Fetal Alcohol Syndrome

1. Fetal Alcohol Syndrome Mary Rachel Bell NSCI 5373

2. 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

3. 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

4. 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

5. 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%

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Deficient Intellectual & Social Performance • Preschoolers: • Very active • Easily distracted • Poor fine motor coordination

15. 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

16. 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

17. 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

18. 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

19. Leads to Problems with… • Language • General intellectual functioning • Controlling precise movements • Attention problems • Impaired social functioning • Disturbed behaviors • Mental retardation • Psychiatric disorders

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. Questions?!?!?

27. 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.