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!!!!!