1. What do we know about KY numbers? 1997 report from 37 Public Health Clinics –1/3 reported drinking in past month –over 40% reported ever using illicit drugs with higher numbers for current use in 11 - 17 year olds

3. Why focus so much attention on effects associated with prenatal alcohol exposure?

4. Fetal Alcohol Syndrome Fetal alcohol syndrome is among the most commonly known causes of mental retardation and is a major public health problem. It is the leading preventable cause of mental retardation!

5. Historical view of alcohol as a teratogen Foolish, drunken, or harebrain women most often bring forth children like unto themselves Aristotle in Problemata Rosett, 1984

6. Historical view of alcohol as a teratogen Foolish, drunken, or harebrain women most often bring forth children like unto themselves Aristotle in Problemata Behold, thou shalt conceive and bear a son: And now, drink no wine or strong drink. Judges 13:7 Rosett, 1984

10. FAS – Only the tip of the iceberg Fetal Alcohol Spectrum Disorder Fetal alcohol syndrome Fetal alcohol effects Clinical suspect but appear normal Normal, but never reach their potential Adapted from Streissguth

11. Incidence and Prevalence of FAS and other effects FAS -.5 to 3 cases/1000 live births –(U.S. 2 - 12,000 FAS births/year) variations in pockets/locations –International Studies ongoing in Moscow, S. Africa Affected but not full blown FAS - 3-6 cases /1000 live births

12. *** ** CerebrumCerebellum 75 80 85 90 95 100 PEA FAS <p 0.001 p < 0.010 Cerebrum Cerebellum Corpus Callosum Mattson et al., 1994 Change in brain size

13. General Intellectual Performance FSIQVIQPIQ 40 55 70 85 100 115 Standard score IQ scale NC PEA FAS * * * ** * * Mattson, S.N., 1997.

14. 2 1 3 1 2 3 Group 0 2 4 6 Rule Violations NC PEA FAS P<0.001 Move only one piece at a time using one hand and never place a big piece on top of a little piece Starting position Ending position Mattson, et al., 1999 Executive functioning deficits

15. Behavioral characteristics associated with Fetal Alcohol Spectrum Disorder hyperactivity, response inhibition deficits, attentional problems, motor coordination deficits, executive function (planning) problems,

16. Secondary Disabilities Individuals with FAS/FAE have a range of secondary disabilities – disabilities that the individual is not born with, and which could be ameliorated withappropriate interventions. Streissguth, et al., 1996

17. Animal models – Example of the comparability of effects Growth retardation Facial characteristics Heart, skeletal defects Microcephaly Reductions in basal ganglia and cerebellar volumes Callosal anomalies Hyperactivity, attentional problems Inhibitory deficits Impaired learning Perseveration errors Feeding difficulties Gait anomalies Hearing anomalies Driscoll, et al., 1990; Samson, 1986;

18. Smoking and nicotine during pregnancy 25-35% of women smoke cigarettes during pregnancy although clearly there are regional differences Cigarette smoking during pregnancy is one of the most important preventable risk factors for SGA pregnancies, as well possibly for late fetal death

19. Cigarette smoke contains more than 2000 pharmacologically active substances including carbon monoxide (which could lead to fetal hypoxia), cyanide, nitrous oxide Increased obstetric complications such as spontaneous abortion Dose-dependent reductions in birthweight, possible increased risk of SIDS Passive smoking

20. What about nicotine? animal models – data is mixed

21. Cocaine Confounding factors –polydrug use (alcohol and nicotine most common – 72% used alcohol; 73% used nicotine 59% used marijuana, 42% used heroin or methadone (n of 101 studies) –Sociodemographics –data mixed; variations in caregiving – “boarder babies”

22. Crack cocaine –demographic controls AND crack exposed babies all below “normal” means –influence of other drugs….. –possible attention problems

23. cocaine and methamphetamine no classic withdrawal syndrome –increased reactivity - cocaine idea of cumulative risk not as much known about methamphetamine – –preliminary data that smoked is associated with reduced birth weight

24. marijuana Fried (Ottawa study) –data – mixed; –possible cognitive effects although varies with age and may be related to polydrug interactions

25. heroin or other opiates neonatal abstinence syndrome –often more protracted for methadone treated infants symptoms: CNS, GI, respiratory and autonomic NS involvement –heroin – begins within 24 – 72 hours after birth –methadone – sometimes takes longer »can also be associated with prolonged abstinence syndrome (up to 8+ months)