FASD Foundation

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FASD Foundation

• Competency 1
• Midwest Regional Fetal Alcohol
• Syndrome Training Center
• 2006

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Fetal Alcohol Syndrome Through the Ages

• Alcohol Arabic al Kuhul
• The oldest and most widely used drug in the world
• 7000 B.C. used for rituals and customs
• Greeks Moderation
• Romans Excessive

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Fetal Alcohol Syndrome Through the Ages

• Behold, thou shalt conceive and bear a son and
  now drink no wine or strong drink.
• - Judges 137
• Foolish, drunken and harebrained women most
  often bring forth children like unto themselves,
  morose and languid.
• - Aristotle

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Fetal Alcohol Syndrome Through the Ages

• William Hogarth, 1751
• 1726 - College of Physicians Parental drinking a
  cause of weak, feeble and distempered children.
• 1834 Alcohol Licensure Act infants born to
  alcoholic mothers sometimes had a starved,
  shriveled, and imperfect look.

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Fetal Alcohol Syndrome Through the Ages

• 1899 William Sullivan
• 120 female drunkards in prison compared to
  sober female relatives
• Perinatal and infant mortality 2 ½ times greater
  in offspring of female drunkards.
• General perception was that this was due to
  germ-cell damage or poor home environment.

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Fetal Alcohol Syndrome Through the Ages

• 1968 Paul Lemoine et al.
• French medical journal, not well accepted
• 1973 Kenneth Lyons Jones, David W. Smith,
  Christy Ulleland Ann Streissguth publish
  Pattern of Malformation in Offspring of Chronic
  Alcoholic Mothers.
• Lancet 11267
• 1973 Jones Smith coin term FAS
• Lancet 2999

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Fetal Alcohol Syndrome Through the Ages
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Fetal Alcohol Syndrome Through the Ages

• 1989 Alcoholic Beverage Labeling Act
• 1989 The Broken Cord by Michael Dorris is
  published.
• Tells story of discovery about FAS in adopted
  son.
• Made into major TV movie.
• 1993 Fantastic Antone Succeeds by Kleinfeld and
  Wescott published.
• Practical educational tools and strategies.

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Fetal Alcohol Syndrome

• Fetal alcohol syndrome (FAS) now is recognized
  as the leading known cause of mental retardation
  in the United States, surpassing spina bifida and
  Downs syndrome.
• - JAMA, 1991

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Fetal Alcohol Syndrome

• 1996 Institute of Medicine Report
• mandated by U.S. Congress
• established 5 diagnostic categories
• FAS with alcohol history
• FAS without alcohol history
• partial FAS with alcohol history
• ARBD
• ARND
• concluded that FAS, ARBD and ARND are completely
  preventable and represent a major public health
  concern.

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Fetal Alcohol Syndrome

• Even small amounts of alcohol harmful during
  pregnancy - Pediatrics August, 2001.
• Many current obstetric texts suggest and/or state
  that mild to moderate alcohol use during
  pregnancy is safe - CNN Fall, 2002.
• FAS remains a major health problem - MMWR May 24,
  2002.

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Fetal Alcohol Syndrome

• Alcohol-related birth defects are completely
  preventable.
• We do not know what, if any, amount of alcohol is
  safe.
• The risk of a baby being born with any of the
  fetal alcohol spectrum disorders increases with
  the amount of alcohol a pregnant woman drinks, as
  does the likely severity of the condition.
• Health professionals should inquire about alcohol
  consumption by women of childbearing age, inform
  them of the risks of alcohol consumption during
  pregnancy, and advise them not to drink alcoholic
  beverages during pregnancy.
• Its in the child's best interest for a pregnant
  woman to simply not drink alcohol.
• U.S. Surgeon General Richard Carmona, 2/21/05

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FAS -Incidence

• Down syndrome..1/800 births
• Cleft lip/-palate.1/800 births
• Spina bifida..1/1000 births
• Fetal alcohol syndrome..1-2/1000 births
• 8800 U.S. babies with FAS per year
• Many more with alcohol induced problems
• (Higher rates in some populations)

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Prevalence of FAS (rates per 1000)

• Alaska 0.2 non AI/AN
• 3 AI/AN
• Aberdeen 2.7 AI/AN
• BDMP 0.7
• Atlanta 0.1 full
• 0.3 partial
• IOM 0.6-3 IOM 2 - 8.5
  AI/AN

Seattle 2.8 Cleveland 4.6 Roubaix
1.3 - 4.8 Seattle (FAS and ARND)
9.1 South Africa 48 (Wellington)
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Fetal Alcohol Syndrome

• Diagnosis based upon history, physical features
  (facies), growth retardation, and CNS
  abnormalities
• Leading known cause of mental retardation in U.S.
• All children should be screened
• Entirely preventable!

