Presentation on theme: "Fetal Alcohol Syndrome Anita Olejek"— Presentation transcript:
1Fetal Alcohol Syndrome Anita Olejek Regional Consultant for Gynaecology and Obstetrics, Silesia, PolandMedical University of Silesia
2DefinitionFetal Alcohol Syndrome (FAS) is a disorder that can occur to the embryo when a pregnant woman ingests alcohol during pregnancy.
3HistoryThe earliest known observation of possible links between maternal alcohol use and fetal damage was made in 1899 by Dr. William Sullivan, a Liverpool prison physicianHe noted higher rates of stillbirth for 120 alcoholic female prisoners than their sober female relatives; he suggested the causal agent to be alcohol use
4HistoryLater on, it has been repeatedly noted, that children born by mothers addicted to alcohol had:excessive mortality in the early childhood,high incidence of epilepsiasigns of mental retardationphysical abnormalitiesThese facts were already noted in the 19th centrury, however the interest in this topic decreased during the Prohibition period ( ).
5Early researchFirst scientific discoveries identifying the syndrome were performed in 1968, when Lemoine from Nantes (France) published the results of his researchHe followed the children of the heavily drinking mothers for almost 30 yearsThis is a first time when this syndrome has been really describedThe term „Fetal Alcohol Syndrome” has been hovewer introduced later
6Recognition as a syndrome Fetal Alcohol Syndrome was named in 1973 by two morphologists, Jones and Smith of the University of Washington in the United StatesThey identified a pattern of "craniofacial, limb, and cardiovascular defects associated with prenatal onset growth deficiency and developmental delay" in eight unrelated children of three ethnic groups, all born to mothers who were alcoholicsThe pattern of malformations indicated that the damage was prenatal.
7What do we know today? Development of FAS is dependent on many factors Important is: frequency of drinking, alcohol intake, part of pregnancy most exposed to drinking, nutritional status and concomitant use of various drugsGenetic predispositions may have a limited, but also significant influenceEach etnic and racial group is equally at riskGeneral health status of the pregnant woman is essential. Healthy lifestyle is extremely protective.
8There is no such thing as „safe drinking”in pregnancy Even a small amount of regular drinking may lead to the development of FAS.
10The following criteria must be met to confirm a diagnosis of FAS: Growth deficiency - Prenatal or postnatal height or weight (or both) at or below the 10th percentileFAS facial features - all FAS facial features presentCentral nervous system damage - clinically significant structural, neurological, or functional impairmentPrenatal alcohol exposure - confirmed or unknown prenatal alcohol exposure
11FAS facial featuresA smooth philtrum - the divot or groove between the nose and upper lip flattens with increased prenatal alcohol exposure.Thin vermilion - the upper lip thins with increased prenatal alcohol exposure.Small palpebral fissures - eye width decreases with increased prenatal alcohol exposure.
12In some cases, facial deformations are seen already at birth or in the early childhood
13Central nervous system damage three areas: structural, neurological, and functional impairmentsstructural impairments may include microcephaly (small head size), or other abnormalities in brain structureneurological impairment may be classified into hard signs (epilepsy or other seizure disorders) and soft signs (such as impaired fine motor skills, neurosensory hearing loss, poor gait, clumsiness, poor eye-hand coordination, or sensory integration dysfunction)functional impairment is often referred to as developmental disabilities and includes: learning disabilities, academic achievement, impulse control, social perception, communication, abstraction, math skills, memory, attention and judgment.
14Related signsstemming from prenatal alcohol exposure. However, these conditions are considered Alcohol-Related Birth Defects and not diagnostic criteria for FAS.Includes:Cardiac - a heart murmur that frequently disappears by one year of age.Skeletal - joint anomalies including abnormal position and function, altered palmar crease patterns, small distal phalanges, and small fifth fingernails.Renal - aplastic, dysplastic, or hypoplastic kidneys.
