Alcohol Use and Pregnancy and Fetal Alcohol Spectrum Disorder

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Alcohol is a Teratogen
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

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Teratology: Four Outcomes to Exposure

Malformations (facial, heart, skeletal)
Growth Deficiency (small) Functional Deficits (learning and behavioural problems) Death (stillbirth, miscarriage)

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Effects of Alcohol in Pregnancy

Alcohol freely crosses the placenta Adverse effects to the fetus occur at levels at or below those that are toxic to women

Fetal elimination of alcohol is poor

Increased risk for low birth weight Harm can be caused before a woman knows she is pregnant
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First Trimester
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 bodys movements Third Month: Most major organs and the face are developed. Bones continue to grow and kidneys start to work

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Second Trimester
Fourth Month: The placenta is fully formed and fetal movement may be felt by woman 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

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Third Trimester
In the third trimester, the fetus grows quickly in weight and length 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

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Drinking in Perspective
In general women: may drink alcohol before they realize theyre pregnant

may not know alcohol is harmful to the developing fetus

may drink because it is the social/cultural norm may drink to self-medicate
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No one can predict which infants born to mothers who drink will be affected, nor can anyone predict how severe these effects will be.

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Factors Involved in FASD

The stage in the pregnancy at which alcohol is consumed The amount of alcohol consumed during the pregnancy Other factors such as maternal age, stress, nutrition, smoking, and the use of other drugs (prescribed or street drugs) Fetal susceptibility to alcohol
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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 2008 (18% alcoholwww.faseout.ca )

Paternal Role
Effects on the Fetus: the effects of fathers 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

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Paternal Role: Social Effects

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 A mans drinking after the baby is born could adversely affect the nurturing home environment needed to raise a child

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What is Fetal Alcohol Spectrum Disorder?

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Fetal Alcohol Spectrum Disorder (FASD)

FASD is a combination of mental and physical disabilities
FASD is a lifelong condition FASD is caused by maternal alcohol consumption during pregnancy

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Diagnostic Terms
Fetal Alcohol Syndrome (FAS)
Partial Fetal Alcohol Effects (pFAS) Alcohol Related Neurodevelopmental Disorder (ARND) Alcohol Related Birth Defects (ARBD)

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Fetal Alcohol Syndrome

Recognized and documented in Nantes, France and Seattle, Washington 1968 1973

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

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FAS Features

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ARND/pFAS: The invisible disability

Physical characteristics FASD unremarkable
Disappear: become less prominent over time

Adolescent & Adult Diagnosis often more difficult

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Alcohol-Related NeuroDevelopmental Disorder (ARND)

Individuals with ARND present with neurocognitive dysfunction and complex patterns of behaviour, and have a confirmed exposure to alcohol prenatally Individuals with ARND may not demonstrate any of the facial features or growth restrictions associated with the full syndrome
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Partial Fetal Alcohol Syndrome (PFAS) with confirmed alcohol exposure

This diagnostic term is used when the person presents with central nervous system dysfunction and most (but not all of the growth and/or facial features of FAS), and has a confirmed prenatal alcohol exposure

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Diagnostic Process
Information is collected regarding the individual physical, social, academic, and adaptive skill history
If possible, the physician, along with a psychologist and other specialists, will assess the individual in order to make an appropriate diagnosis
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Possibility of Misdiagnosis
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

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Possibility of Misdiagnosis
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

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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 persons choice to be inattentive or uncooperative

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Primary Disabilities
Are the direct result of structural and/or functional damage to individuals While they can be evident in certain physical characteristics, it is the direct damage to the brain that has the greatest effect on the person

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Primary Disabilities: Organ Anomalies

Cardiac anomalies Joint and limb anomalies Neurotubal defects Anomalies of the urogenital system Hearing disorders Visual problems Severe dental malocclusions

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Primary Disabilities: Central Nervous System

Tremors Poor suck Hypotonic/Hypertonic Irritability Developmental delay

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Primary Disabilities: Central Nervous System

Cognitive problems Fine motor issues

Hyperactivity
Restlessness Poor ability to focus attention

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Primary Disabilities
Generalized damage to the brain typically has a significant impact on: cognitive processing emotional regulation

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Primary Disabilities: Central Nervous System Cognitive problems

Verbal IQ Performance IQ Scatter in Cognitive Skills Specific Learning Disabilities Memory Deficits Executive Functioning

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Primary Disabilities: Central Nervous System

Fine motor issues Hyperactivity Restlessness Poor ability to focus attention

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Primary Disabilities: Central Nervous System

Poor Judgement Impulsiveness Sleep disturbances Extreme anxiety Depression Aggressiveness Other Behavioural Problems

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Executive functions of the prefrontal cortex

working memory planning time perception internal ordering

self-monitoring
regulation of emotion motivation

inhibition

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Emotional Regulation
Emotional instability
For example, going from a calm to an agitated state (unexplained anger, laughing, crying) without apparent explanation

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Emotional Regulation
Deficits in emotional regulation are partly explained by poor inhibition and deficits in sensory integration (SI) Deficits in SI result in confusion in the interpretation of incoming sensations Individuals can become easily overwhelmed by relatively commonplace events/circumstances
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Strategies Need to Address the Whole Being

Mental, physical, emotional, spiritual and sexual well being

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Strategies for Success

Observe patterns of behaviour Identify strengths, skills and interests Reframe the interpretation of behaviours Provide structure rather than control Establish routines and consistency

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Strategies for Success

Build transitions into every routine Model behaviours Provide simple instructions or cues Identify behaviours which indicate the accumulation of frustration Help develop skills for expressing feelings

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Strategies for Success

Provide specific support for social skill development Understand the various forms of communication

Include as many sensory modalities as possible to facilitate integration of information and experience

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Strategies for Success

Consider information processing abilities Re-evaluate expectations and goals for the individual: clarify whose needs are being met by the goals Clarify goals and values for education/job training and independence

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Resources
Canadian Centre on Substance Abuse www.ccsa.ca/fas Public Health Agency of Canada www.publichealth.gc.ca/fasd Motherisk, The Hospital for Sick Children www.motherisk.org Saskatchewan Prevention Institute www.preventioninstitute.sk.ca
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Thank you!

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