fetal alcohol syndrome mary rachel bell nsci 5373
TRANSCRIPT
Fetal Alcohol Syndrome
Mary Rachel Bell
NSCI 5373
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
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
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
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%
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
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
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
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
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
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
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
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
Deficient Intellectual & Social Performance Preschoolers:
Very active Easily distracted Poor fine motor coordination
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
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
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
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
Leads to Problems with…
Language General intellectual functioning Controlling precise movements Attention problems Impaired social functioning Disturbed behaviors Mental retardation Psychiatric disorders
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
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
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
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
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
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
Questions?!?!?
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.