Sarah Fraser Nasivik Canadian Institutes of Health Research NAHO 2009 National Conference

1. PRENATAL EXPOSURE TO ALCOHOL
AND PRENATAL DIET AMONG INUIT
WOMEN OF NUNAVIK
Sarah Fraser

2. Plan
• What are the prenatal alcohol consumption patterns
in Nunavik?
• What is the impact on infant development?
• Nutrition and prenatal alcohol exposure: how are
these associated?
• Diet in Nunavik
• Conclusions

3. Nunavik
• 14 remote and isolated communities on two
coasts, Hudson and Ungava
• 11 000 inhabitants
• 90% inuit

4. Research project
• Recrutement started in 1995
• 248 women participated to prenatal interviews
• 185 mothers and infants were followed-up at 6 months and 178 at 11
mois.
Information gathered:
• Maternal Interviews (demographic information, alcohol, nicotine
and drug use, psychological distress…)
• Maternal blood and umbilical cord blood
• Infant weight, birth and head-circumference at birth
• Visual acuity at 6 months

5. Results: Sample Characteristics
Characteristics N % Mean S.D. Range
Maternal Age (Years) 215 25.1 ± 5.9 15.0 – 41.0
Maternal Education (years) 215 8.0 ± 1.7 5.0 – 14.3
Maternal SES 215 17.5 ±11.4 5.0 – 55.0
Number of live births 215 2.1 ± 1.8 0.0 - 9.0
Maternal weight before delivery 215 70.6 ±12.4 50.0 - 123.9
(kg)
Gestational hypertension (% yes) 201 7.5
Antibiotics during pregnancy (5 yes) 207 60.4
Sex of infant (% male) 215 57.0
Gestational age at birth (wks) 213 38.7 ± 1.8 32.0 - 42.0

6. Patterns of prenatal exposure
• 90% smoked during pregnancy with an average of 10
cigarettes per day
• 36% consumed marijuana at least once
• 60% of women consumed alcohol at least once during
pregnancy, with an average of 6 drinking days
• 38% binged at least once during pregnancy
• The quantity of alcohol consumed and pattern of
consumption was not associated with socio-economic
status or maternal age
• Feeling down/blue, lonely, hopeless about the futur,
bored, and crying easily are associated with higher
quantity of alcohol consumed during pregnancy

7. Prenatal alcohol exposure and development
• In epidemiological research we see an association
between alcohol and development in samples where
alcohol consumption is ≥ 2 drinks/day
• Effects include reduced growth, cognitive
development (memory, attention, language, math),
visual development, and difficult behaviours.
• Animal research suggests that exposure to high doses
per occasion (≥ 5 drinks) is more harmful to the fœtus
than more frequent exposure to small doses

8. Results: the effects of binge drinking on infant
development
Outcome N Std β (P) R2
Birth weight1,2,3,4,5,6 196 -.129 (.01) .571
Head Circumference at birth1,2,4,5,6 184 -.154 (.01) .396
Birth length 1,2,4,6 185 -.042 (.48) .389
Visual Acuity 6 months 1,6,7 181 -.244 (.00) .094
Mean looking duration, Fagan 6 months 8,9 174 -.049 (.51) .068
Mean looking duration, Fagan 12 months10,11 169 .062 (.41) .065
Controlling for 1 gestational age, 2 number of live births, 3 maternal weight before delivery, 4 gestational
hypertension (Yes/No), 5 maternal socio-economic status, 6 infants sex, 7 average number of cigarettes
smoked during pregnancy, 8 Maternal score on the Raven, 9 number of traditional meals consumed per
week during pregnancy, 10 number of years of schooling completed by mother 11 lead (pb) concentrations in maternal blood
12 birth weight 13 Score on HOME interview

9. Nutrition and prenatal alcohol consumption
• Research suggests that the FAS/ FASD is not an equal
opportunity birth defect
• The incidence of FAS and FASD is much greater in aboriginal
and African American communities: lower SES, nutrition
• Experimental research on animals suggests that certain
nutrients can reduce the effects of prenatal alcohol on exposed
pups (vitamin C and E, polyunsaturated fatty acids, folic acid,
choline)

10. Nutrition in Nunavik
• Traditional foods are rich in various nutients and
especially in polyunsaturated fatty acids: artic char
(690mg de DHA par 100g), salmon (612mg DHA par
100g), beluga fat (4974mg DHA par 100g), seal fat
(12285mg par 100g).
• Important changes in diet have taken place in the past
decades with a decrease in consumption in foods rich in
PUFAs and an increase in foods rich in fats.

11. Research question
Does a high level of polyunsaturated fatty aicds in umbilical
cord phospholipids protect against the effects of alcohol
consumption during pregnancy on prenatal growth and
visual acuity at 6 months?

12. Nutrition in Nunavik
Prenatal diet Mean Min - Max
S.D.
Country Food per week 4.9 ± 5.4 0 - 44.0
Fish meals per week 3.4 ± 4.0 0 - 28.0
Beluga meals throughout pregnancy 24 ± 39.0 0 - 231.0
Whale meals throughout pregnancy 0.8 ± 5.2 0 - 52.0
Seal meals throughout pregnancy 0.8 ± 1.8 0 - 21.7
PUFA
DHA in umbilical cord 3.6 ± 1.1 .1 – 1.1
DHA/AA in umbilical cord .4 ± .2 .5 – 7.2

13. Prenatal alcohol and PUFAs on infant development
Predictors N Beta (p)
Birth weight Step 1: Maternal weight 103 .44 (.00)
Binge drinking -.14 (.11)
DHA/AA .17 (.05)
Step 2: Binge* DHA/AA -.28 (.30)
Head circumference Step 1: Maternal weight 102 .46 (.00)
Sex of baby .15 (.09)
Binge drinking - .11 (.21)
DHA/AA .07 (.44)
Step 2: Binge* DHA/AA -.22 (.42)
Visual Acuity Step 1: Smoking3 95 .29 (.01)
Binge drinking -.33 (.00)
DHA/AA .08 (.42)
Step 2: Binge* DHA/AA -.21 (.48)

14. Limitations of this study
• Infant blood is available for 50% of the sample with significant
differences between infants for whom samples are available
and missing cases
• Low statistical power because of small sample size
• PUFA Blood levels represent maternal intake during weeks
preceding labour. Considering seasonal variations in diet this
may not be a valid measure of PUFA intake through-out
pregnancy

15. Conclusion and final thoughts
• The results suggest an impact of binge drinking on prenatal
growth and postnatal vision
• Binge drinking is associated with psychological well-being
(sadness, boredom)
• Our results concerning the impact of polyunsaturated fatty
acids suggest no protection against prenatal alcohol exposure
• Studies suggest an association between eating traditional foods,
fatty acid levels and psychological well-being

16. Nakurmik Marialuk

17. Patterns of prenatal exposure among pregnant
women of Nunavik
Prenatal exposure N % Mean S.D. Range
Consumed alcohol during 215 60.6%
pregnancy (% yes)
Ounces of absolute alcohol 130 0.08 ± 0.2 0.0 – 1.6
per day
Number of drinking days 130 6.0 ± 14.9 0.0 – 136.0
Binge drinking during 215 38.1%
pregnancy (% yes)
Frequency of binging 82 3.4 ± 9.6 0.0 – 71.0
Smoked during pregnancy 213 90.1
(% yes)
Number of cigarettes 194 10.5 ± 5.4 0.3 – 25.0
smoked/day
Marijuana during pregnancy 215 36.3
(% yes)