Transcript Martha Krijgsheld

Alcohol & Pregnancy
Protecting the unborn baby
Martha Krijgsheld
Foetaal Alcohol Syndroom Stichting
Nederland
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)
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Clarren SK (Alcohol and Brain Development, 1986)
from Alcohol Health & Research World, vol 18, no. 1, 1994.
FAS--top of the iceberg
F A S D
FAE
pFAS
ARND
PEA
 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!
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Prevalence FASD (1)
 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
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Prevalence FASD (2)
 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
May PA et al., Alc Clin Exp Res (2006); Petkovic & Barisic, Reprod Toxicol (2010)
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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)
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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)
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Long term outcome
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
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Streissguth et al. (CDC, 1996)