Alcohol Use and Pregnancy and Fetal Alcohol Spectrum Disorder

1. Alcohol Use and Pregnancy and Fetal Alcohol Spectrum Disorder www.faseout.ca 2008

2. Alcohol is a Teratogen • A teratogen is a substance that interferes with the normal development of the fetus • Specifically, alcohol is a neurobehavioural teratogen – alcohol can damage the brain and change behaviour www.faseout.ca 2008

3. Teratology:Four Outcomes to Exposure • Malformations (facial, heart, skeletal) • Growth Deficiency (small) • Functional Deficits (learning and behavioural problems) • Death (stillbirth, miscarriage) www.faseout.ca 2008

4. 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 www.faseout.ca 2008

5. 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 body’s movements • Third Month: Most major organs and the face are developed. Bones continue to grow and kidneys start to work www.faseout.ca 2008

6. 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 www.faseout.ca 2008

7. 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 alcohol can cause www.faseout.ca 2008

8. www.faseout.ca 2008

9. Drinking in Perspective In general women: • may drink alcohol before they realize they’re 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 www.faseout.ca 2008

10. No one can predict which infants born to mothers who drink will be affected, nor can anyone predict how severe these effects will be. www.faseout.ca 2008

11. Factors Involved in FASD • The stage in the pregnancy at which alcohol is consumed • The amount of alcohol consumed during the pregnancy • Other factors such as maternal age, stress, nutrition, smoking, and the use of other drugs (prescribed or street drugs) • Fetal susceptibility to alcohol www.faseout.ca 2008

12. 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 ) www.faseout.ca 2008

13. Paternal Role • Effects on the Fetus: the effects of father’s drinking on the fetus are not fully known • Effects on Pregnancy: Alcohol can result in lower 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 not alcohol-affected www.faseout.ca 2008

14. 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 their pregnant partners • A man’s drinking after the baby is born could adversely affect the nurturing home environment needed to raise a child www.faseout.ca 2008

15. What is Fetal Alcohol Spectrum Disorder? www.faseout.ca 2008

16. 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 www.faseout.ca 2008

17. Diagnostic Terms • Fetal Alcohol Syndrome (FAS) • Partial Fetal Alcohol Effects (pFAS) • Alcohol Related Neurodevelopmental Disorder (ARND) • Alcohol Related Birth Defects (ARBD) www.faseout.ca 2008

18. Fetal Alcohol Syndrome Recognized and documented in Nantes, France and Seattle, Washington 1968 – 1973 www.faseout.ca 2008

19. 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 www.faseout.ca 2008

20. FAS Features www.faseout.ca 2008

21. ARND/pFAS: The invisible disability • Physical characteristics FASD unremarkable • Disappear: become less prominent over time • Adolescent & Adult Diagnosis often more difficult www.faseout.ca 2008

22. Alcohol-Related Neuro-Developmental Disorder (ARND) • Individuals with ARND present with neuro-cognitive dysfunction and complex patterns of behaviour, and have a confirmed exposure to alcohol prenatally • Individuals with ARND may not demonstrate any of the facial features or growth restrictions associated with the full syndrome www.faseout.ca 2008

23. Partial Fetal Alcohol Syndrome (PFAS) with confirmed alcohol exposure This diagnostic term is used when the person presents with central nervous system dysfunction and most (but not all of the growth and/or facial features of FAS), and has a confirmed prenatal alcohol exposure www.faseout.ca 2008

24. 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 appropriate diagnosis www.faseout.ca 2008

25. 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 www.faseout.ca 2008

26. 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 www.faseout.ca 2008

27. Benefits to a diagnosis Parents and professionals often find their ability to cope improves when they understand problems are most likely caused by brain damage not the person’s choice to be inattentive or uncooperative www.faseout.ca 2008

28. 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 www.faseout.ca 2008

29. Primary Disabilities: Organ Anomalies • Cardiac anomalies • Joint and limb anomalies • Neurotubal defects • Anomalies of the urogenital system • Hearing disorders • Visual problems • Severe dental malocclusions www.faseout.ca 2008

30. Primary Disabilities: Central Nervous System • Tremors • Poor suck • Hypotonic/Hypertonic • Irritability • Developmental delay www.faseout.ca 2008

31. Primary Disabilities: Central Nervous System • Cognitive problems • Fine motor issues • Hyperactivity • Restlessness • Poor ability to focus attention www.faseout.ca 2008

32. Primary Disabilities Generalized damage to the brain typically has a significant impact on: • cognitive processing • emotional regulation www.faseout.ca 2008

33. Primary Disabilities: Central Nervous System Cognitive problems • Verbal IQ • Performance IQ • Scatter in Cognitive Skills • Specific Learning Disabilities • Memory Deficits • Executive Functioning www.faseout.ca 2008

34. Primary Disabilities: Central Nervous System • Fine motor issues • Hyperactivity • Restlessness • Poor ability to focus attention www.faseout.ca 2008

35. Primary Disabilities: Central Nervous System • Poor Judgement • Impulsiveness • Sleep disturbances • Extreme anxiety • Depression • Aggressiveness • Other Behavioural Problems www.faseout.ca 2008

36. working memory planning time perception internal ordering self-monitoring regulation of emotion motivation inhibition Executive functions ofthe prefrontal cortex www.faseout.ca 2008

37. Emotional Regulation Emotional instability For example, going from a calm to an agitated state (unexplained anger, laughing, crying) without apparent explanation www.faseout.ca 2008

38. 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 by relatively commonplace events/circumstances www.faseout.ca 2008

39. Strategies Need to Address the Whole Being Mental, physical, emotional, spiritual and sexual well being www.faseout.ca 2008

40. 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 www.faseout.ca 2008

41. Strategies for Success • 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 www.faseout.ca 2008

42. Strategies for Success • 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 www.faseout.ca 2008

43. Strategies for Success • 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 www.faseout.ca 2008

44. Resources • Canadian Centre on Substance Abuse www.ccsa.ca/fas • Public Health Agency of Canada www.publichealth.gc.ca/fasd • Motherisk, The Hospital for Sick Children www.motherisk.org • Saskatchewan Prevention Institute www.preventioninstitute.sk.ca www.faseout.ca 2008

45. Thank you! www.faseout.ca 2008