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 States- 0.5 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 processes-

such 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 Syndrome- Overview 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:S7-S15.