@PoeMasque Thank you for saying what's been on my mind the last few weeks. You expressed a lot of why I've taken to lurking these boards after being fairly active for the first few weeks. When the boards got busier, it was hard to keep up. I simply can't post as often as a lot of ladies on here, so now I don't feel like I can post anywhere because of the possibility of being flamed by the in-crowd if they don't happen to recognize my username. I know I'm not alone in feeling this way, and I wonder how many more lurkers are out there afraid to join in for the same reason.
@missphil Nice to see another Dec15 gal. I agree, that board was the same way towards the end of the 2nd trimester.
I don't get it. When we started this board I was saying that I wanted it to be more open, and have people post. None of you jumped in and agreed with me or said anything. So everyone else said no and I adapted to fit our boards rules. Now, I see this calling (I'm guessing me amongst others) out for being catty.
@AMCsquared@clovelyone I also didn't find this post offensive or sanctimommy but I can see why some would. @milkbar thanks for the article and yea haven't looked at the scientific validity of this. I have not read expecting better but as a health care provider I always feel suspicious when someone comes out with a book "debunking" all research on a certain topic or calling conspiracy theories. I'm sure there's perfectly valid points in that book and will investigate myself at some point
I agree with @clovelyone that everyone parents differently and I think it's fine to get all perspectives out there but maybe not to assume that someone posting an article is a deliberate attack on you or your lifestyle .
Anyway I don't believe in necessarily kumbaya for the sake of it but I do think there's room for disagreement when it comes to something as complex and personal as parenting.
I had a very long discussion with @GraysonsMama about why I felt her views on sex and gender to be hurtful. I'm trying to see the parallel here and I guess it would be maybe @milkbar a post on a controversial topic may be good to approach in a tread lightly kind of way to avoid negative reactions or just otherwise you may have to expect the repercussions
Oh man, my old BMB was vicious....I feel like this is way more tame than what I've seen before. It's an online chat group, if it's bothersome or hurtful, just don't participate. Snark comes with these types of groups. I disagree with @PoeMasque 's comment that "if you're going to be roasted online, just imagine what horrors await you IRL". Comparing an online chat group to real life isn't exactly apples to apples. Part of the appeal is being able to voice opinions and disagreements that you might otherwise internalize. I am not condoning mean behavior, but I didn't see anyone on here do/say anything mean.
Momma to Amelia Marie (7/14) and Austin Samuel (11/17). Adding baby (girl) #3 on 7/21
I don't get it. When we started this board I was saying that I wanted it to be more open, and have people post. None of you jumped in and agreed with me or said anything. So everyone else said no and I adapted to fit our boards rules. Now, I see this calling (I'm guessing me amongst others) out for being catty.
Yeah, I'm guessing this is for me too. I feel like it's a lose-lose situation. I just do what feels right for me. Yeah, I'm gonna post an eyeroll gif when another drive by posts about Ramzi or nub theory. Maybe some newb will be discouraged from posting another and clogging our board, when they rarely come back to interact with us. As far as this whole alcohol article, it had poor timing. While it was coincidental, some of our regulars reasonably felt slighted after posting about indulging recently. I personally explained to her why her post was received the way it was and it lead to her posting an intro and I welcomed her.
I feel like no one is being unnecessarily flamed. Most of us are not being bullies. I don't think there is an in-crowd at all and this is not a popularity competition. But is it unreasonable to expect invested interaction? I don't think so. It's not about the amount of time spent on the board or how frequently one checks in. Hell, I've been MIA for the large part of the last couple weeks because mobile bump hates me. But I try to create meaningful connections with the women here who care, when I have a chance. I expect the same out of everyone else. That's what makes this a community, not just a dumping ground. And that is why my best friends in the whole world are from my first BMB.
I hardly hang out here, so it was interesting to see the responses when I didn't have the backstory (didn't know anything about people posting about drinking until I read the responses - so maybe the OP didn't either). @Millphil@babypi also D15 over here! Heyyy! I think sometimes you read things and want to share with people who might have the same response as you did - of fear, or uncertainty - not to place judgment upon them or make them paranoid because misery likes company, but just to take the temperature and see if your own response was reasonable. I don't know if that makes sense. I'm friggin tired.
It's calming to see that there are people with adequate adult attitude in this community, who also find aggression unnecessary and unhealthy. The last thing you want to do when pregnant is to think of how to deal with attacks on an internet forum.
I am so surprised that it's happening here. It's not a teenager forum, we are all around 30, the future moms that supposed to be nurturing, caring and loving. We are all expecting babies, we should be here for each other, not against each other even if we don't agree on certain topics.
I have already witnessed some people saying are afraid to share information because they don't want to be attacked. And how many users just decided quietly not to get involved in this forum, after seeing the panopticon happening in this thread?
The study I shared might not have numbers available for us now, but it doesn't mean that it is invalid. It can be just as much valid as invalid. The chances are 50/50. Actually, it's the first study with its new findings puts a question mark on the validity of the epidemiological studies which the above mentioned book refers to. Isn't it information worth sharing?
I don't know what's up with the female-only communities, but they do tend to be overly hostile. My interaction here just reminded me a passage from the book "The Unbearable Lightness of Being" by Milan Kundera, on what I'll finish:
“It was drizzling. As people rushed along, they began opening umbrellas over their heads, and all at once the streets were crowded, too. Arched umbrella roofs collided with one another. The men were courteous, and when passing Tereza they held their umbrellas high over their heads and gave her room to go by. But the women would not yield; each looked straight ahead, waiting for the other woman to acknowledge her inferiority and step aside. The meeting of the umbrellas was a test of strength. At first Tereza gave way, but when she realized her courtesy was not being reciprocated, she started clutching her umbrella like the other women and ramming it forcefully against the oncoming umbrellas. No one ever said "Sorry." For the most part no one said anything, though once or twice she did hear a "Fat cow!" or "Fuck you!"
The women thus armed with umbrellas were both young and old, but the younger among them proved the more steeled warriors. Tereza recalled the days of the invasion and the girls in miniskirts carrying flags on long staffs. Theirs was a sexual vengeance: the Russian soldiers had been kept in enforced celibacy for several long years and must have felt they had landed on a planet invented by a science fiction writer, a planet of stunning women who paraded their scorn on beautiful long legs the likes of which had not been seen in Russia for the past five or six centuries.
She had taken many pictures of those young women against a backdrop of tanks. How she had admired them! And now these same women were bumping into her, meanly and spitefully. Instead of flags, they held umbrellas, but they held them with the same pride. They were ready to fight as obstinately against a foreign army as against an umbrella that refused to move out of their way. ”
Just because some disagreed with the approach of this post doesn't mean we are lacking "adequate adult attitude" or are "teenagers." I think most people who did have an issue with the posting tried to explain why in a constructive way. Again, newbies are absolutely 100% welcome here. Please, join us! It was explained that it was a combination of things in the topic, presentation, and timing that rubbed some the wrong way. I think some of us are protective of the culture here because it is what separates us from places like Babycenter where it's just a big chaotic mess of posts where no one knows anyone. We want to get to know you and form connections through this group.
I'm sorry to hear that some people are feeling they can't express their opinion for fear of being flamed, but TBH, I don't think anyone been unnecessarily flamed. I think there have been several DISCUSSIONS about things besides baby showers and nightmare IL's, and I personally think that's a good thing. It's interesting and makes you think about other people's perspectives on things that you may not have before. There's nothing wrong with a little disagreement every now and then. For me, this article was nothing that I haven't heard before, and it's expected that someone would eventually post something like this. It's an eyeroll for me, but I don't care if you want to post it. Whatever. But if you do post an article that could be controversial, then get ready to have other people discuss how they feel about it. It's not all sunshine and rainbows everywhere all the time, ladies. We live in the world. Chill.
@milkbar I know you felt attacked, but in my opinion it's also not nice to say that the ladies here aren't being adults. I may not agree with their approach sometimes, but we're all adults here. I don't think they're being childish, it's just not the way I would choose to handle things. Maybe we can just consider this a misunderstanding.
@clovelyone I didn't meant to say that they are not adults, they are, just bulling is something more characteristic of the school age, to my mind. But I agree with you, it's a better to say a misunderstanding, it'll be more productive for us all.
@breezybee You are right, discussions with non-offensive exchange of opinions is healthy and help to see different perspectives. That's why I am very thankful to @Amber_Waves for her comments. But "dirty lurker", "sanctimom" and passive-agressive "Happy 9 months" is not a discussion. It's an attack.
@milkbar "dirty lurker" was not meant for you - it's a term used to identify when someone is commenting on a thread when they are not a part of this board. The others were jokes. They're supposed to be funny, not offensive. Some gentle teasing is really not a big deal. And really, to some, this article could be perceived as sanctimonious. Sorry. It's the truth.
@milkbar Nobody called you a dirty lurker. The person who said that was referring to herself. It's a common term used by people who don't post often aside from intros, etc. when they decide to pop in to post.
Also, I care, love, and nurture my own children. I don't need to do that to internet strangers. This is not an attack or an attempt at bullying. Just stating that I'm not part of an online community to make new best friends.
