Multimodal neuroimaging and early neurobehavioural and developmental correlates of alcohol and methamphetamine exposed infants in Cape Town

Includes bibliographical referencesAlcohol use and alcohol use disorders contribute a significant proportion of the burden of disease in low, middle, and high-income countries. As a result, fetal alcohol spectrum disorders (FASD) represent one of the most common preventable causes of intellectual disability globally. Understanding the core brain areas of susceptibility to prenatal alcohol as they manifest in early life is key to developing strategies for early focused identification and intervention. This thesis explored the relative impact of prenatal alcohol exposure on the brain in infants as measured by multimodal brain imaging and the relationship of these findings to early neurobehavioral and developmental status. The specific aims the thesis addressed included leveraging structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), proton magnetic resonance spectroscopy (1H-MRS) and resting sate functional MRI (rs-fMRI) scans in approximately 100 infants (50 alcohol exposed and a matched number of control, unexposed babies) at 2-4 weeks of age, to assess group differences in early brain development. Correlations between multimodal neuroimaging measures and neonatal neurobehavioral assessments and associations between early structural imaging findings and later infant developmental, as measured by the Bayley III assessment at 6 months, were further explored in the same group of infants. These studies addressed the hypothesis that maternal alcohol use in pregnancy would result in quantitative MRI abnormalities demonstrable at 2-4weeks of age and that these changes would correlate with early indicators of neurobehavior and development. Chapter 1 presents the rationale and outline of the thesis. The burden of fetal alcohol spectrum disorders (FASD) is described in the context of different resource settings around the world with detailed reference to South Africa. Chapter 2 presents a published systematic literature review of published studies of MRI in children and adolescents with prenatal alcohol exposure. Chapter 3 provides an overall description of the methods and context for this study. Although the results chapters each include a focused methods section, the word restrictions of journal articles did not allow for adequate contextual detail for the project as a whole