Alcoholism.

INTRODUCTION: Illicit substance use in pregnancy has received significant media attention over the past 25 years. However, far too little attention has been given to the consequences of the use/misuse of social drugs such as tobacco and ethanol, which are by far the most commonly used/misused substances in pregnancy. DISCUSSION: While the deleterious effects of amphetamines or cocaine on the mother and the fetus are more pronounced and easier to detect, the addiction to tobacco and ethanol is usually subtle and more difficult to diagnose. As a result, recreational use of tobacco and alcohol in pregnancy may continue undetected, significantly impacting pregnancy outcome and the peripartum management of these patients.

Alcoholism↗

PubMed2004

Chronic alcoholism causes deleterious conditioning of innate immunity.

AIMS: To examine the immune consequences of chronic alcoholism in man, in relation to the known association between alcoholism and raised incidence and severity of infections. METHODS: In 36 alcoholics without liver disease, at the point of commencing withdrawal from alcohol, the following measures of immune competence were measured: the immunophenotypes of cells, acute phase proteins, the endotoxin-neutralizing capacity (ENC) of the serum, titers of anti-lipopolysaccharide (LPS) antibodies, and ex vivo cytokine inducibility in T cells and monocytes (TNFalpha, IL1beta, IL1RA, IL4, IL6, IL8, IL10 and IL12). The results were compared to those from healthy volunteers (day controls). Measures were repeated after 8-13 days of abstinence. RESULTS: LPS-binding protein (LBP) and soluble CD14 (sCD14) were significantly increased in patients' sera at the outset of withdrawal, whereas reduced titers of anti-LPS IgG (P = 0.012) and a reduced ENC (P = 0.001) were measured. Only ENC rapidly returned to normal values after withdrawal therapy. Cytokine induction with phorbol ester showed no significant alterations in patients' T cells. Patients' monocytes, however, responded to LPS stimulation with enhanced IL1beta-, but reduced TNFalpha- and IL12-production (P = 0.004, P = 0.0042 and P = 0.001, respectively). While IL1- and TNFalpha-responses normalized after the withdrawal period, impairment of the IL12 response persisted throughout the observation period of 2 weeks. CONCLUSIONS: Alcoholism results in a prolonged LPS-mediated hypoinflammatory conditioning of the innate but not the adaptive immune system, which is not reversed immediately after withdrawal. This alcohol-induced status of the immune system predisposes to infections and sepsis by blunting initial response to the pathogens.

Alcoholism↗