Study protocol: Asking QUestions about Alcohol in pregnancy (AQUA): a longitudinal cohort study of fetal effects of low to moderate alcohol exposure

Abstract

BackgroundDespite extensive research, a direct correlation between low to moderate prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorders has been elusive. Conflicting results are attributed to a lack of accurate and detailed data on PAE and incomplete information on contributing factors. The public health effectiveness of policies recommending complete abstinence from alcohol during pregnancy is challenged by the high frequency of unplanned pregnancies, where many women consumed some alcohol prior to pregnancy recognition. There is a need for research evidence emphasizing timing and dosage of PAE and its effects on child development.Methods/DesignAsking QUestions about Alcohol (AQUA) is a longitudinal cohort aiming to clarify the complex effects of low to moderate PAE using specifically developed and tested questions incorporating dose, pattern and timing of exposure. From 2011, 2146 pregnant women completed a questionnaire at 8-18 weeks of pregnancy. Further prenatal data collection took place via a questionnaire at 26-28 weeks and 35 weeks gestation. Extensive information was obtained on a large number of risk factors to assist in understanding the heterogeneous nature of PAE effects. 1571 women (73%) completed all three pregnancy questionnaires. A biobank of DNA from maternal and infant buccal cells, placental biopsies and cord blood mononuclear cells will be used to examine epigenetic state at birth as well as genetic factors in the mother and child. Participants will be followed up at 12 and 24 months after birth to assess child health and measure infant behavioural and sensory difficulties, as well as family environment and parenting styles. A subgroup of the cohort will have 3D facial photography of their child at 12 months and a comprehensive developmental assessment (Bayley Scales of Infant & Toddler Development, Bayley-III) at two years of age.DiscussionUsing detailed, prospective methods of data collection, the AQUA study will comprehensively examine the effects of low to moderate alcohol consumption throughout pregnancy on child health and development, including the role of key mediators and confounders. These data will ultimately contribute to policy review and development, health professional education and information about alcohol consumption for pregnant women in the future.

Association Between Prenatal Alcohol Exposure and Craniofacial Shape of Children at 12 Months of Age

“…[13][14][15] Exposure levels were low (≤20 g of AA per occasion and ≤70 g of AA per week), moderate (21-49 g of AA per occasion and ≤70 g of AA per week), high (>70 g of AA per week), and binge (≥50 g of AA per occasion). 12 Mothers who were abstinent throughout pregnancy comprised the control group for all analyses. Analysis used a 3-tiered approach in which PAE tier 1 consisted of children of women who drank any alcohol while pregnant.…”

Alcohol consumption in a general antenatal population and child neurodevelopment at 2 years

“…Being 16 years or older and being able to read and write English were prerequisites for participation. The methods are described in detail in the protocol publication 24. During pregnancy, women completed three questionnaires.…”

“…Questionnaire 1 was administered at the time of recruitment and collected information about the 3 months prior to conception until 13 weeks gestation (n=2146). Questionnaire 2 covered the period from the 14th to the 26th week (n=1715, 79.9%), and questionnaire 3 included the remainder of the pregnancy (n=1571, 73.2%) 24. Postnatal questionnaires were sent to women who had completed questionnaires 1–3.…”

“…In total, there were detailed data on alcohol consumption for five stages of pregnancy: (1) 3 months before, (2) T1 pre-aware, (3) T1 post-aware, (4) second trimester and (5) third trimester. Levels of exposure were expressed as grams of absolute alcohol (AA) using algorithms previously described13 24 26: abstinent during pregnancy (but not lifetime abstainer), low (≤20 g AA/occasion and ≤70 g AA/week), moderate (21–49 g AA/occasion and ≤70 g AA/week), high (>70 g AA/week) and binge (≥50 g AA/occasion) 24. In Australia, 10 g AA equals one standard drink.…”

“…The Asking QUestions about Alcohol (AQUA) study comprises a unique cohort of mother/child dyads recruited from the general population in early pregnancy for longitudinal observation 24. As PAE is the primary focus of this study, its accuracy has been sought through detailed prospective data collection and classification 13.…”