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Alcohol Use in Pregnancy Melanie McKean, D.O., Ph.D. Department of Neurology and Psychiatry Saint Louis University
© Alcohol Medical Scholars Program2 http://clutchmag.s3.amazonaws.com/wp-content/uploads/2012/06/Alcohol-in-pregnancy-copy-533x800.jpeg
© Alcohol Medical Scholars Program3 Introduction Alcohol:↑ pregnancy risks ↑ risks to fetus Birth defects are preventable
Alcohol Use & Pregnancy 1.Definitions 2.Risk factors 3.Drinking effects in pregnancy 4.Prevention and treatment © Alcohol Medical Scholars Program4
Cases Case 1 –27yo WF, 1 st pregnancy –Recognition 10 wks –H/O depression –Pattern: 2-5+ drinks/night Blackouts ↑ Drinks for same effect DUI 2 yrs ago No alcohol since knew pregnant Case 2 –36 yo AAF, 2 nd preg –Recognition 4 wks –No psych hx –Pattern: 1 wine/night 1 glass/week w preg © Alcohol Medical Scholars Program5
DEFINITIONS © Alcohol Medical Scholars Program6
7 What is a Standard Drink? http://www.niaaa.nih.gov/sites/default/files/just_drinks_for_web.jpg
© Alcohol Medical Scholars Program8 Definitions Heavy episodic drinking Alcohol dependence Alcohol abuse Alcohol use disorder (DSM-V)
Heavy Episodic Drinking 4+ std drinks/event♀ 5+ std drinks/event ♂ 7+ drinks/week♀ © Alcohol Medical Scholars Program9
Alcohol Dependence 3+ same 12 months of: –Tolerance –Withdrawal –Intake > or longer than intended –Unsuccessful cutting down/controlling use –↑ time spent obtaining substance –↓ social/occupational/recreational activities –Continued use despite physical/psych problem © Alcohol Medical Scholars Program10
Alcohol Abuse 1+ same 12 mos (if not dependent) of: –Role failure –Placing self hazardous situations –Legal problems –Social/interpersonal problems © Alcohol Medical Scholars Program11
Alcohol Use Disorder DSM-V (2013) Single list of 11 items Moderate: 2 or 3 criteria + Severe: ≥ 4 criteria + © Alcohol Medical Scholars Program12
RISK FACTORS © Alcohol Medical Scholars Program13 http://www.eumom.ie/blog/wp-content/uploads/2011/08/babyalcohol.jpg
Alcohol Use in Pregnancy Prevalence in ♀ who know pregnant –2%: ≥ 5 drinks/occasion 5+ days past mo –28% ≥ 5 drinks typical drinking days –21% 45 drinks per month ~50% pregnancies unplanned –50% don’t know pregnant early –45% drink before know pregnant –~5% ♀ drink ≥ 6 drinks/ week © Alcohol Medical Scholars Program14
Who Drinks while Pregnant? Pre-pregnancy drinker Unmarried Comorbid psych and med dx Age ≥ 35 Less education © Alcohol Medical Scholars Program15
What about Our Cases? Case 1 Alcohol Dependence Case 2 No Alcohol Use Disorder © Alcohol Medical Scholars Program16
DRINKING EFFECTS IN PREGNANCY © Alcohol Medical Scholars Program17
Fetal Alcohol Effects - History 1600s: Sir Francis Bacon 1700s: UK gov’t, gin tax 1800s: Appearance of ETOH mothers’ infants © Alcohol Medical Scholars Program18 1900s: Fetal alcohol effects identified –Lemoine – “Alcohol embryopathy” –Jones & Smith – malformations, ↓growth, CNS defects –FAS prevention programs –Surgeon General warning –Alcohol Beverage Labeling Act
Fetal Alcohol Spectrum Disorders (FASD) © Alcohol Medical Scholars Program19
Fetal Alcohol Syndrome 1980 Neuro, behavioral, cognitive deficits Poor growth, learning, socialization 4 major criteria: 1.Characteristic facial abnormalities 2.Brain structural, neuro, functional defic 3.Growth deficiencies 4.Maternal alcohol use during pregnancy © Alcohol Medical Scholars Program20
© Alcohol Medical Scholars Program21
Partial FAS Confirmed ETOH exposure in utero 2+ characteristic minor facial anomalies 1+ of: –Growth retardation –Deficient brain growth –Behavioral/cognitive abnormalities How pFAS differs from FAS © Alcohol Medical Scholars Program22
Alcohol-Related Neurodevelopmental Disorder 3+ CNS impairments Few or no facial abnormalities Growth deficiency Prenatal alcohol exposure Differs from other FASD by: –Focus on CNS deficits –Minimal to no growth or facial abnormalities © Alcohol Medical Scholars Program23
Alcohol-Related Birth Defects Not fit other FASD category Maternal ETOH exposure Minor facial anomalies 1+ Congenital defects: – Cardiac – Renal – Skeletal – Eye, ear © Alcohol Medical Scholars Program24
Maternal Risk Factors for FASD ↑ Quantity & frequency of drinking Drank 1 st trimester Poor health and nutrition Live where heavy drinking common Little awareness of FASD © Alcohol Medical Scholars Program25
Neonatal Risk Factors Inadequate prenatal care Social isolation ↑ Stress © Alcohol Medical Scholars Program26
Lactation ACOG Committee opinion Breastfeeding after drinking: –↓ milk intake –↓ sleep & postnatal growth Don’t breastfeed for 3 hrs after ETOH © Alcohol Medical Scholars Program27
PREVENTION & TREATMENT © Alcohol Medical Scholars Program28 http://pernod-ricard.com/files/contenu/4.4.4-Les-femmes-enceintes_small_0.jpg
Prevention ABSTINENCE IS SAFEST Surgeon General statement Surgeon General recs © Alcohol Medical Scholars Program29
