Fetal Alcohol Spectrum Disorders Understanding Effects Improving Outcomes Part 2: Who Is at Risk? Presentation by Teresa Kellerman Director of the Fetal Alcohol Resource Center Arizona Division of Developmental Disabilities Part 2 Who Is at Risk? Review Diagnosis and Symptoms FASD facts and statistics Birth Moms Stories What About Dad s Drinking? What About Illegal Drugs? What Does FASD Look Like? There may or may not be physical symptoms birth defects facial features developmental delays In most cases, the child with FASD looks just like any other child. Diagnostic Criteria for Full FAS Low birth weight/height Microcephaly (small head circumference) Facial characteristics CNS (brain) damage History of prenatal exposure to alcohol FASD Diagnostic Guidelines Go to www.fascrc.com Scroll down to Doctor s Office IOM guidelines for FAS diagnosis Clarren-Astley 4-digit code (March of Dimes) New IOM guidelines include ARND: A Practical Clinical Approach to Diagnosis of Fetal Alcohol Spectrum Disorders: Clarification of the 1996 Institute of Medicine Criteria - Pediatrics 205;115;39-47 by H. Eugene Hoyme, MD, Philip A. May, PhD, Kenneth Lyons Jones, MD, and Luther K. Robinson, MD et al Common Challenges Across the Spectrum Most children with FASD have Memory deficits Lack of impulse control Poor judgment Emotional dysmaturity Think Young 1
Neurological signs during childhood Difficulties with bonding and attachment Inappropriately affectionate to strangers Inability to form healthy relationships Memory deficits (forget the rules) Poorly formed conscience (lying/ stealing) Stubborn, compulsive, perseverate, tantrums Arrested social development ( Think Young ) Poor judgment, lack of impulse control On any given day in the U.S. 10,657 babies are born 1 is HIV positive (CDC) 3 have Muscular Dystrophy (MDA) 4 have Spina Bifida (CDC) 10 have Down Syndrome (CDC) 20 have Fetal Alcohol Syndrome (FAS) 80 have alcohol related disorders (ARND) Combined rate: 1:100 babies have FASD This means 100 babies are born in the U.S. every day with Fetal Alcohol Spectrum Disorders (FASD) Teratology 1997 Nov;56(5):317-26 This year in Arizona 102,042 babies will be born 4 or 5 will be HIV positive. 18 will have Spina Bifida 28 will have Muscular Dystrophy. 90 will have Down Syndrome 200 will have Fetal Alcohol Syndrome (FAS) 800 will have alcohol related disorders (ARND) Combined rate: 1:100 babies have FASD This means 1,000 babies are born every year in AZ with Fetal Alcohol Spectrum Disorders (FASD) Alcohol is a Toxic Substance Alcohol is a toxin Alcohol is a carcinogen Alcohol is a teratogen Alcohol causes more damage to the developing baby s brain than any other substance, including marijuana, cocaine, meth, and heroin. -- Institute of Medicine Report to Congress Look Who s Drinking Half of all women of childbearing age drink alcohol Binge Drinking by Women of Childbearing Age March of Dimes Report Half of all pregnancies are unplanned The rate of drinking reported by pregnant women in their first trimester is 22%. SAMHSA 2004 National Survey on Drug Use and Health 2
Look Who s Drinking Too! Every time a pregnant woman has a drink, it's like giving a drink to the baby inside. The BAC (blood alcohol content) in the mother is the same as the BAC in the baby! How Much is Too Much? The more the mother drinks, the greater the risk to her unborn baby The sooner she stops drinking, the better the outcome for her and her baby. There is no safe amount of alcohol during pregnancy. March of Dimes How Alcohol Affects the Developing Fetus Tiny molecule passes through placenta BAC in mother = BAC in baby Placenta is formed and functioning about 15-18 days after conception Weeks 2-10, baby is vulnerable to structural damage Brain is vulnerable during entire pregnancy During the course of pregnancy, one drink a day adds up to 39 baby bottles full of booze. One drink a day Age of mother Amount of alcohol, BAC Timing Susceptibility of fetus Risk factors High risk groups Women who have already had a child with FAS (75%) White women (their rate of drinking during pregnancy is slightly higher than other ethnic groups) Native American women in communities with high rate of alcohol use Women with invisible FASD 3
Women with increased risk of drinking during pregnancy CDC Study: Obstet Gynecol. 1998 Aug;92(2):187-92 Female students Women who smoke Single women Women with college education Household income over $50,000 What does this data mean to you? About Birth Mothers Birth mothers who drink generally do not intend to harm their babies. Some birth mothers quit drinking after they find out they are pregnant. Almost all birth mothers who continue to drink are victims of sexual and/or physical abuse. About half of birth mothers have undetected Fetal Alcohol disorders themselves. -Sterling Clarren Study Effects of paternal drinking Reduces mobility of healthy sperm Inherited tendency toward alcoholism Increased risk of abuse of children Dad s drinking behavior influences Mom s drinking behavior #1 factor in pregnant woman staying sober: having a partner who abstains from alcohol with her What About Illegal Drugs? US Environmental Protection Agency had identified a list of substances that could be neurobehavioral teratogens that included: Cocaine Alcohol Tobacco Heroin Methadone but Institute of Health 1996 Report to Congress Research shows no neurological effects caused by cocaine, heroin, or methadone, except for possible withdrawal symptoms for a short time after birth. As such, they are no longer considered teratogens. Early research could not be replicated, and outcomes could have resulted from concurrent abuse of alcohol, tobacco and other illicit substances. Environmental Teratogens Alcohol Mercury Radiation Phenytoin PCBs Lead Heroin Marijuana Tobacco Cocaine X X X X 4
What About Methamphetamine? Animal research indicates that prenatal exposure to meth alone has no effects. However, there may be a risk to males who were exposed prenatally to meth and later use it as adults, due to impact on dopamine in the brain. The National Institute of Health has funded research into prenatal effects in humans. Household Survey on Drug Use and Health Of all the women who reported use of illicit drugs during pregnancy, 97% were also consuming alcohol. When we see lasting effects in babies born to mothers who tested positive for illicit drugs, we must consider the likelihood that she also drank alcohol and that the effects we see in development and behavior are most likely due to the prenatal exposure to alcohol. Greatest Danger: Alcohol Prenatal alcohol exposure represents the largest environmental cause of behavioral teratogenesis yet discovered and, perhaps, the largest single environmental cause that will ever be discovered." Most Serious Effect: Neurobehavioral Disorders Story about John [Riley, E. P., and Vorhees, C. V. (1986). Handbook of Behavioral Teratology. Plenum Press, New York, NY.] 5