Biomedical subjects
Publications and source records attributed to H L Rosett.
Exposure of the fetus at any gestational stage to high concentrations of alcohol can adversely affect growth, morphology, and neurophysiologic development. Sustained heavy drinking can result in the fetal alcohol syndrome. Cessation of heavy drinking during pregnancy will benefit both mother and child. Primary health care providers can effectively identify and treat women at risk.
Therapy for heavy drinking was integrated with routine prenatal care at Boston City Hospital's women's clinic. Of 49 pregnant problem drinkers who participated in at least three counseling sessions, 33 (67%) reduced alcohol consumption before the third trimester. Therapeutic success was achieved with some of the heaviest drinkers. The desire to have a healthy baby was a powerful motivating force. Supportive counseling focused on reduction of alcohol consumption and potential benefits to the fetus. Guilt-provoking criticism was avoided. Referrals were made when women did not respond within two weeks. Planning of treatment strategies was facilitated by classification into social, symptom, and alcohol-dependence phases. Primary providers who are knowledgeable, interested, and accepting can successfully treat pregnant patients at risk from alcohol. Examinations of two cohorts of newborns have previously demonstrated benefits to offspring when heavy drinking ceased before the third trimester.
Demographic and behavioral characteristics, including use of alcohol, were investigated among 1711 women registering for prenatal care at Boston City Hospital. During personal interviews, 9% reported drinking heavily, 37% moderately, and 53% rarely or not at all. The women who drank heavily differed from the rest of the pregnant population on several traits, including age, education, use of cigarettes, marijuana and other drugs, parity, and association with others who drank heavily. Multiple regression analysis revealed that these traits had little predictive power for whether a woman was a heavy drinker. A systematic drinking history remains the most practical method in identifying problem drinkers.
Effects of heavy, moderate, and rare alcohol consumption on fetal development were analyzed in a prospective study of 469 mother-infant pairs. Differential effects of heavy drinking in early and late gestation were evaluated by separate analysis of neonates born to women who reduced consumption before the third trimester. Using chi 2 analysis, multiple regression, and matched sets, statistically significant associations (P less than .01) were observed between sustained heavy drinking and both intrauterine growth retardation and congenital anomalies. These associations were independent of eight other risk factors. No differences were observed between offspring of rare and moderate drinkers. Infants born to women who reduced heavy drinking did not differ in growth from offspring of rare and moderate drinkers but demonstrated a higher frequency of abnormalities. Sustained heavy drinking represents a major risk; reduction in midpregnancy can benefit the newborn. Identification and therapy of heavy drinking are important components of prenatal care.
Assessment of clinical behavior has been neglected in evaluating alcohol training for professionals. Inclusion of a systematic drinking history in patient charts provides a sensitive yet simple behavioral marker. At Boston City Hospital, a Ten Question Drinking History (TQDH) was incorporated into a prenatal intake procedure and used to monitor staff behavior. Utilization of the TQDH, measured for six time periods, ranged from 92% to 33%. Obstetrical staff was more likely to complete the TQDH when the alcoholism research staff was visible in the clinic and readily available for consultation and referral.
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Heavy alcohol consumption during pregnancy has been associated with retardation of fetal growth and abnormal fetal development. Pregnant women whose offspring are at risk because of alcohol abuse can be identified and counselled by health professional providing prenatal care. Offspring born to women who had been drinking heavily and subsequently abstained from or reduced their intake of alcohol before the third trimester demonstrated improvements in growth and in regulation of sleep-awake states. The existing health care delivery system can be modified in a cost-effective manner to treat pregnant women who are problem drinkers. Physicians' attitudes and behaviour are critical for the success of this strategy.
This paper describes the methods of the Maternal Health and Child Development of Project at the Boston City Hospital which explored the impact of maternal drinking prior to and during pregnancy on fetal development. Between February 1977 and October 1979, of 3222 women who delivered single infants, 1690 were interviewed in hospital after delivery and their babies examined by a pediatrician who was unaware of the interview results. The 1690 mother-infant pairs of whom both interview and exam are available did not systematically differ from the 272 for whom the interview only or 824 for whom the exam only was conducted. Interviews were also collected prenatally in the Boston City Hospital's Women's Clinic, from 470 women whose infants were examined. Maternal and infant characteristics are described. Heavy drinkers were much more likely to smoke cigarettes and to have used psychoactive drugs than lighter drinkers. Heavy drinkers also differed from non-heavy drinkers on several other factors which may influence fetal development.