15Apart from all these symptoms, there is an intelectual and emotional impairment
16Related disordersFetal Alcohol Effect (FAE) – used when drinking in pregnancy is documented and some FAS criteria are presentAlcohol Related Neurodevelopmental Disorer (ARND)Fetal Alcohol Related Conditions (FARC)Alcohol Related Birth Deformations (ARBD)
17Neuropsychological disturbances memorycoordinationreading and writingconcentrationspeechmotivationmood
18Research performed on 61 young patients with FAS was able to demostrate, that levels of IQ were generally not that bad (68, while 2.5% of the general population has IQ around 70).Recognition of words was acceptable, but reading with understanding was much worse in all the tests performed.
19FAS in the early childhood Many children are born with signs of “delirium tremens” - this indicates a potential of epilepsia in the nearest future.As newborns, children with FAS may have impaired coordination and abnormal sleep patterns.Later in their childhood, they may have problems with concentration, cannot distinguish colours and assess time. Their vocabulary is very poor.
20FAS later on...At school, children with FAS usually experience major problems, even if their IQ is average or only slightly below that value.Such children cannot assess the situation properly and predict the consequences of their behaviour. They also do not learn from mistakes.They ignore warnings and require continuous repetition of the given instruction. Lack of thank discourages people trying to guide them.
21Important issue!Children with FAS are easily involved in minor crimes, inappropriate sexual behaviour and alcohol or drug abuse.This is the main reason why women with FAS have a higher probability to have children with FAS (but FAS is not a genetic, inherited disorder!)
22Fetal Alcohol Effect (FAE) Not all the children born from mothers who drunk alcohol during the pregnancy have a full-blown FAS syndrome. If drinking is sporadic, physical and mental abnormalities may not be easily traced.Children may have normal IQ but serious problems at school.Such “uncomplete” syndrome is sometimes referred as Fetal Alcohol Effect (FAE).
23Management of FAE very complicated level of intelligence actually normalpatterns of social behaviour abnormalsuch people, even if their IQ is satisfactory, should only work under a strict supervision, and have to be constantly controlled.
24Epidemiology of FASMost reliable research in the USA shows that there are births of children with FAS every yearThat means that on the average there are 3/1000 (0.3%) live births of children with FAS (for women known to be alcoholic this figures are 2.5%).In the United States, FAS is a leading cause of mental retardation, apart from Down’s syndrome.
25Epidemiology of FAE Lack of reliable data It is concluded that up to 8-10% of all cases of mental retardation in the USA may be due to FAS.In the Indian reserves (where alcoholism is an epidemic) as much as 25% of children may have some symptoms of FAE.
26Situation in Silesia Largely unknown There are no data on the real amount of women drinking alcohol during pregnancy (no records)Main reasons – women who drink excessive alcohol when pregnant feel shame and accuse themselves but do not report this to the physicianThey also fear of repressions from their social enviroment
27What could be done?Observation shows that most women are aware of the fact that drinking in pregnancy is dangerous.Public education campaign may discourage moderately drinking womenThis is however not effective in heavily drinking and alcoholics. Women from these groups are best treated directly by their physicians.
28LimitationsUnfortunately, physicians feel constrained and ashamed to ask women for their alcohol problems.Institutions taking care of pregnant women should therefore create systematic, problem-specific questionnaires exploring the problem of alcohol intake during pregnancy. This information should be later transferred to patient’s records.
29Animal studies suggest that pregnancy is more at risk when alcohol is given in large single doses (occasional binge drinking).Moreover, the consequences of heavy drinking in the earlypregnancy may persist even if drinking was completelystopped in the second and third trimester.
30Consequences of alcohol intake in pregnancy First trimester:Brain damageAttenuation of cell developmentHeart and kidneys damageFace deformationAbortionSecond trimester:Attenuation of brain developmentDamage of muscles, skin, bones, teethAbortionThird trimester:Attenuation of brain and lungs developmentAttenuation of growth
31No one knows what amount of alcohol is safe for a pregnant woman This is why women are advised to stop drinking alcohol completely during pregancy