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Pediatric Nephrology
Published in: Pediatric Nephrology 4/2020

01-04-2020 | Obesity | Original Article

Prenatal alcohol exposure affects renal function in overweight schoolchildren: birth cohort analysis

Authors: Liane Correia-Costa, Franz Schaefer, Alberto Caldas Afonso, Sofia Correia, João Tiago Guimarães, António Guerra, Henrique Barros, Ana Azevedo

Published in: Pediatric Nephrology | Issue 4/2020

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Abstract

Background

Prenatal ethanol exposure has been shown to reduce nephron endowment in animal models, but the effect of alcohol during human pregnancy on postnatal kidney function has not been explored. We aim to investigate the potential association of maternal alcohol consumption during pregnancy with the offspring renal function, considering potential confounding by intrauterine growth and children’s current nutritional status.

Methods

Prospective longitudinal study in a random sample of 1093 children from a population-based birth cohort. Anthropometrics and estimated glomerular filtration rate (eGFR) were assessed at 7 years of age. Multiple linear regression models were fitted, adjusting for child’s gender, age, birthweight, and maternal age, education, prepregnancy nutritional status, and smoking.

Results

Thirteen percent of mothers consumed alcohol during pregnancy. At 7 years of age, eGFR was significantly lower in children with prenatal alcohol exposure (134 ± 17 vs.138 ± 16 mL/min/1.73m2, p = 0.014). The effect was dose dependent and only present in overweight and obese children, among whom adjusted eGFR was −6.6(−12.0 to −1.1)mL/min/1.73m2 and −11.1(−21.3 to −1.2)mL/min/1.73m2 in those exposed to ≤ 40 g and to > 40 g of alcohol per week, respectively, compared to no consumption (ptrend = 0.002).

