FASEout Project Alcohol Use and Pregnancy and Fetal Alcohol Spectrum Disorder

Copyright 2005, Saskatchewan Prevention Institute Alcohol is a Teratogen A teratogen is a substance that interferes with the normal development of the fetus A teratogen is a substance that interferes with the normal development of the fetus Specifically, alcohol is a neurobehavioural teratogen – alcohol can damage the brain and change behaviour Specifically, alcohol is a neurobehavioural teratogen – alcohol can damage the brain and change behaviour

Copyright 2005, Saskatchewan Prevention Institute Teratology: Four Outcomes to Exposure Malformations (facial, heart, skeletal) Malformations (facial, heart, skeletal) Growth Deficiency (small) Growth Deficiency (small) Functional Deficits (learning and behavioural problems) Functional Deficits (learning and behavioural problems) Death (stillbirth, miscarriage) Death (stillbirth, miscarriage)

FASEout Project Effects of Alcohol in Pregnancy Alcohol freely crosses the placenta Alcohol freely crosses the placenta Adverse effects to the fetus occur at levels at or below those that are toxic to women Adverse effects to the fetus occur at levels at or below those that are toxic to women Fetal elimination of alcohol is poor Fetal elimination of alcohol is poor Increased risk for low birth weight Increased risk for low birth weight Harm can be caused before a woman knows she is pregnant Harm can be caused before a woman knows she is pregnant

Copyright 2005, Saskatchewan Prevention Institute First Trimester First Month: heart, lungs, limbs, face, ears, eyes, spinal cord, and brain begin to form First Month: heart, lungs, limbs, face, ears, eyes, spinal cord, and brain begin to form Second Month: toes and eyelids form and brain grows quickly and directs body’s movements Second Month: toes and eyelids form and brain grows quickly and directs body’s movements Third Month: Most major organs and the face are developed. Bones continue to grow and kidneys start to work Third Month: Most major organs and the face are developed. Bones continue to grow and kidneys start to work

Copyright 2005, Saskatchewan Prevention Institute Second Trimester Fourth Month: The placenta is fully formed and fetal movement may be felt by mother Fourth Month: The placenta is fully formed and fetal movement may be felt by mother Fifth Month: Eyelashes, eyebrows and scalp and hair appear. Fetal heartbeat can be heard Fifth Month: Eyelashes, eyebrows and scalp and hair appear. Fetal heartbeat can be heard Sixth Month: Eyes open and close. Lungs, brain and other organs continue to develop Sixth Month: Eyes open and close. Lungs, brain and other organs continue to develop

Copyright 2005, Saskatchewan Prevention Institute Third Trimester In the third trimester, the fetus grows quickly in weight and length In the third trimester, the fetus grows quickly in weight and length Lungs and other major organs mature to support life Lungs and other major organs mature to support life The brain continues to grow and develop and remains vulnerable to the damage that alcohol can cause The brain continues to grow and develop and remains vulnerable to the damage that alcohol can cause

FASEout Project

Drinking in Perspective In general: Women want healthy, happy children Women want healthy, happy children Some may drink before they knew they were pregnant Some may drink before they knew they were pregnant Some may not know it is harmful Some may not know it is harmful Some drink because of life problems Some drink because of life problems Some drink because it is the social norm Some drink because it is the social norm

FASEout Project No one can predict which infants born to mothers who drink will be affected, nor can anyone predict how severe these effects will be.

Copyright 2005, Saskatchewan Prevention Institute Factors Involved in FASD Factors Involved in FASD The stage in the pregnancy at which alcohol is consumed The stage in the pregnancy at which alcohol is consumed The amount of alcohol consumed during the pregnancy The amount of alcohol consumed during the pregnancy Fetal susceptibility to alcohol Fetal susceptibility to alcohol Other factors such as maternal age, stress, nutrition, smoking, and the use of other drugs (prescribed or street drugs) Other factors such as maternal age, stress, nutrition, smoking, and the use of other drugs (prescribed or street drugs)

FASEout Project Standard drinks = 0.5 oz alcohol 12 oz (341 mL) can of beer (5% alcohol) 12 oz (341 mL) bottle of cooler (5% alcohol) 5 oz (142 mL) glass of wine (12% alcohol) 1.5 oz (43 mL) distilled spirits (40% alcohol) 3 oz (85 mL) fortified wine e.g. sherry or port (18% alcohol )

