Diagnosis of fetal alcohol spectrum disorders (FASD) is challenging and typically requires confirmation of in utero alcohol exposure. Due to the poor reliability of maternal self-reports, biomarkers have emerged to address the problem of obtaining exposure history. A relatively novel method for detecting prenatal alcohol exposure is analysis of meconium for fatty acid ethyl esters (FAEEs), which are non-oxidative ethanol metabolites. Screening newborns using meconium FAEEs may facilitate early diagnosis and intervention in alcohol-affected individuals. The overall objective of this thesis is to further investigate, validate, and assess the clinical utility of meconium FAEE analysis as a screening tool for the identification of neonates at-risk for FASD. This objective was addressed in four separate studies. The first study assessed whether meconium FAEE concentrations can be predictive of ethanol-induced organ injury in fetal sheep, and determined that the levels of these esters could be used to identify fetuses at-risk for organ dysfunction that do not display overt physical signs of ethanol teratogenicity. The second study investigated the effect of delayed meconium collection and contamination with postnatal stool on FAEE analysis, and determined it to be a risk factor for false positive test results. In the third study, maternal willingness to partake in an open meconium screening program was assessed and found to be low enough to diminish the utility of meconium FAEE testing for population-based open screening. Lastly, a systematic review examining the capacity for FAEE synthesis and the enzymology of this non-oxidative metabolic pathway in mammalian organs and tissues revealed that FAEE synthesis is mediated by numerous enzymes and isoenzymes, many of which have other primary physiological functions, and that their contribution to overall FAEE-synthesis may be tissue-specific. Overall, the results of this research provide new information on the benefits, limitations, and utility of meconium FAEE testing as a screening tool for identifying prenatal alcohol exposure − a test that may be of great clinical value in the diagnosis and management of FASD.

Diagnosis of fetal alcohol spectrum disorders (FASD) is challenging and typically requires confirmation of in utero alcohol exposure. Due to the poor reliability of maternal self-reports, biomarkers have emerged to address the problem of obtaining exposure history. A relatively novel method for detecting prenatal alcohol exposure is analysis of meconium for fatty acid ethyl esters (FAEEs), which are non-oxidative ethanol metabolites. Screening newborns using meconium FAEEs may facilitate early diagnosis and intervention in alcohol-affected individuals. The overall objective of this thesis is to further investigate, validate, and assess the clinical utility of meconium FAEE analysis as a screening tool for the identification of neonates at-risk for FASD. This objective was addressed in four separate studies. The first study assessed whether meconium FAEE concentrations can be predictive of ethanol-induced organ injury in fetal sheep, and determined that the levels of these esters could be used to identify fetuses at-risk for organ dysfunction that do not display overt physical signs of ethanol teratogenicity. The second study investigated the effect of delayed meconium collection and contamination with postnatal stool on FAEE analysis, and determined it to be a risk factor for false positive test results. In the third study, maternal willingness to partake in an open meconium screening program was assessed and found to be low enough to diminish the utility of meconium FAEE testing for population-based open screening. Lastly, a systematic review examining the capacity for FAEE synthesis and the enzymology of this non-oxidative metabolic pathway in mammalian organs and tissues revealed that FAEE synthesis is mediated by numerous enzymes and isoenzymes, many of which have other primary physiological functions, and that their contribution to overall FAEE-synthesis may be tissue-specific. Overall, the results of this research provide new information on the benefits, limitations, and utility of meconium FAEE testing as a screening tool for identifying prenatal alcohol exposure − a test that may be of great clinical value in the diagnosis and management of FASD.

In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposures and conditions. Consequently, attributing poor birth outcomes to prenatal alcohol exposure is a complicated and ongoing task, requiring continued attention to validated methodology and to identifying specific biological mechanisms.

The effects from prenatal alcohol exposure have been found to cause a range of congenital physical and cognitive abnormalities (Chasnoff, Wells, Telford, Schmidt, & Messer, 2010; Kable & Coles, 2004a). The neurological impairments associated with the effects from prenatal alcohol exposure often cause learning problems, most notably in mathematics (Kable & Coles, 2004a; Howell et al., 2006). Studies have indicated that when provided instructional interventions in mathematics, children affected by prenatal alcohol exposure made gains in learning. However, the studies did not provide specifics as to how children with FAS construct the understanding of a skill or concept (Kable, Coles, & Taddeo, 2007; Coles, Kable, & Taddeo, 2009). This study contributes to the literature by examining how children affected by prenatal alcohol exposure learn the concept of equivalence through their use of gestures in contrast to their learning outcomes. Previous studies have shown that children’s use of gestures while learning mathematics assist with the integration of verbal and visual stimuli, support concept formation, and facilitate flexible encoding of problems (Goldin-Meadow, Cook, & Mitchell, 2009; McNeil & Alibali, 2004). The results from this study indicated that children in the Alcohol Exposed group showed little to no learning after the intervention as compared to a control group matched by age and IQ. The study showed that children affected by prenatal alcohol exposure used fewer conceptual gestures while learning equivalence as compared to a control group. According to the gesture analysis, the children in the Alcohol Exposed group mentally represented the concept of equivalence as a series of isolated steps or procedures. The procedural representation was not transitioned into a flexible conceptual format and applied to solve different problem types accurately (McNeil & Alibali, 2004). Future studies need to investigate whether teaching children affected by prenatal alcohol exposure to gesture during mathematics instruction would be effective to increase concept formation, accurate encoding, and learning mathematics / Inclusive Education / D. Ed. (Inclusive Education)

