25 August 2020 In Pregnant Women

In this article, we follow the approach taken by Riesch and Spiegalhalter in "Careless pork costs lives': Risk stories from science to press release to media' published in this journal, and offer an assessment of one example of a 'risk story'.

Using content and thematic qualitative analysis, we consider how the findings of an article 'Fetal Alcohol Exposure and IQ at Age 8: Evidence from a Population-Based Birth-Cohort Study' were framed in the article itself, the associated press release, and the subsequent extensive media coverage. We contextualise this consideration of a risk story by discussing a body of work that critically engages with the development and global proliferation of efforts to advocate for alcohol abstinence to pregnant (and pre-pregnant) women.

This work considers the 'democratisation' of risk, a term used to draw attention to the expansion of the definition of the problem of drinking in pregnancy to include any drinking and all women. We show here how this risk story contributed a new dimension to the democratisation of risk through claims that were made about uncertainty and certainty. A central argument we make concerns the contribution of the researchers themselves (not just lobby groups or journalists) to this outcome.

We conclude that the democratisation of risk was advanced in this case not simply through journalists exaggerating and misrepresenting research findings, but that communication to the press and the initial interpretation of findings played their part. We suggest that this risk story raises concerns about the accuracy of reporting of research findings, and about the communication of unwarrantedly worrying messages to pregnant women about drinking alcohol.

24 October 2019 In Pregnant Women

OBJECTIVE: Alcohol use during pregnancy can harm the developing fetus. The exact amount, pattern, and critical period of exposure necessary for harm to occur are unclear, although official guidance often emphasizes precautionary abstention. The impacts on fertility and breastfeeding are also unclear. Information on alcohol and pregnancy is disseminated by the alcohol industry-funded organizations, and there are emerging concerns about its accuracy, suggesting the need for detailed analysis.

METHOD: Information on alcohol consumption in relation to fertility, pregnancy, and breastfeeding was extracted from the websites of 23 alcohol industry-funded bodies (e.g., Drinkaware [United Kingdom] and DrinkWise [Australia]), and 19 public health organizations (e.g., Health.gov and NHS Choices). Comparative qualitative and quantitative analysis of the framing and completeness of this information was undertaken.

RESULTS: Alcohol industry-funded organizations were statistically significantly less likely than public health websites to provide information on fetal alcohol spectrum disorder and less likely to advise that no amount of alcohol is safe during pregnancy. They were significantly more likely to emphasize uncertainties and less likely to use direct language (e.g., "don't drink"). Some alcohol industry-funded (and no public health) websites appear to use "alternate causation" arguments, similar to those used by the tobacco industry, to argue for causes of alcohol harms in pregnancy other than alcohol.

CONCLUSIONS: Alcohol industry-funded websites omit and misrepresent the evidence on key risks of alcohol consumption during pregnancy. This may "nudge" women toward continuing to drink during pregnancy. These findings suggest that alcohol industry-funded bodies may increase risk to pregnant women by disseminating misinformation. The public should be made widely aware of the risks of obtaining health information from alcohol industry-funded sources.

12 August 2019 In Pregnant Women

It is common knowledge that alcohol consumption during pregnancy would cause cognitive impairment in children. However, recent works suggested that the risk of drinking during pregnancy may have been exaggerated. It is critical to determine whether and up to which amount the consumption of alcohol will affect the cognitive development of children. We evaluate time-varying functional connectivity using magnetoencephalogram data from somatosensory evoked response experiments for 19 teenage subjects with prenatal alcohol exposure and 21 healthy control teenage subjects using a new time-varying connectivity approach, combining renormalised partial directed coherence with state space modeling. Children exposed to alcohol prenatally are at risk of developing a Fetal Alcohol Spectrum Disorder (FASD) characterized by cerebral connectivity deficiency and impaired cognitive abilities. Through a comparison study of teenage subjects exposed to alcohol prenatally with healthy control subjects, we establish that the inter-hemispheric connectivity is deficient for the former, which may lead to disruption in the cortical inter-hemispheric connectivity and deficits in higher order cognitive functions as measured by an IQ test, for example. We provide quantitative evidence that the disruption is correlated with cognitive deficits. These findings could lead to a novel, highly sensitive biomarker for FASD and support a recommendation of no safe amount of alcohol consumption during pregnancy.

24 June 2019 In Pregnant Women

BACKGROUND: Fetal alcohol syndrome (FAS) typically is observed among individuals with high prenatal alcohol exposures (PAE), but exposure histories obtained in clinical diagnostic settings are often inaccurate. The present analysis used the Lifestyle During Pregnancy Study (LDPS) to assess the potential effects of low-to-moderate average weekly alcohol consumption and binge drinking in early pregnancy on facial features associated with FAS among children 5 years of age.

METHODS: The analysis is a prospective follow-up study of 670 women and their children sampled from the LDPS cohort based on maternal alcohol consumption during pregnancy. The 4-Digit Code FAS Facial Photographic Analysis Software was used to measure the magnitude of expression of the 3 diagnostic facial features of FAS from standardized digital photographs. Logistic regression was used to estimate the odds of presenting with the FAS/partial fetal alcohol syndrome (PFAS) facial phenotypes relative to different patterns of prenatal alcohol exposure.

RESULTS: Ten children presented with the FAS/PFAS facial phenotypes. None of the children sampled met the central nervous system (CNS) criteria for FAS or PFAS at age 5 years. All remained at risk for PFAS since some types of CNS dysfunction associated with this diagnosis may only be assessed at older ages. The FAS/PFAS facial phenotypes were 8.5-fold more likely among children exposed to an average of 1 to 4 drinks/wk and 2.5-fold more likely among children with a single binge exposure in gestational weeks 3 to 4 compared to children with no such exposures. The magnitude of expression of the FAS facial phenotype was significantly correlated with all other diagnostic features of FAS: growth deficiency, microcephaly, and measures of CNS dysfunction.

CONCLUSIONS: These findings suggest that low-to-moderate levels of PAE or isolated binge exposures may place some fetuses at risk for FAS/PFAS. Thus, conservative advice is still for women to abstain from alcohol consumption during pregnancy.

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