Drinking in Pregnancy: Fetal Alcohol Spectrum Disorder

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Drinking in Pregnancy Fetal Alcohol Spectrum
Disorder

• Moira Plant
• Professor/Director
• Alcohol Health Research Trust

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Drinking in Pregnancy

• Lower Levels of Drinking
• Incidence
• Diagnostic Criteria FAS FAE FASD
• Facial Features
• Older Children

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Lower Levels of Drinking

• Reduction in birth weight.
• Developmental delays both psychomotor and mental.
• Possible problems at school both behavioural and
  with academic performance
• e.g.. Attention/memory deficits

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Alcohol-Related Birth Damage

• Many studies have now shown that heavy drinking
  by pregnant women is associated with fetal
  abnormalities.
• Evidence on low/moderate consumption is mixed.
  This is a very emotive subject
• Alcohol-related birth damage is associated with a
  number of factors, only one of which is alcohol.

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Whos at higher risk?

• Poverty
• Poor prenatal care
• Poor nutrition and health
• Poly-drug use
• Prostitution (sex trade)
• Parent, partner, peer problems (AD)
• Psychiatric concerns ( mood, anxiety, thought
  disorders)
• Prior abuse (childhood sexual/- physical)

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Incidence of FAS

• In North America 10 per 1,000 live
  births Sampson et al 1997
• In UK ?
• Other Countries ?
• A woman who has had one child with FAS and who
  continues to drink is at greater risk of
  producing another child with FAS
• 2nd child 75 risk
• 3rd and subsequent children 90 risk

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Diagnostic Paradigms

• 1973 Fetal Alcohol Syndrome
• Pre and post natal growth defficiency
• Physical anomalies
• distinctive facial features
• Central nervous system dysfunction
• Severe learning/living difficulties
• Identifiable drinking problem in mother

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Diagnostic Paradigms

• Fetal Alcohol Effects
• If heavy drinking caused severe damage then
  lighter drinking would cause similar damage less
  severely
• Recently this diagnosis has been dismissed as it
  is unhelpful and leads to inaccurate reporting
• (Kaskutas 1995)

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Diagnostic Paradigms

• 1996 Institute of Medicine (US)
• 1)FAS with confirmed maternal alcohol exposure.
• 2) FAS without confirmed maternal alcohol
  exposure.
• 3) Partial FAS with confirmed alcohol
  exposure.
• 4) Alcohol-related birth defects.

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Diagnostic Paradigms

• US Institute of Medicine (Conti)
• 5) Alcohol-related neurodevelopmental disorder.
• This category includes Evidence of a complex
  pattern of behaviour or cognitive abnormalities
  that are inconsistent with the developmental
  level and cannot be explained by familial
  background or environment alone----including
  learning difficulties and problems related to
  memory, attention or judgement

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Diagnostic ParadigmsFetal Alcohol Spectrum
Disorders (FASD) 2002

• 1) Growth
• 2) Facial features
• 3) Brain
• 4) Maternal Drinking History

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FAS FACIAL FEATURES
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WHEN? Critical Periods of Human Development
BRAIN
K.L. Moore. The Developing Human, Clinically
Oriented Embryology (1988).
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FAS Diagnostic Guide and CD-ROM
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Alcohol inhibits the let down reflex Changes
the Smell and Taste of Breast Milk
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Changes with Age

• Facial features become less obvious
• Developmental changes may be negative. IQ may
  decrease by up to 15 points between early
  childhood and adolescence.
• Cognitive and behavioural deficits persists into
  adulthood
• Steinhausen et al 1994

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Adult

• Judgement and critical thinking are poor
• Lacks social skills either aggressive or
  withdrawn
• Blames others for own mistakes
• Involved in criminal activity
• Difficulty in keeping job
• Abusive relationships
• Parenting problems
• Mental health problems
• Depression/ suicide attempts
• Anxious
• Future patients?

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Secondary Disabilities

• Joblessness
• Homelessness
• Trouble with the law
• Early school drop-out
• Unplanned pregnancies
• Parenting problems

• Mental health concerns
• Alcohol and drug issues
• Sex trade
• HIV risk
• Premature death
• Streissguth et al,1996

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Protective Factors(Streissguth et al, 1997)

• Stable, nurturing home, 72 of life
• Diagnosis before age 6
• No experience of violence against self increased
  risk for Inappropriate Sexual Behavior either
  towards them or by them
• Staying in each living situation for minimum of
  2.8 yrs. (average)