I disagree with you @PoeMasque. Patriarchy and capitalism that only let white men initially own property and make rules and vote are why women were the last group to get the vote. Also, while black men legally got the right to vote before white women, in many places and many cases this was just "de facto", and there were poll taxes, tests and many other discriminatory ways (some of which still exist!) that limited black men's right and today limit people of color's right to vote, including discriminatory voter ID laws.
It's total speculation on your part to say that because you think women are hyper critical of each other (or don't practice a "bro-mentality"), that's why we haven't had a woman president. In my community i am part of many women run groups or all women groups that do a much better job cooperating than many groups I've seen run by men.
I think sexism is real. Women and our opinions are devalued all the time. I think that's one of the main reasons why we haven't had a woman president yet.
I think there are also ways to be critical while also being compassionate, and to have real discussion, debate and dialogue with different people coming from different perspectives. Of course, on the internet this is difficult since we don't know each other in person, so it's hard to have a real relationship or really trust.
___ Due date 12/9 I can't figure out the pregnancy countdown tickers, but I do know how to make a signature! #40andpregnant
As of 12/15/2017, my new hashtag is #41 and pregnant!
Really struggling with the idea that people legit think a forum of mostly women is more "hostile" and catty. The reason women didn't have be the right to vote is not because we're emotional beings. It's be cause men have a long history of being assholes.
@milkbar I tried to look into your article. In the interest of fostering a scientific-minded conversation, here's what I found:
About the journal: JAMA Pediatrics is a high impact factor (10+), peer-reviewed journal. (Online publication by a journal does not imply lack of peer-review, and the citation information reflects JAMA Pediatr. as the publishing journal.) Impact factors are a debatable and imperfect measure of journal quality, but it's a starting point for topics outside of my expertise.
Unfortunately, it's not covered by the journal subscriptions at work or through my university's alumni access. I can't get access to more than the abstract, so I can only base my opinions on what is presented there.
About the study: The sample size seems large at first reading (>400), but that falls to around 200 when sub-divided by sex. Further when allocated into their strata for alcohol consumption, and timing of alcohol consumption. If we assume 4 consumption-bins (abstain, low, med, high/binge) and 3 trimester-bins, and an even distribution of patients across 12 resulting bins, each of those sex+consumption+trimester bins would have 16-17 patients. The study appears to be controlled/constrained for race and age, but it's unclear what other confounding factors (maternal age, health, nutrition, etc etc etc, there are so many possible) may be influential in their analysis. It's impossible to infer from the abstract whether they are powered to show significance for the differences they observed.
Someone else already mentioned that the apparent study design also can only show correlation, but not causation.
Opinions follow: IMO, this makes the article an informational blurb that might support the existing US recommendations/standards. It doesn't change how I view alcohol use in my pregnancy, but I can see how it might reinforce another's resolve to keep with the guidelines (especially if they are applying a 'better safe than sorry' mentality to unknowns). For me, it doesn't shift the narrative or provide any actionable information (based on the abstract alone), but it also might be a cool pilot study worthy of additional follow up.
Really struggling with the idea that people legit think a forum of mostly women is more "hostile" and catty. The reason women didn't have be the right to vote is not because we're emotional beings. It's be cause men have a long history of being assholes.
Agreed I have always been a girl's girl so I don't get why people generalize and say women are catty with other women. I think people can be a-holes with other people. Men and women alike.
Eta: not calling anyone an a-hole; I'm just speaking in general
yeah, @rainbowdashh, this makes me so angry and sad as well.
i am part of several women led or all women groups and we do a great job cooperating and getting stuff done. i get asked all the time if we have a hard time working together, since "you know how women are." ugh
___ Due date 12/9 I can't figure out the pregnancy countdown tickers, but I do know how to make a signature! #40andpregnant
As of 12/15/2017, my new hashtag is #41 and pregnant!
@rainbowdashh@collectiveliving@poemasque oh, I already dislike myself for getting involved into another controversial discussion after being just almost burnt alive for this one Have you seen a recent documentary "The Red Pill" filmed by a feminist? It's a must-see to get a perspective on the topic of gender oppression. https://theredpillmovie.com/ Sorry, no more comments from me on this account. Everybody have a nice day!
eta- Just watched the trailer and read a great review of it in the Village Voice. Yeah, @rainbowdashh I don't think I'll be watching it either.
A quote from the Village Voice review, about the supposedly feminist filmmaker, "I feel comfortable calling her “propagandist” because of my own “research” (ie. “reading the top search results”). Here’s something Elam wrote on A Voice for Men in 2010: “Should I be called to sit on a jury for a rape trial, I vow publicly to vote not guilty, even in the face of overwhelming evidence that the charges are true.” What excuse would any serious documentarian have for not asking Elam to explain that?"
@kyrwyn just wanted to shout out to you for your extremely well written, well-thought-out critique of the article in question. These were similar to my thoughts, though I didn't share them near as eloquently!
@kyrwyn If you were next to me I'd give you a big hug. Thanks for brining your expertise to help us understand the study better! From the supplement to the study below I understand they considered Maternal age, Maternal pre pregnancy body mass index, Maternal smoking during pregnancy, Child birth weight and Child sex. But it's too short to really to understand a full picture.
@rainbowdashh although that's true, it doesn't mean another group is without its own struggles. Not all the men are doing the oppressing, and I think it would be interesting to learn the ways men perceive their own oppression, particularly through the eyes of a self-identified feminist. In the name of even attempting to consider myself an enlightened and educated person, I always try to see all the sides - so at least if I continue to disagree, now I have more reasons as to why.
Of course all groups struggle. I never said they didn't. But it's about the men's rights movement and I am not sympathetic to that while POC, LGBT+, and women are still fighting to be seen as equals.
ETA: not sympathetic comes across harshly, but my point is there are other groups who aren't being heard in their fights and a group of men who feel their rights are being infringed on is not at the top of my "I'd like to help" list.
It's calming to see that there are people with adequate adult attitude in this community, who also find aggression unnecessary and unhealthy. The last thing you want to do when pregnant is to think of how to deal with attacks on an internet forum.
I am so surprised that it's happening here. It's not a teenager forum, we are all around 30, the future moms that supposed to be nurturing, caring and loving. We are all expecting babies, we should be here for each other, not against each other even if we don't agree on certain topics.
I have already witnessed some people saying are afraid to share information because they don't want to be attacked. And how many users just decided quietly not to get involved in this forum, after seeing the panopticon happening in this thread?
The study I shared might not have numbers available for us now, but it doesn't mean that it is invalid. It can be just as much valid as invalid. The chances are 50/50. Actually, it's the first study with its new findings puts a question mark on the validity of the epidemiological studies which the above mentioned book refers to. Isn't it information worth sharing?
I don't know what's up with the female-only communities, but they do tend to be overly hostile. My interaction here just reminded me a passage from the book "The Unbearable Lightness of Being" by Milan Kundera, on what I'll finish:
@clovelyone I didn't meant to say that they are not adults, they are, just bulling is something more characteristic of the school age, to my mind. But I agree with you, it's a better to say a misunderstanding, it'll be more productive for us all.
@breezybee You are right, discussions with non-offensive exchange of opinions is healthy and help to see different perspectives. That's why I am very thankful to @Amber_Waves for her comments. But "dirty lurker", "sanctimom" and passive-agressive "Happy 9 months" is not a discussion. It's an attack.
No one has bullied you. That is laughable.
I continue to strenuously object to your incessant condescension. Get off your high horse. You're so far up there we can't even see you. You do not get to dictate how people respond to your thread. You do not get to indicate that only a certain type of response is acceptable. Even in your intro, you couldn't refrain from similar statements. Every single one of your posts is dripping with smugness.
Your constant insistence that any disagreement with you that isn't couched in rainbows, hugs, and kisses equates to childish, aggressive behavior is pretentious.
As for the other ladies that supposedly feel like non-regulars are flamed for participating, I think you need to reevaluate your opinion. The 400 drive-by posts about nub theory are all going to get the same response. NOT ONCE has a thread with a legitimate discussion involved any flaming of less frequent posters for daring to share their opinions. Controversial topics, such as this very thread, will obviously bring out strong reactions. As @vvitchhazel so kindly pointed out, if you are going to make a thread about a touchy subject, there is a better way to go about it than the OP. There was nothing wrong with pointing this out. It's not that there are OMG SO MANY RULES. It's not that people are supposed to magically know what those rules are. But if you come in here with a topic about drinking, birth defects, circumcision, formula feeding, etc. then don't expect rainbows and kisses even if you're a so-called "reg."
Please, participate.
As for the "this is why women didn't get the right to vote sooner" ... I don't have anything fit to print to say about this statement.
Met: September 2005Married: October 2008 DS: 09/2014
For those who say the board is unnecessarily catty, that's always been the culture of the bump, and part of the reason there was the mass banning back in 2014/15. Everything was getting out of control. I'm not saying I find it pleasant or necessary, but I'm also not surprised when it happens.
as for the article not being a scientific study, I don't think it ever presumed to be. Some researchers found some data that is interesting and seems to support the current recommendations. It was published in a legitimate journal and needs more research in order to be verified as "scientific proof." That will probably never happen because it's generally presumed unethical to use a control group and an experiment group when we're dealing with something that could potentially harm unborn babies. It would also be difficult because, as people said, differences in cognitive ability can be related to differences in socioeconomic class and genetics.
