1

Short Talk

By

Dr. Shaikh B.M.

Fetal Alcohol Syndrome

2

Fetal Alcohol Syndrome

When a woman consume alcohol during pregnancy, she risks giving birth to a child who will be born with fetal alcohol syndrome (FAS) characterized by 1) characteristic facial anomalies (2) growth retardation and (3) CNS involvement (cognitive impairment, learning disabilities, or behavioural abnormalities).

It affects fetal , neonatal and childhood life.

100% Avertable Disability #1 Cause of Mental Retardation

The risk of FAS more if alcohol is consumed in first FOUR weeks BUT….

3

Fetal Alcohol Syndrome

4

Fetal Alcohol Syndrome

• Alcohol can cause permanent damage to a baby before most women realize they are pregnant.

The effect of alcohol on fetus show spectrum of disorders called as fetal alcohol spectrum of disorders (FASD) and

FETAL ALCOHOL SYNDROME(FAS) is severe one out of them

5

Fetal Alcohol Syndrome FETAL ALCOHOL SPECTRUM OF DISORDERS (FASD)

Fetal Alcohol Syndrome (FAS): Abnormal characteristic facial features, growth problems, and central nervous system (CNS) problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing.

Alcohol-Related Neurodevelopmental Disorder (ARND): Intellectual disabilities and problems with behavior and learning, POOR memory, attention, judgment, and poor impulse control.

Alcohol-Related Birth Defects (ARBD): cleft palate,/lip, congenital heart, kidney diseases , foot anomalies

6

Fetal Alcohol SyndromePATHOPHYSIOLOGY • Alcohol crosses the placenta and rapidly reaches the fetus • Fetus liver does not have significant alcoholdehydrogenase(ADH), ALDH

and other antioxidants like glutathion

• Also amniotic acts as reservoir for alcohol, prolonging fetal exposure

• Acetaldehyde( metabolite of ethanol) disrupt cellular differentiation and growth, disrupting DNA and protein synthesis and inhibits cell migration

• Acetaldehyde and ethanol modify metabolism of carbohydrate, protein and fats

• They both also decrease the transfer of amino acids, glucose, folic acid, zinc and other nutrients across the placenta barrier which affects fetal growth.

7

Fetal Alcohol Syndrome

Dark lines = Great fetal sensitivity Light lines = Continued alcohol sensitivity

8

Fetal Alcohol SyndromeAlcohol Exposure During the Pregnancy Trimesters

First: During the first trimester, alcohol interferes with the migration and organization of brain cells and the formation of the CNS.

Second: Heavy drinking during the second trimester, particularly from the 10th to 20th week after conception, seems to cause more clinical features of FAS than at other times during pregnancy.

Third: During the third trimester, the hippocappus is greatly affected, which leads to problems with encoding visual and auditory information (reading and math) and the inability to form or retain new memories.

9

Fetal Alcohol Syndrome PREVALENCE The incidence of fetal alcohol syndrome in the United States is estimated to be 1-2 cases per 1000 live births.

Worldwide in all races and ethinicity where female drinks alcohol . It is 44% among drinker mothers .

10

11

Fetal Alcohol Syndrome

In India due to rising female aspirations and changing lifestyle increased alcoholism among female in metro cities risking pregnancies for FAS

Some states in India is having high prevalence of female alcohol drinking which leads to FAS babies .

12

Fetal Alcohol SyndromeSymptoms: 1) characteristic facial anomalies (2) growth retardation and (3) CNS involvement (cognitive impairment, learning disabilities, or behavioural abnormalities).

1) characteristic facial anomalies

13

Fetal Alcohol Syndrome

14

Fetal Alcohol Syndrome• (2) Growth retardation

• Intrauterine growth retardation (IUGR) , • Low birth weight (LBW ),• Weight below 10th percentile • Height below 10th percentile • Small head size• DELAYED DEVELOPMENTAL MILESTONES

15

16

Fetal Alcohol Syndrome(3) CNS involvement : (cognitive impairment, learning disabilities, or behavioral abnormalities).

Poor coordination Hyperactive behavior Difficulty with attention Poor memory Difficulty in school (especially with math) Learning disabilities Speech and language delays Intellectual disability or low IQ Poor reasoning and judgment skills Sleep and sucking problems as a baby Vision or hearing problems

17

Fetal Alcohol Syndrome

Fetal Alcohol Effects or FAE

FAE is not as easily identifiable as FAS because there may be fewer physical abnormalities, but knowledge of maternal use of alcohol makes it certain that brain damage has occurred.

18

Fetal Alcohol Syndrome

Criteria For Diagnosis Of FAS :

A diagnosis apart from `History of alcohol consumption during pregnancy` requires

the presence of all three of the following:

1. Documentation of three facial abnormalitiessmooth philtrumthin vermillion border small palpebral fissures

2. Documentation of growth deficits

3. Documentation of CNS abnormalities

19

Fetal Alcohol SyndromeCONTROL AND PREVENTION:

FAS is non treatable non curable condition but its 100% preventable .

FAS children can be helped to ease the life by early diagnosisNeuropsychological AssessmentsEarly Intervention (Age 0 to 3)Special Education ServicesParent and Caregiver EducationPhysical, Speech and Language and Occupational TherapiesSocial Skills training

Social awareness and resolutions for prevention of alcohol use and deaddiction programme .

20

Fetal Alcohol SyndromeCONTROL AND PREVENTION: In India The North east States Tribal FASD project seeks to reduce incidence of FASD and assist the tribal community to improve quality of life WITH FASD and prevention of FASD

WE MUST ALSO PROMOTE HOLISTIC HEALING THROUGH TRADITIONAL AND DEVELOPMENTALLY APPROPRIATE TECHNIQUES THAT ADDRESS THE PHYSICAL, INTELLECTUAL, EMOTIONAL AND SPIRITUAL NEEDS OF

INDIVIDUALS AFFECTED BY FASD

21

Fetal Alcohol Syndrome

22

Fetal Alcohol Syndrome

23

References:1. J Trop Pediatr. 2012 Feb;58(1):19-24. doi: 10.1093/tropej/fmr015.

Epub 2011 Feb 14.Fetal alcohol spectrum disorders--a case-control study from India.Nayak R, Murthy P, Girimaji S, Navaneetham J.

2. Bulletin of the World Health Organization 2011;89:398–399. Fetal alcohol syndrome: dashed hopes, damaged lives

3. Gregory C. &Kupesky, Regina H. (2002). Parenting the Hurt Child: Helping Adoptive Families Heal and Grow. Pinon Press. Retrieved December 23,2009. http://www.faslink.org/strategies_not_solutions.pdf

4. Learning about FASD (2009). Retrieved from http://www.fasdoutreach.ca/elearning/learning-about-fasd

5. Mayo Clinic (2009). Fetal Alcohol Ayndrome. Retrieved December 28, 2009, from http://www.mayoclinic.com/health/fetal-alcohol- syndrome/DS00184/ DSECTION=symptoms.

6. National Institute on Alcohol Abuse and Alcoholism (n.d.). Module 10K Fetal Alcohol Exposure. January 2, 2010.

24

25

THANK YOU