Cardiovascular Risk in Adult FASD & its Impact on Prefrontal Cortical Functioning

Emory University, Atlanta GA

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Abstract

ABSTRACT Fetal Alcohol Spectrum Disorders (FASDs) is a term used to describe a range of effects seen in individuals who have a history of prenatal alcohol exposure (PAE). Since the original recognition of Fetal Alcohol Syndrome, the most extreme variant of these effects, over 40 years of research has been amassed documenting the physical and neurobehavioral impact of PAE. Surprisingly though, there exist only a handful of studies that have examined the long-term impact of PAE in adulthood despite recent interests in exploring the developmental origins of health and disease among the scientific community. We are proposing to assess the cardiovascular risk of adults who are between 30-40 years of age who were recruited while in utero and followed over time as part of a prospective cohort of alcohol-exposed individuals and a control group with comparable socio-economic characteristics who did not have PAE. The individuals from the cohort were last seen in their 20's and are actively being recruited for a study whose aims are to characterize the characteristics of FASD in adulthood and to assess their health status in adulthood, using predominantly self-report and medical record abstraction. As part of the assessment proposed for this study, we will obtain traditional measures of cardiovascular risk, including blood pressure, triglycerides (total, high and low density lipids), cholesterol, and fasting glucose levels, and a measure of microvascular peripheral functioning, using peripheral arterial tonometry (PAT). We will further assess the impact of microvascular peripheral function on prefrontal cortical (PFC) activation using functional near-infrared spectroscopy (fNIRS) to assess the impact the level of vascular occlusion has on oxygen perfusion in this area of the brain that is heavily involved in inhibitory control and higher level reasoning and judgement. FNIRS assesses levels of oxygenated (HBO) and deoxygenated (HBR) hemoglobin by emitting infrared light through human tissue, which is nearly transparent to light in this range. This method has been validated by documenting changes in blood oxygenation levels relative those obtained in fMRI and PET studies and has the advantage of being lower cost and providing estimates of both HBO and HBR. Hemodynamic changes in the brain have been used previously to differentiate clinical groups, including children with a history of PAE, and to be related to parent-reported measures of behavioral functioning. In this study, we will relate indices of PFC brain hemodynamic changes to neurobehavioral functioning, specifically executive functioning skills, and assess how these relationships are influenced by peripheral microvascular functioning. Previous research has established that PAE can disrupt vascular development in animal models and this proposal will allow us to evaluate alterations in cardiovascular functioning and the impact of this on the perfusion of oxygen to the PFC and to determine if this mechanisms underlies the neurobehavioral deficits seen in individuals with FASDs. .