Coming out of my Bump vacation to just point out that I find it super interesting the poster giving us a questionably valid study regarding drinking during pregnancy that is a total subtle mommy guilt move also posts about a documentary on the men's rights movement. Puh-lease.
eta- Just watched the trailer and read a great review of it in the Village Voice. Yeah, @rainbowdashh I don't think I'll be watching it either.
A quote from the Village Voice review, about the supposedly feminist filmmaker, "I feel comfortable calling her “propagandist” because of my own “research” (ie. “reading the top search results”). Here’s something Elam wrote on A Voice for Men in 2010: “Should I be called to sit on a jury for a rape trial, I vow publicly to vote not guilty, even in the face of overwhelming evidence that the charges are true.” What excuse would any serious documentarian have for not asking Elam to explain that?"
EDITED TO DELETE ARTICLE CONTENT DUE TO INTELLECTUAL PROPERTY CONCERNS
My university has the full text of the article. Here you are. A little puzzled by those who say the Journal of the American Medical Association is not "scientific". Which medical journal is then?! I have no stake in this game as I like drinking even less than I like data analysis, but the statisticians out there can have at it parsing the research here. The PDF of the article had some images and tables in addition, but I don't know how to share a pdf here. This is what what available through the text-only interface at JAMA. It is too long to post all together so I will split it up.
Original Investigation
June 5, 2017
Association Between Prenatal Alcohol Exposure and Craniofacial Shape of Children at 12 Months of Age
Evelyne Muggli, MPH1,2; Harold Matthews, BPsych(Hons)2,3,4; Anthony Penington, MDBS2,3,4; et alPeter Claes, PhD4,5,6; Colleen O’Leary, PhD7; Della Forster, PhD8,9; Susan Donath, MA2,10; Peter J. Anderson, PhD2,11,12; Sharon Lewis, PhD1,2; Cate Nagle, PhD13,14; Jeffrey M. Craig, PhD2,15; Susan M. White, MBBS2,16; Elizabeth J. Elliott, MD17; Jane Halliday, PhD1,2
Author Affiliations Article Information
JAMA Pediatr. Published online June 5, 2017. doi:10.1001/jamapediatrics.2017.0778
editorial comment icon
Editorial
Comment
related articles icon
Related
Articles
Key Points
Question Is there an association between different levels of prenatal alcohol exposure and child craniofacial shape at 12 months?
Findings This cohort study conducted an objective and sensitive craniofacial phenotype analysis of 415 children, which showed an association between prenatal alcohol exposure and craniofacial shape at almost every level of exposure examined. Differences in the midface and nose resemble midface anomalies associated with fetal alcohol spectrum disorder.
Meaning Any alcohol consumption has consequences on craniofacial development, supporting advice that complete abstinence from alcohol while pregnant is the safest option; it remains unclear whether the facial differences are associated neurocognitive outcomes of prenatal alcohol exposure.
Abstract
Importance Children who receive a diagnosis of fetal alcohol spectrum disorder may have a characteristic facial appearance in addition to neurodevelopmental impairment. It is not well understood whether there is a gradient of facial characteristics of children who did not receive a diagnosis of fetal alcohol spectrum disorder but who were exposed to a range of common drinking patterns during pregnancy.
Objective To examine the association between dose, frequency, and timing of prenatal alcohol exposure and craniofacial phenotype in 12-month-old children.
Design, Setting, and Participants A prospective cohort study was performed from January 1, 2011, to December 30, 2014, among mothers recruited in the first trimester of pregnancy from low-risk, public maternity clinics in metropolitan Melbourne, Australia. A total of 415 white children were included in this analysis of 3-dimensional craniofacial images taken at 12 months of age. Analysis was performed with objective, holistic craniofacial phenotyping using dense surface models of the face and head. Partial least square regression models included covariates known to affect craniofacial shape.
Exposures Low, moderate to high, or binge-level alcohol exposure in the first trimester or throughout pregnancy.
Main Outcomes and Measures Anatomical differences in global and regional craniofacial shape between children of women who abstained from alcohol during pregnancy and children with varying levels of prenatal alcohol exposure.
Results Of the 415 children in the study (195 girls and 220 boys; mean [SD] age, 363.0 [8.3] days), a consistent association between craniofacial shape and prenatal alcohol exposure was observed at almost any level regardless of whether exposure occurred only in the first trimester or throughout pregnancy. Regions of difference were concentrated around the midface, nose, lips, and eyes. Directional visualization showed that these differences corresponded to general recession of the midface and superior displacement of the nose, especially the tip of the nose, indicating shortening of the nose and upturning of the nose tip. Differences were most pronounced between groups with no exposure and groups with low exposure in the first trimester (forehead), moderate to high exposure in the first trimester (eyes, midface, chin, and parietal region), and binge-level exposure in the first trimester (chin).
Conclusions and Relevance Prenatal alcohol exposure, even at low levels, can influence craniofacial development. Although the clinical significance of these findings is yet to be determined, they support the conclusion that for women who are or may become pregnant, avoiding alcohol is the safest option.
Introduction
Prenatal alcohol exposure (PAE) is a major preventable cause of health and developmental problems in children. It may cause irreversible damage to the brain, resulting in fetal alcohol spectrum disorder (FASD), which is characterized by learning difficulties, executive dysfunction, impaired speech, motor problems, and behavior problems. Fetal alcohol spectrum disorder may affect 3% to 5% of mainstream school-aged children [. . .] [DELETED SECTION (Middle section of this paragraph] [. . .] Together these findings suggest a possible dose-related association between PAE and craniofacial shape.
Most of the studies cited have used facial measurements, which capture limited information and are prone to measurement error, or used clinical examination, which may be subjective. [. . .] [DELETED SECTION (remainder of this paragraph)]
EDITED TO DELETE CONTENT DUE TO INTELLECTUAL PROPERTY CONCERNS
Methods
Study Population
Asking Questions About Alcohol in Pregnancy (AQUA) is a population-based longitudinal study of the neurodevelopmental outcomes in children with PAE, with a focus on low to moderate alcohol consumption. Participants are 1570 women and their offspring, recruited in early pregnancy during a 12-month period from July 25, 2011, to July 30, 2012, from low-risk public maternity clinics in Melbourne, Australia. Three-dimensional craniofacial images were captured at 12 months from a subset of 517 participants. [. . .] [DELETED SECTION (Remainder of paragraph)]
Measurement of Alcohol Exposure
Questionnaires were collected that had detailed information on the quantity and frequency of alcohol consumption for the 3 months before pregnancy and for each trimester, including the time prior to recognition of pregnancy. Frequency of drinking and typical amount and type of alcoholic drink were combined to provide a single-exposure measure for each stage of pregnancy, expressed in grams of absolute alcohol (AA) and using algorithms previously described.
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). Mothers who were abstinent throughout pregnancy comprised the control group for all analyses.
[DELETED PARAGRAPH]
Image Acquisition and Preprocessing
Medical photographers not involved in the analysis collected 3-D craniofacial images between January 8, 2013, and February 11, 2014, inclusive, within 2 weeks of the child’s first birthday, at the Royal Children’s Hospital in Melbourne, Australia. [. . .] [DELETED SECTION (Remainder of paragraph)]
Craniofacial Measurement
Craniofacial measurement was undertaken by a researcher (H.M.) blinded to the participants’ PAE group. To represent the entire surface of the face, a spatially dense array of 69 587 points on a template 1-year-old face (derived with bootstrapping) was automatically placed onto each target image by a 3-D surface registration algorithm. [. . .] [DELETED REMAINDER OF PARAGRAPH]
Covariates
Regression covariates included risk factors known to be, or that could plausibly be, associated with craniofacial shape: child’s sex, which is known to be associated with early craniofacial dimorphism; maternal age, a risk factor for malformations; and maternal smoking in pregnancy, a risk factor for malformations of the head and face.The child’s birth weight and maternal prepregnancy body mass index were included as factors potentially resulting in greater fat deposition around the cheeks.
To gauge individual variation in alcohol metabolism, mothers were asked how quickly they felt the effects of alcohol (very slowly or slowly, normally, or very quickly or quickly). [. . .] [DELETED TWO SENTENCES]
Statistical Analysis
The distribution of PAE groups and covariates was described using frequency counts and percentages if categorical, and mean (SD) values if continuous. To test for a difference in craniofacial shape between the control and each PAE group in each tier, partial least squares regression models were fitted. [. . .] [DELETED 2.5 PARAGRAPHS].
Results
The characteristics of the children included in the analysis are summarized in Table 1. The cohort included 220 boys and 195 girls with a mean (SD) age of 363.0 (8.3) days at imaging. Of the 326 children with PAE, 133 (40.8%) were exposed in the first trimester only and 193 (59.2%) throughout the pregnancy.
