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Research Summary: DOHaD 2022: Fetal Alcohol Spectrum Disorder and Chronic Low-Grade Inflammation
Conference Summary
The Developmental Origins of Health and Disease (DOHaD) World Congress is an international conference that takes place every 2-3 years. This year’s meeting took place August 29 – 31 and was held in Vancouver, British Columbia. DOHaD Canada and Kids Brain Health Network (KBHN) were both partners with DOHaD’s International Society for this conference. DOHaD promotes research into fetal and developmental origins of disorders and diseases. Researchers from many fields present their findings at DOHaD conferences, including public health policy, developmental biology, nutrition, genetics, cancer, pregnancy/birth complications, and heart disease. This year, multiple events highlighted the perspectives and experiences of Indigenous and First Nations People both in Canada and in other countries. The topics of Climate Change and Social Inequities were also discussed in sessions throughout the conference.
DOHaD 2022 Session:
Early Brain Development and The Origins of Infant Mental Health
Presentation:
Fetal Alcohol Spectrum Disorder: Novel Insights Through a DOHaD Lens
Presenting Author:
Dr. Joanne Weinberg
Professor Emerita and Distinguished University Scholar
Department of Cellular & Physiological Sciences
Faculty of Medicine
University of British Columbia
Background
People with Fetal Alcohol Spectrum Disorders (FASD) may have a range of physical, behavioural, and/or learning challenges. It is estimated that as much as 4-5% of children may have FASD1. Most studies have explored learning and behavioural challenges in children, so not much is known about FASD in adults, and even less is known about overall health in these individuals. More studies are needed to understand the long-term health effects of prenatal alcohol exposure in adults. Recently, an informal community survey run by three adults with FASD found that many adults with FASD have higher rates of physical and mental health issues than those who were not exposed to alcohol2 and concluded that FASD should be considered as a ‘whole-body’ diagnosis. This means that doctors should screen patients with FASD more carefully for certain physical and mental health issues as they age. Autoimmune disorders caused by chronic inflammation, like rheumatoid arthritis and lupus, are more common for people with FASD, but researchers are still trying to understand why.
What causes inflammation?
Inflammation is how our body signals our immune system to respond to injuries and infections. For example, if you are scratched on the arm by a sharp stick, you may notice some pain and swelling around the wound. When an area is inflamed, the immune system will attack anything that it sees as a possible invader, like a bacteria or virus. Inflammation can also be caused by stress, meaning that people who are constantly overwhelmed or under a lot of pressure can have more inflammation in their bodies. Often that inflammation is low-grade, meaning it is occurring at a steady low level throughout the body. In the short-term, this may not result in obvious symptoms.
For people who have autoimmune disorders, however, their immune system thinks their own body cells are invaders and will attack healthy parts of the body. This can lead to chronic pain and swelling in certain parts of the body, or even cause long term damage to certain organs.
DOHaD presentation: How does Fetal Alcohol Spectrum Disorder relate to inflammation?
Dr. Weinberg studies the impact of stress on what is known as the HPA axis. H stands for hypothalamus, P stands for pituitary gland, and A stands for adrenal gland. These are the parts of a system that releases hormones in response to stress and regulates things like digestion, moods, sleep, and the immune system. When a person has chronic stress, their HPA axis can be triggered to release high levels of stress hormones that can, in turn, cause an immune response. This means that people with lots of stress, especially in early life, can have low-grade inflammation throughout their body. This prolonged inflammation can lead to increased risk for various diseases and disorders like autoimmune disorders, type 2 diabetes, heart disease, and chronic pain over time.
Once a person is no longer under stress, the immune response calms down and there will be less inflammation in their body. What is different for people with FASD is that they are more vulnerable to the effects of stress on their bodies because prenatal alcohol exposure may affect how their stress and immune systems function over time. They may react more strongly to stress, and therefore their immune system may be ‘biased’ towards inflammation, leading to a greater risk for developing physical and mental health problems.
Dr. Weinberg and her lab have been studying the HPA axis and inflammation responses in rodents that were exposed to alcohol while in the womb. These rodents show higher rates of arthritis and other health conditions relating to the immune system. She is also one of the researchers looking at inflammation and the risk for diseases and disorders in people with FASD. They are also comparing the number of adverse childhood experiences (ACEs) a person with FASD experiences and seeing if those with more ACEs are more likely to have autoimmune disorders such as arthritis. The study with humans is still collecting data and is not ready for publication yet.
How do you know if you have an autoimmune disorder?
If your doctor suspects you may have an autoimmune disorder, they may send you for some blood tests to look for specific proteins, hormone levels, and types of blood cells. Depending on what those blood tests show, your doctor may send you for more tests in order to make a more specific diagnosis.
What can I do with this information?
If you have FASD, be sure to let your doctor know about any pain or swelling you notice. You can make a “Pain Diary” to help you remember. Keeping track of where your pain is, how much it hurts, and what makes the pain worse or better can help your doctor make better decisions for your care. You can download a copy of a Pain Diary here:
Another thing you can do is tell your doctor about other symptoms you are experiencing, such as rashes, lack of energy or general weakness, fevers, or dry mouth. These could be signs that you have some level of inflammation, even if no obvious disease is present yet.
Chronic stress can lead to lots of long-term health issues. Getting enough sleep, regularly exercising, and eating healthy have all been shown to reduce stress and inflammation levels in people with autoimmune and chronic pain disorders. It is important to do what you can on your own to help reduce stress and keep your immune system calm.
Researchers like Dr. Weinberg are doing studies with adults with FASD to learn more about their health concerns and to better understand why certain health conditions are more common. To learn more about this research, go to weinberglab.ca or email adulthealth.fasd@ubc.ca.
For more information about FASD you can reach out to groups like CanFASD to learn more about their Research Network.
Additional Resources/Reading:
Government of Canada: Fetal Alcohol Spectrum Disorder: Therapies and Supports
CAMH: Fetal Alcohol Spectrum Disorder
References:
- Flannigan, K., Unsworth, MA, and Harding, K. (2018) The Prevalence of Fetal Alcohol Spectrum Disorder. Canada FASD Research Network.
- IN: Himmelreich, M., Lutke, C.J. and Hargrove, E.T. Chapter 12. The Lay of the Land: Fetal Alcohol Spectrum Disorder (FASD): A Whole-Body Diagnosis. In: Begun, A.L. & Murray, M.M., Co-Editors. The Routledge Handbook of Social Work and Addictive Behaviours, New York, Routledge, 2020, pp 191-215.
- Raineki C, Bodnar TS, Holman PJ, Baglot SL, Lan N, Weinberg J. (2017). Effects of early-life adversity on immune function are mediated by prenatal environment: Role of prenatal alcohol exposure. Brain, Behavior, and Immunity. 66:210-220.
- Bodnar TS, Hill LA, Weinberg J. (2016). Evidence for an immune signature of prenatal alcohol exposure in female rats. Brain, Behavior, and Immunity. 58:130-41.
