Prenatal alcohol exposure and child health: How can I protect my baby from accidental exposure?

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1. SUMMARY

Approximately 80% of Australian women drink alcohol around conception. Although it is well known that high levels of alcohol throughout pregnancy can cause brain damage, the effects of exposure exclusively around conception are less well known. Our preclinical studies demonstrate that alcohol around conception can affect fetal development and contribute to a range of adverse health and behavioural outcomes in offspring. The urgent challenge is to understand the mechanisms contributing to disease and intervene to prevent, or at least minimise, the long-term effects of alcohol exposure in early pregnancy. Our work aims to determine if these deleterious effects can be ameliorated by maternal dietary supplementation with choline. Choline is an essential nutrient required for normal development but maternal concentrations are reduced by alcohol consumption. If successful, choline would represent a safe and feasible supplement that could be taken by pregnant women who inadvertently consumed alcohol around the time of conception.

2. BENEFIT

Our research group is unique, as we use clinically relevant animal models to mimic common drinking behaviours by Australian women during pregnancy. Through this work, we have discovered that there are a broad range of long-term health problems that can develop in offspring that are associated with even low-moderate levels of alcohol during pregnancy, or restricted to around conception. This includes an increased risk for diabetic-like symptoms, obesity, hypertension and kidney dysfunction. Interestingly, risk for these chronic conditions is often sex-specific, occurring more often in males than females. An understanding of the level and timing of prenatal alcohol exposure and the potential health and behavioural deficits that can occur in the offspring is important for dispelling the myth that it is OK for women to drink alcohol during pregnancy, particularly at low levels. While not all children appear to be affected by prenatal exposure to alcohol, impacts have been seen across a wide spectrum of exposures and so there is no known safe level of alcohol consumption during pregnancy. Our studies help to provide the important evidence-base for public health messages around women abstaining from alcohol while pregnant or planning a pregnancy.


Importantly, this preclinical work is now informing our clinical studies at the Child Health Research Centre at the University of Queensland, where we are investigating the incidence of these chronic health conditions in Queensland children and adolescents diagnosed with fetal alcohol spectrum disorder (FASD). FASD is an under-recognised and often misdiagnosed condition that is caused by alcohol exposure during pregnancy and is characterised by specific cognitive and behavioural deficits. By understanding the range of health problems that these children may face later in life, we have the chance to intervene early and manage these conditions to improve their quality of life into adulthood.


Whilst abstinence from alcohol consumption can prevent all alcohol induced fetal damage, this is unlikely to be feasible at a population level, particularly in pregnancies that are unplanned. Interestingly, studies have demonstrated that the impact of alcohol exposure in pregnancy on developmental outcomes differs significantly between women. Several lines of evidence have suggested that women who consume a well-balanced diet may be partially protected from some adverse impacts of alcohol. This is thought to be due to availability of specific micronutrients, one of which is choline. Our intervention studies have enormous public health implications, both in Queensland and Australia-wide, as many women are likely to have consumed alcohol around the time of conception and prior to recognition of pregnancy. Although the key public health message is still to abstain from alcohol if pregnant or planning a pregnancy, as currently recommended by the NHMRC, choline represents a safe and feasible supplement for women who inadvertently expose their early pregnancy to alcohol. This simple and highly feasible intervention could change current management of pregnant women in Queensland and improve the quality of life for their offspring.

3. ENGAGEMENT

In my role as an academic at the University of Queensland (UQ), I am passionate about encouraging my students to pursue a life-long interest in STEM. I have been actively teaching undergraduate students in the Biomedical Sciences for the past 5 years, with a focus on endocrinology, reproductive biology and metabolism. I have developed inquiry-based curricula as a fundamental component of their scientific ‘apprenticeship’. I provide authentic learning and assessment activities that mirror real-life tasks or challenges, allowing students the chance to apply problem-solving skills used by professionals in many STEM fields. I also discuss my research with students, helping them be aware of the relevance of considering their drinking behavior in the context of their reproductive health. I relish my interactions with the students, and am actively involved in all practical classes associated with my courses. This has been recognised with high student evaluation scores each year, and I was awarded a UQ Faculty of Medicine Tutor, Clinical, Research or Professional Practice Supervisors Award in 2018. In addition to tertiary education, I have also been involved in discussing my work with senior secondary school students in Brisbane through invited guest teaching activities in the classroom.


I actively engage in disseminating our work to the scientific community via publications in scientific journals and presentations at both national and international conferences. I have currently published over 30 reviews or research articles, with a recent paper in the Journal of Physiology being highlighted in 28 media articles from both Australia and overseas. I have presented at the Society for Reproductive Biology annual meeting every year since 2010. I have also presented at the World Congress for Reproductive Biology in Japan (2017) and the Research Society on Alcoholism in the USA (2018).


Since 2015, I have been very active on Twitter (as @DrLisaAkison), where I promote our work but also the work of others in areas such as assisted reproduction, oncofertility, fetal alcohol spectrum disorder and prenatal nutrition. I also discuss general aspects of working or studying in a STEM field, including content specific to being a woman in a STEM field, and promote interesting presentations at the conferences and meetings I attend. I currently have over 1200 followers, including other scientists, students, media, professional societies, journals and the general public.


In 2015, I represented the Society for Reproductive Biology and the University of Queensland at ‘Science Meets Parliament’, an event organised each year by Science and Technology Australia to bring together politicians and STEM professionals and to promote the valuable role of STEM in politics and society as a whole. This provided the opportunity to meet with a federal member of parliament at parliament house in Canberra, and discuss our work on the impact of alcohol exposure during pregnancy on long-term health. As a result of this event, I contributed a submission to the ‘Inquiry on Chronic Disease Prevention and Management in Primary Health Care’ that specifically highlighted evidence that prenatal alcohol exposure contributes to increased chronic disease risk in adulthood.

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