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Fetal Alcohol Syndrome. Mary Rachel Bell NSCI 5373. Why is it a Problem?. It is the leading cause of non-hereditary mental retardation & number one cause of mental retardation in the United States One of the top three leading causes of birth defects

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fetal alcohol syndrome

Fetal Alcohol Syndrome

Mary Rachel Bell

NSCI 5373

why is it a problem
Why is it a Problem?
  • It is the leading cause of non-hereditary mental retardation & number one cause of mental retardation in the United States
  • One of the top three leading causes of birth defects
  • Out of 1000 live births in the United States- 0.5 to 3.0 have FAS
  • Every year- over 40,000 babies are born with some degree of alcohol-related effects in the United States
why is it a problem3
Why is it a Problem?
  • One-third of babies born to mothers who drink heavily during pregnancy have FAS
  • Lifetime healthcare costs of a child born with FAS in 2000 is estimated at $588,000
history of fas
History of FAS
  • First described in France in 1968
  • Described in United States by KL Jones and DW Smith in 1973
  • Judges 13:3-4: “Behold, thou shalt conceive and bear a son; and now drink no wine or strong drink…”
  • Aristotle described children of foolish, drunken women as foolish
alcohol consumption among pregnant women on the rise
Alcohol Consumption among Pregnant Women on the Rise
  • Since 1991, the proportion of pregnant women drinking at least one glass of wine per day has quadrupled
  • Alcohol use among pregnant women:
    • 1988- 22.5%
    • 1992- 9.5%
    • 1995- 15.3%
alcohol consumption
Alcohol Consumption
  • Recent survey on Babycenter.com revealed :
    • 51% stopped drinking completely
    • 30% still had a few sips
    • 11% drank once per month
    • 7% drank once per week
    • 1% drank regularly- several times a week
    • 4374 Participants
alcohol consumption among pregnant women on the rise7
Alcohol Consumption among Pregnant Women on the Rise
  • 2000- 1 out of 29 pregnant women report “risky” drinking
    • At least half of these report “binge drinking”
    • Binge drinking- consuming more than five drinks on one occasion
    • Type & extent of damage is due to pattern & timing of maternal drinking
diagnostic criteria
Diagnostic Criteria
  • Slow growth both before and after birth
  • Consistent pattern of minor structural anomalies of the face, together with more variable involvement of limbs and heart
  • Deficient intellectual & social performance, & muscular coordination
deficient growth
Deficient Growth
  • Involves height, weight & head circumference
    • Children with FAS grow taller at 60% of normal rate through early childhood
    • Gain weight at 33% of normal rate
      • Therefore, FAS children may appear malnourished
    • Decreased head growth indicates decreased brain growth
structural anomalies
Structural Anomalies
  • Facial features
    • Small eyes
    • Skin folds at corners of eyes
    • Flattened area between nose & upper lip (flat philtrum)
    • Narrow upper lips
    • Short, small nose
    • May have drooping of eyes
structural anomalies11
Structural Anomalies
  • May have limitations of joint movement
    • May have deformities of small joints of the hands
      • May not be able to straighten fingers
    • May have incomplete elbow rotation
  • 5 to 60 times more likely to get congenital defects
  • More susceptible to ear infections
    • May lead to hearing loss
reasons for these anomalies
Reasons for these Anomalies
  • Alcohol causes premature cell death in the bones & cartilage of the head & face
  • Alcohol intake decreases antioxidant effects, so free radicals damage mitochondria, which leads to cell death
deficient intellectual social performance
Deficient Intellectual & Social Performance
  • Half of all FAS patients have IQs less than 70
  • Infancy:
    • Feeding problems
    • Irritability
    • Unpredictable patterns of sleeping & eating
      • Decreases maternal bonding
deficient intellectual social performance14
Deficient Intellectual & Social Performance
  • Preschoolers:
    • Very active
    • Easily distracted
    • Poor fine motor coordination
deficient intellectual social performance15
Deficient Intellectual & Social Performance
  • Elementary Children:
    • Often diagnosed with ADHD
    • Increased activity level
    • Short attention span
    • Poor short-term memory
    • Poor communication skills
      • Speech difficulties
    • Difficulty with social interactions
deficient intellectual social performance16
Deficient Intellectual & Social Performance
  • Adolescents:
    • Poor judgment
    • Depression
    • Trouble with abstract thinking
    • Limited problem-solving skills
    • Poor communication skills
    • Difficulty with social interactions- may worsen as child ages
reasons for decreased intelligence
Reasons for Decreased Intelligence
  • Alcohol interferes with nerve cell development
    • Causes some regions to die off
    • Damage to gray & white matter
    • Failure of some regions to develop
    • Failure of some cells to migrate properly during development
  • Affects left side of brain- like Down’s Syndrome
areas of the brain affected
Areas of the Brain Affected
  • Cerebellum
    • Smaller in FAS children
    • Due to tissue death
    • Responsible for movement & cognitive processes- such as attention
  • Basal Ganglia
    • Smaller in FAS children
    • Responsible for voluntary movement & cognitive functions- such as perception, thinking, memory
leads to problems with
Leads to Problems with…
  • Language
  • General intellectual functioning
  • Controlling precise movements
  • Attention problems
  • Impaired social functioning
  • Disturbed behaviors
  • Mental retardation
  • Psychiatric disorders
psychiatric disorders
Psychiatric Disorders
  • 94% had history of mental health problems
  • 61% had attention-deficit problems
  • 52% of FAS adults had depression
  • Preschool & school-aged children show autistic characteristics
  • Higher prevalence of eating disorders
possible nutrition links
Possible Nutrition Links
  • Mother may not consume enough nutrients
  • Alcohol may impair placental transport
  • May receive less thiamin and folate due to decreased intestinal absorption of the mother, and due to decreased transport across the placenta
  • Phillips et al
possible nutrition links22
Possible Nutrition Links
  • Animal studies have shown alcohol intake (acute and chronic) leads to the decreased placental transfer of amino acids
  • Zinc Deficiency (Beattie)
    • Can occur in chronic alcoholics- zinc levels are lower in alcoholic women
    • Associated with congenital malformations in humans
    • Animal studies have revealed FAS-like anomalies
    • Studies have shown decreased zinc transport across the placenta
possible nutrition links23
Possible Nutrition Links
  • Glucose (Phillips et al)
    • Alcohol impairs glucose placental transport
    • Alcohol impairs enzymes needed for fetus to make glycogen
    • Glucose is needed for proper brain growth
      • May be why FAS babies have decreased brain growth
feeding fas patient
Feeding FAS patient
  • Follow same rules as feeding mentally-handicapped patient
  • Have set expectations at mealtime
  • Decrease distractions
    • Don’t have television on during mealtime
  • Serve lots of finger foods
feeding fas patient25
Feeding FAS Patient
  • Feed child several meals a day- especially infants (increased needs)
  • May have sucking problems
    • May try feeding spoon or cup
  • Be aware of possible development of eating disorders among adolescents
references
References
  • Phillips DK, Henderson GI, & Schenken S. “Pathogenesis of Fetal Alcohol Syndrome- Overview with Possible Role of Nutrition”. Alcohol Health and Research World 1989;13(3):219-226.
  • Beattie JO. “Alcohol Exposure and the Fetus”. European J Clin Nutr 1992;46:S7-S15.