copyright alcohol medical scholars program1 fetal alcohol syndrome (fas) an overview lauren d....

Copyright Alcohol Medical Scholars Program 1

Fetal Alcohol Syndrome (FAS)Fetal Alcohol Syndrome (FAS)An OverviewAn Overview

Lauren D. Williams, M.D.Lauren D. Williams, M.D.

University of Miami School of University of Miami School of MedicineMedicine


DefinitionDefinition

• FAS is a serious developmental disorder caused by FAS is a serious developmental disorder caused by prenatal alcohol exposure of the fetus and prenatal alcohol exposure of the fetus and characterized bycharacterized by

- Prenatal and/or postnatal growth retardationPrenatal and/or postnatal growth retardation

- Central nervous system dysfunctionCentral nervous system dysfunction

- Characteristic craniofacial abnormalitiesCharacteristic craniofacial abnormalities


Definition (cont.)Definition (cont.)

• FAS:FAS:- First described by Lemoine in 1968First described by Lemoine in 1968- Term coined by Jones and Smith in 1973Term coined by Jones and Smith in 1973


Facies in FASFacies in FAS

Source: Streissguth and Little 1994Source: Streissguth and Little 1994


Source: Aase 1994Source: Aase 1994


Spectrum of EffectsSpectrum of Effects

N o E ffec t

A lcoh o l R e la tedB irth D e fec ts

(A R B D )

A lcoh o l R e la tedN eu rod eve lop m en ta l

D isord ers(A R N D )

F eta l A lcoh o lE ffec ts

Fetal AlcoholSyndrom e

D eath

P ren ata l A lcoh o l E xp osu re


Diagnostic CriteriaDiagnostic Criteria

• Prenatal and/or postnatal growth retardation Prenatal and/or postnatal growth retardation

< 10< 10thth percentile percentile

• Central nervous system dysfunction: Central nervous system dysfunction: neurological, developmental, cognitive neurological, developmental, cognitive

• At least 2 facial featuresAt least 2 facial features


PathogenesisPathogenesis

• Direct toxic effects of alcoholDirect toxic effects of alcohol

• Toxic effects of acetaldehydeToxic effects of acetaldehyde

• Placental dysmorphology/functionPlacental dysmorphology/function

• Prostaglandin synthesisProstaglandin synthesis

• Early cell death (Apoptosis)Early cell death (Apoptosis)


EpidemiologyEpidemiology

• IncidenceIncidence- 0.26-4.6 per 1000 live births0.26-4.6 per 1000 live births


EpidemiologyEpidemiology

• Risk FactorsRisk Factors- Alcohol intake pattern/quantityAlcohol intake pattern/quantity- Maternal age /parityMaternal age /parity- Race/socioeconomic statusRace/socioeconomic status- Genetic susceptibilityGenetic susceptibility


Clinical CourseClinical CourseMorphological AbnormalitiesMorphological Abnormalities

Source: Streissguth et al. 1991Source: Streissguth et al. 1991


Clinical CourseClinical Course

Morphological AbnormalitiesMorphological Abnormalities




• Neurobehavioral EffectsNeurobehavioral Effects- Newborn/InfantsNewborn/Infants

- Disturbed sleep patternsDisturbed sleep patterns

- Excessive arousalExcessive arousal

- Feeding difficulties, failure to thriveFeeding difficulties, failure to thrive

- Preschool/School agePreschool/School age- HyperactivityHyperactivity

- Attention difficultiesAttention difficulties

- Mental retardationMental retardation



• Neurobehavioral Effects (cont.)Neurobehavioral Effects (cont.)- AdolescenceAdolescence

- Academic problemsAcademic problems- Independent living problemsIndependent living problems- Conduct problemsConduct problems



• Neurobehavioral EffectsNeurobehavioral Effects- AdulthoodAdulthood

- Mental problemsMental problems- Memory problemsMemory problems- Behavior problemsBehavior problems



• Secondary DisabilitiesSecondary Disabilities- School failureSchool failure

- DelinquencyDelinquency

- Difficulty with employmentDifficulty with employment

- Difficulty with independent living Difficulty with independent living


Treatment InterventionsTreatment Interventions

• Medical careMedical care

• Cognitive rehabilitation and special educationCognitive rehabilitation and special education

• Structured environment and supervisionStructured environment and supervision


PreventionPrevention

• IdentificationIdentification- HistoryHistory

- Screening instruments-AUDIT,TWEAKScreening instruments-AUDIT,TWEAK- T = ToleranceT = Tolerance- W = WorriedW = Worried- E = Eye-openersE = Eye-openers- A = Amnesia (Blackouts)A = Amnesia (Blackouts)- K (c) = Cut-downK (c) = Cut-down



• Identification (cont.)Identification (cont.)– Biological markersBiological markers

- Gamma-glutamyl transpeptidase (GGT)Gamma-glutamyl transpeptidase (GGT)- Carbohydrate-deficient transferrin (CDT)Carbohydrate-deficient transferrin (CDT)- Mean corpuscular volume (MCV)Mean corpuscular volume (MCV)



• InterventionIntervention- Universal approachesUniversal approaches

- Selective strategiesSelective strategies

- Indicated approachesIndicated approaches


SummarySummary

• FASFAS- Severe developmental disability resulting from Severe developmental disability resulting from

prenatal alcohol exposureprenatal alcohol exposure- One of the leading causes of mental retardationOne of the leading causes of mental retardation- Not just a childhood problemNot just a childhood problem- Early diagnosis and intervention importantEarly diagnosis and intervention important- PreventablePreventable

copyright alcohol medical scholars program1 fetal alcohol syndrome (fas) an overview lauren d....

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prenatal alcohol exposure

serious developmental

amnesia blackoutsk c