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A lcoho l Use and Pregnancy

and Fetal Alcoho l Spectrum

Disorder


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Alcohol is a Teratogen

A teratogen is a substance that interferes with

the normal development of the fetus

Specifically, alcohol is a neurobehaviouralteratogen alcohol can damage the brain and

change behaviour


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Teratology:

Four Outcomes to Exposure

Malformations (facial, heart, skeletal)

Growth Deficiency (small)

Functional Deficits (learning and behaviouralproblems)

Death (stillbirth, miscarriage)


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Effects of Alcohol in Pregnancy

Alcohol freely crosses the placenta

Adverse effects to the fetus occur at levels at or

below those that are toxic to women

Fetal elimination of alcohol is poor

Increased risk for low birth weight

Harm can be caused before a woman knows

she is pregnant


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First Trimester

First Month: heart, lungs, limbs, face, ears, eyes,

spinal cord, and brain begin to form

Second Month: toes and eyelids form and brain

grows quickly and directs bodys movements

Third Month: Most major organs and the face

are developed. Bones continue to grow and

kidneys start to work


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Second Trimester

Fourth Month: The placenta is fully formed and

fetal movement may be felt by woman

Fifth Month: Eyelashes, eyebrows and scalp and

hair appear. Fetal heartbeat can be heard

Sixth Month: Eyes open and close. Lungs, brain

and other organs continue to develop


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Third Trimester

In the third trimester, the fetus grows quickly in

weight and length

Lungs and other major organs mature to support

life

The brain continues to grow and develop and

remains vulnerable to thedamage that alcoholcan cause


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Drinking in Perspective

In general women:

may drink alcohol before they realize theyre

pregnant

may not know alcohol is harmful to the

developing fetus

may drink because it is the social/cultural norm

may drink to self-medicate


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No one can predict which infants born to mothers

who drink will be affected, nor can anyone

predict how severe these effects will be.


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Factors Involved in FASD

The stage in the pregnancy at which alcohol is

consumed

The amount of alcohol consumed during thepregnancy

Other factors such as maternal age, stress,

nutrition, smoking, and the use of other drugs(prescribed or street drugs)

Fetal susceptibility to alcohol


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Standard drinks = 0.5 oz alcohol

12 oz (341 mL) can of beer (5% alcohol)

12 oz (341 mL) bottle of cooler (5% alcohol)

5 oz (142 mL) glass of wine (12% alcohol)

1.5 oz (43 mL) distilled spirits (40% alcohol)

3 oz (85 mL) fortified wine e.g. sherry or port

(18% alcohol )


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Paternal Role

Effects on the Fetus: the effects of fathers

drinking on the fetus are not fully known

Effects on Pregnancy: Alcohol can result inlower sperm count and abnormal sperm, which

may effect fertility. If alcohol-affected sperm

does fertilize an egg, the likelihood of

miscarriage is higher than if the sperm were notalcohol-affected


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Paternal Role: Social Effects

Women most often drink with their partners

Men who drink heavily are unlikely to provide the

necessary emotional support and care for theirpregnant partners

A mans drinking after the baby is born could

adversely affect the nurturing home environmentneeded to raise a child


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What is Fetal Alcohol Spectrum

Disorder?


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Fetal Alcohol Spectrum Disorder

(FASD) FASD is a combination of mental and physical

disabilities

FASD is a lifelong condition

FASD is caused by maternal alcohol

consumption during pregnancy


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Diagnostic Terms

Fetal Alcohol Syndrome (FAS)

Partial Fetal Alcohol Effects (pFAS)

Alcohol Related Neurodevelopmental Disorder(ARND)

Alcohol Related Birth Defects (ARBD)


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Fetal Alcohol Syndrome

Recognized and documented in Nantes, France

and Seattle, Washington

1968 1973


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Characteristics of FAS

Facial anomalies

Evidence of growth restriction (may be apparent

prenatally and/or postnatally), (below the 10th

percentile) and microcephaly

Central nervous system abnormalities


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FAS Features


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ARND/pFAS:

The invisible disability

Physical characteristics FASD unremarkable

Disappear: become less prominent over time Adolescent & Adult Diagnosis often more difficult


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Alcohol-Related Neuro-

Developmental Disorder (ARND)

