Fetal

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Fetal Alcohol Syndrome Manish Saran
MD Department of Psychiatry Louisiana State
University Health Sciences Center
Shreveport February 8, 2006
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Historical view of alcohol as a teratogen

• Foolish, drunken, or harebrain women most often
  bring forth children like unto themselves
  Aristotle in
  Problemata
• Behold, thou shalt conceive and bear a son And
  now, drink no wine or strong drink.
• Judges 137

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Some Facts

• 60 of adult women drink
• 4 abuse or are dependent
• 20 of pregnant women drink
• 3 heavy drinkers
• 5.5 illegal drugs, 0.9cocaine

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Fetal alcohol syndrome

• FAS is a developmental disability caused by
  prenatal exposure to high levels of ETOH
• Most common preventable cause of adverse CNS
  development
• The reported prevalence of the disorder varies
  widely, estimates approach 1 of live births
• 4,000-12,000 infants per year in US
• The disorder is identified by the presence of
  growth impairment, central nervous system
  dysfunction, and a characteristic pattern of
  craniofacial features

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Facies in Fetal Alcohol Syndrome
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Adult Facies
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Fetal Alcohol Effects

• Only a minority (10-40) of the children of
  chronic alcoholic women are diagnosed with FAS
• Fetal Alcohol Effects (FAE) individuals lack the
  outward physical appearance of alcohol damage,
  and generally have higher IQ's
• 7,000-36,000 infants per year in US
• The internal damage to the brain and other organs
  can be just as serious

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Fetal Alcohol Spectrum Disorders

• category 1 FAS with confirmed maternal ETOH
  exposure
• category 2 FAS without confirmed maternal ETOH
  exposure
• category 3 partial  FAS with confirmed maternal
  ETOH exposure
• category 4 ARBD (alcohol -related birth defects),
  (physical only)
• category 5 ARND (alcohol -related
  neurodevelopmental disorder)

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Co morbid Conditions

• attention deficit hyperactivity disorder (40)
• mental retardation (1520)
• learning disorders (25)
• speech and language disorders (30), sensory
  impairment (30)
• cerebral palsy (4)
• epilepsy (810).

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Brain damage
The brain on the right suffers from
microencephaly and migration anomalies (neural
and glia cells did not migrate to their proper
location in the brain, but instead many of them
simply migrated to the top of the cortex).
Although it cannot be seen here, there is also
agenesis of the corpus callosum and the
ventricles are dilated.
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General Intellectual Performance







Standard score
FSIQ
VIQ
PIQ
IQ scale
Fetal Alcohol Syndrome
Normal control
Prenatal Exposure to Alcohol
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Neuropsychological Performance
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Executive functioning deficits
Move only one piece at a time using one hand and
never place a big piece on top of a little piece
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3
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Starting position
Ending position
Mattson, et al., 1999
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Secondary Disabilities
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Risk Factors

• Dose of alcohol
• the higher the dose of alcohol, the greater the
  likelihood that the child will exhibit fetal
  alcohol effects
• Pattern of exposure - binge vs chronic
• Both human and animal studies have found that
  binge drinking (drinking a large amount of
  alcohol in a short period of time), which
  produces high blood alcohol levels, is more
  damaging to the fetus than chronic alcohol
  exposure that produces lower blood alcohol
  levels.

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Risk Factors

• Developmental timing of exposure
• the facial features associated with prenatal
  alcohol treatment appear to be related to alcohol
  exposure during the first trimester
• The brain undergoes a very prolonged
  developmental course and therefore, may be
  susceptible to fetal alcohol effects throughout
  gestation
• Genetic variation
• Maternal characteristics
• Synergistic reactions with other drugs
• Nutrition

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Treatment and Prevention

• Very little research done on these topics
• Many children with FAS treated for their
  individual symptoms (e.g. stimulants for ADHD)
• Animal data indicates that early intervention
  with environmental variables might have a
  beneficial effect such as motor training
• Public education may not be reaching the women
  most likely to have a child with FAS
• Intensive, case-management approaches appear to
  work very well.

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Prevention The Birth to 3 Program

• Parent-child assistance program
• Intensive home visitation model for the highest
  risk mothers
• Paraprofessional Advocates
• Paired with client for 3 years following the
  birth of the target Baby
• Link clients with community services
• Extensively trained and closely supervised
• Maximum caseload of 15
• Outcomes
• Fewer alcohol/drug affected children
• Reduced foster care placement
• Reduced dependence on welfare

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Ethnic Considerations

• Rate of FAS (per 1000 1980-1986)
• Native Americans 2.97
• African Americans 0.6
• Caucasians 0.09
• Hispanics 0.08
• Asians 0.03

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Summary

• Fetal Alcohol Syndrome is a devastating
  developmental disorder that affects children born
  to women who abuse alcohol during pregnancy.
• Although FAS is entirely preventable, and in
  spite of our increasing knowledge about the
  effects of prenatal alcohol exposure, children
  continue to be born exposed to high amounts of
  alcohol.
• Its consequences affect the individual, the
  family, and society.
• Its costs are tremendous, both personally and
  financially.
• Effective treatment and prevention strategies
  must be developed and made available.

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• Discussion/
• Questions

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