What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: In utero exposure to alcohol and cigarette smoking (n=307). Intervention: In utero alcohol and tobacco exposure vs. No exposure (control group). Primary outcome: Left carotid intima-media thickness (LcIMT) (b = 0.0128, 95% CI 0.0002-0.0255, p=<0.05).

August 7, 2025BMC Cardiovascular Disorders1 citationsOpen Access

Carotid intima–media thickness and endothelial function in adolescents exposed to alcohol consumption and cigarette smoking in utero: a mediation analysis

Q: What are the key findings of this study?

The duration of maternal alcohol consumption during pregnancy was significantly associated with increased left carotid intima-media thickness in adolescents.

Q: What does this research mean for the field?

The duration of maternal alcohol consumption during pregnancy is significantly associated with increased left carotid intima-media thickness in adolescents. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

THTammy Charlene HartelUniversity of the Western Cape ASAamer SandooBangor University AOA OelofseUniversity of the Western Cape

Key Result

The duration of maternal alcohol consumption during pregnancy was significantly associated with increased left carotid intima-media thickness in adolescents.

Study Design

Type

Cross-Sectional (n=307)

Blinding

Single-blind

Multicenter

Yes

Structured PICO

Does in utero exposure to alcohol and cigarette smoking affect carotid intima-media thickness and flow-mediated dilation in adolescents?

Population

307 adolescents (aged 10-14) and their mothers from a low socioeconomic population in Cape Town, South Africa.

Intervention

In utero exposure to alcohol and/or cigarette smoking (tobacco-exposed n=115, dual-exposed n=73, alcohol-exposed n=14)

Comparator

No in utero exposure to alcohol or cigarette smoking (control group, n=105)

Outcome

Carotid intima-media thickness (cIMT) and flow-mediated dilation (FMD), including brachial artery peak diametersurrogate

In utero exposure to alcohol is associated with increased left carotid intima-media thickness and reduced brachial artery peak diameter in adolescents, suggesting early subclinical vascular changes.

Main Result

Effect estimate: b = 0.0128 (95% CI 0.0002-0.0255)

p-value: p=<0.05

Limitations

Possibility of recall bias regarding maternal smoking and drinking habits
Could not control for maternal preeclampsia and gestational hypertension
Physical activity of the mothers was not recorded
Smaller-than-expected sample size for the FMD measurements due to movement artifacts
Several participants were lost to follow-up

Abstract

Abstract Background Previous studies have shown the effects of teratogen exposure in utero on the vascular system, but its direct and indirect effects are still questionable. Therefore, this study explored the effects of potential mediators of teratogen exposure on carotid intima–media thickness (cIMT) and flow-mediated dilation (FMD). Methods This study was conducted between January 2022 and August 2024 in Cape Town, South Africa, and included 307 adolescents (aged 10–14) and their mothers. Anthropometry data, lipid profiles, systolic (SBP) and diastolic blood pressure (DBP), physical activity and maternal health behaviours were obtained. Vascular measurements (left and right cIMT and brachial artery FMD) were obtained via ultrasound, which included analysing the peak artery diameter separately. Statistical analyses were performed via SPSS ® version 29, and mediation analyses were conducted via PROCESS Macros. Results The cohort included a control group ( n = 105), tobacco-exposed individuals ( n = 115), dual-exposed individuals (tobacco and alcohol) ( n = 73), and alcohol-exposed individuals ( n = 14). A significant positive correlation was observed between alcohol exposure duration and LcIMT (rho = 0.531, p < 0.05), and a strong negative correlation was observed with peak diameter (rho=-0.788, p < 0.001), with a very strong correlation in males ( r =-0.894, p < 0.05). The duration of alcohol exposure significantly affected LcIMT ( p = 0.0468) after adjusting for body mass index (BMI), SBP and DBP. However, brachial artery (BA) peak diameter was not significantly associated with the duration of alcohol consumption during pregnancy after the adjustment for age, SBP or BA baseline diameter. Conclusion Increased BMI and SBP may contribute to a reduced peak diameter in adolescents exposed to alcohol, potentially indicating lower FMD in adulthood. Further studies should elucidate the biological mechanisms involved through long-term prospective studies.

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