1. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Chapter 3 Alcohol

2. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri An Ounce of Prevention Addressing Health Issues of Adolescents and Young Adults

3. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Chapter 3 Alcohol Fetal alcohol syndrome – There is no excuse ! Practical problem: How do I make a decision about alcohol use during pregnancy?

4. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Key concepts 1.Alcohol use during pregnancy: No amount is safe The leading cause of preventable intellectual disability Increases risks for physical anomalies, growth problems, learning disabilities, behavioral problems and miscarriage 2.Fetal alcohol syndrome diagnostic criteria: Growth problems Central nervous system (CNS) involvement Characteristic facial features Confirmed maternal use

5. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Objectives 1.Relate the incidence of intellectual disability to alcohol use during pregnancy. 2. Summarize the risks associated with alcohol use during pregnancy. 3. Identify the short-term consequences and long-term impact of fetal alcohol syndrome.

6. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Rationale Alcohol is a very potent teratogen. Fetal alcohol syndrome is the most common preventable cause of intellectual disability in the United States. This chapter describes the risks associated with drinking during pregnancy. In addition, fetal alcohol syndrome is reviewed.

7. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Alcohol exposure in pregnancy Frequency 1 in 8 women of child-bearing age report frequent drinking Neurobehavioral teratogen* Causes prenatal damage to the central nervous system; the organ most affected is the brain Maternal use No amount is safe; volume of alcoholic beverage doesn’t predict the amount of alcohol consumed *Anything in the environment that harms a developing fetus

8. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri How does alcohol reach the fetus? Passes to the fetus through the placenta Amount absorbed will equal the maternal concentration Fetal liver can break down only a small percentage of alcohol Majority of the alcohol remains in the amniotic fluid for a prolonged time

9. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri © 1991 Wisconsin Clearinghouse. FAS: Facts and Choices. Maternal and fetal blood alcohol content (BAC) after one drink (Based on a graph by H.L. Rosett)

10. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Comparison of alcohol content 12 oz. beer x 4% alcohol.48 oz. pure alcohol 4 oz. wine X 12% alcohol.48 oz. pure alcohol 1.2 oz. liquor X 40% alcohol.48 oz. pure alcohol 12 oz. wine cooler X 6% alcohol.72 oz. pure alcohol

11. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Alcohol comparison

12. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri

13. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri

14. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Just one drink a day

15. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Physical effects Alcohol is water-soluble and penetrates all membranes and body tissues. Women have less alcohol dehydrogenase (enzyme needed to breakdown alcohol), so more alcohol passes into the bloodstream. Even small amounts of alcohol put the fetus at risk. Results may be miscarriage, fetal death, birth defects, growth deficiency, intellectual disabilities and fetal alcohol syndrome.

16. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Central nervous system abnormalities When brain development occurs: Primary prenatal development: day 15 to 25 Third month of pregnancy through age 4

17. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Criteria for fetal alcohol syndrome (FAS) diagnosis All four factors must be present to confirm diagnosis. 1. Growth problems Prenatal, infancy and childhood 2. Characteristic facial features Small eye opening, short upturned nose, small lower jaw, small head circumference, thin upper lip, epicanthal folds, smooth philtrum 3. Central nervous system abnormalities Intellectual disability, hyperactivity, decreased attention span, poor gross motor coordination, developmental delays 4. Confirmed maternal use

18. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Facies in FAS in the young child © 1994 Project Cork Institute. Alcohol Use and Its Consequences.

19. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Fetal alcohol syndrome facial features Short palpebral fissure Short nose Small/smooth philtrum Thin upper lip Flat, mild face

20. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Fetal alcohol syndrome body features Low body weight Disproportionate height for age Little subcutaneous fat

21. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Risk from alcohol exposure by developmental periods Months 0 to 3 Critical for organ development Risk for physical birth defect increases Months 3 to 6 Increases risk for miscarriage Months 6 to 9 Critical for fetal growth Increases risk for fetal growth retardation The brain develops throughout pregnancy. There is no safe period in pregnancy to consume alcohol. No amount of alcohol is safe during pregnancy.

22. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Prenatal exposure to alcohol and intelligence Children with FAS a.Average IQ = 63 b.Intellectual disability* c.Abilities constant, no improvement or decline over time Children without FAS diagnosis, but mothers drank alcohol during pregnancy a. Average IQ = about 80 b. Learning disabilities** “Normal” children a.Average IQ = 90 - 110 b.Typical mental abilities c.Good potential for future learning *Degree of intellectual disability usually correspond to severity of physical characteristics. **There are many types and causes of learning disabilities.

23. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Effects of alcohol exposure during pregnancy FAS — Fetal alcohol syndrome FASD — Fetal alcohol spectrum disorders include a range of effects: physical, behavioral and/or intellectual

24. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Effects of alcohol exposure during pregnancy Cardiac defects Eye anomalies Learning problems Developmental delay Hyperactivity

25. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri

26. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Breastfeeding and alcohol Alcohol passes into breast milk. Alcohol can inhibit the hormone necessary to maintain breast milk production. Infants whose mothers drink alcohol while nursing are at increased risk for growth delay.

27. An Ounce of Prevention  2000, 2005, 2011 The Curators of the University of Missouri Key learning activities Bottles with impact Visual illustration of alcohol content Puzzling Effects Make Room for Males E-learning activity: Alcohol Use online quiz