Transcript Alcohol, Pregnancy and Fetal Alcohol Spectrum Disorders

Gabriela Olivas RN, BSN, SNNP
University of Texas Medical Branch
GNRS 5631
March 26th, 2014
Leigh Ann Cates PhD, MSN, RN, NNP-BC, RRT-NPS
Debra Armentrout RN, MSN, NNP-BC, PhD
 Define Fetal Alcohol Spectrum Disorders (FASD)
 Define maternal/fetal pathophysiology of alcohol
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on fetus during pregnancy
Discuss physiological impact of alcohol on fetus
Describe clinical manifestations of FASD at birth
Discuss diagnostic evaluation of the neonate
Discuss therapeutic approach and treatment
options
Define economic, emotional and social
implications of FASD
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Approximately 12% of women in the United
States and over 20% worldwide drink alcohol
during pregnancy.
Many women are not aware they are
pregnant until 4-6 weeks into pregnancy;
consequently those women have been
drinking alcohol during the critical time of
development in the first trimester.
As a result fetus may experience detrimental
effects of alcohol.
(Balachova et al., 2013)
Consumption of alcohol
during any gestation of
pregnancy = alcohol fetal
consumption; consequently,
it causes detrimental
physical & neurological
defects, which can be lead to
any one of the array of
disorders which are
described as Fetal Alcohol
Spectrum Disorders [FASD].
(Martin, Fanaroff, & Walsh, 2011)
(May & Gossage, 2011)
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Alcohol easily crosses placenta and reaches
fetus.
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Amniotic fluid acts as a reservoir for alcohol,
prolonging fetal exposure.
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Ethanol and its metabolite, acetyldehydrate
(the placenta deoxidizes ethanol to this
substance) alters fetal development by:
(Blackburn, 2013)
(Vaux, 2012)
1) disrupting cellular differentiation & growth
2) disrupting DNA & protein synthesis
3) inhibiting cell migration due to the fact it
reaches 50% of maternal levels
4) modifies the metabolism of carbohydrates,
proteins, & fats
(Blackburn, 2013)
(Vaux, 2012)
5) interferes and decreases the transfer of
amino acids, glucose, folic acid, zinc &
other nutrients across placental barrier
disrupting fetal growth due to intrauterine
nutrient deprivation
6) interferes with the incorporation of amino
acids into proteins
(Blackburn, 2013)
(Vaux, 2012)
7) affects cell membranes & cell migration
altering embryonic tissue organization
with dysmorphic changes; consequently,
this may limit the number of fetal cells and
lead to fetal growth restriction
8) decreased placental transfer of linoleic &
docosahexanoic acid may also alter fetal
growth & development
(Blackburn, 2013)
(Vaux, 2012)
Physiological impact on fetus development
depends on the time of gestation & amount of
alcohol consumption
 Heavy drinking (four or more drinks in a day at
least occasionally) throughout pregnancy can
cause major structural defects to the fetus.
 These include defects in several major organ
systems, growth retardation, and brain
abnormalities. However, different systems are
more vulnerable at different times.
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(Sadler & Langman, 2012)
(Paoletti et al., 2013)
(NOFAS, n.d.)
(NOFAS, n.d.)
(Vaux, 2012)
Upon birth there are distinct set of facial anomalies seen
when a fetus is exposed to alcohol in utero.
(Fetal alcohol syndrome, n.d.)
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The infant may also have decreased muscle
tone, poor coordination and heart defects
such as ventricular septal defect (VSD) or
atrial septal defect (ASD).
Central nervous symptoms seen within 24
hours after delivery are tremors, irritability,
twitching, hyperacusis(decreased tolerance
to noise), hyperventilation, hypertonicity,
opisthotonos, and seizures.
(Gomella et al., 2013)
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When a diagnosis of FASD is considered, there
are three major factors that must be addressed
in the individual:
(1) physical growth, development, and structural
defects (for example, dysmorphology)
(2) cognitive and neurobehavioral function; and
(3) maternal exposure and risk
(Douzgou et al., 2012)
(May & Gossage, 2011)
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In 1996, the Institute of Medicine published
specific diagnostic criteria for FAS with
confirmed maternal alcohol exposure, FAS
without confirmed maternal alcohol
exposure, partial FAS with confirmed alcohol
exposure, alcohol related birth defects
(ARBD), and alcohol-related
neurodevelopmental disorders [ARND].
(Douzgou et al., 2012)
(CDC, 2011)
A new test capable of
detecting fetal fatty acid
ethyl esters in the meconium
of newborns of heavy alcohol
users may be useful for
identification of infants in
need of early health,
developmental and
psychosocial intervention
and may enhance clinical
research involving prenatal
drug and alcohol exposure .
(Martin et al., 2011)
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There is no cure for FASD.
Main focus of treatment is ultimately
prevention, education & early intervention.
Abstinence from alcohol preconceptually and
during pregnancy.
Guidelines for screening and management of
FASD include universal screening of pregnant
women for alcohol use, so that appropriate
management can be provided.
(Martin et al., 2011)
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It is imperative to identify possible diagnosis
of one of the FASD because early
intervention is associated with better
outcomes.
Prompt referrals and enrollment in indicated
services are required to achieve best
outcomes.
(CDC, 2011)
(Schaefer & Deere, 2011)
Due to possibility of wide array of disabilities,
patients with FASD may have special needs that
require lifelong help.
 FASD costs $6 billion annually in the United
States.
 It costs $1.4 million to treat one person with FAS
over their lifetime. (This estimates medical
treatment, home and residential care, special
educational services and productivity losses with
patients with FASD of all ages .
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(NOFAS, n.d.)
(Popova et al., 2011)
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These children often come from unstable
families and are at higher risk for physical,
sexual abuse and neglect.
As many as 85% of children with FASD are
raised by grandparents, other relatives, foster
parents, or adoptive parents.
They are at increased risk for negative
attachment & reactive attachment disorder.
(NOFAS, n.d.)
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The mother may feel guilty upon learning of
infants diagnosis; counseling should be
recommended to deal with life-long
behavioral and learning problems the child
will have.
This can be extremely stressful and
overwhelming for the family.
These children may require a range of
specialized medical, social , educational, and
legal services.
(NOFAS, n.d.)
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Worldwide rate of FAS has been estimated to be
1.9 per 1,000 in the United States.
Alcohol is now recognized as the leading of
preventable cause of birth defects and
developmental disorders in the United States.
The national Organization of Fetal Alcohol
Syndrome best sums up the relationship of
alcohol and pregnancy by stating, ““Alcohol and
Pregnancy. No safe amount. No safe time. No
safe alcohol. Period.”
(Belachova et al., 2013)
(NOFAS, n.d.)
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