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FASD Societal Costs

• 5.4 billion in lifetime health costs
• 860,000 per child in health costs
• 200,000 per child in lost potential wages
• Estimates do not include other services
• Special education
• Foster care
• Incarceration

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FAS - Diagnosis

• A clinical diagnosis
• CDC Criteria (2004)
• IOM Criteria (1996)
• 4 Digit Diagnostic Code (Astley Clarren)
• History Physical
• We are utilizing the CDC criteria as they are
  based upon the most current data and National
  Task Force on Fetal Alcohol Syndrome and Fetal
  Alcohol Effect definitions

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Fetal Alcohol Syndrome

• Limb abnormalities
• Crease differences
• Cardiac
• Small genitalia
• Ocular
• Skeletal
• Auditory

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FAS the Brain IQ at 8 yrs
FAS fetal alcohol syndrome PEA prenatal
exposure to alcohol NC normal control FSIQ
full scale IQ VIQ verbal IQ PIQ performance
IQ
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Mattson J Pediatr, Volume 131(5).November
1997.718-721
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Spectrum of Clinical Symptoms

• Mental retardation
• Learning disability
• ADD, ADHD
• Poor memory and recall

• Poor compliance
• Poor planning and impulsivity
• Abstraction difficulties

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FAS - Nomenclature

• FAS Fetal Alcohol Syndrome
• ARBD Alcohol-Related Birth Defects
• ARND Alcohol-Related Neurodevelopmental
  Disorder
• FASD Fetal Alcohol Spectrum Disorders
• FAE Fetal Alcohol Effects
• term no longer utilized

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Diagnosis

• CDC criteria (2004)
• All 3 facial abnormalities
• Growth deficits
• CNS or neurobehavioral disorders
• Rule out other possible diagnoses

CDC/NCBDDD Scientific Working Group, 2004
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CDC Criteria (2004)

• Face
• Smooth philtrum
• Lip philtrum guide 4 or 5
• Thin vermillion
• Lip philtrum guide 4 or 5
• Palpebral fissures
• lt 10th centile

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CDC Criteria (2004)

• Growth
• Prenatal or postnatal weight and/or height lt 10th
  centile
• Adjusted for age, gender, gestational age, race
  and ethnicity

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Growth in FAS
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Growth in FAS - Males
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CDC Criteria (2004)

• Central Nervous System or Neurobehavioral
  Disorders
• Structural
• Neurological
• Functional

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CDC Criteria (2004)

• Structural
• Head circumference (OFC) lt 10th centile
• Brain abnormalities observed via
• Imaging
• Seizures
• Impaired motor skills

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CDC Criteria (2004)

• Neurological
• Seizures not due to postnatal insult
• Impaired motor skills
• Sensorineural hearing loss
• Memory loss
• Poor eye-hand coordination

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CDC Criteria (2004)

• Functional
• Below average scores on standardized instrument
  or clinical impression of functional deficit in
  one of the following domains

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CDC Criteria (2004)

• Functional (continued)
• General Cognitive Deficits
• Executive Functions
• Motor Functions
• Attention Deficit/Hyperactivity
• Social Skills
• Mental Health Problems
• Other

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CDC Criteria (2004)

• Maternal Alcohol Exposure
• Confirmed alcohol exposure
• Unknown alcohol exposure
• Confirmed absence of alcohol exposure

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FAS Differential Diagnosis

• Williams syndrome (ELN deletion)
• Velocardiofacial syndrome (del 22q11)
• Noonan syndrome (PTPN deletion)
• DeLange syndrome
• Dubowitz syndrome
• Maternal PKU embryopathy
• Maternal Toluene embryopathy

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• Collectively, scientific studies clearly indicate
  that
• NO alcohol during pregnancy
• remains the best medical advice!

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FAS The Road Ahead

• FAS Only the tip of the iceberg
• Prompt diagnosis leads to better prognosis.
• Treatment begins with prevention.

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