Conclusions

Prenatal alcohol exposure has a dose-dependent adverse effect on renal function at school age in overweight and obese children.
Literature
1.
Ritz E, Amann K, Koleganova N, Benz K (2011) Prenatal programming-effects on blood pressure and renal function. Nat Rev Nephrol 7:137–144PubMed
2.
Kuure S, Vuolteenaho R, Vainio S (2000) Kidney morphogenesis: cellular and molecular regulation. Mech Dev 92:31–45PubMed
3.
Kingdom JC, Hayes M, McQueen J et al (1999) Intrauterine growth restriction is associated with persistent juxtamedullary expression of renin in the fetal kidney. Kidney Int 55:424–429PubMed
4.
Moreau E, Vilar J, Lelièvre-Pégorier M et al (1998) Regulation of c-ret expression by retinoic acid in rat metanephros: implication in nephron mass control. Am J Phys 275:F938–F945
5.
Woods LL, Ingelfinger JR, Nyengaard JR, Rasch R (2001) Maternal protein restriction suppresses the newborn renin-angiotensin system and programs adult hypertension in rats. Pediatr Res 49:460–467PubMed
6.
Dagan A, Gattineni J, Cook V, Baum M (2007) Prenatal programming of rat proximal tubule Na+/H+ exchanger by dexamethasone. Am J Phys Regul Integr Comp Phys 292:R1230–R1235
7.
Vikse BE, Irgens LM, Leivestad T et al (2008) Low birth weight increases risk for end-stage renal disease. J Am Soc Nephrol 19:151–157PubMedPubMedCentral
8.
Lackland DT, Egan BM, Fan ZJ, Syddall HE (2001) Low birth weight contributes to the excess prevalence of end-stage renal disease in African Americans. J Clin Hypertens 3:29–31
9.
White SL, Perkovic V, Cass A et al (2009) Is low birth weight an antecedent of CKD in later life? a systematic review of observational studies. Am J Kidney Dis 54:248–261PubMed
10.
Hallan S, Euser AM, Irgens LM et al (2008) Effect of intrauterine growth restriction on kidney function at young adult age: the Nord Trøndelag Health (HUNT 2) Study. Am J Kidney Dis 51:10–20PubMed
11.
Vehaskari VM (2010) Prenatal programming of kidney disease. Curr Opin Pediatr 22:176–182PubMed
12.
Baum M (2010) Role of the kidney in the prenatal and early postnatal programming of hypertension. Am J Physiol Ren Physiol 298:F235–F247
13.
Moritz KM, Mazzuca MQ, Siebel AL et al (2009) Uteroplacental insufficiency causes a nephron deficit, modest renal insufficiency but no hypertension with ageing in female rats. J Physiol 587:2635–2646PubMedPubMedCentral
14.
Brenner BM, Garcia DL, Anderson S (1988) Glomeruli and blood pressure. Less of one, more the other? Am J Hypertens 1:335–347PubMed
15.
Parkington HC, Coleman HA, Wintour EM, Tare M (2010) Prenatal alcohol exposure: implications for cardiovascular function in the fetus and beyond. Clin Exp Pharmacol Physiol 37:e91–e98PubMed
16.
Parkington HC, Kenna KR, Sozo F et al (2014) Maternal alcohol consumption in pregnancy enhances arterial stiffness and alters vasodilator function that varies between vascular beds in fetal sheep. J Physiol 592:2591–2603PubMedPubMedCentral
17.
Gray SP, Denton KM, Cullen-McEwen L et al (2010) Prenatal exposure to alcohol reduces nephron number and raises blood pressure in progeny. J Am Soc Nephrol 21:1891–1902PubMedPubMedCentral
18.
Moore CA, Khoury MJ, Liu Y (1997) Does light-to-moderate alcohol consumption during pregnancy increase the risk for renal anomalies among offspring? Pediatrics 99:E11PubMed
19.
Epstein FH, Brenner BM, Meyer TW, Hostetter TH (1982) Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med 307:652–659
20.
Abitbol CL, Chandar J, Rodríguez MM et al (2009) Obesity and preterm birth: additive risks in the progression of kidney disease in children. Pediatr Nephrol 24:1363–1370PubMed
21.
Cignarelli M, Lamacchia O (2007) Obesity and kidney disease. Nutr Metab Cardiovasc Dis 17:757–762PubMed
22.
Gunta SS, Mak RH (2013) Is obesity a risk factor for chronic kidney disease in children? Pediatr Nephrol 28:1949–1956PubMed
23.
Nenov VD, Taal MW, Sakharova OV, Brenner BM (2000) Multi-hit nature of chronic renal disease. Curr Opin Nephrol Hypertens 9:85–97PubMed
24.
Silverwood RJ, Pierce M, Hardy R et al (2013) Low birth weight, later renal function, and the roles of adulthood blood pressure, diabetes, and obesity in a British birth cohort. Kidney Blood Press Res 84:1262–1270
25.
Silverwood RJ, Pierce M, Hardy R et al (2013) Early-life overweight trajectory and CKD in the 1946 British birth cohort study. Am J Kidney Dis 62:276–284PubMedPubMedCentral
26.
Larsen PS, Kamper-Jorgensen M, Adamson A et al (2013) Pregnancy and birth cohort resources in Europe: a large opportunity for aetiological child health research. Paediatr Perinat Epidemiol 27:393–414PubMed
