Alcohol & Pregnancy Protecting the unborn baby Martha Krijgsheld Foetaal Alcohol Syndroom Stichting Nederland

Fetal Alcohol Syndrome FAS is diagnosed if the mother drank during pregnancy and the child exhibits the following:  Retarded growth  Characteristic facial features  Neurological damage Lemoine (Ouest Medical,1968); Jones, Smith, Ulleland, Streissguth (Lancet, 1973) 2

Clarren SK (Alcohol and Brain Development, 1986) 3

from Alcohol Health & Research World, vol 18, no. 1, 1994.

FAS--top of the iceberg  FAE (Fetal Alcohol Effects)  pFAS (partial FAS)  ARND (Alcohol-Related Neurodevelopmental Disorder)  PEA (Prenatal Exposure to Alcohol)  FASD (Fetal Alcohol Spectrum Disorder) Not "less" damaged! FAE ARND PEA F A S D pFAS 5

 Difficult to know how much  Passive reports underestimate prevalence  Preference for "nonguilty" diagnoses (ADHD, PDD-NOS, cerebrale paresis, etc.)  Earlier estimates 1 to 3 per thousand full FAS and 10 to 12 per thousand FASD Prevalence FASD (1) 6

 Active case ascertainment studies  Study of 6-year-olds in Lazio region of Italy: 3.7 per thousand full FAS; 20 to 40 per thousand FASD  School children in Croatia: 6.4 per thousand full FAS: 34 per thousand FASD Prevalence FASD (2) May PA et al., Alc Clin Exp Res (2006); Petkovic & Barisic, Reprod Toxicol (2010) 7

Not full FAS.....  Children of light drinkers (0.2 drinks per day) lighter at age 14 (Day 2002)  Database of 170,258 births in Schleswig Holstein, Germany. Increased defects of airways and other organs with 3-4 glasses of beer or 2 glasses of wine per day or binge drinking (Baumann 2006)  Clinically significant mental health problems in girls at 47 months at <1 drink per week (Sayal 2007)  Increased risk childhood leukemia with 1-2 drinks per week (MacArthur 2008) 8

Where are they?  Foster care population in Washington State: 10 to 15 per thousand full FAS. (Astley 2002)  Up to 80% of children with FASD in foster care or adoptive families. (NOFAS)  Most children with FAS are in special education or receive extra support. (Parental report)  Youth evaluated in Youth Forensic Pyschiatric Services, Burnaby, BC: 23% FASD (Fast 1999)  Study of 473 persons with FAS: "Confinement" (psychiatric treatment, alcohol or drug treatment, prison) : 50% of persons age 12 and over. (CDC 1996) 9

 Mental illness >90%  Early school leavers 60%  Trouble with the law 60%  Institutionalization (psychiatric, drugs- or alcohol addiction treatment, prison) 50%  Inappropriate sexual behavior 50%  Alcohol or drug addiction 30%  Dependent living 80% of those over age 21 Streissguth et al. (CDC, 1996) Long term outcome 10