Christina Chambers, PhD, MPH
Pediatrics and Family and Preventive Medicine
University of California San Diego
Investigative Team
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Tina Chambers, PhD – University of California, San Diego
Ken Jones, MD - University of California, San Diego
Claire Coles, PhD - Emory University/Marcus Institute
Julie Kable, PhD - Emory University/Marcus Institute
Carl Keen, PhD – University of California, Davis
Jan Uriu-Adams, PhD – University of California, Davis
Tatiana Foroud, PhD – Indiana University
Andy Hull, MD – University of California, San Diego
Lyuba Yevtushok, MD – Rivne Oblast, Ukraine
Natalya Zymak, MD – Khmelnytsky Oblast, Ukraine
Wladimir Wertelecki, MD – University So. Alabama
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Prospective cohort study involving 300 moderate to
heavily exposed pregnant women recruited from
Diagnostic and Prenatal Care Centers in two
regions of Ukraine, and 300 low/unexposed
comparison women
Measure incidence and spectrum of
alcohol-related birth outcomes in relation
to dose and timing of alcohol
Assess contribution of nutritional status
and effect of nutritional intervention trial
initiated in mid-pregnancy
Examine methods for earlier diagnosis
including infant physical exams, prenatal
ultrasound, 2D-3D photography,
neurobehavioral testing
 Standardized in-person maternal interviews at
intake, third trimester
 Standardized physical examinations at birth, 6
months and 12 months by specially trained
neonatologists/geneticists, validated by expert
dysmorphologist
 Neurobehavioral testing at 6m and 12m with BSID
II; infant stimulus response testing at 6m
 Blood samples taken at enrollment and third
trimester – evaluated at UC Davis for vitamin and
mineral status, measures of oxidative defense
 RCT
 Multivitamin/mineral supplement provided for 50%
of sample upon enrollment (n=300)
 Additional 750 mg. choline supplement provided to
50% of the multivitamin/mineral supplemented
sample upon enrollment (n=150)
Rivne
 Repeated prenatal ultrasound measures 1-4
times during pregnancy including growth plus
additional brain measures, fetal breathing
movements and startle response
Khmelnitsky
Training of
neonatologists/geneticists
Exam validation
Neurobehavioral testing
Characteristic – mean
(SD)
Exposed
Enrolled
Exposed
Declined
Unexposed
Enrolled
Unexposed
Not Enrolled
Maternal age
23.7 (4.5)
24.4 (5.9)
25.0 (5.0)
25.7 (5.3)
Paternal age
26.8 (4.6)
28.3 (7.0)
26.9 (5.7)
28.6 (5.9)
Gravidity
1.5 (0.9)
1.4 (0.8)
1.8 (0.9)
2.1 (1.4)
Parity
0.2 (0.5)
0.2 (0.4)
0.5 (0.7)
0.8 (1.2)
13.0 (2.4)
13.6 (2.1)
14.1 (1.8)
13.4 (2.2)
Gestational weeks at
screen
9.0 (4.9)
9.9 (5.8)
8.5 (3.5)
9.8 (5.4)
Cigarettes per day
5.9 (5.9)
5.3 (3.3)
2.5 (0.7)
4.0 (2.5)
Age at first drink
14.4 (2.5)
15.1 (2.1)
16.5 (2.0)
16.4 (1.9)
#4 or more drinks
conception
3.8 (2.5)
2.9 (2.3)
0
0
Tolerance
5.5 (2.3)
4.3 (2.4)
1.9 (0.8)
1.8 (0.7)
TWEAK
1.3 (1.6)
0.3 (0.7)
0
0
Years education
Feature - n (%)
Alcohol
Exposed
N = 67
No Alcohol
N = 55
Palpebral fissures ≤10th centile
Smooth philtrum
Thin vermilion border
Hockey stick crease
Birth weight ≤10th centile
Birth length ≤10th centile
Birth head circumference ≤10th centile
FAS
Some features of FAS
14 (21.2)
10 (15.2)
11 (16.7)
4 (6.0)
4 (6.0)
6 (9.0)
4 (6.0)
3 (4.5)
13 (19.4)
5 (9.1)
2 (3.6)
4 (7.3)
0
3 (5.5)
0
0
0
5 (9.1)
p-value
0.068
0.035
0.118
0.126
1.000
0.032
0.126
0.031
Measure
Mean (SD)
Alcohol Group
N = 40
Unexposed
Group
N = 49
pvalue
Choline (uM)
8.04 (0.30)
7.91 (0.37)
0.78
Betaine (uM)
14.02 (0.60)
14.06 (0.63)
0.96
DMG (uM)
1.51 (0.13)
1.51 (0.12)
0.98
Choline/Betaine
0.61 (0.03)
0.59 (0.03)
0.63
11.44 (0.81)
11.26 (0.97)
0.89
Betaine/DMG
Measure
Zn (ug/mL)
Fe (ug/mL)
Cu (ug/mL)
Cp (units/L)
hsCRP (log)
TfR (log)
Ferritin (log)
Unexposed
Group
N = 103
Mean (SD)
Exposed
Group
N = 114
Mean (SD)
Adjusted
P-value
0.65 (0.12)
0.61 (0.10)
0.0769
0.87 (0.32)
0.90 (0.38)
0.5914
1.79 (0.29)
1.72 (0.30)
0.0067
238.07 (51.29)
228.12 (50.27)
0.0968
0.93 (1.19)
0.60 (1.15)
0.0806
2.75 (0.29)
2.70 (0.34)
0.3663
3.06 (0.78)
3.22 (0.9)
0.0954
Adjusted for maternal age, parity, SES, smoking, pre-pregnancy BMI, and
gestational age at blood draw
Measure
and Dose
Adjusted estimate
pvalue
Zn (ug/mL)
<3 DDD
3+ DDD
-0.0221
-0.0409
0.200
0.044
-0.1061
-0.1181
0.012
0.017
Cu (ug/mL)
<3 DDD
3+ DDD