Adventures in the Design and Trial of an Innovative FASD Risk Assessment: Integrating Known Risks with New Measures of Weekly Prenatal Alcohol Exposure, Maternal Mental Health, and Paternal Alcohol

About This Grant

Program Director/Principal Investigator (Last, First, Middle): Cheatham, Carol Abstract and Public Health narrative of the Phase Summary of the Phase I/II: Abstract of the Phase Summary of the Phase I/II Prevention of and intervention in fetal alcohol spectrum disorders (FASD) requires a detailed knowledge of proximal and distal maternal and paternal risk factors that are associated with specific child traits common to FASD. In the completed R61 Phase, we created and piloted novel protocols for: 1) interviewing mothers (with biomarker validation) to determine maternal alcohol consumption on a weekly/monthly basis across pregnancy to assess their specific contributions to child traits and severity of FASD outcomes; 2) determining maternal experience with stress, trauma, and mental health status during pregnancy and their contribution to the severity of effect on FASD diagnostic traits in their offspring; 3) interviewing biological fathers of the index pregnancy regarding paternal traits that may contribute to the risk for FASD from exposure to teratogens such as alcohol, other drugs, environmental toxins, and social environment during pre-conception; and 4) establishing a comprehensive, summary FASD risk score from the above innovations when combined with other empirically-established risk factors. The R33 Phase will now initiate an exploration of a multivariate, comprehensive approach to FASD risk via two applications for better understanding FASD etiology. In the prospective study, 200 women and as many of their partners as we can consent (estimated to be a minimum of 100) will be recruited from prenatal clinics, and their offspring will be assessed at six weeks and nine months post-partum and diagnosed as to their status on the continuum of FASD by pediatric dysmorphologists and a multidisciplinary team. The second application of the new methods will gather the new data retrospectively and link the data to two existing cohorts of maternal/child dyads whom we have followed over time to assess their FASD status and the severity of their physical, neurodevelopmental, and behavioral traits. Both studies will add new insight to our long-term quest to understand more completely the respective contributions of a broad range of host, agent, and environmental factors to the etiology of FASD. This R33 Phase will provide substantial validation of the utility of collecting weekly alcohol use data, mental health status assessments, paternal information, and FASD risk score innovations via expert clinical assessment of the offspring of each pregnancy. In developing this more comprehensive approach to FASD risk, both study phases draw on our existing clinical epidemiology infrastructure, the experience of our multidisciplinary team, and the participants in existing longitudinal cohorts. RELEVANCE (See instructions):