ALCOHOL IN PREGNANCY JEONG SHIN OK Mothersafe round Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cheil General Hospital & Women 's Healthcare Center, Dankook University College of Medicine
ALCOHOL IN PREGNANCY
JEONG SHIN OK
Mothersafe round
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology,
Cheil General Hospital & Women 's Healthcare Center, Dankook University College of Medicine
Contents
Introduction
Fetal alcohol spectrum disorders
Clinical manifestations of FASD
Conclusion
Alcohol…
Teratogen Alcohol passes through the placenta directly to the
baby’s bloodstream No known safe amount of alcohol use during preg-
nancy No safe time during pregnancy to drink All types of alcohol are equally harmful Binge drinking is especially harmful
Introduction
What is a standard drink?
Binge drink : 4 or more standard drinks on one occasion for women
Introduction
about 14 gm of pure alcohol (about 0.6 fl oz/17.7ml)
Alcohol use during pregnancy
Fetal alcohol spectrum disorders (FASDs) Birth defects Developmental disabilities
Other pregnancy problems Miscarriage Stillbirth Prematurity
Introduction
Fetal alcohol spectrum disorders(FASDs)
Not diagnostic term Group of conditions that
can occur in a person whose mother drank alco-hol during pregnancy
FASD
Discovery of FASD (I) 1960’
“alcohol embryopathy” – Lemoine et al. 1970’
Fetal alcohol syndrome – Jones and Smith Fetal alcohol effect – Clare and Smith
1996, Institute of Medicine(IOM) FAE ARBD and ARND
FASD
Classification of FASDs (IOM)
Fetal alcohol syndrome Most severe end outcome of FASDs
Partial FAS Alcohol related birth defect Alcohol related neurodevelopmental disorders
FASD
Discovery of FASD (II)
2005 Chudley et al.
Canadian diagnostic guidelines IOM system + 4-Digit diagnostic code system
Hoyme et al. Revised IOM diagnostic classification system
FASD
Comparison of diagnostic criteriaFASD
Susan J. Astly, 2006
Revised IOM criteria for diagnosis of FASD (I)I. FAS With Confirmed Maternal Alcohol Exposure (all of A–D)
(A) Confirmed maternal alcohol exposure(B) Minor facial anomalies (≥2) (1) Short palpebral fissures (p10%)(2) Thin vermilion border of the upper lip (score 4 or 5)(3) Smooth philtrum (score 4 or 5)(C) Prenatal and/or postnatal growth retardation(1) Height and/or weight p10%(D) Deficient brain growth and/or abnormal morphogenesis (≥1) (1) Structural brain abnormalities(2) Head circumference p10%
II. FAS Without Confirmed Maternal Alcohol ExposureIB, IC, and ID as above
FASD
Revised IOM criteria for diagnosis of FASD (II)III. Partial FAS With Confirmed Maternal Alcohol Exposure (all A-C)
(A) Confirmed maternal alcohol exposure(B) Minor facial anomalies (≥2)(1) Short palpebral fissures (p10%)(2) Thin vermilion border of the upper lip (score 4 or 5)(3) Smooth philtrum (score 4 or 5)(C) One of the following other characteristics:(1) Prenatal and/or postnatal growth retardation(a) Height and/or weight p10%(2) Deficient brain growth or abnormal morphogenesis (≥1)
(a) Structural brain abnormalities(b) Head circumference p10%(3) Complex pattern of behavioral or cognitive abnormalities
IV. Partial FAS Without confirmed Maternal Alcohol ExposureIIIB and IIIC, as above
FASD
Revised IOM criteria for diagnosis of FASD(III)
V. ARBD (all of A-C)(A) Confirmed maternal alcohol exposure(B) Minor facial anomalies (≥2)(1) Short palpebral fissures (p10%)(2) Thin vermilion border of the upper lip (score 4 or 5)(3) Smooth philtrum (score 4 or 5)(C) Congenital structural defect (≥1)
(if the patient displays minor anomalies only, ≥ 2 must be present)cardiac/skeletal/renal/eyes/ears/minor anomalies
FASD
Revised IOM criteria for diagnosis of FASD(IV)
VI. ARND (both A and B)(A) Confirmed maternal alcohol exposure(B) At least 1 of the following:(1) Deficient brain growth or abnormal morphogenesis (≥1)(a) Structural brain abnormalities(b) Head circumference p10%(2) Complex pattern of behavioral or cognitive abnormalities
FASD
Variability of Adverse Fetal OutcomesClinical manifestations
Amount of alcohol Genetic variation Maternal nutrition Maternal age Socioeconomic status Timing of exposure
Facial anomalies (I)Clinical manifestations
Facial anomalies (II)
8 months – 8 years of age
Not smiling
Clinical manifestations
Growth retardation
Usually presents in the prenatal period and per-sists as a consistent impairment over time
Below 10 percentile Diminish in adolescence and adult
Clinical manifestations
CNS anomalies - structural Cerebrum
Volume reduction Lt. > Rt. White matter hypoplasia
Cerebellum Reduction in the anterior vermis
Basal ganglia Caudate nucleus
Corpus callosum Agenesis, thinning, hypoplasia Role in the coordination of various function
Clinical manifestations
CNS anomalies - functional (I)
Cognitive defects General intelligence ↓
Low IQ (70 for FAS, 80 for nondysmorphic individuals) Learning disabilities
Significant relation between general cognitive function and degree of dysmorphic features and growth defi-ciency
Clinical manifestations
Ervalahti et al. 2007
CNS anomalies - functional (II) Executive function deficits
Executive function Maintain an appropriate problem-solving set for attainment of a
future goal Related to frontal-subcortical circuit
Difficulty set-shifting Poor inhibitory control Poor organization and planning Poor judgment Difficulty following multistep direction Deficits working memory(verbal/visuo-spatial)
Clinical manifestations
Stroop testGreen Red Blue
Purple Blue PurpleBlue Purple Red
Green Purple Green
CNS anomalies - functional (III)
Motor function delay Affect muscle control
Gross motor skill – delay in walking Fine motor skill – difficulty writing or drawing
Balanced problems Tremors Dexterity Poor sucking
Clinical manifestations
CNS anomalies - functional (IV)
Attention problems and hyperactivity Higher rate of ADHD Hyperkinetic disorders Difficulty complete tasks Difficulty moving from one activity to the next
Clinical manifestations
Other abnormalitiesClinical manifestations
SkeletalJoint contracture, scoliosis, hemivertebraebrachydactyly, clinodactyly, high arched palate
Cardiac ASD, VSD, hypoplastic pulmonary artery, TOF, pectus excavatum or carinatum
RenalPyelonephritis, hydronephrosis, dysplastic kidney, ureteral duplications, hypoplasia
Ocular Strabismus, retinal vascular anomalies
Auditory Conductive hearing loss, SNHL
Secondary Disabilities Wide range of maladaptive, behavioral and emo-
tional disturbances Psychiatric problem
ADHD Schizophrenia, depression, PD
Disrupted school experience Dependent living Trouble with the law Addiction
Clinical manifestations
Conclusions Fetal Alcohol Syndrome (FAS) is the leading cause of pre-
ventable mental retardation FASD is a lifelong disability that causes health,learning
and behavioural problems Awareness about dangers of drinking alcohol during preg-
nancy can help to prevent FAS
FAS is 100% preventable if a woman does not drink alcohol while she is pregnant
Thank you for your attention!!!!!