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

2. 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

3. Clarren SK (Alcohol and Brain Development, 1986) 3

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

5. 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

6.  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

7.  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

8. 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

9. 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

10.  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