Global and Regional Association Between PAE and Craniofacial Shape
There was no significant association between PAE and craniofacial shape at the global level (Table 2). There were, however, regional mean differences in craniofacial shape of children exposed to any alcohol (tier 1), regardless of whether PAE occurred in the first trimester only or throughout pregnancy (tier 2) [. . . ] [DELETED 1.5 PARAGRAPHS]
Stratified Regional Association Between PAE and Craniofacial Shape
The partial least squares regression analysis was repeated, stratified by maternal report of feeling the effects of alcohol normally and very quickly or quickly (omitting those who reported feeling the effects of alcohol slowly or very slowly owing to small group numbers). [. . .] [REMAINDER OF PARAGRAPH DELETED]
Association of Covariates With Craniofacial Shape
There were significant global differences in craniofacial shape associated with maternal age, prepregnancy body mass index, children’s birth weight, and child’s sex. Maternal smoking during pregnancy was not associated with craniofacial shape at a global level. The tier 1 regression model showing these associations is in eTable in the Supplement (global associations) and eFigure in the Supplement (regional associations).
Discussion
To our knowledge, this study is the first to examine the association between the face of the child and common patterns of PAE, using objective, holistic methods of craniofacial phenotyping. A consistent association with craniofacial shape was observed in almost all exposure groups, with differences concentrated on regions around the nose, eyes, upper lips, and lower lips. Results indicate a mild midfacial recession suggestive of subclinical hypoplasia and an upturning of the nasal tip in those exposed to alcohol prenatally. This phenotype was evident even when drinking was at a low level and mothers ceased alcohol consumption in the first trimester.
In the unstratified analysis, we observed the strongest association with facial shape in children of mothers who drank at moderate levels in the first trimester only. In the stratified analysis, craniofacial differences were strongest in children of mothers who said they felt the effects of alcohol quickly, particularly if they continued drinking throughout pregnancy and initially drank at moderate levels. The apparent discrepancy between the 2 analyses may be because fewer women who reported feeling the effects of alcohol quickly drank throughout pregnancy. A higher proportion of mothers who felt the effects of alcohol normally in those exposure groups may have masked the association in the unstratified analysis.
[TWO PARAGRAPHS DELETED]
During embryogenesis, facial bone and cartilage are derived from the cranial neural crest. Sizing and positioning of facial elements begins 17 to 18 days after fertilization and before most pregnancies are recognized. Evidence from mouse studies shows that exposure to ethanol affects all stages of neural crest development, resulting in variation in craniofacial appearance, depending on the gestational timing of exposure. For example, alcohol exposure at gestational day 7 (the 15th-17th day in human development) leads to severe midfacial hypoplasia, an elongated upper lip, and a deficient philtrum, while exposure at day 8.5 causes mild midfacial hypoplasia, a shortened upper lip, and a preserved philtrum. We observed a similar facial phenotype to that seen in animal models, particularly after first-trimester moderate PAE. Although it was not possible to localize the timing of exposure as precisely as in these animal studies, our findings confirm an association between moderate PAE and facial shape in the first trimester in humans, which is convergent with the animal evidence.
EDITED TO DELETE CONTENT DUE TO INTELLECTUAL PROPERTY CONCERNS
Even in children of mothers who drink heavily, facial abnormalities associated with PAE are highly variable,5 which may reflect variation in the timing of exposure in the first trimester or unmeasured risk factors. For example, genetic variants in maternal and fetal alcohol metabolism have been shown to influence the level of alcohol and/or its toxic metabolites experienced by the fetus. [. . .] [REMAINDER OF PARAGRAPH DELETED]
We observed that children of mothers who reported feeling the effects of alcohol quickly or very quickly exhibited larger craniofacial differences in most exposure groups. We hypothesize that this rate of feeling the effects of alcohol reflects genetically determined variation in alcohol metabolism. The rate of feeling the effects of alcohol may ultimately be clinically useful to differentiate individuals with a greater susceptibility to the effects of alcohol, conferring increased fetal vulnerability, and may in part explain the heterogeneity of outcomes in alcohol-exposed pregnancies and in FASD.
Craniofacial development closely corresponds to brain induction and expansion, and, as such, characteristic facial differences have been linked to brain abnormalities and cognitive outcome in FASD.31 Correlative face-brain phenotypes have been described in human and animal studies, suggesting that the type and severity of brain abnormality may be predicted in part by hypoplasia of the midface,28,32 and that the classic facial features of FASD (short palpebral fissure, smooth philtrum, and thin upper lip) may assist in identifying children at risk of developing neurobehavioral deficits.5 Given that cognitive outcomes for the children in our study have not yet been examined in this context, it is as yet unknown if the craniofacial differences found are of diagnostic or predictive value.
Strengths and Limitations
This study is a well-described cohort of mother-child dyads with detailed PAE data and classification not available in many other studies. [. . .] [REMAINDER OF PARAGRAPH DELETED]
[PARAGRAPH DELETED]
We postulate that the rate of feeling the effects of alcohol is a proxy for metabolic factors influencing PAE and its association with facial shape, but have no direct measure such as blood alcohol concentration or alcohol elimination rates to examine. Investigation of maternal and/or child allelic differences (genotypes) at specific genes associated with alcohol metabolism or alcohol use behavior is under way.
Conclusions
The results of this study suggest that even low levels of alcohol consumption can influence craniofacial development of the fetus and confirm that the first trimester is a critical period. We observed aspects of a craniofacial phenotype with almost any level of PAE, something previously only documented following a high level of long-term alcohol exposure. Although the clinical significance of our findings is yet to be determined, these findings support the conclusion that, for women who are, or may become pregnant, avoiding alcohol is the safest option.
Back to top
Article Information
Accepted for Publication: March 2, 2017.
Corresponding Author: Jane Halliday, PhD, Public Health Genetics, Murdoch Childrens Research Institute, 50 Flemington Rd, Parkville, Victoria 3052, Australia (jane.halliday.h@mcri.edu.au).
Published Online: June 5, 2017. doi:10.1001/jamapediatrics.2017.0778
Author Contributions: Ms Muggli and Mr Matthews are co-first authors. Ms Muggli and Mr Matthews had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Muggli, Penington, O’Leary, Forster, Donath, Anderson, Nagle, Craig, Elliott, Halliday.
Acquisition, analysis, or interpretation of data: Muggli, Matthews, Claes, O’Leary, Forster, Donath, Lewis, Nagle, White, Elliott, Halliday.
Drafting of the manuscript: Muggli, Matthews, Donath, Nagle, White, Elliott, Halliday.
Critical revision of the manuscript for important intellectual content: Muggli, Matthews, Penington, Claes, O’Leary, Forster, Donath, Anderson, Lewis, Nagle, Craig, Elliott, Halliday.
Administrative, technical, or material support: Muggli, Matthews, Nagle, Craig, Elliott, Halliday.
Study supervision: Muggli, Penington, Claes, Anderson, Craig, Elliott, Halliday.
Conflict of Interest Disclosures: None reported.
Funding/Support: This work is supported by grant 1011070 from the Australian National Health and Medical Research Council, Senior Research Fellowships 1081288 (Dr Anderson) and 1021252 (Dr Halliday) from the Australian National Health and Medical Research Council, Practitioner Fellowship 1021480 (Dr Elliott) from the Australian National Health and Medical Research Council, and the Victorian State Government’s Operational Infrastructure Support Program.
Role of Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Ine Saey, MS, Department of Electrical Engineering, KU Leuven, contributed to the preliminary analyses; she was not compensated for her contribution. We also thank all the women and their children who are taking part in this study and the medical photographers who undertook the 3-dimensional imaging.
References
1.
Mattson SN, Crocker N, Nguyen TT. Fetal alcohol spectrum disorders: neuropsychological and behavioral features. Neuropsychol Rev. 2011;21(2):81-101.PubMedArticle UKE-LinkSolver
2.
May P, Baete A, Russo J, et al. Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics. 2014;134(5):855-866.PubMedArticle UKE-LinkSolver
3.
Hoyme HE, Kalberg WO, Elliott AJ, et al. Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders. Pediatrics. 2016;138(2):e20154256.PubMedArticle UKE-LinkSolver
4.
Manning MA, Eugene Hoyme H. Fetal alcohol spectrum disorders: a practical clinical approach to diagnosis. Neurosci Biobehav Rev. 2007;31(2):230-238.PubMedArticle UKE-LinkSolver
5.
Suttie M, Foroud T, Wetherill L, et al. Facial dysmorphism across the fetal alcohol spectrum. Pediatrics. 2013;131(3):e779-e788.PubMedArticle UKE-LinkSolver
6.
Moore ES, Ward RE, Jamison PL, Morris CA, Bader PI, Hall BD. New perspectives on the face in fetal alcohol syndrome: what anthropometry tells us. Am J Med Genet. 2002;109(4):249-260.PubMedArticle UKE-LinkSolver
7.
Foroud T, Wetherill L, Vinci-Booher S, et al. Relation over time between facial measurements and cognitive outcomes in fetal alcohol-exposed children. Alcohol Clin Exp Res. 2012;36(9):1634-1646.PubMedArticle UKE-LinkSolver
8.
May PA, Blankenship J, Marais AS, et al. Maternal alcohol consumption producing fetal alcohol spectrum disorders (FASD): quantity, frequency, and timing of drinking. Drug Alcohol Depend. 2013;133(2):502-512.PubMedArticle UKE-LinkSolver
9.