Individuals with ARND present with neuro-

cognitive dysfunction and complex patterns

of behaviour, and have a confirmedexposure to alcohol prenatally

Individuals with ARND may not

demonstrate any of the facial features orgrowth restrictions associated with the full

syndrome


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Partial Fetal Alcohol Syndrome

(PFAS) with confirmed alcohol

exposure

This diagnostic term is used when theperson presents with central nervous

system dysfunction and most (but not all ofthe growth and/or facial features of FAS),and has a confirmed prenatal alcoholexposure


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Diagnostic Process

Information is collected regarding the individual

physical, social, academic, and adaptive skill

history

If possible, the physician, along with a

psychologist and other specialists, will assess

the individual in order to make an appropriatediagnosis


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Possibility of Misdiagnosis

Since FASD is not a mental health diagnosis, it

might not be considered or recognized

The symptom presentation of individuals with

FASD is similar to that of many other mental

health diagnoses


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Possibility of Misdiagnosis

Individuals may be diagnosed with a mental

health disorder without closely examining the

total picture

Even when FASD is recognized, another

diagnosis is often used in order to get

reimbursement for treatment


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Benefits to a diagnosis

Parents and professionals often find their ability

to cope improves when they understand

problems are most likely caused by braindamage not the persons choice to be inattentive

or uncooperative


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Primary Disabilities

Are the direct result of structural and/or

functional damage to individuals

While they can be evident in certain physical

characteristics, it is the direct damage to the

brain that has the greatest effect on the person


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Primary Disabilities:

Organ Anomalies

Cardiac anomalies

Joint and limb anomalies

Neurotubal defects

Anomalies of the urogenital system

Hearing disorders

Visual problems

Severe dental malocclusions


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Central Nervous System

Tremors

Poor suck

Hypotonic/Hypertonic

Irritability

Developmental delay


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Cognitive problems

Fine motor issues Hyperactivity

Restlessness

Poor ability to focus attention


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Primary Disabilities

Generalized damage to the brain typically has a

significant impact on:

cognitive processing

emotional regulation


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Cognitive problems

Verbal IQPerformance IQ

Scatter in Cognitive Skills

Specific Learning Disabilities

Memory DeficitsExecutive Functioning


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Fine motor issues

Hyperactivity

Restlessness

Poor ability to focus attention


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Poor Judgement

Impulsiveness

Sleep disturbances

Extreme anxiety

Depression

Aggressiveness

Other Behavioural Problems


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Executive functions of

the prefrontal cortex

working memory

planning

time perception

internal ordering

self-monitoring

regulation ofemotion

motivation

inhibition


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Emotional Regulation

Emotional ins tabi l i ty

For example, going from a calm to an agitated

state (unexplained anger, laughing, crying)without apparent explanation


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Emotional Regulation

Deficits in emotional regulation are partly

explained by poor inhibition and deficits in

sensory integration (SI)

Deficits in SI result in confusion in the

interpretation of incoming sensations

Individuals can become easily overwhelmed byrelatively commonplace events/circumstances


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Strateg ies Need to Address the

Whole Being

Mental, physical,emotional,

spiritual andsexual well being


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Strategies for Success

Observe patterns of behaviour

Identify strengths, skills and interests

Reframe the interpretation of behaviours

Provide structure rather than control

Establish routines and consistency


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Build transitions into every routine

Model behaviours

Provide simple instructions or cues

Identify behaviours which indicate the

accumulation of frustration

Help develop skills for expressing feelings


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Provide specific support for social skill

development

Understand the various forms of communication

Include as many sensory modalities as possible

to facilitate integration of information and

experience


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Consider information processing abilities

Re-evaluate expectations and goals for the

individual: clarify whose needs are being met by

the goals

Clarify goals and values for education/job

training and independence


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Resources

Canadian Centre on Substance Abusewww.ccsa.ca/fas

Public Health Agency of Canada

www.publichealth.gc.ca/fasd

Motherisk, The Hospital for Sick Childrenwww.motherisk.org

Saskatchewan Prevention Institutewww.preventioninstitute.sk.ca
http://www.ccsa.ca/fashttp://www.publichealth.gc.ca/fasdhttp://www.motherisk.org/http://www.preventioninstitute.sk.ca/http://www.preventioninstitute.sk.ca/http://www.motherisk.org/http://www.publichealth.gc.ca/fasdhttp://www.ccsa.ca/fas


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