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Early identification/brief intervention of alcohol related problems during pregnancy:

Simona Pichini Board Member of European Alliance on Fetal Alcohol Spectrum Disorders National Counterpart on alcohol policies at WHO. Early identification/brief intervention of alcohol related problems during pregnancy: the Mediterranean Experience.

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Early identification/brief intervention of alcohol related problems during pregnancy:

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  1. Simona Pichini Board Member of European Alliance on Fetal Alcohol Spectrum DisordersNational Counterpart on alcohol policies at WHO Early identification/brief intervention of alcohol related problems during pregnancy: the Mediterranean Experience Protecting the unborn baby from alcohol, EUROPARLAMENT, Brussels, September 2013

  2. The adverse effects of prenatal exposure to maternal alcohol comprise a spectrum of structural anomalies and behavioral and neurocognitive disabilities, most accurately termed fetal alcohol spectrum disorders (FASD) including the full blown fetal alcohol syndrome (FAS) At present, there are no systematic data on ethanol consumption during pregnancy and consequent fetal exposure to this toxin in any European country.

  3. Most of the research on the prevalence of FAS and FASD comes from North America and South Africa Prevalence estimates of FAS and FASD in Canada range from 1-3 to 9 cases per 1,000 live-born infants. State-based estimates of the prevalence of FAS in the United States vary from 0.3 to 1.5 per 1,000 live-born infants, whereas the highest prevalence of FAS worldwide was reported in a wine-growing region in the Western Cape province of South Africa with a FAS prevalence of 40.5 to 46.4 per 1,000 children aged 5–9 years in one community in Western Cape.

  4. The only Italian experience of a field study, aimed to assess the prevalence of FAS and FASD by retrospective cohort study, was carried out in a restricted area of Rome wine-producing province and reported a striking FAS and FADS prevalence of 0.37 and 2.3% examined children, respectively The most recent Italian National Surveys on use and abuse of alcohol show that the percentage of women of childbearing age who declare daily intake of any alcoholic drink is around 5-6% between 18 and 44 years of age, while that of risky consumers, those who declare to exceed the daily ethanol dose of 12-24 g is 9.5 at 18–24 and 5.0% at 25–44 years of age It is thus conceivable that a significant number of women who are not only problem drinkers but also social drinkers and are of child bearing age will not refrain from ethanol drinking during pregnancy and may give birth to an infant in utero exposed to this toxin.

  5. “The Meconium Project”: An Italian-Spanish Joint Study to Assess Exposure to Illicit Drugs During Pregnancy and Birth Outcomes in a mediterranean city (2004-2008) Istituto Superiore di Sanità, Roma, Italy IMIM- Hospital del Mar, Barcelona, Spain We found in 1209 meconium samples of mother-infant dyads attending the Hospital during 2002-2004 a prevalence of prenatal exposure to 2.6% Cocaine, 4.7% heroin and 5.3% cannabis and…. 45% daily maternal ethanol measured by FAEEs in meconium

  6. ITALIAN MULTICENTRE STUDY 2010 Meconium samples of newborns of Neonatology Units from: Reggio Emilia- 160 Roma- 51 Napoli- 61 San Daniele del Friuli- 50 Crotone- 96 Firenze- 99 Verona- 90 All the neonates born in the Unit in a certain period of time (e.g.1 month) excluding the ones with severe pathologies (e.g. prematures, N=8) requesting intensive care

  7. % newborns prenatally exposed to maternal ethanol in different Italian Cities: Roma-29.4% Reggio Emilia- 10.6% Crotone- 6.2% Firenze- 5.0% Napoli- 4.9% San Daniele del Friuli- 4.0% Verona- 0% Overall: 7.9% newborns prenatally exposed to maternal ethanol

  8. Neurodevelopmental characteristics of newborns exposed to maternal alcohol as proved by meconium screening: preliminary dataG. Coriale, L. Tarani, S. Pichini, R. Pacifici, D. Fiorentino, M. Fiore, F. Di Lauro, R. Marchitelli, G. Parlapiano, B. Scalese, M. Ceccanti n=8 children (mean age 16 months; s.d. 2.3) positive for FAEEs and EtG in meconium and n=8 children (mean age 17 months; s.d. 1.4) negative for the biomarkers in meconium were enrolled in the study. Physical growth and dysmorphological data collected by pediatrician, Cognitive motor development and the adaptive abilities assessed using the Griffiths Mental Development Scales (GMDS ) and Vineland Adaptive Behaviour Scale (VABS).

  9. Fig.1 The developmental profiles of the Fig.1 The developmental profiles of the Fig.1 The developmental profiles of the positiveand positiveand positiveand negative negative negative meconium meconium meconium sample on GMDS sample on GMDS sample on GMDS (Percentile) (Percentile) (Percentile) 80 80 Positive Meconium Positive Meconium * * * 71.6 71,6 Negative Meconium Negative Meconium 60.9 60,9 70 70 * * * 52,5 52.5 52,5 52.5 51.3 51,3 60 60 69.5 69,5 50 50 50.9 50,9 50.8 50,8 40 40 43,5 43.5 30.0 30,0 *significant comparison ( *significant comparison ( *significant comparison ( p p p < 0.05) < 0.05) < 0.05) 30 30 20 20 10 10 0 0 Eye-Hand Eye-Hand Locomotor Locomotor Performance Performance Hearing-Speech Hearing-Speech Personal-Social Personal-Social Figure 2 The developmental profiles of the positive and negative Figure 2 The developmental profiles of the positive and negative meconium meconium sample sample on VABS (raw scores on VABS (raw scores ) ) * * * * 80 80 68,4 68.4 Positive Meconium Positive Meconium 65,0 65.0 62,7 62.7 60.4 60,4 70 70 Negative Meconium Negative Meconium 60 60 50 50 *significant comparison ( *significant comparison ( < 0.05) < 0.05) p p 54.3 54,3 40 40 55,2 55.2 49.9 49,9 47,9 47.9 30 30 20 20 10 10 0 0 Motor Motor Daily Living Daily Living Socialization Socialization Communication Communication * * *significant comparison (p < 0.05) * * *significant comparison (p < 0.05) Results

  10. In order to The FRAMES methodology The 5 A’s counseling

  11. Released in 3000 copies the last September 9, 2011 during a press releasewithrepresentatives of pediatricians, neonatologists and gynecologists. Availablealso on line at http://www.iss.it/ofad. Distributedto the principalhospitals, neonatologywards, regionaldepartments of healthalong the peninsula

  12. Guideline To diagnose FAS and FASD 3000 printed copies 

  13. Lazio Region Alcohologic Centre • Italian Society on FASD/ Since 2012 earlydiagnosis /briefinterventionhasbeenperformed on 1500 pregnant women attending Umberto I Hospital in Rome

  14. Suggested strategy to detect drinking during pregnancy: Questionnaire and EtG in urine at first antenatal visit; if positive- EtG in hair; if positive brief intervention or detoxification centre. If suspicion, EtG in urine at each visit, standard biomarkers Suggested strategy to detect fetal exposure to maternal drinking: EtG in meconium for all newborns; for newborns from risky environments; for newborns of mothers suspected of drinking during pregnancy

  15. Thanks

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