1. Copyright Alcohol Medical Scholars Program1 Fetal Alcohol Syndrome (FAS) An Overview Lauren D. Williams, M.D. University of Miami School of Medicine

2. Copyright Alcohol Medical Scholars Program2 Definition FAS is a serious developmental disorder caused by prenatal alcohol exposure of the fetus and characterized byFAS is a serious developmental disorder caused by prenatal alcohol exposure of the fetus and characterized by -Prenatal and/or postnatal growth retardation -Central nervous system dysfunction -Characteristic craniofacial abnormalities

3. Copyright Alcohol Medical Scholars Program3 Definition (cont.) FAS:FAS: -First described by Lemoine in 1968 -Term coined by Jones and Smith in 1973

4. Copyright Alcohol Medical Scholars Program4 Facies in FAS Source: Streissguth and Little 1994

5. Copyright Alcohol Medical Scholars Program5 Source: Aase 1994

6. Copyright Alcohol Medical Scholars Program6 Source: Aase 1994

7. Copyright Alcohol Medical Scholars Program7 Spectrum of Effects

8. Copyright Alcohol Medical Scholars Program8 Diagnostic Criteria Prenatal and/or postnatal growth retardation < 10 th percentilePrenatal and/or postnatal growth retardation < 10 th percentile Central nervous system dysfunction: neurological, developmental, cognitiveCentral nervous system dysfunction: neurological, developmental, cognitive At least 2 facial featuresAt least 2 facial features

9. Copyright Alcohol Medical Scholars Program9 Pathogenesis Direct toxic effects of alcoholDirect toxic effects of alcohol Toxic effects of acetaldehydeToxic effects of acetaldehyde Placental dysmorphology/functionPlacental dysmorphology/function Prostaglandin synthesisProstaglandin synthesis Early cell death (Apoptosis)Early cell death (Apoptosis)

10. Copyright Alcohol Medical Scholars Program10 Epidemiology IncidenceIncidence -0.26-4.6 per 1000 live births

11. Copyright Alcohol Medical Scholars Program11 Epidemiology Risk FactorsRisk Factors -Alcohol intake pattern/quantity -Maternal age /parity -Race/socioeconomic status -Genetic susceptibility

12. Copyright Alcohol Medical Scholars Program12 Clinical Course Morphological Abnormalities Source: Streissguth et al. 1991

13. Copyright Alcohol Medical Scholars Program13 Clinical Course Morphological Abnormalities Source: Streissguth et al. 1991

14. Copyright Alcohol Medical Scholars Program14 Clinical Course Morphological Abnormalities Source: Streissguth et al. 1991

15. Copyright Alcohol Medical Scholars Program15 Clinical Course Morphological Abnormalities Source: Streissguth et al. 1991

16. Copyright Alcohol Medical Scholars Program16 Clinical Course Neurobehavioral EffectsNeurobehavioral Effects - Newborn/Infants - Disturbed sleep patterns - Excessive arousal - Feeding difficulties, failure to thrive -Preschool/School age - Hyperactivity - Attention difficulties - Mental retardation

17. Copyright Alcohol Medical Scholars Program17 Clinical Course Neurobehavioral Effects (cont.) Neurobehavioral Effects (cont.) - Adolescence - Academic problems - Independent living problems - Conduct problems

18. Copyright Alcohol Medical Scholars Program18 Clinical Course Neurobehavioral Effects Neurobehavioral Effects -Adulthood -Mental problems -Memory problems -Behavior problems

19. Copyright Alcohol Medical Scholars Program19 Clinical Course Secondary DisabilitiesSecondary Disabilities -School failure -Delinquency -Difficulty with employment -Difficulty with independent living

20. Copyright Alcohol Medical Scholars Program20 Treatment Interventions Medical careMedical care Cognitive rehabilitation and special educationCognitive rehabilitation and special education Structured environment and supervisionStructured environment and supervision

21. Copyright Alcohol Medical Scholars Program21 Prevention IdentificationIdentification -History -Screening instruments-AUDIT,TWEAK - T = Tolerance - W = Worried - E = Eye-openers - A = Amnesia (Blackouts) - K (c) = Cut-down

22. Copyright Alcohol Medical Scholars Program22 Prevention Identification (cont.) Identification (cont.) –Biological markers -Gamma-glutamyl transpeptidase (GGT) -Carbohydrate-deficient transferrin (CDT) -Mean corpuscular volume (MCV)

23. Copyright Alcohol Medical Scholars Program23 Prevention InterventionIntervention -Universal approaches -Selective strategies -Indicated approaches

24. Copyright Alcohol Medical Scholars Program24 Summary FASFAS -Severe developmental disability resulting from prenatal alcohol exposure -One of the leading causes of mental retardation -Not just a childhood problem -Early diagnosis and intervention important -Preventable