Transcript Fetal Alcohol Syndrome

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 States0.5 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 processessuch 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 SyndromeOverview 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:S7S15.