Fetal Alcohol Syndrome

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Fetal Alcohol Syndrome
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Objectives

• Participants will be able to
• State the definitions of FAS, ARBD, and ARND
• List the diagnostic criteria for FAS, ARBD, and
  ARND
• Understand the importance of identifying women
  and children who are at risk
• Become aware of office-based prevention
  strategies and resources for families

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Definitions

• FAS Fetal Alcohol Syndrome
• ARBD Alcohol-Related Birth Defects
• ARND Alcohol-Related Neuro-developmental
  Defects

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FAS

• Criteria 1 Alcohol use
• Binge drinking (gt2-3 drinks/occasion)
• Daily use (1-2 drinks/day)
• 1st trimester vs 3rd trimester use

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FAS

• Criteria 2 Growth retardation
• decreased head circumference
• decreased height
• decreased weight

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FAS

• Criteria 3 Facial malformation
• indistinct philtrum
• short palpebral fissures
• thin upper lip

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FAS

• Criteria 4 Neurodevelopmental disorders

• impaired intelligence
• delayed speech development
• impaired fine motor skills
• attention deficit disorder
• attachment concerns
• learning disabilities
• hearing impairment

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FAS Facial Features
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Physical Abnormalities

• Cardiac
• Auditory
• Ocular
• Renal
• Skeletal
• Other

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Prevalence

• General population
• FAS 3-10/10,000 live births
• Exposure 165,000 children born in the US in 1995
  were exposed to potentially teratogenic doses of
  alcohol
• Women who are alcohol dependent
• 7 - 10 of children born with FAS

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Alcohol Use During Pregnancy

• No known safe level of alcohol use
• 20 of pregnant women drink alcohol
• 3.4 drink two or more drinks per day or five or
  more drinks per occasion

(CDC, 1995)
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Prevention of Fetal Alcohol Exposure
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Steps for Alcohol Screening Brief Intervention
Prior to Conception
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ASK All Women About...

• Frequency of use
• Quantity of use
• Binge use
• Tolerance
• Partner use
• Family concerns

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Screen for At-risk Drinking

• Non Pregnant Women
• Daily alcohol use
• more than 3 drinks per occasion
• more than 2 drinks to get high
• Partner use
• Family member concerns
• Pregnant Women
• Any use

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Screening Opportunities

• Routine health examination
• Before prescribing interacting medication
• In response to problems that may be
  alcohol-related
• First prenatal visit

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Recommendations for Low-Risk Drinking

• Women
• no more than 7 drinks per week
• or
• 3 drinks per occasion
• Pregnant Women (or those contemplating
  pregnancy)
• abstain

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ASSESS
Ask about employment, family, and legal
problems Assess for evidence of physical
dependence Assess for alcohol-related health
problems
Step 1
Step 2
Step 3
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ASSESS
Ask about readiness to change...
Step 4
Not ready
Maintenance
Ready
Action
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ADVISE

• Discuss pregnancy, FAS, and alcohol
• Engage the patient in the process
• Provide a self-help booklet
• Establish drinking goals

Step 1
Step 2
Step 3
Step 4
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ADVISE and REFER
Criteria for referral Access alcohol specialists
in the community Methods of referral Strategies
for resistant patients Strategies for those who
refuse to see a specialist or have no money
Step 1
Step 2
Step 3
Step 4
Step 5
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Follow-up Patient Progress
Step 1
Follow-up phone call Repeat physician office
visit
Step 2
Refer to specialized treatment when needed