27.
(1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr 68:899–917.
28.
Rasmussen K, Yaktine A (2009) Weight gain during pregnancy: reexamining the guidelines; Washington (DC): National Academies Press (US) 2009
29.
Fenton TR, Kim JH (2013) A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 13:59PubMedPubMedCentral
30.
Hoyme HE, Kalberg WO, Elliott AJ et al (2016) Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders. Pediatrics 138:e20154256PubMedPubMedCentral
31.
Durão C, Severo M, Oliveira A et al (2014) Evaluating the effect of energy-dense foods consumption on preschool children’s body mass index: a prospective analysis from 2 to 4 years of age. Eur J Nutr 54:835–843PubMed
32.
de Onis M, Onyango AW, Borghi E et al (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85:660–667PubMedPubMedCentral
33.
Flynn JT, Kaelber DC, Baker-Smith CM et al (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904PubMed
34.
Zappitelli M, Parvex P, Joseph L et al (2006) Derivation and validation of cystatin C-based prediction equations for GFR in children. Am J Kidney Dis 48:221–230PubMed
35.
Hutchinson D, Moore EA, Breen C et al (2013) Alcohol use in pregnancy: prevalence and predictors in the Longitudinal Study of Australian Children. Drug Alcohol Rev 32:475–482PubMed
36.
Mills JL, Graubard BI, Harley EE et al (1984) Maternal alcohol consumption and birth weight. How much drinking during pregnancy is safe? JAMA 252:1875–1879PubMed
37.
Dörrie N, Föcker M, Freunscht I, Hebebrand J (2014) Fetal alcohol spectrum disorders. Eur Child Adolesc Psychiatry 23:863–875PubMed
38.
Taylor CL, Jones KL, Jones MC, Kaplan GW (1994) Incidence of renal anomalies in children prenatally exposed to ethanol. Pediatrics 94:209–212PubMed
39.
Qazi Q, Masakawa A, Milman D et al (1979) Renal anomalies in fetal alcohol syndrome. Pediatrics 63:886–889PubMed
40.
Havers W, Majewski F, Olbing H, Eickenberg HU (1980) Anomalies of the kidneys and genitourinary tract in alcoholic embryopathy. J Urol 124:108–110PubMed
41.
Gray SP, Kenna K, Bertram JF et al (2008) Repeated ethanol exposure during late gestation decreases nephron endowment in fetal sheep. Am J Phys Regul Integr Comp Phys 295:R568–R574
42.
O’Leary CM, Taylor C, Zubrick SR et al (2013) Prenatal alcohol exposure and educational achievement in children aged 8-9 years. Pediatrics 132:e468–e475PubMed
43.
Alati R, Davey Smith G, Lewis SJ et al (2013) Effect of prenatal alcohol exposure on childhood academic outcomes: contrasting maternal and paternal associations in the ALSPAC study. PLoS One 8:e74844PubMedPubMedCentral
44.
(2008) National Collaborating Centre for Women’s and Children’s Health. Antenatal Care: Routine Care for the Healthy Pregnant Woman. NICE Clin Guidel RCOG Press 62:1–58.
45.
Gilliam DM, Mantle MA, Barkhausen DA, Tweden DR (1997) Effects of acute prenatal ethanol administration in a reciprocal cross of C57BL/6 J and short-sleep mice: maternal effects and nonmaternal factors. Alcohol Clin Exp Res 21:28–34PubMed
46.
Assadi FK, Zajac CS (1992) Ultrastructural changes in the rat kidney following fetal exposure to ethanol. Alcohol 9:509–512PubMed
47.
Assadi FK, Manaligod JR, Fleischmann LE, Zajac CS (1991) Effects of prenatal ethanol exposure on postnatal renal function and structure in the rat. Alcohol 8:259–263PubMed
48.
Assadi FK (1990) Renal tubular dysfunction in fetal alcohol syndrome. Pediatr Nephrol 4:48–51PubMed
49.
Mathew AV, Okada S, Sharma K (2011) Obesity related kidney disease. Curr Diabetes Rev 7:41–49PubMed
50.
Bacchetta J, Cochat P, Rognant N et al (2011) Which creatinine and cystatin C equations can be reliably used in children? Clin J Am Soc Nephrol 6:552–560PubMedPubMedCentral
51.
Andersen TB, Eskild-Jensen A, Frøkiaer J, Brøchner-Mortensen J (2009) Measuring glomerular filtration rate in children; can cystatin C replace established methods? A review. Pediatr Nephrol 24:929–941PubMed
52.
Baña A, Tabernero MJ, Pérez-Muñuzuri A et al (2014) Prenatal alcohol exposure and its repercussion on newborns. J Neonatal-Perinatal Med 7:47–54PubMed
Metadata
Title
Prenatal alcohol exposure affects renal function in overweight schoolchildren: birth cohort analysis
Authors
Liane Correia-Costa
Franz Schaefer
Alberto Caldas Afonso
Sofia Correia
João Tiago Guimarães
António Guerra
Henrique Barros
Ana Azevedo
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 4/2020
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-019-04429-x

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