PRENATAL EXPOSURE TO ALCOHOL

AND PRENATAL DIET AMONG INUIT

WOMEN OF NUNAVIK

Sarah Fraser

Plan

• What are the prenatal alcohol consumption patterns in Nunavik?

• What is the impact on infant development?

• Nutrition and prenatal alcohol exposure: how are these associated?

• Diet in Nunavik

• Conclusions

Nunavik

• 14 remote and isolated communities on two

coasts, Hudson and Ungava

• 11 000 inhabitants

• 90% inuit

Research project

• Recrutement started in 1995

• 248 women participated to prenatal interviews

• 185 mothers and infants were followed-up at 6 months and 178 at 11 mois.

Information gathered:

• Maternal Interviews (demographic information, alcohol, nicotine and drug use, psychological distress…)

• Maternal blood and umbilical cord blood

• Infant weight, birth and head-circumference at birth

• Visual acuity at 6 months

Results: Sample Characteristics

Characteristics N % Mean S.D. Range

Maternal Age (Years) 215 25.1 ± 5.9 15.0 – 41.0

Maternal Education (years) 215 8.0 ± 1.7 5.0 – 14.3

Maternal SES 215 17.5 ±11.4 5.0 – 55.0

Number of live births 215 2.1 ± 1.8 0.0 - 9.0

Maternal weight before delivery

(kg)

215 70.6 ±12.4 50.0 - 123.9

Gestational hypertension (% yes) 201 7.5

Antibiotics during pregnancy (5 yes) 207 60.4

Sex of infant (% male) 215 57.0

Gestational age at birth (wks) 213 38.7 ± 1.8 32.0 - 42.0

Patterns of prenatal exposure

• 90% smoked during pregnancy with an average of 10 cigarettes per day

• 36% consumed marijuana at least once

• 60% of women consumed alcohol at least once during pregnancy, with an average of 6 drinking days

• 38% binged at least once during pregnancy

• The quantity of alcohol consumed and pattern of consumption was not associated with socio-economic status or maternal age

• Feeling down/blue, lonely, hopeless about the futur, bored, and crying easily are associated with higher quantity of alcohol consumed during pregnancy

Prenatal alcohol exposure and development

• In epidemiological research we see an association

between alcohol and development in samples where

alcohol consumption is ≥ 2 drinks/day

• Effects include reduced growth, cognitive

development (memory, attention, language, math),

visual development, and difficult behaviours.

• Animal research suggests that exposure to high doses

per occasion (≥ 5 drinks) is more harmful to the fœtus

than more frequent exposure to small doses

Results: the effects of binge drinking on infant

development

Outcome N Std β (P) R2

Birth weight1,2,3,4,5,6 196 -.129 (.01) .571

Head Circumference at birth1,2,4,5,6 184 -.154 (.01) .396

Birth length 1,2,4,6 185 -.042 (.48) .389

Visual Acuity 6 months 1,6,7 181 -.244 (.00) .094

Mean looking duration, Fagan 6 months 8,9 174 -.049 (.51) .068

Mean looking duration, Fagan 12 months10,11 169 .062 (.41) .065

Controlling for 1 gestational age, 2 number of live births, 3 maternal weight before delivery, 4 gestational

hypertension (Yes/No), 5 maternal socio-economic status, 6 infants sex, 7 average number of cigarettes

smoked during pregnancy, 8 Maternal score on the Raven, 9 number of traditional meals consumed per

week during pregnancy, 10 number of years of schooling completed by mother 11 lead (pb) concentrations in maternal blood

12 birth weight 13 Score on HOME interview

Nutrition and prenatal alcohol consumption

• Research suggests that the FAS/ FASD is not an equal opportunity birth defect

• The incidence of FAS and FASD is much greater in aboriginal and African American communities: lower SES, nutrition

• Experimental research on animals suggests that certain nutrients can reduce the effects of prenatal alcohol on exposed pups (vitamin C and E, polyunsaturated fatty acids, folic acid, choline)

Nutrition in Nunavik

• Traditional foods are rich in various nutients and especially in polyunsaturated fatty acids: artic char (690mg de DHA par 100g), salmon (612mg DHA par 100g), beluga fat (4974mg DHA par 100g), seal fat (12285mg par 100g).

• Important changes in diet have taken place in the past decades with a decrease in consumption in foods rich in PUFAs and an increase in foods rich in fats.

Research question

Does a high level of polyunsaturated fatty aicds in umbilical

cord phospholipids protect against the effects of alcohol

consumption during pregnancy on prenatal growth and

visual acuity at 6 months?

Nutrition in Nunavik

Prenatal diet Mean

S.D.

Min - Max

Country Food per week 4.9 ± 5.4 0 - 44.0

Fish meals per week 3.4 ± 4.0 0 - 28.0

Beluga meals throughout pregnancy 24 ± 39.0 0 - 231.0

Whale meals throughout pregnancy 0.8 ± 5.2 0 - 52.0

Seal meals throughout pregnancy

PUFA

DHA in umbilical cord

DHA/AA in umbilical cord

0.8 ± 1.8

3.6 ± 1.1

.4 ± .2

0 - 21.7

.1 – 1.1

.5 – 7.2

Prenatal alcohol and PUFAs on infant development

Predictors N Beta (p)

Birth weight Step 1: Maternal weight

Binge drinking

DHA/AA

Step 2: Binge* DHA/AA

103 .44 (.00)

-.14 (.11)

.17 (.05)

-.28 (.30)

Head circumference Step 1: Maternal weight

Sex of baby

Binge drinking

DHA/AA

Step 2: Binge* DHA/AA

102 .46 (.00)

.15 (.09)

- .11 (.21)

.07 (.44)

-.22 (.42)

Visual Acuity Step 1: Smoking3

Binge drinking

DHA/AA

Step 2: Binge* DHA/AA

95 .29 (.01)

-.33 (.00)

.08 (.42)

-.21 (.48)

Limitations of this study

• Infant blood is available for 50% of the sample with significant

differences between infants for whom samples are available

and missing cases

• Low statistical power because of small sample size

• PUFA Blood levels represent maternal intake during weeks

preceding labour. Considering seasonal variations in diet this

may not be a valid measure of PUFA intake through-out

pregnancy

Conclusion and final thoughts

• The results suggest an impact of binge drinking on prenatal

growth and postnatal vision

• Binge drinking is associated with psychological well-being

(sadness, boredom)

• Our results concerning the impact of polyunsaturated fatty

acids suggest no protection against prenatal alcohol exposure

• Studies suggest an association between eating traditional foods,

fatty acid levels and psychological well-being

Nakurmik Marialuk

Prenatal exposure N % Mean S.D. Range

Consumed alcohol during

pregnancy (% yes)

215 60.6%

Ounces of absolute alcohol

per day

130 0.08 ± 0.2 0.0 – 1.6

Number of drinking days 130 6.0 ± 14.9 0.0 – 136.0

Binge drinking during

pregnancy (% yes)

215 38.1%

Frequency of binging 82 3.4 ± 9.6 0.0 – 71.0

Smoked during pregnancy

(% yes)

213 90.1

Number of cigarettes

smoked/day

194 10.5 ± 5.4 0.3 – 25.0

Marijuana during pregnancy

(% yes)

215 36.3

Patterns of prenatal exposure among pregnant

women of Nunavik