May PA, Tabachnick BG, Gossage JP, et al. Maternal risk factors predicting child physical characteristics and dysmorphology in fetal alcohol syndrome and partial fetal alcohol syndrome. Drug Alcohol Depend. 2011;119(1-2):18-27.PubMedArticle UKE-LinkSolver
10.
May PA, Marais AS, de Vries MM, et al. The continuum of fetal alcohol spectrum disorders in a community in South Africa: prevalence and characteristics in a fifth sample. Drug Alcohol Depend. 2016;168:274-286.PubMedArticle UKE-LinkSolver
11.
Shrimpton S, Daniels K, de Greef S, et al. A spatially-dense regression study of facial form and tissue depth: towards an interactive tool for craniofacial reconstruction. Forensic Sci Int. 2014;234:103-110.PubMedArticle UKE-LinkSolver
12.
Muggli E, O’Leary C, Forster D, et al. Study protocol: Asking QUestions about Alcohol in pregnancy (AQUA): a longitudinal cohort study of fetal effects of low to moderate alcohol exposure. BMC Pregnancy Childbirth. 2014;14(1):302.PubMedArticle UKE-LinkSolver
13.
O’Leary CM, Bower C, Zubrick SR, Geelhoed E, Kurinczuk JJ, Nassar N. A new method of prenatal alcohol classification accounting for dose, pattern and timing of exposure: improving our ability to examine fetal effects from low to moderate alcohol. J Epidemiol Community Health. 2010;64(11):956-962.PubMedArticle UKE-LinkSolver
14.
Muggli E, Cook B, O’Leary C, Forster D, Halliday J. Increasing accurate self-report in surveys of pregnancy alcohol use. Midwifery. 2015;31(3):e23-e28.PubMedArticle UKE-LinkSolver
15.
Muggli E, O’Leary C, Donath S, et al. “Did you ever drink more?”: a detailed description of pregnant women’s drinking patterns. BMC Public Health. 2016;16:683.PubMedArticle UKE-LinkSolver
16.
Matthews H, Penington T, Saey I, Halliday J, Muggli E, Claes P. Spatially dense morphometrics of craniofacial sexual dimorphism in 1-year-olds. J Anat. 2016;229(4):549-559.PubMedArticle UKE-LinkSolver
17.
Claes P. A Robust Statistical Surface Registration Framework Using Implicit Function Representations: Application in Craniofacial Reconstruction [PhD thesis]. Leuven, Belgium: Faculty of Engineering, Katholieke Universiteit Leuven; 2007.
18.
Claes P, Walters M, Clement J. Improved facial outcome assessment using a 3D anthropometric mask. Int J Oral Maxillofac Surg. 2012;41(3):324-330.PubMedArticle UKE-LinkSolver
19.
Snyders J, Claes P, Vandermeulen D, Suetens P. Development and Comparison of Non-Rigid Surface Registration and Extensions. Leuven, Belgium: Department of Electrical Engineering, Katholieke Universiteit Leuven; 2014. Technical Report KUL/ESAT/PSI/1401.
Gill SK, Broussard C, Devine O, Green RF, Rasmussen SA, Reefhuis J; National Birth Defects Prevention Study. Association between maternal age and birth defects of unknown etiology: United States, 1997-2007. Birth Defects Res A Clin Mol Teratol. 2012;94(12):1010-1018.PubMedArticle UKE-LinkSolver
22.
Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update. 2011;17(5):589-604.PubMedArticle UKE-LinkSolver
23.
Anderson MJ, Legendre P. An empirical comparison of permutation methods for tests of partial regression coefficients in a linear model. J Stat Comput Simul. 1999;62(3):271-303. doi:10.1080/00949659908811936Article UKE-LinkSolver
24.
Claes P, Liberton DK, Daniels K, et al. Modeling 3D facial shape from DNA. PLoS Genet. 2014;10(3):e1004224.PubMedArticle UKE-LinkSolver
25.
Iveli MF, Morales S, Rebolledo A, et al. Effects of light ethanol consumption during pregnancy: increased frequency of minor anomalies in the newborn and altered contractility of umbilical cord artery. Pediatr Res. 2007;61(4):456-461.PubMedArticle UKE-LinkSolver
26.
Smith SM, Garic A, Berres ME, Flentke GR. Genomic factors that shape craniofacial outcome and neural crest vulnerability in FASD. Front Genet. 2014;5:224.PubMed
Lipinski RJ, Hammond P, O’Leary-Moore SK, et al. Ethanol-induced face-brain dysmorphology patterns are correlative and exposure-stage dependent. PLoS One. 2012;7(8):e43067.PubMedArticle UKE-LinkSolver
29.
Zuccolo L, Lewis SJ, Smith GD, et al. Prenatal alcohol exposure and offspring cognition and school performance. A ‘Mendelian randomization’ natural experiment. Int J Epidemiol. 2013;42(5):1358-1370.PubMedArticle UKE-LinkSolver
30.
Lewis SJ, Zuccolo L, Davey Smith G, et al. Fetal alcohol exposure and IQ at age 8: evidence from a population-based birth-cohort study. PLoS One. 2012;7(11):e49407.PubMedArticle UKE-LinkSolver
31.
Smith SM, Garic A, Flentke GR, Berres ME. Neural crest development in fetal alcohol syndrome. Birth Defects Res C Embryo Today. 2014;102(3):210-220.PubMedArticle UKE-LinkSolver
32.
Yang Y, Phillips OR, Kan E, et al. Callosal thickness reductions relate to facial dysmorphology in fetal alcohol spectrum disorders. Alcohol Clin Exp Res. 2012;36(5):798-806.
Just to enter the fray a little... I also am of the opinion that the flaming of "drive-by posters" is depressing and is bullying. I don't think the "it's the internet you should expect to be flamed" justifies the hurtful replies that individuals take the time out of their day to post. That excuse sounds like victim blaming to me, in fact. So they didn't read the "rules," no excuse for mob ridicule.
@milkbar I love the Kundera quote and think it sheds a lot of light on the defensive impulse among internet forums and moms groups. I am a slavist by education and profession and think Czech lit (and culture overall) is where it is at! Could go on and on about defensiveness in Slavic cultures, but it's a little too off topic.
@collectiveliving I agree that I'm def not so happy about the disparaging comments about women. People are people and all make mistakes I hate generalizations. I also think it's pretty rough to have the reason this thread went sour is because it's a bunch of women. Lol just log onto Reddit, 4chan or go to any sporting event to see men being petty af.
@collectiveliving I agree that I'm def not so happy about the disparaging comments about women. People are people and all make mistakes I hate generalizations. I also think it's pretty rough to have the reason this thread went sour is because it's a bunch of women. Lol just log onto Reddit, 4chan or go to any sporting event to see men being petty af.
So this is what happens when DH takes me out for lunch... I'm not even going to bother jumping back in at this point. @anewadventure Basically summed up what I'd say. I wanted to give @milkbar another chance, but damn... She couldn't be more condescending if she tried. That being said, I like everyone else here and respect the differing opinions, but it's because you also treat me with respect.
Re: New findings about alcohol: even low amounts can influence baby's development
@missphil Nice to see another Dec15 gal. I agree, that board was the same way towards the end of the 2nd trimester.
@milkbar thanks for the article and yea haven't looked at the scientific validity of this. I have not read expecting better but as a health care provider I always feel suspicious when someone comes out with a book "debunking" all research on a certain topic or calling conspiracy theories. I'm sure there's perfectly valid points in that book and will investigate myself at some point
I agree with @clovelyone that everyone parents differently and I think it's fine to get all perspectives out there but maybe not to assume that someone posting an article is a deliberate attack on you or your lifestyle .
Anyway I don't believe in necessarily kumbaya for the sake of it but I do think there's room for disagreement when it comes to something as complex and personal as parenting.
I had a very long discussion with @GraysonsMama about why I felt her views on sex and gender to be hurtful. I'm trying to see the parallel here and I guess it would be maybe @milkbar a post on a controversial topic may be good to approach in a tread lightly kind of way to avoid negative reactions or just otherwise you may have to expect the repercussions
Yeah, I'm guessing this is for me too. I feel like it's a lose-lose situation. I just do what feels right for me. Yeah, I'm gonna post an eyeroll gif when another drive by posts about Ramzi or nub theory. Maybe some newb will be discouraged from posting another and clogging our board, when they rarely come back to interact with us. As far as this whole alcohol article, it had poor timing. While it was coincidental, some of our regulars reasonably felt slighted after posting about indulging recently. I personally explained to her why her post was received the way it was and it lead to her posting an intro and I welcomed her.
I feel like no one is being unnecessarily flamed. Most of us are not being bullies. I don't think there is an in-crowd at all and this is not a popularity competition. But is it unreasonable to expect invested interaction? I don't think so. It's not about the amount of time spent on the board or how frequently one checks in. Hell, I've been MIA for the large part of the last couple weeks because mobile bump hates me. But I try to create meaningful connections with the women here who care, when I have a chance. I expect the same out of everyone else. That's what makes this a community, not just a dumping ground. And that is why my best friends in the whole world are from my first BMB.