The effects of alcohol on the fetus include a wide range of problems; the complete fetal alcohol syndrome is the extreme end of the spectrum. At critical doses alcohol has the potential for multiple adverse effects on the maternal--placental--fetal system. Variability of outcome probably is related to individual differences in drinking patterns as well as in biologic susceptibility. At Boston City Hospital Prenatal Clinic, therapy was provided for pregnant women who reported drinking heavily. Reduction in maternal alcohol consumption before the third trimester was associated with improved neonatal outcome. The obstetrician's office is a potential site for prevention programs. A 10-question drinking history enables physicians to identify pregnant women at risk. Supportive counseling focused on reduction of alcohol use can be integrated with regular prenatal care. Pregnant women who do not respond promptly should be referred to specialized treatment programs. This strategy has the potential to improve the health of both mother and infant.
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Among a group of 69 pregnant women who drank heavily, 25 reduced alcohol consumption before the third trimester. Infants born to these women showed less growth retardation than did infants born to 44 women who continued to drink heavily throughout the pregnancy. Analysis of other risk factors showed little effect on outcome when third trimester drinking patterns were held constant, Identification and counseling of heavy-drinking pregnent women should provide benefits for both the mother and her newborn.
Sleep-awake state distribution during inter-feed intervals over a 24-hour period on the third day of life was investigated by means of a continuous non-intrusive bassinet sleep monitor. 31 infants were studied: 14 born to mothers who drank heavily throughout pregnancy (group A), eight whose mothers modified their heavy drinking (group B) and nine whose mothers never were heavy drinkers (group C). Over the 24-hour period, group A infants slept less than those in group B. In comparison with group C, group A infants had a larger proportion of quiet sleep episodes interrupted by awake or unclassified epochs, and were more restless, with more frequent major body movements. These pilot observations suggest that heavy maternal consumption of alcohol, when continued throughout pregnancy, is associated with a disturbance of sleep-awake state distribution. Successful therapy of heavy drinking during pregnancy may improve the physiological competence of the newborn to regulate sleep-awake states and facilitate interaction between mother and infant.
A survey of patients registering at the Boston City Hospital Prenatal Clinic had demonstrated that 9 percent were heavy drinkers. To reduce the health hazards to mothers and children, treatment of heavy alcohol use was integrated with prenatal care. A pediatric neurologist independently examined 322 offspring, including 42 whose mothers were heavy drinkers. Frequency of congenital anomalies, growth retardation, or functional abnormalities among these 42 was twice that of infants born to abstinent or moderate drinking mothers P less than .001). Within that group of 42, there were 15 whose mothers were able to abstain or reduce alcohol intake during the third trimester. These 15 demonstrated fewer abnormalities than those 27 whose mothers had continued heavy drinking (P less than .001). Since pregnant women can be motivated to reduce heavy drinking, treatment programs can benefit both mothers and infants.
To evaluate the risk of offspring of heavy drinking during pregnancy, we administered a questionnaire to 633 women at the first prenatal visit. Nutritional status, smoking, drug and alcohol use were determined. Women were classified into three groups: abstinent and rare drinkers; moderate drinkers; and heavy drinkers. After delivery, detailed pediatric, neurologic and developmental examinations were administered by a physician without prior knowledge of any history. Infants born to heavy drinkers had twice the risk of abnormality of those born to abstinent or moderate drinkers (P less than 0.001). Thirty-two per cent of infants born to heavy drinkers demonstrated congenital anomalies, as compared to 9 per cent in the abstinent and 14 per cent in the moderate group (P less than 0.001). Microcephaly and multiple congenital anomalies were much more frequent in this group (P less than 0.001). Heavy drinking during pregnancy increases the risk to offspring.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Current research on the effects on offspring of drinking during pregnancy has revived interest in an extremely old topic. Observations made during England's Gin Epidemic (1720-1750) were followed by warnings of 19th-century medical writers that parental drinking could damage the fetus. Many concurring studies were reported in the medical literature from 1865 to 1920. Research interest declined during Prohibition, and authorities later discounted the previous work. Recently a relationship between maternal drinking and abnormal morphogenesis has been again described.