Fetal Alcohol Syndrome

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Fetal Alcohol Syndrome Department of Human Services, Public Health Division, Office of Family Health, Women’s and Reproductive Health, FAS Prevention Program

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What Is Fetal Alcohol Syndrome? The Leading Preventable Cause of Mental Retardation

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Fetal Alcohol Spectrum DisordersFAS --the most severe diagnosis on the spectrum of alcohol related disorders FASD --Fetal Alcohol Spectrum Disorder ARBD (alcohol related birth defects) ARND (alcohol related neuro-developmental disorder) FAE (fetal alcohol effects) FAS (fetal alcohol syndrome)

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FAS is 100% preventable if a woman does not drink alcohol while she is pregnant.

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FAS Facts First described 1968-72 Dose-response effect---the more alcohol the higher the likelihood of FAS No known safe level of alcohol use during pregnancy Greatest contributor to preventable mental retardation

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FAS FactsAlcohol diffuses through placenta Concentration in fetal blood is the same as in the mother’s blood within a few minutes The fetus is able to metabolize alcohol 10% as fast as the mother

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Over half of all pregnancies in the United States are unplanned.

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Most women who drink alcohol will continue to drink until their pregnancy is confirmed--four to eight weeks after conception. (CD Summary Sept 2007)

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When Pregnancy Is UnknownWhat if a woman drinks before she knows she’s pregnant? Embryonic Stage: 3rd post conception week of pregnancy is considered the most critical for alcohol teratogens More severe features of FAS Avg of 3 drinks/day following conception (before pregnancy is confirmed), increases risk of having an FAS childSantrock, J.W., Life Span Development, Brown Publishers, 1986.

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Embryonic/Fetal Development

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Criteria for FAS DiagnosisA diagnosis requires the presence of all three of the following: Documentation of three facial abnormalities smooth philtrum thin vermillion border small palpebral fissures Documentation of growth deficits Documentation of CNS abnormalities

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Facial Malformations Short palpebral fissures Abnormal philtrum Thin upper lip Hypoplastic midface Short nose

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Facial Features of FAS

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Changes Over Time Physical features Shape of nose Coarsening facial features Weight gain Cognitive skills Behavior

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Changes Over Time

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FAS Diagnosis To assist with differential diagnosis between FAS and environmental causes for CNS abnormalities it is important to obtain a complete and detailed history for the individual and his or her family.

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Difficulties Identifying FASDoctors describe facial features differently/no consistency Lack of FAS knowledge among care providers* Lack of uniform diagnostic criterion* MD resistance/concerns: stigmatization Many other diagnoses and conditions are related to FAS Absence of documentation of Mother’s drinking habits in medical records**Streissguth, Ann. (1997). Fetal Alcohol Syndrome: A Guide for Families and Communities. Paul H. Brooks Publishing Co., Baltimore, MD.

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A Hidden DisabilityFAS may be incorrectly labeled as a behavior disorder There may be no visible indicators of a disability Many cases of FAS undiagnosed FASD—many children have no facial abnormalities

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Criteria for DiagnosisMaternal alcohol use during pregnancy is NOT a requirement for diagnosis* Growth Retardation Height/weight – less than 10th percentile Intrauterine growth retardation and continued poor growth * Often times this information is not known

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Growth RetardationHistory of growth deficits, even if resolved Confirmed prenatal or postnatal height or weight, or both, at or below the 10th percentile, documented at anyone point in time (adjusted for age, sex, gestational age, and race or ethnicity)

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Brain DevelopmentDocumented small overall head circumference (OFC) Also known as microcephaly Includes head circumference at birth and over time At or below the 3rd or 10th percentile* * Use of the 10th percentile results in more false positives, use of the 3rd percentile results in more false negatives.

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Brain ChangesClinically significant brain abnormalities observable through imaging techniques Reduction in size of brain, areas of the brain Change in or absence of corpus callosum Change in cerebellum or basal ganglia Other structural abnormalities that may not necessarily result in functional deficits

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CNS AbnormalitiesMemory problems Attachment disorder Impaired motor skills Learning disabilities Problems with reasoning and judgment Inability to discern consequences of actions Intellectual impairmentNeurodevelopmental Disorders

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Developmental DisabilitiesADHD/ADD Speech/Language Disorders Difficulties with feeding Tactile dysfunction/overly stimulated Cognitive or intellectual deficits Delayed development Impaired visual skills Neurosensory hearing loss

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Developmental DisabilitiesSocial skills Lack of stranger fear Naiveté and gullibility Immaturity Executive functioning deficits Reasoning, judgment, planning ahead

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Motor Functioning DelaysFor infants—poor suck, feeding difficulties Delayed motor milestones Difficulty writing or drawing Balance problems Poor dexterity

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Last Updated: 8th March 2018

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