@Millphil @babypi also D15 over here! Heyyy!
I think sometimes you read things and want to share with people who might have the same response as you did - of fear, or uncertainty - not to place judgment upon them or make them paranoid because misery likes company, but just to take the temperature and see if your own response was reasonable. I don't know if that makes sense. I'm friggin tired.
It's calming to see that there are people with adequate adult attitude in this community, who also find aggression unnecessary and unhealthy. The last thing you want to do when pregnant is to think of how to deal with attacks on an internet forum.
I am so surprised that it's happening here. It's not a teenager forum, we are all around 30, the future moms that supposed to be nurturing, caring and loving. We are all expecting babies, we should be here for each other, not against each other even if we don't agree on certain topics.
I have already witnessed some people saying are afraid to share information because they don't want to be attacked. And how many users just decided quietly not to get involved in this forum, after seeing the panopticon happening in this thread?
The study I shared might not have numbers available for us now, but it doesn't mean that it is invalid. It can be just as much valid as invalid. The chances are 50/50. Actually, it's the first study with its new findings puts a question mark on the validity of the epidemiological studies which the above mentioned book refers to. Isn't it information worth sharing?
I don't know what's up with the female-only communities, but they do tend to be overly hostile. My interaction here just reminded me a passage from the book "The Unbearable Lightness of Being" by Milan Kundera, on what I'll finish:
“It was drizzling. As people rushed along, they began opening umbrellas over their heads, and all at once the streets were crowded, too. Arched umbrella roofs collided with one another. The men were courteous, and when passing Tereza they held their umbrellas high over their heads and gave her room to go by. But the women would not yield; each looked straight ahead, waiting for the other woman to acknowledge her inferiority and step aside. The meeting of the umbrellas was a test of strength. At first Tereza gave way, but when she realized her courtesy was not being reciprocated, she started clutching her umbrella like the other women and ramming it forcefully against the oncoming umbrellas. No one ever said "Sorry." For the most part no one said anything, though once or twice she did hear a "Fat cow!" or "Fuck you!"
The women thus armed with umbrellas were both young and old, but the younger among them proved the more steeled warriors. Tereza recalled the days of the invasion and the girls in miniskirts carrying flags on long staffs. Theirs was a sexual vengeance: the Russian soldiers had been kept in enforced celibacy for several long years and must have felt they had landed on a planet invented by a science fiction writer, a planet of stunning women who paraded their scorn on beautiful long legs the likes of which had not been seen in Russia for the past five or six centuries.
She had taken many pictures of those young women against a backdrop of tanks. How she had admired them! And now these same women were bumping into her, meanly and spitefully. Instead of flags, they held umbrellas, but they held them with the same pride. They were ready to fight as obstinately against a foreign army as against an umbrella that refused to move out of their way. ”
Me: 36 DH: 41
For me, this article was nothing that I haven't heard before, and it's expected that someone would eventually post something like this. It's an eyeroll for me, but I don't care if you want to post it. Whatever. But if you do post an article that could be controversial, then get ready to have other people discuss how they feel about it. It's not all sunshine and rainbows everywhere all the time, ladies. We live in the world. Chill.
*gets down from soapbox
Sorry this is completely unrelated to the article. Lol.
DD - 12/28/17
TTC #2 3/2019
BFP 5/2019 || MC - D&C 5/2019
BFP 2/2020 || EDD 10/10/2020
@breezybee You are right, discussions with non-offensive exchange of opinions is healthy and help to see different perspectives. That's why I am very thankful to @Amber_Waves for her comments. But "dirty lurker", "sanctimom" and passive-agressive "Happy 9 months" is not a discussion. It's an attack.
"dirty lurker" was not meant for you - it's a term used to identify when someone is commenting on a thread when they are not a part of this board.
The others were jokes. They're supposed to be funny, not offensive. Some gentle teasing is really not a big deal. And really, to some, this article could be perceived as sanctimonious. Sorry. It's the truth.
Also, I care, love, and nurture my own children. I don't need to do that to internet strangers. This is not an attack or an attempt at bullying. Just stating that I'm not part of an online community to make new best friends.
It's total speculation on your part to say that because you think women are hyper critical of each other (or don't practice a "bro-mentality"), that's why we haven't had a woman president. In my community i am part of many women run groups or all women groups that do a much better job cooperating than many groups I've seen run by men.
I think sexism is real. Women and our opinions are devalued all the time. I think that's one of the main reasons why we haven't had a woman president yet.
I think there are also ways to be critical while also being compassionate, and to have real discussion, debate and dialogue with different people coming from different perspectives. Of course, on the internet this is difficult since we don't know each other in person, so it's hard to have a real relationship or really trust.
Due date 12/9
I can't figure out the pregnancy countdown tickers, but I do know how to make a signature!
#40andpregnant
As of 12/15/2017, my new hashtag is #41 and pregnant!
About the journal:
JAMA Pediatrics is a high impact factor (10+), peer-reviewed journal. (Online publication by a journal does not imply lack of peer-review, and the citation information reflects JAMA Pediatr. as the publishing journal.) Impact factors are a debatable and imperfect measure of journal quality, but it's a starting point for topics outside of my expertise.
Unfortunately, it's not covered by the journal subscriptions at work or through my university's alumni access. I can't get access to more than the abstract, so I can only base my opinions on what is presented there.
About the study:
The sample size seems large at first reading (>400), but that falls to around 200 when sub-divided by sex. Further when allocated into their strata for alcohol consumption, and timing of alcohol consumption. If we assume 4 consumption-bins (abstain, low, med, high/binge) and 3 trimester-bins, and an even distribution of patients across 12 resulting bins, each of those sex+consumption+trimester bins would have 16-17 patients. The study appears to be controlled/constrained for race and age, but it's unclear what other confounding factors (maternal age, health, nutrition, etc etc etc, there are so many possible) may be influential in their analysis. It's impossible to infer from the abstract whether they are powered to show significance for the differences they observed.
Someone else already mentioned that the apparent study design also can only show correlation, but not causation.
Opinions follow:
IMO, this makes the article an informational blurb that might support the existing US recommendations/standards. It doesn't change how I view alcohol use in my pregnancy, but I can see how it might reinforce another's resolve to keep with the guidelines (especially if they are applying a 'better safe than sorry' mentality to unknowns). For me, it doesn't shift the narrative or provide any actionable information (based on the abstract alone), but it also might be a cool pilot study worthy of additional follow up.
Eta: not calling anyone an a-hole; I'm just speaking in general
i am part of several women led or all women groups and we do a great job cooperating and getting stuff done. i get asked all the time if we have a hard time working together, since "you know how women are."
ugh
Due date 12/9
I can't figure out the pregnancy countdown tickers, but I do know how to make a signature!
#40andpregnant
As of 12/15/2017, my new hashtag is #41 and pregnant!
Sorry, no more comments from me on this account. Everybody have a nice day!
eta- Just watched the trailer and read a great review of it in the Village Voice. Yeah, @rainbowdashh I don't think I'll be watching it either.
A quote from the Village Voice review, about the supposedly feminist filmmaker, "I feel comfortable calling her “propagandist” because of my own “research” (ie. “reading the top search results”). Here’s something Elam wrote on A Voice for Men in 2010: “Should I be called to sit on a jury for a rape trial, I vow publicly to vote not guilty, even in the face of overwhelming evidence that the charges are true.” What excuse would any serious documentarian have for not asking Elam to explain that?"
https://www.villagevoice.com/2016/10/04/warning-you-cant-unsee-the-red-pill-the-documentary-about-a-filmmaker-who-learns-to-love-mras/
Due date 12/9
I can't figure out the pregnancy countdown tickers, but I do know how to make a signature!
#40andpregnant
As of 12/15/2017, my new hashtag is #41 and pregnant!
From the supplement to the study below I understand they considered Maternal age, Maternal pre pregnancy body mass index, Maternal smoking during pregnancy, Child birth weight and Child sex. But it's too short to really to understand a full picture.
https://jamanetwork.com/data/Journals/PEDS/0/POI170026supp1_prod.pdf
ETA: not sympathetic comes across harshly, but my point is there are other groups who aren't being heard in their fights and a group of men who feel their rights are being infringed on is not at the top of my "I'd like to help" list.
I continue to strenuously object to your incessant condescension. Get off your high horse. You're so far up there we can't even see you. You do not get to dictate how people respond to your thread. You do not get to indicate that only a certain type of response is acceptable. Even in your intro, you couldn't refrain from similar statements. Every single one of your posts is dripping with smugness.
Your constant insistence that any disagreement with you that isn't couched in rainbows, hugs, and kisses equates to childish, aggressive behavior is pretentious.
As for the other ladies that supposedly feel like non-regulars are flamed for participating, I think you need to reevaluate your opinion. The 400 drive-by posts about nub theory are all going to get the same response. NOT ONCE has a thread with a legitimate discussion involved any flaming of less frequent posters for daring to share their opinions. Controversial topics, such as this very thread, will obviously bring out strong reactions. As @vvitchhazel so kindly pointed out, if you are going to make a thread about a touchy subject, there is a better way to go about it than the OP. There was nothing wrong with pointing this out. It's not that there are OMG SO MANY RULES. It's not that people are supposed to magically know what those rules are. But if you come in here with a topic about drinking, birth defects, circumcision, formula feeding, etc. then don't expect rainbows and kisses even if you're a so-called "reg."