Screening/Intervention OB/GYNs intervene re: at-risk ETOH –ID ♀ heavy episodic drinking bf pregnant –Screen for drinking while pregnant –Brief intervention & education –Non-pregnant pt goals –Pregnant pt goals = abstinence Refer pts w/ Alcohol Dependence for Tx © Alcohol Medical Scholars Program30
Brief Intervention Elements FACT –Feedback problem to patient –Advice re stop drinking –Commitment to keep monitoring –Tracking patient’s outcome © Alcohol Medical Scholars Program31 http://www.sciencemediacentre.co.nz/wp-content/upload/2012/06/PregAlcohol1.jpg
Brief Interventions with Cases Case 1 –Discussed hx of alcohol dependence –Advised cont’d abstinence –Encouraged commitment –Frequent appts to monitor Case 2 –Informed pt of risk of ETOH during pregnancy –Advised to stop drinking –Encouraged commitment –Frequent appts for tracking © Alcohol Medical Scholars Program32
Screening Tools for OB/GYNs TACE –Tolerance, annoyed, cut down, eye opener –≥ 2 pts = at-risk drinking AUDIT –Accurate across all genders, ethnic groups –10 multiple choice questions –Score > 8 indicates ETOH problem © Alcohol Medical Scholars Program33
Treatment Four goals: 1.Build motivation for abstinence 2.Enhance life functioning 3.Restructure life w/o substances 4.Prevent relapse Immediate action necessary Inpatient detox tx as needed Collaborative approach © Alcohol Medical Scholars Program34
Intensive Outpatient Treatment Motivational enhancement Assess high-risk situations Collaboratively plan to manage risks Close monitoring to prevent relapse Regular supportive counseling Tailor med/psych assessment to needs Educate on benefits of abstinence © Alcohol Medical Scholars Program35
Case 1 OB/GYN used BI Referred to psych for depression Pt abstinent thru pregnancy Baby born with: –short palpebral fissures –smooth philtrum –prenatal growth retardation –structural brain abnormalities c/w pFAS © Alcohol Medical Scholars Program36
Case 2 OB/GYN used BI Referred to psychiatry, did not go Attended all prenatal appointments Reported abstinence from alcohol Baby born without signs of FASD © Alcohol Medical Scholars Program37
© Alcohol Medical Scholars Program38 Summary Alcohol + pregnancy = Concern Alcohol + pregnancy = Risk Abstinence is safest Screening essential Collaborative care key
Resources Alcohol’s Effects on the Body: http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body Alcohol’s Effects on the Fetus: http://www.niaaa.nih.gov/alcohol-health/fetal-alcohol-exposure http://www.niaaa.nih.gov/alcohol-health/fetal-alcohol-exposure National Organization on Fetal Alcohol Syndrome: http://www.nofas.org/ http://www.nofas.org/ © Alcohol Medical Scholars Program39
© Alcohol Medical Scholars Program40
Fetal Alcohol Spectrum Disorder: A Preventable Epidemic Barry S Parsonson PhD Explore & Applied Psychology International.
Fetal Alcohol Spectrum Disorder (FASD) Reducing alcohol-related harm through a nonjudgmental approach Dr. Samuel Harper.
1 Stimulating Systems Change for Fetal Alcohol Spectrum Disorder (FASD) Canadian Public Health Association Conference June 2, 2008.
UNDERSTANDING PRENATAL ALCOHOL EXPOSURE
Fetal Alcohol Spectrum Disorders: Competency II – Screening and Brief Interventions for Alcohol Use The Arctic FASD Regional Training Center is a project.
DID YOU KNOW…… The destructive and irresponsible use of alcohol and other drugs costs North Carolina more than $5.5 billion annually. Approximately 15%
Fetal Alcohol Spectrum Disorders Your Name* Your Institution Your Contact Information Date *in collaboration with the Southeastern Fetal Alcohol Syndrome.
F ETAL A LCOHOL S YNDROME Summarize the consequences of alcohol or tobacco use during pregnancy.
Fetal Alcohol Spectrum Disorders (FASDs) Outpatient Office Approach by David Garry, DO FACOG Fetal Alcohol Spectrum Disorders Prevention Project.
An Ounce of Prevention 2000, 2005, 2011 The Curators of the University of Missouri Chapter 3 Alcohol.
Fetal Alcohol Syndrome (FAS)
Pregnancy and Drug Abuse Eva Janecek-Rucker. Learning Objectives 1.To develop a knowledge base of the effects of substances of abuse (e.g., alcohol, cocaine,
Fetal Alcohol Spectrum Disorders: Competency V – Screening, Assessment, and Diagnosis The Arctic FASD Regional Training Center is a project of the UAA.
Alcohol Screening and Brief Interventions for Patients with Non-communicable Diseases Thomas F. Babor Department of Community Medicine University of Connecticut.
Fetal Alcohol Syndrome By Melissa Sterling. Questions? Should legal policies be developed in regard to FAS? Should Parents be charged with child abuse?
Fetal Alcohol Spectrum Disorders Fetal Alcohol Syndrome Fetal Alcohol Effects Alcohol-Related Neurodevelopmental Disorder Alcohol-Related Birth Defects.
How To Do… Screening. Screening: Why do SBIRT? “Who are the addicts?”
Alcohol, tobacco, & other drugs
Fetal Alcohol Syndrome
Footprints across the Territory 1 Remote Alcohol & Other Drugs Workforce Northern Territory Fetal Alcohol Spectrum Disorder (FASD)
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