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Biomedical subjects

C B Ernhart

Publications and source records attributed to C B Ernhart.

At least 19 recordsLinked to original sources
PubMed1992

Contributions of risk factors to elevated blood and dentine lead levels in preschool children.

The relationship between blood lead level (PbB) and an array of socio-demographic, behavioral, caregiving and environmental risk factors was investigated in a cohort of socioeconomically disadvantaged urban children at ages 2, 3 and 4 years and 10 months. The risk factors were also related to dentine lead level (PbD) from shed deciduous teeth. Strong persistent pairwise relationships with PbB and PbD were observed for maternal IQ, parental education, examiner ratings of the condition and cleanliness of the physical environment, and the HOME scale, which assesses the quality of the caretaking environment. The association between dirt pica and PbB was strong at 2 years (r = 0.30), but was less pronounced in subsequent assessments as the prevalence of pica decreased. Insignificant or weak relationships were found for maternal assessments of paint-and-plaster peeling in the home and non-dirt pica. The HOME scale and the ratings of the condition of the physical environment were significantly related to PbB and PbD even after adjustment for socio-demographic factors. These two measures were also strongly related to an array of developmental outcomes. The results indicate that statistical adjustment specifically for the quality of the caretaking environment can lead to substantial reductions in estimates of adverse lead effects.

Adult↗
PubMed1992

Postpartum changes in maternal blood lead concentrations.

Studies of lead concentrations in blood during pregnancy are of interest because of the possibility of adverse effects on the fetus. One report of a single case suggested that blood lead concentrations are raised during pregnancy. This is consistent with the hypothesis of a pregnancy induced mobilisation of lead from bone. Data presented herein, however, indicate that blood lead measures are appreciably lower at delivery than they are at six months post partum. Other factors including but not limited to transmission to the fetus, may be influencing lead concentrations during pregnancy.

Adult↗
PubMed1991

Prenatal alcohol exposure and preschool physical growth: a longitudinal analysis.

This report examines the effects of fetal alcohol exposure on size and growth in an urban cohort followed prospectively through early childhood. Indices of prenatal drinking were related to measurements of weight, stature (length), and head circumference obtained at birth and during five subsequent in-home assessments. Small but statistically significant relationships were detected between short-term recall estimates of drinking during pregnancy and weight and length at birth. The strength of these relationships diminished during the preschool assessments. However, estimates of catch-up growth associated with alcohol exposure were not statistically significant. With the exception of a single case with a profile of signs characteristic of fetal alcohol syndrome, an adverse effect of prenatal alcohol exposure on head circumference was not indicated.

Alcohol Drinking↗
PubMed1991

Adjustment for cofactors in pediatric research.

Behavioral and developmental pediatric research often seeks to form causal inferences from associations between variables obtained in nonrandomized studies. To do this it is necessary to distinguish the effects of the independent variable of interest from other factors with which it is correlated. We review statistical adjustment procedures for assessing the effects of the independent variable after controlling for other variables, called cofactors. We present guidelines for cofactor adjustment for different patterns of causal relationships occurring in the developmental pediatric literature. We also review procedures for selecting a subset of cofactors from a larger array of candidate variables. Finally, we examine common methodological complications related to cofactor adjustment, including the presence of measurement error in the independent variable and/or the cofactors.

Child↗
PubMed1991

Clinical correlations between ethanol intake and fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) is a cluster of features observed in some offspring of women who abuse alcohol in pregnancy. The defining features include intrauterine growth retardation, specific craniofacial dysmorphology, and central nervous system dysfunction. FAS is a full expression of a continuum of fetal alcohol effects. The assessment of alcohol abuse is one of several major problems in the study of the topic. Research findings are reviewed under a hypothesis of increasing effect in ordered categories: lethal effects, adverse obstetrical outcomes, malformations, growth retardation, reduced head circumference, and neuropsychological effects. Evidence of fetal alcohol effects may be found for each outcome category. The evidence across studies is not consistent nor is there any clear support for an effect order. The risk for psychological deficit may depend on the presence of dysmorphic effects.

Alcohol Drinking↗
PubMed1990

Prenatal alcohol exposure and language development.

The effects of fetal alcohol exposure on language and speech acquisition were investigated in a cohort of socioeconomically disadvantaged urban children. Language development was assessed by instruments derived from the Expressive and Receptive Scales of the Sequenced Inventory of Communication Development (SICD) at 1, 2, and 3 years, and by indices constructed from a taped speech sample at age 2 years. Three indices of maternal drinking were supplemented with birth weight and a tally of craniofacial anomalies as early indicators of fetal alcohol damage. No statistically significant relationships were found between the alcohol and language indices after statistical control for confounding variables. The anomalies tally was marginally related to reduced language scores. The statistical significance of this relationship, depended, however, on a single child with the characteristics of fetal alcohol syndrome. The pattern of results suggested that the anomalies tally, and to a lesser extent birth weight, are more sensitive indicators of fetal alcohol exposure than subsequent language development.