Please, participate.
As for the "this is why women didn't get the right to vote sooner" ... I don't have anything fit to print to say about this statement.
Met: September 2005 Married: October 2008 DS: 09/2014
as for the article not being a scientific study, I don't think it ever presumed to be. Some researchers found some data that is interesting and seems to support the current recommendations. It was published in a legitimate journal and needs more research in order to be verified as "scientific proof." That will probably never happen because it's generally presumed unethical to use a control group and an experiment group when we're dealing with something that could potentially harm unborn babies. It would also be difficult because, as people said, differences in cognitive ability can be related to differences in socioeconomic class and genetics.
Either way, the article didn't bother me either.
My university has the full text of the article. Here you are. A little puzzled by those who say the Journal of the American Medical Association is not "scientific". Which medical journal is then?! I have no stake in this game as I like drinking even less than I like data analysis, but the statisticians out there can have at it parsing the research here. The PDF of the article had some images and tables in addition, but I don't know how to share a pdf here. This is what what available through the text-only interface at JAMA. It is too long to post all together so I will split it up.
Association Between Prenatal Alcohol Exposure and Craniofacial Shape of Children at 12 Months of Age
Question Is there an association between different levels of prenatal alcohol exposure and child craniofacial shape at 12 months?
Findings This cohort study conducted an objective and sensitive craniofacial phenotype analysis of 415 children, which showed an association between prenatal alcohol exposure and craniofacial shape at almost every level of exposure examined. Differences in the midface and nose resemble midface anomalies associated with fetal alcohol spectrum disorder.
Meaning Any alcohol consumption has consequences on craniofacial development, supporting advice that complete abstinence from alcohol while pregnant is the safest option; it remains unclear whether the facial differences are associated neurocognitive outcomes of prenatal alcohol exposure.
Importance Children who receive a diagnosis of fetal alcohol spectrum disorder may have a characteristic facial appearance in addition to neurodevelopmental impairment. It is not well understood whether there is a gradient of facial characteristics of children who did not receive a diagnosis of fetal alcohol spectrum disorder but who were exposed to a range of common drinking patterns during pregnancy.
Objective To examine the association between dose, frequency, and timing of prenatal alcohol exposure and craniofacial phenotype in 12-month-old children.
Design, Setting, and Participants A prospective cohort study was performed from January 1, 2011, to December 30, 2014, among mothers recruited in the first trimester of pregnancy from low-risk, public maternity clinics in metropolitan Melbourne, Australia. A total of 415 white children were included in this analysis of 3-dimensional craniofacial images taken at 12 months of age. Analysis was performed with objective, holistic craniofacial phenotyping using dense surface models of the face and head. Partial least square regression models included covariates known to affect craniofacial shape.
Exposures Low, moderate to high, or binge-level alcohol exposure in the first trimester or throughout pregnancy.
Main Outcomes and Measures Anatomical differences in global and regional craniofacial shape between children of women who abstained from alcohol during pregnancy and children with varying levels of prenatal alcohol exposure.
Results Of the 415 children in the study (195 girls and 220 boys; mean [SD] age, 363.0 [8.3] days), a consistent association between craniofacial shape and prenatal alcohol exposure was observed at almost any level regardless of whether exposure occurred only in the first trimester or throughout pregnancy. Regions of difference were concentrated around the midface, nose, lips, and eyes. Directional visualization showed that these differences corresponded to general recession of the midface and superior displacement of the nose, especially the tip of the nose, indicating shortening of the nose and upturning of the nose tip. Differences were most pronounced between groups with no exposure and groups with low exposure in the first trimester (forehead), moderate to high exposure in the first trimester (eyes, midface, chin, and parietal region), and binge-level exposure in the first trimester (chin).
Conclusions and Relevance Prenatal alcohol exposure, even at low levels, can influence craniofacial development. Although the clinical significance of these findings is yet to be determined, they support the conclusion that for women who are or may become pregnant, avoiding alcohol is the safest option.
Prenatal alcohol exposure (PAE) is a major preventable cause of health and developmental problems in children. It may cause irreversible damage to the brain, resulting in fetal alcohol spectrum disorder (FASD), which is characterized by learning difficulties, executive dysfunction, impaired speech, motor problems, and behavior problems. Fetal alcohol spectrum disorder may affect 3% to 5% of mainstream school-aged children [. . .] [DELETED SECTION (Middle section of this paragraph] [. . .] Together these findings suggest a possible dose-related association between PAE and craniofacial shape.
Most of the studies cited have used facial measurements, which capture limited information and are prone to measurement error, or used clinical examination, which may be subjective. [. . .] [DELETED SECTION (remainder of this paragraph)]
EDITED TO DELETE CONTENT DUE TO INTELLECTUAL PROPERTY CONCERNS
Even in children of mothers who drink heavily, facial abnormalities associated with PAE are highly variable,5 which may reflect variation in the timing of exposure in the first trimester or unmeasured risk factors. For example, genetic variants in maternal and fetal alcohol metabolism have been shown to influence the level of alcohol and/or its toxic metabolites experienced by the fetus. [. . .] [REMAINDER OF PARAGRAPH DELETED]
We observed that children of mothers who reported feeling the effects of alcohol quickly or very quickly exhibited larger craniofacial differences in most exposure groups. We hypothesize that this rate of feeling the effects of alcohol reflects genetically determined variation in alcohol metabolism. The rate of feeling the effects of alcohol may ultimately be clinically useful to differentiate individuals with a greater susceptibility to the effects of alcohol, conferring increased fetal vulnerability, and may in part explain the heterogeneity of outcomes in alcohol-exposed pregnancies and in FASD.
Craniofacial development closely corresponds to brain induction and expansion, and, as such, characteristic facial differences have been linked to brain abnormalities and cognitive outcome in FASD.31 Correlative face-brain phenotypes have been described in human and animal studies, suggesting that the type and severity of brain abnormality may be predicted in part by hypoplasia of the midface,28,32 and that the classic facial features of FASD (short palpebral fissure, smooth philtrum, and thin upper lip) may assist in identifying children at risk of developing neurobehavioral deficits.5 Given that cognitive outcomes for the children in our study have not yet been examined in this context, it is as yet unknown if the craniofacial differences found are of diagnostic or predictive value.
Strengths and Limitations
This study is a well-described cohort of mother-child dyads with detailed PAE data and classification not available in many other studies. [. . .] [REMAINDER OF PARAGRAPH DELETED]
[PARAGRAPH DELETED]
We postulate that the rate of feeling the effects of alcohol is a proxy for metabolic factors influencing PAE and its association with facial shape, but have no direct measure such as blood alcohol concentration or alcohol elimination rates to examine. Investigation of maternal and/or child allelic differences (genotypes) at specific genes associated with alcohol metabolism or alcohol use behavior is under way.
Conclusions
The results of this study suggest that even low levels of alcohol consumption can influence craniofacial development of the fetus and confirm that the first trimester is a critical period. We observed aspects of a craniofacial phenotype with almost any level of PAE, something previously only documented following a high level of long-term alcohol exposure. Although the clinical significance of our findings is yet to be determined, these findings support the conclusion that, for women who are, or may become pregnant, avoiding alcohol is the safest option.
Back to top
Article Information
Accepted for Publication: March 2, 2017.
Corresponding Author: Jane Halliday, PhD, Public Health Genetics, Murdoch Childrens Research Institute, 50 Flemington Rd, Parkville, Victoria 3052, Australia (jane.halliday.h@mcri.edu.au).
Published Online: June 5, 2017. doi:10.1001/jamapediatrics.2017.0778
Author Contributions: Ms Muggli and Mr Matthews are co-first authors. Ms Muggli and Mr Matthews had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Muggli, Penington, O’Leary, Forster, Donath, Anderson, Nagle, Craig, Elliott, Halliday.
Acquisition, analysis, or interpretation of data: Muggli, Matthews, Claes, O’Leary, Forster, Donath, Lewis, Nagle, White, Elliott, Halliday.
Drafting of the manuscript: Muggli, Matthews, Donath, Nagle, White, Elliott, Halliday.
Critical revision of the manuscript for important intellectual content: Muggli, Matthews, Penington, Claes, O’Leary, Forster, Donath, Anderson, Lewis, Nagle, Craig, Elliott, Halliday.
Statistical analysis: Matthews, Claes, Donath, Halliday.
Obtained funding: Muggli, O’Leary, Forster, Anderson, Nagle, Craig, Elliott, Halliday.
Administrative, technical, or material support: Muggli, Matthews, Nagle, Craig, Elliott, Halliday.
Study supervision: Muggli, Penington, Claes, Anderson, Craig, Elliott, Halliday.
Conflict of Interest Disclosures: None reported.