FASEout Project Paternal Role Effects on the Fetus: the effects of father’s drinking on the fetus are not fully known Effects on the Fetus: the effects of father’s drinking on the fetus are not fully known Effects on Pregnancy: Alcohol can result in lower sperm count and abnormal sperm, which may effect fertility. If alcohol-affected sperm does fertilize an egg, the likelihood of miscarriage is higher than if the sperm were not alcohol-affected Effects on Pregnancy: Alcohol can result in lower sperm count and abnormal sperm, which may effect fertility. If alcohol-affected sperm does fertilize an egg, the likelihood of miscarriage is higher than if the sperm were not alcohol-affected

FASEout Project Paternal Role: Social Effects Women most often drink with their partners Women most often drink with their partners Men who drink heavily are unlikely to provide the necessary emotional support and care for their pregnant partners Men who drink heavily are unlikely to provide the necessary emotional support and care for their pregnant partners A man’s drinking after the baby is born could adversely affect the nurturing home environment needed to raise a child A man’s drinking after the baby is born could adversely affect the nurturing home environment needed to raise a child

FASEout Project What is Fetal Alcohol Spectrum Disorder?

Copyright 2005, Saskatchewan Prevention Institute Fetal Alcohol Spectrum Disorder (FASD) FASD is a combination of mental and physical disabilities FASD is a combination of mental and physical disabilities FASD is a lifelong condition FASD is a lifelong condition FASD is caused by maternal alcohol consumption during pregnancy FASD is caused by maternal alcohol consumption during pregnancy

FASEout Project Diagnostic Terms Fetal Alcohol Syndrome (FAS) Fetal Alcohol Syndrome (FAS) Partial Fetal Alcohol Effects (pFAS) Partial Fetal Alcohol Effects (pFAS) Alcohol Related Neurodevelopmental Disorder (ARND) Alcohol Related Neurodevelopmental Disorder (ARND) Alcohol Related Birth Defects (ARBD) Alcohol Related Birth Defects (ARBD) Fetal Alcohol Effects (FAE) has been replaced with ARND and pFAS Fetal Alcohol Effects (FAE) has been replaced with ARND and pFAS

FASEout Project Fetal Alcohol Syndrome Recognized and documented in Nantes, France and Seattle, Washington 1968 – – 1973

FASEout Project Characteristics of FAS Facial anomalies Facial anomalies Evidence of growth restriction (may be apparent prenatally and/or postnatally), (below the 10 th percentile) and microcephaly Evidence of growth restriction (may be apparent prenatally and/or postnatally), (below the 10 th percentile) and microcephaly Central nervous system abnormalities Central nervous system abnormalities

FASEout Project FAS Features

Dr. Lori Vitale Cox, 2006 The invisible disability Physical characteristics FASD unremarkable Physical characteristics FASD unremarkable Disappear: become less prominent over time Disappear: become less prominent over time Adolescent & Adult Diagnosis often more difficult Adolescent & Adult Diagnosis often more difficult

FASEout Project Diagnostic Process Information is collected regarding the individual – physical, social, academic, and adaptive skill history Information is collected regarding the individual – physical, social, academic, and adaptive skill history Individual is seen by a medical doctor who may diagnose or refer for further assessment Individual is seen by a medical doctor who may diagnose or refer for further assessment If possible, the physician, along with a psychologist and other specialists, will assess the individual in order to make an appropriate diagnosis If possible, the physician, along with a psychologist and other specialists, will assess the individual in order to make an appropriate diagnosis

FASEout Project Possibility of Misdiagnosis Since FASD is not a mental health diagnosis, it might not be considered or recognized Since FASD is not a mental health diagnosis, it might not be considered or recognized The symptom presentation of individuals with FASD is similar to that of many other mental health diagnoses The symptom presentation of individuals with FASD is similar to that of many other mental health diagnoses

Dan Dubovsky, 2002 Possibility of Misdiagnosis Individuals may be diagnosed with a mental health disorder without closely examining the total picture Individuals may be diagnosed with a mental health disorder without closely examining the total picture Even when FASD is recognized, another diagnosis is often used in order to get reimbursement for treatment Even when FASD is recognized, another diagnosis is often used in order to get reimbursement for treatment

FASEout Project Benefits to a diagnosis Parents and professionals often find their ability to cope improves when they understand problems are most likely caused by brain damage not the child/person’s choice to be inattentive or uncooperative Parents and professionals often find their ability to cope improves when they understand problems are most likely caused by brain damage not the child/person’s choice to be inattentive or uncooperative

Copyright 2005, Saskatchewan Prevention Institute Fetal Alcohol Spectrum Disorder is a lifelong condition that affects the individual, the family and the community.

FASEout Project Resources Canadian Centre on Substance Abuse Canadian Centre on Substance Abuse Public Health Agency of Canada Public Health Agency of Canada Motherisk, The Hospital for Sick Children Motherisk, The Hospital for Sick Children Saskatchewan Prevention Institute Saskatchewan Prevention Institute