Background: Prenatal alcohol consumption is one of the leading preventable causes of birth defects, including fetal alcohol syndrome and learning disabilities. Although there is strong evidence of the benefits of screening and alcohol brief interventions (ABIs) in reducing hazardous and harmful drinking among the primary care population, evidence of its effectiveness with the antenatal care population is limited. Nevertheless, the Scottish Government is incorporating an alcohol screening and ABI programme as part of the routine antenatal care provided to women in a bid to protect the health and safety of the unborn child and improve subsequent health and developmental outcomes. This research therefore seeks to increase understanding of the factors that are likely to influence the effectiveness of this recently implemented programme. It also aims to explore the extent to which contemporary issues such as change in guidelines regarding alcohol consumption during pregnancy influences perceptions and attitudes, and the possible implications of these on the screening and ABI delivery. Methods: The study described in this thesis employed a realistic evaluation methodology. Realistic evaluation is a theory-driven approach to investigating social programmes. It is concerned with hypothesising, testing and refining programme theories by exploring the interaction of contexts, mechanisms and outcomes. To identify the relevant screening and ABI programme theories, two separate systematic reviews, a critical review and four face-to-face interviews were undertaken with health policy implementers. The findings were used to construct context, mechanism and outcomes propositions. The propositions were then tested by conducting individual interviews with seventeen pregnant women and fifteen midwives, a further six midwifery team leaders were involved in a focus group discussion. A thematic approach using a hybrid of inductive and deductive coding and theme development informed the qualitative analysis. Results: In the context of uncertainties regarding the threshold of drinking that causes fetal harm, pregnant women reported that screening assessment helped them to reflect on their drinking behaviour and facilitate behaviour change. For women who drank at hazardous and harmful levels before attending the booking appointment, screening and ABI may be helpful in terms of eliciting behaviour change. However, they may not be very beneficial in terms of reducing harm to the fetus as it has been found that drinking during the first trimester poses the most risk to the fetus. Training and resources provided to midwives as part of the screening and ABI programme were found to be facilitating mechanisms that midwives indicated improved their skills and confidence. However, most of the midwives had not subsequently employed the motivational interviewing skills required for the ABI delivery, as many of the pregnant women reported that they reduced or abstained from alcohol consumption once pregnancy was confirmed. The outcome noted was that midwives confidence decreased leading to missed opportunities to appropriately deliver the ABI to eligible women. The small numbers of women being identified for ABI meant midwives rarely delivered the ABI. This negatively influenced midwives attitudes as they then accorded ABI low priority in their workload. Other disenabling mechanisms noted to be hampering the implementation of the screening and ABI initiative included midwives contending with competing priorities at the booking appointments, and the lack of adequate rapport between midwives and pregnant women at the booking appointment to discuss alcohol issues appropriately, leading to women providing socially desirable responses to screening questions. Conclusions: The findings of this study has generated greater explanations of the working of the screening and ABI programme in antenatal care setting and has provided transferable lessons that can be used by others intending to implement similar programmes in other settings.

No description available.

The effects from prenatal alcohol exposure have been found to cause a range of congenital physical and cognitive abnormalities (Chasnoff, Wells, Telford, Schmidt, & Messer, 2010; Kable & Coles, 2004a). The neurological impairments associated with the effects from prenatal alcohol exposure often cause learning problems, most notably in mathematics (Kable & Coles, 2004a; Howell et al., 2006). Studies have indicated that when provided instructional interventions in mathematics, children affected by prenatal alcohol exposure made gains in learning. However, the studies did not provide specifics as to how children with FAS construct the understanding of a skill or concept (Kable, Coles, & Taddeo, 2007; Coles, Kable, & Taddeo, 2009). This study contributes to the literature by examining how children affected by prenatal alcohol exposure learn the concept of equivalence through their use of gestures in contrast to their learning outcomes. Previous studies have shown that children’s use of gestures while learning mathematics assist with the integration of verbal and visual stimuli, support concept formation, and facilitate flexible encoding of problems (Goldin-Meadow, Cook, & Mitchell, 2009; McNeil & Alibali, 2004). The results from this study indicated that children in the Alcohol Exposed group showed little to no learning after the intervention as compared to a control group matched by age and IQ. The study showed that children affected by prenatal alcohol exposure used fewer conceptual gestures while learning equivalence as compared to a control group. According to the gesture analysis, the children in the Alcohol Exposed group mentally represented the concept of equivalence as a series of isolated steps or procedures. The procedural representation was not transitioned into a flexible conceptual format and applied to solve different problem types accurately (McNeil & Alibali, 2004). Future studies need to investigate whether teaching children affected by prenatal alcohol exposure to gesture during mathematics instruction would be effective to increase concept formation, accurate encoding, and learning mathematics / Inclusive Education / D. Ed. (Inclusive Education)

No description available.

No description available.

No description available.