Funding/Support: This work is supported by grant 1011070 from the Australian National Health and Medical Research Council, Senior Research Fellowships 1081288 (Dr Anderson) and 1021252 (Dr Halliday) from the Australian National Health and Medical Research Council, Practitioner Fellowship 1021480 (Dr Elliott) from the Australian National Health and Medical Research Council, and the Victorian State Government’s Operational Infrastructure Support Program.
Role of Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Ine Saey, MS, Department of Electrical Engineering, KU Leuven, contributed to the preliminary analyses; she was not compensated for her contribution. We also thank all the women and their children who are taking part in this study and the medical photographers who undertook the 3-dimensional imaging.
References
1.
Mattson SN, Crocker N, Nguyen TT. Fetal alcohol spectrum disorders: neuropsychological and behavioral features. Neuropsychol Rev. 2011;21(2):81-101.PubMedArticle UKE-LinkSolver
2.
May P, Baete A, Russo J, et al. Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics. 2014;134(5):855-866.PubMedArticle UKE-LinkSolver
3.
Hoyme HE, Kalberg WO, Elliott AJ, et al. Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders. Pediatrics. 2016;138(2):e20154256.PubMedArticle UKE-LinkSolver
4.
Manning MA, Eugene Hoyme H. Fetal alcohol spectrum disorders: a practical clinical approach to diagnosis. Neurosci Biobehav Rev. 2007;31(2):230-238.PubMedArticle UKE-LinkSolver
5.
Suttie M, Foroud T, Wetherill L, et al. Facial dysmorphism across the fetal alcohol spectrum. Pediatrics. 2013;131(3):e779-e788.PubMedArticle UKE-LinkSolver
6.
Moore ES, Ward RE, Jamison PL, Morris CA, Bader PI, Hall BD. New perspectives on the face in fetal alcohol syndrome: what anthropometry tells us. Am J Med Genet. 2002;109(4):249-260.PubMedArticle UKE-LinkSolver
7.
Foroud T, Wetherill L, Vinci-Booher S, et al. Relation over time between facial measurements and cognitive outcomes in fetal alcohol-exposed children. Alcohol Clin Exp Res. 2012;36(9):1634-1646.PubMedArticle UKE-LinkSolver
8.
May PA, Blankenship J, Marais AS, et al. Maternal alcohol consumption producing fetal alcohol spectrum disorders (FASD): quantity, frequency, and timing of drinking. Drug Alcohol Depend. 2013;133(2):502-512.PubMedArticle UKE-LinkSolver
9.
May PA, Tabachnick BG, Gossage JP, et al. Maternal risk factors predicting child physical characteristics and dysmorphology in fetal alcohol syndrome and partial fetal alcohol syndrome. Drug Alcohol Depend. 2011;119(1-2):18-27.PubMedArticle UKE-LinkSolver
10.
May PA, Marais AS, de Vries MM, et al. The continuum of fetal alcohol spectrum disorders in a community in South Africa: prevalence and characteristics in a fifth sample. Drug Alcohol Depend. 2016;168:274-286.PubMedArticle UKE-LinkSolver
11.
Shrimpton S, Daniels K, de Greef S, et al. A spatially-dense regression study of facial form and tissue depth: towards an interactive tool for craniofacial reconstruction. Forensic Sci Int. 2014;234:103-110.PubMedArticle UKE-LinkSolver
12.
Muggli E, O’Leary C, Forster D, et al. Study protocol: Asking QUestions about Alcohol in pregnancy (AQUA): a longitudinal cohort study of fetal effects of low to moderate alcohol exposure. BMC Pregnancy Childbirth. 2014;14(1):302.PubMedArticle UKE-LinkSolver
13.
O’Leary CM, Bower C, Zubrick SR, Geelhoed E, Kurinczuk JJ, Nassar N. A new method of prenatal alcohol classification accounting for dose, pattern and timing of exposure: improving our ability to examine fetal effects from low to moderate alcohol. J Epidemiol Community Health. 2010;64(11):956-962.PubMedArticle UKE-LinkSolver
14.
Muggli E, Cook B, O’Leary C, Forster D, Halliday J. Increasing accurate self-report in surveys of pregnancy alcohol use. Midwifery. 2015;31(3):e23-e28.PubMedArticle UKE-LinkSolver
15.
Muggli E, O’Leary C, Donath S, et al. “Did you ever drink more?”: a detailed description of pregnant women’s drinking patterns. BMC Public Health. 2016;16:683.PubMedArticle UKE-LinkSolver
16.
Matthews H, Penington T, Saey I, Halliday J, Muggli E, Claes P. Spatially dense morphometrics of craniofacial sexual dimorphism in 1-year-olds. J Anat. 2016;229(4):549-559.PubMedArticle UKE-LinkSolver
17.
Claes P. A Robust Statistical Surface Registration Framework Using Implicit Function Representations: Application in Craniofacial Reconstruction [PhD thesis]. Leuven, Belgium: Faculty of Engineering, Katholieke Universiteit Leuven; 2007.
18.
Claes P, Walters M, Clement J. Improved facial outcome assessment using a 3D anthropometric mask. Int J Oral Maxillofac Surg. 2012;41(3):324-330.PubMedArticle UKE-LinkSolver
19.
Snyders J, Claes P, Vandermeulen D, Suetens P. Development and Comparison of Non-Rigid Surface Registration and Extensions. Leuven, Belgium: Department of Electrical Engineering, Katholieke Universiteit Leuven; 2014. Technical Report KUL/ESAT/PSI/1401.
20.
Gower JC. Generalized Procrustes analysis. Psychometrika. 1975;40(1):33-51. doi:10.1007/BF02291478Article UKE-LinkSolver
21.
Gill SK, Broussard C, Devine O, Green RF, Rasmussen SA, Reefhuis J; National Birth Defects Prevention Study. Association between maternal age and birth defects of unknown etiology: United States, 1997-2007. Birth Defects Res A Clin Mol Teratol. 2012;94(12):1010-1018.PubMedArticle UKE-LinkSolver
22.
Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update. 2011;17(5):589-604.PubMedArticle UKE-LinkSolver
23.
Anderson MJ, Legendre P. An empirical comparison of permutation methods for tests of partial regression coefficients in a linear model. J Stat Comput Simul. 1999;62(3):271-303. doi:10.1080/00949659908811936Article UKE-LinkSolver
24.
Claes P, Liberton DK, Daniels K, et al. Modeling 3D facial shape from DNA. PLoS Genet. 2014;10(3):e1004224.PubMedArticle UKE-LinkSolver
25.
Iveli MF, Morales S, Rebolledo A, et al. Effects of light ethanol consumption during pregnancy: increased frequency of minor anomalies in the newborn and altered contractility of umbilical cord artery. Pediatr Res. 2007;61(4):456-461.PubMedArticle UKE-LinkSolver
26.
Smith SM, Garic A, Berres ME, Flentke GR. Genomic factors that shape craniofacial outcome and neural crest vulnerability in FASD. Front Genet. 2014;5:224.PubMed
27.
Hill MA. Carnegie stage comparison. https://embryology.med.unsw.edu.au/embryology/index.php/Carnegie_Stage_Comparison. Accessed September 11, 2016.
28.
Lipinski RJ, Hammond P, O’Leary-Moore SK, et al. Ethanol-induced face-brain dysmorphology patterns are correlative and exposure-stage dependent. PLoS One. 2012;7(8):e43067.PubMedArticle UKE-LinkSolver
29.
Zuccolo L, Lewis SJ, Smith GD, et al. Prenatal alcohol exposure and offspring cognition and school performance. A ‘Mendelian randomization’ natural experiment. Int J Epidemiol. 2013;42(5):1358-1370.PubMedArticle UKE-LinkSolver
30.
Lewis SJ, Zuccolo L, Davey Smith G, et al. Fetal alcohol exposure and IQ at age 8: evidence from a population-based birth-cohort study. PLoS One. 2012;7(11):e49407.PubMedArticle UKE-LinkSolver
31.
Smith SM, Garic A, Flentke GR, Berres ME. Neural crest development in fetal alcohol syndrome. Birth Defects Res C Embryo Today. 2014;102(3):210-220.PubMedArticle UKE-LinkSolver
32.
Yang Y, Phillips OR, Kan E, et al. Callosal thickness reductions relate to facial dysmorphology in fetal alcohol spectrum disorders. Alcohol Clin Exp Res. 2012;36(5):798-806.
@milkbar I love the Kundera quote and think it sheds a lot of light on the defensive impulse among internet forums and moms groups. I am a slavist by education and profession and think Czech lit (and culture overall) is where it is at! Could go on and on about defensiveness in Slavic cultures, but it's a little too off topic.
@collectiveliving I agree that I'm def not so happy about the disparaging comments about women. People are people and all make mistakes I hate generalizations. I also think it's pretty rough to have the reason this thread went sour is because it's a bunch of women. Lol just log onto Reddit, 4chan or go to any sporting event to see men being petty af.
So this is what happens when DH takes me out for lunch... I'm not even going to bother jumping back in at this point. @anewadventure Basically summed up what I'd say. I wanted to give @milkbar another chance, but damn... She couldn't be more condescending if she tried. That being said, I like everyone else here and respect the differing opinions, but it's because you also treat me with respect.