1. Fetal Alcohol Syndrome Mary Rachel Bell NSCI 5373

2. Why is it a Problem? It is the leading cause of non-hereditary mental retardation & number one cause of mental retardation in the United States One of the top three leading causes of birth defects Out of 1000 live births in the United States- 0.5 to 3.0 have FAS Every year- over 40,000 babies are born with some degree of alcohol-related effects in the United States

3. Why is it a Problem? One-third of babies born to mothers who drink heavily during pregnancy have FAS Lifetime healthcare costs of a child born with FAS in 2000 is estimated at $588,000

4. History of FAS First described in France in 1968 Described in United States by KL Jones and DW Smith in 1973 Judges 13:3-4: “Behold, thou shalt conceive and bear a son; and now drink no wine or strong drink…” Aristotle described children of foolish, drunken women as foolish

5. Alcohol Consumption among Pregnant Women on the Rise Since 1991, the proportion of pregnant women drinking at least one glass of wine per day has quadrupled Alcohol use among pregnant women: 1988- 22.5% 1992- 9.5% 1995- 15.3%

6. Alcohol Consumption Recent survey on Babycenter.com revealed : 51% stopped drinking completely 30% still had a few sips 11% drank once per month 7% drank once per week 1% drank regularly- several times a week 4374 Participants

7. Alcohol Consumption among Pregnant Women on the Rise 2000- 1 out of 29 pregnant women report “risky” drinking At least half of these report “binge drinking” Binge drinking- consuming more than five drinks on one occasion Type & extent of damage is due to pattern & timing of maternal drinking

8. Diagnostic Criteria Slow growth both before and after birth Consistent pattern of minor structural anomalies of the face, together with more variable involvement of limbs and heart Deficient intellectual & social performance, & muscular coordination

9. Deficient Growth Involves height, weight & head circumference Children with FAS grow taller at 60% of normal rate through early childhood Gain weight at 33% of normal rate Therefore, FAS children may appear malnourished Decreased head growth indicates decreased brain growth

10. Structural Anomalies Facial features Small eyes Skin folds at corners of eyes Flattened area between nose & upper lip (flat philtrum) Narrow upper lips Short, small nose May have drooping of eyes

11. Structural Anomalies May have limitations of joint movement May have deformities of small joints of the hands May not be able to straighten fingers May have incomplete elbow rotation 5 to 60 times more likely to get congenital defects More susceptible to ear infections May lead to hearing loss

12. Reasons for these Anomalies Alcohol causes premature cell death in the bones & cartilage of the head & face Alcohol intake decreases antioxidant effects, so free radicals damage mitochondria, which leads to cell death

13. Deficient Intellectual & Social Performance Half of all FAS patients have IQs less than 70 Infancy: Feeding problems Irritability Unpredictable patterns of sleeping & eating Decreases maternal bonding

14. Deficient Intellectual & Social Performance Preschoolers: Very active Easily distracted Poor fine motor coordination

15. Deficient Intellectual & Social Performance Elementary Children: Often diagnosed with ADHD Increased activity level Short attention span Poor short-term memory Poor communication skills Speech difficulties Difficulty with social interactions

16. Deficient Intellectual & Social Performance Adolescents: Poor judgment Depression Trouble with abstract thinking Limited problem-solving skills Poor communication skills Difficulty with social interactions- may worsen as child ages

17. Reasons for Decreased Intelligence Alcohol interferes with nerve cell development Causes some regions to die off Damage to gray & white matter Failure of some regions to develop Failure of some cells to migrate properly during development Affects left side of brain- like Down’s Syndrome

18. Areas of the Brain Affected Cerebellum Smaller in FAS children Due to tissue death Responsible for movement & cognitive processes- such as attention Basal Ganglia Smaller in FAS children Responsible for voluntary movement & cognitive functions- such as perception, thinking, memory

19. Leads to Problems with… Language General intellectual functioning Controlling precise movements Attention problems Impaired social functioning Disturbed behaviors Mental retardation Psychiatric disorders

20. Psychiatric Disorders 94% had history of mental health problems 61% had attention-deficit problems 52% of FAS adults had depression Preschool & school-aged children show autistic characteristics Higher prevalence of eating disorders

21. Possible Nutrition Links Mother may not consume enough nutrients Alcohol may impair placental transport May receive less thiamin and folate due to decreased intestinal absorption of the mother, and due to decreased transport across the placenta Phillips et al

22. Possible Nutrition Links Animal studies have shown alcohol intake (acute and chronic) leads to the decreased placental transfer of amino acids Zinc Deficiency (Beattie) Can occur in chronic alcoholics- zinc levels are lower in alcoholic women Associated with congenital malformations in humans Animal studies have revealed FAS-like anomalies Studies have shown decreased zinc transport across the placenta

23. Possible Nutrition Links Glucose (Phillips et al) Alcohol impairs glucose placental transport Alcohol impairs enzymes needed for fetus to make glycogen Glucose is needed for proper brain growth May be why FAS babies have decreased brain growth

24. Feeding FAS patient Follow same rules as feeding mentally- handicapped patient Have set expectations at mealtime Decrease distractions Don’t have television on during mealtime Serve lots of finger foods

25. Feeding FAS Patient Feed child several meals a day- especially infants (increased needs) May have sucking problems May try feeding spoon or cup Be aware of possible development of eating disorders among adolescents

26. Questions?!?!?

27. References Phillips DK, Henderson GI, & Schenken S. “Pathogenesis of Fetal Alcohol Syndrome- Overview with Possible Role of Nutrition”. Alcohol Health and Research World 1989;13(3):219-226. Beattie JO. “Alcohol Exposure and the Fetus”. European J Clin Nutr 1992;46:S7- S15.