Child, Preschool↗
PubMed1989

Underreporting of alcohol use in pregnancy: relationship to alcohol problem history.

Assessment of alcohol-related fetal risk is complicated by difficulties in assessing alcohol exposure. We previously described considerable underreporting of alcohol use during pregnancy, particularly among problem drinkers. This report is of the relationship between severity of drinking problems and the magnitude of underreporting. Pregnant disadvantaged women responded to the Michigan Alcoholism Screening Test (MAST) at the first antenatal visit and provided self-report data regarding alcohol use at each antenatal visit. Five years later, 238 of these women again provided self-report information about drinking during the target pregnancy. Underreporting was defined as a positive difference between the indices computed from the retrospective and the in-pregnancy data. The relationship of underreporting to the MAST score was highly significant and indicated a 20-fold increase in underreporting from the lowest to highest MAST score. However, the marked individual variability seen in this relationship indicates that while the MAST may be a better indicator of risk than self-reports of drinking, it is also not sufficient for the purpose. Further work examining other measures and techniques for obtaining drinking information is indicated.

Adult↗
PubMed1988

Breastfeeding and cognitive development in the first 2 years of life.

The relationship between breastfeeding and cognitive development in the first 2 years of life was examined in a cohort of children being followed in a study of risk factors in development. A significant difference between bottlefed children, children breastfed less than or equal to 4 months and those breastfed greater than 4 months was found on the Mental Development Index of the Bayley Scales at ages 1 and 2 years, favoring the breastfed children. At age 6 months, the direction of the relationship was the same but did not reach significance. Supplementary regression analyses examining the strength of the relationship between duration of breastfeeding and cognitive development similarly showed a small but significant relationship between duration of breastfeeding and scores on the Bayley at 1 and 2 years. Alternative explanations for the results are discussed.

Analysis of Variance↗
PubMed1988

Underreporting of alcohol use in pregnancy.

Studies of alcohol-related birth defects in humans rely heavily on maternal self-reports of alcohol use. The accuracy of self-reports, and thus of related risk levels, is of concern to investigators, to public health professionals, and to persons advising pregnant women. We contrasted quantitative reports of drinking in pregnancy by 238 women with retrospective reports obtained 5 years later. Although correlated (r = 0.67, p less than 0.0001), marked discrepancies suggested underreporting during pregnancy by a significant proportion of the women. The validity of the retrospective index was indicated in that it was somewhat more highly related to scores on the Michigan Alcoholism Screening Test (MAST) and to a tally of alcohol-related craniofacial anomalies in the neonate than was the in-pregnancy index. Furthermore, the retrospective index and the MAST score were significant predictors of other neonatal anomalies; the in-pregnancy index was not. The only variable related to underreporting was MAST score, i.e., the higher the MAST score the greater the underreporting. The results suggest that previously reported thresholds of effect based on self-report data may be underestimates. The results also suggest that questions regarding alcohol-related problems may be more effective than direct consumption questions in the identification of women who drink heavily in pregnancy.

Alcohol Drinking↗
PubMedDate not supplied

Low level lead exposure in the prenatal and early preschool periods: early preschool development.

The hypothesis that low level lead exposure in the fetal and early preschool years is related to neuropsychological deficit was examined in a prospective study of child development. We also tested the hypothesis of reverse causality, i.e., that lead level is a function of prior developmental status. Fetal lead exposure was measured in maternal and cord blood while preschool lead level was measured in venous blood samples at ages six months, two years and three years. These blood lead measures (PbB) were related to concurrent and ensuing scores on developmental measures at six months, one year, two years, and three years. With statistical control of covariate measures (age, sex, race, birth weight, birth order, gestational exposure to other toxic substances, maternal intelligence, and several indicators of the quality of the caretaking environment) as well as potentially confounding risk factors (gestational exposure to alcohol and other toxic substances), most statistically significant associations of PbB with concurrent and later development were completely attenuated. Effects of lead exposure, significant or not, were not consistent in direction. In reverse-causality analyses, PbB was not related significantly to prior measures of developmental retardation or acceleration. It was concluded that the relationship of lead level and measures of development in these early years was primarily a function of the dependence of each on the quality of the caretaking environment.

Developmental Disabilities↗