos microestruturais, a diversidade lexical e a ocorrência de "C-Units" incompletos foram aspectos que diferenciaram os grupos TEAF e DTL. O grupo TEAF apresentou nível de coerência global inferior ao grupo DTL. Correlações negativas foram encontradas entre os aspectos macroestruturais e os itens características faciais e alterações no Sistema Nervoso Central. Conclusão O uso restrito de elementos estruturais típicos de história com níveis inferiores de coerência e vocabulário reduzido diferenciaram o TEAF do DTL. Estudos futuros poderão explorar se a associação entre o desempenho narrativo e os itens do "4-Digit Diagnostic Code" apresentam valor preditivo no desempenho narrativo dos indivíduos com TEAF.

ABSTRACT Purpose To investigate and compare the oral narrative of individuals with FASD and individuals with typical language development (TLD), as well as to correlate the narrative performance with the score from 4-Digit Diagnostic Code. Methods Participants were 20 individuals with FASD, of both genders, with chronological age between 6 and 16 years, and 20 individuals with TLD, same gender and similar to the FASD group in age and socioeconomic status. The oral narrative was elicited using the book Frog, where are you? and the data were analyzed in terms of macrostructure, microstructure and global coherence level. Measures regarding the macrostructure included the presence of typical structural elements of storytelling, while the microstructural aspects included words (total and different words), communication units (C-Units), lexical diversity, and mean length of C-Units. Results Low performance was found in the FASD group for all macrostructural aspects, with the exception of linguistic markers. Among the microstructural aspects, lexical diversity and incomplete C-Units were different between the FASD and TLD groups. The FASD group presented lower global coherence level compared to the TLD group. Negative correlations were found between macrostructural aspects, facial characteristics, and Central Nervous System impairment. Conclusion Restricted use of typical structural elements of storytelling with lower levels of coherence and reduced vocabulary distinguished the FASD from the TDL group. Future studies may explore whether the association between narrative performance and the 4-Digit Diagnostic Code items present predictive values in the narrative performance of individuals with FASD.

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Prenatal alcohol exposure can have serious and permanent adverse effects. The developing brain is the most vulnerable organ to the insults of prenatal alcohol exposure. A behavioral phenotype of prenatal alcohol exposure including conduct disorders is also described. This study on a sample of Brazilian adolescents convicted for criminal behavior aimed to evaluate possible clinical features of Fetal Alcohol Syndrome (FAS). These were compared to a control group of school adolescents, as well as tested for other environmental risk factors for antisocial behavior. A sample of 262 institutionalized male adolescents due to criminal behavior and 154 male students aged between 13 and 21 years comprised the study population. Maternal use of alcohol was admitted by 48.8% of the mothers of institutionalized adolescents and by 39.9% of the school students. In this sample of adolescents we could not identify individual cases with a clear diagnosis of FAS, but signs suggestive of FASD were more common in the institutionalized adolescents. Social factors like domestic and family violence were frequent in the risk group, this also being associated to maternal drinking during pregnancy. The inference is that in our sample, criminal behavior is more related to complex interactions between environmental and social issues including prenatal alcohol exposure.

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CONTEXTO: A exposição pré-natal ao etanol pode produzir diversos efeitos adversos no desenvolvimento fetal denominados doença espectral do alcoolismo fetal (DEAF). A detecção precoce de exposição ao etanol permite que medidas preventivas sejam tomadas para minimizar os efeitos adversos da exposição. OBJETIVOS: O presente trabalho teve como objetivo revisar os principais efeitos tóxicos do etanol no neonato e os biomarcadores de exposição ao álcool. MÉTODOS: Foi realizada uma pesquisa bibliográfica na base de dados PubMed utilizando os descritores "effects maternal ethanol exposure" e "biomarkers ethanol prenatal exposure", além de referências cruzadas dos artigos selecionados. RESULTADOS: Diversos efeitos adversos no desenvolvimento fetal têm sido descritos, especialmente os prejuízos no sistema nervoso central. Os biomarcadores de exposição mais citados na literatura são os etil ésteres de ácidos graxos (EEAG), etil glicuronídeo (EtG) e etil sulfato (EtS) utilizando mecônio e cabelo como matriz biológica. CONCLUSÃO: A detecção precoce de exposição ao álcool na vida intrauterina pode ser realizada e é um instrumento para prevenir efeitos secundários, porque possibilita a intervenção farmacológica e educacional na criança com DEAF.

BACKGROUND: Prenatal exposure to ethanol can produce a complex set of effects on fetal development, which is denominated fetal alcohol spectrum disorder (FASD). Early detection of ethanol exposure can allow the prevention of some relevant adverse effects associated to FASD. OBJECTIVES: The aim of this work was to review the main toxic effects of ethanol on the neonate and the available biomarkers of prenatal alcohol exposure. METHODS: A bibliographic search was performed in PubMed employing the terms "effects maternal ethanol exposure" and "biomarkers ethanol prenatal exposure" and cross references. RESULTS: Many adverse effects on fetal development were described, especially deficits in the central nervous system. The biomarkers of ethanol exposure more widely described were fatty acid ethyl esters (FAEEs), ethyl glucuronide (EtG) and ethyl sulphate (EtS), being meconium and hair the most common biological matrices for laboratorial evaluation. DISCUSSION: The early detection of alcohol exposure in intra-uterine life is useful to prevent the secondary effects of FASD through pharmacologic and educational intervention in affected children.

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