Overview

Currently, we don't know how much alcohol pregnant women can safely drink without harming the developing baby, so avoiding alcohol entirely is the best option.

The lack of knowledge in this area has the potential to cause anxiety for women who drink even small amounts of alcohol before realising they are pregnant.

This also creates problems for doctors and midwives about how to best advise women.

Through their involvement in this research project, participants are helping researchers find out whether low or moderate alcohol drinking during pregnancy adversely affects early childhood health and development.

In the future, this information may be useful for women planning to get pregnant, pregnant women, and the health professionals who provide maternity care.

Aims of AQUA

The research aims to collect detailed information about alcohol consumption in pregnancy from a large group of pregnant women and to assess the effect of different doses of alcohol and other associated influences on the unborn child.

The specific aims of this project are to find out whether:

• Low to moderate quantities of alcohol at various stages of pregnancy are associated with problems in the health and development of young children and,
• Maternal DNA variations, specific dietary factors,factors, or other environmental influences can affect the impact of low-to-moderate quantities of alcohol in pregnancy.

Our study has been conducted in two stages.

Research team

Principal investigator

• Professor Peter Anderson (Murdoch Children's Research Institute)

Chief investigators

• Evi Muggli (Project Manager)
• Professor Jane Halliday (Murdoch Children's Research Institute)
• Professor Deanne Thompson (Murdoch Children's Research Institute)
• Professor Alicia Spittle (The University of Melbourne)
• Professor Tony Penington (The Royal Children’s Hospital)
• Professor Elizabeth Elliot (University of Sydney)
• Professor Della Foster (La Trobe University)
• Associate Professor Stephen Hearps (Murdoch Children's Research Institute)
• Doctor Sharon Lewis (Murdoch Children's Research Institute)

Collaborations

Collaborations for 3D imaging 

As with our 12-month follow-up, we are collaborating with two experts in 3D morphometric analysis of image data: Drs Peter Claes and Harold Matthews from KU Leuven in Belgium. The collaboration aims to develop new approaches to undertake our craniofacial analysis and to interpret these results.

Collaborations for laboratory studies

Collaborations to-date have arisen from our interest in epigenetics. Specifically, the association between PAE and DNA methylation and its role as a mediator of neurodevelopment and FASD. We are contributing data to the Pregnancy And Childhood Epigenetics (consortium as part of their meta-analysis project studying early life environmental impacts on human disease using epigenetics. The consortium is based at the US National Institute of Environmental Health Sciences and includes researchers from around the world. 

We are also collaborating with the lab of Professor Michael Kobor, Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, The University of British Columbia. The Kobor lab recently developed a pediatric epigenetic clock (using buccal epithelial swabs. The collaboration will generate epigenetic and genotypic data from our child buccal DNA to contribute to their project investigating the extent to which the PedBE clock informs on child development across diverse populations and sex. 

Another collaboration in this area of study is with a team at the Telethon Institute, Western Australia, led by the AQUA study is contributing EWAS data from buccal epithelial swabs for this project, which aims to identify DNA methylation biomarkers of PAE in a controlled murine experiment, with replication in existing methylation data sets from human infants with well characterised PAE exposure patterns and children diagnosed with FASD. 

AQUA Partners

Future collaborations

The AQUA study has obtained participant consent to have their data included in other ethically approved studies in related areas of research. AQUA study welcomes new collaborations with other investigators and has engaged in collaborative data-sharing projects.

Contact us to get additional information about the study and referral to the appropriate Chief investigators for the discussion of collaborative opportunities.

Project Manager Evi Muggli
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Publications

A data driven approach to identify trajectories of prenatal alcohol consumption in an Australian population-based cohort of pregnant women. Muggli, E, Hearps, S, Halliday, J, Elliott, EJ, Penington, A, Thompson, DK, Spittle, A, Forster, DA, Lewis, S, Anderson, PJ. Scientific Reports 2022. 

Sex- and tissue-specific effects of binge levels of prenatal alcohol consumption on DNA methylation at birth. Loke, YJ, Muggli, E, Saffery, R, Ryan, J, Lewis, S, Elliott, EJ, Halliday, J, Craig, JM. (2021). Epigenomics, 13(24), 1921–1938.

Cohort profile: early school years follow-up of the Asking Questions about Alcohol in Pregnancy Longitudinal Study in Melbourne, Australia (AQUA at 6). Muggli, E, Halliday, J, Elliott, EJ, Penington, A, Thompson, D, Spittle, AJ, Forster, D, Lewis, S, Hearps, S, Anderson, PJ. (2021). BMJ Open. 12(1). 

What do pregnant women eat, andWhat do pregnant women eat, and are they meeting the recommended dietary requirements for pregnancy? Lee, A, Muggli, M, Halliday, J, Lewis, S, Gasparini, E, Forster, D. (2018). Midwifery, (67).

Engaging pregnant women in observational research: a qualitative exploratory study. Muggli E, Curd H, Nagle C, Forster D, Halliday J. BMC Pregnancy and Childbirth (2018) 18:334

Time- and sex-dependent associations between prenatal alcohol exposure and placental global DNA methylation. Loke YJ, Muggli E, Nguyen L, Ryan J, Saffery R Elliott E, Halliday J, Craig JM. Epigenomics. 2018 Jul;10(7):981-991.

Alcohol consumption in a general antenatal population and child neurodevelopment at 2 years. Halliday JL, Muggli E,  Lewis S, Elliott EJ,  Amor DJ, O’Leary C, Donath S, Forster D, Nagle C, Craig JM, Anderson PJ. JECH 2017, 71 (10).

Association Between Prenatal Alcohol Exposure and Craniofacial Shape of Children at 12 Months of Age. Muggli E, Matthews H,  Penington A, Claes P, O’Leary C, Forster D, Donath S,  Anderson PJ,  Lewis S, Nagle C, Craig JM,  White SM,  Elliott EJ,  Jane Halliday J. JAMA pediatrics. 2017, epub Preventing harm from alcohol: Asking questions about alcohol in pregnancy (AQUA study) harm from alcohol: Asking questions about alcohol in pregnancy (AQUA study) June 5.

Maternal micronutrient consumption peri-conceptionally and during pregnancy: a prospective cohort study. Livock M, Anderson P, Lewis S, Bowden S, Muggli E and Halliday J. Public Health Nutrition. 2017, Feb;20(2):294-304. 

Did you ever drink more? A detailed description of pregnant women's drinking patterns. Muggli E, O'Leary C, Donath S, Orsini F, Forster D, Anderson PJ, Lewis S, Nagle C, Craig JM, Elliott E and Halliday J. BMC Public Health. 2016, 16:683.

Spatially dense morphometrics of craniofacial sexual dimorphism in 1-year-olds. Matthews H, Penington T, Saey I, Halliday J, Muggli E, and Claes P. J Anatomy. 2016, J Anatomy, 229:549-559. 

Study protocol: Asking QUestions about Alcohol in pregnancy (AQUA): a longitudinal cohort study of fetal effects of low to moderate alcohol exposure. Muggli E, O'Leary C, Forster D, Anderson P, Lewis S, Nagle C, Craig JM, Donath S, Elliott E, Halliday J.  BMC Pregnancy Childbirth. 2014 Sep 3;14:302. 

Increasing accurate self-report in surveys of pregnancy alcohol use. Muggli E, Cook B, O'Leary C, Forster D, Halliday J.  Midwifery. 2015 Mar;31(3):e23-8.

Preventing harm from alcohol: Asking questions about alcohol in pregnancy (AQUA study). A VicHealth Fact sheet. Published Jan 2012