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Results for “Fetal Alcohol Spectrum Disorders”

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PubMed2006

A retrospective review of self-reported alcohol intake among women attending for antenatal care in Far North Queensland.

BACKGROUND: Fetal alcohol syndrome and fetal alcohol spectrum disorder are known to occur among children delivered to women in Far North Queensland; to date, the problem has not been quantified or related directly to maternal alcohol consumption during pregnancy. AIMS: To identify the characteristics of women who consume alcohol during pregnancy, in order to identify 'high-risk' women to whom educational intervention regarding fetal alcohol syndrome may be targeted. METHODS: A retrospective descriptive study using the case notes of all women attending the antenatal booking clinic in Cairns Base Hospital over the 3-month period from April to June 2005. Obstetric and demographic information and self-reported alcohol intake before and during pregnancy were noted and self-reported alcohol intake before and during pregnancy. RESULTS: Five hundred and forty-one women were included in this study. Of these women, 24.6% were found to consume alcohol during pregnancy and 57.7% were found to consume alcohol before pregnancy, indicating a reduction in alcohol consumed once women became aware of pregnancy. The most significant indicator for alcohol consumption during pregnancy was found to be alcohol consumption before pregnancy. Of women who consumed alcohol in pregnancy, 71.5% drank moderate amounts of alcohol before pregnancy and 28.7% drank heavily before pregnancy. CONCLUSION: Alcohol consumption during pregnancy is common in Far North Queensland. Methods currently used during antenatal booking visits to determine alcohol consumption before and during pregnancy are unreliable. Strategies to identify women consuming alcohol before and during pregnancy and education programs are vitally important if the incidence of fetal alcohol syndrome and spectrum disorder is to be reduced.

Adult↗

PubMed1999

Under-recognition of prenatal alcohol effects in infants of known alcohol abusing women.

Medical records of 124 women and their infants were analyzed for: (1) documentation of maternal alcohol and other substance abuse and (2) evaluation of exposed infants. These results were compared with the study interview and infant examination. More obstetric nurses documented the presence or absence of alcohol and substance abuse than did pediatricians. More women reported using alcohol in the study interview than documented in the medical records. There was slightly better documentation for cocaine use than for alcohol use in the medical records. One of the 19 infants with documentation of maternal alcohol use was noted to have possible alcohol-related features by the pediatrician, in contrast to 7 infants identified by the study examiner. In addition, 2 of these 19 infants were determined by the study examiner to have fetal alcohol syndrome; neither case was diagnosed by the pediatricians. Continued efforts at education regarding the importance of asking about prenatal alcohol exposure and the spectrum of fetal alcohol effects are needed for early diagnosis.

Alcoholism↗

PubMed2005

A Guinea pig model for the identification of in utero alcohol exposure using fatty acid ethyl esters in neonatal hair.

Measuring levels of fatty acid ethyl esters (FAEE) in hair has been a useful way to discriminate between adult heavy and nondrinkers. Extending the use of FAEE into neonatal hair to objectively identify children exposed to alcohol in utero may revolutionize current methods used to diagnose fetal alcohol spectrum disorder (FASD). Here we confirm for the first time that chronic exposure to alcohol during pregnancy in guinea pigs leads to increased levels of FAEE in both maternal and neonatal hair. The mean cumulative FAEE concentration in exposed maternal samples taken at GD57 was 0.431+/-0.140 pmol/mg (mean+/-SEM); levels observed in corresponding sucrose and water controls were 10-fold lower. Similarly, FAEE concentrations in exposed offspring samples taken at postnatal d 1 (mean cumulative FAEE=0.491+/-0.177 pmol/mg) were more than 15-fold higher than control counterparts. Sixty percent of all alcohol-exposed animal samples contained two or more quantifiable FAEE, whereas close to 90% of either water or sucrose control samples did not have more than one quantifiable level of a single FAEE. Results of this study suggest that FAEE in neonatal hair may be useful biomarkers in identifying in utero alcohol exposure and may facilitate the early diagnosis and treatment of FASD.

Animals↗

PubMed2005

Ethanol exposure affects gene expression in the embryonic organizer and reduces retinoic acid levels.

Fetal Alcohol Spectrum Disorder (FASD) is a set of developmental malformations caused by alcohol consumption during pregnancy. Fetal Alcohol Syndrome (FAS), the strongest manifestation of FASD, results in short stature, microcephally and facial dysmorphogenesis including microphthalmia. Using Xenopus embryos as a model developmental system, we show that ethanol exposure recapitulates many aspects of FAS, including a shortened rostro-caudal axis, microcephally and microphthalmia. Temporal analysis revealed that Xenopus embryos are most sensitive to ethanol exposure between late blastula and early/mid gastrula stages. This window of sensitivity overlaps with the formation and early function of the embryonic organizer, Spemann's organizer. Molecular analysis revealed that ethanol exposure of embryos induces changes in the domains and levels of organizer-specific gene expression, identifying Spemann's organizer as an early target of ethanol. Ethanol also induces a defect in convergent extension movements that delays gastrulation movements and may affect the overall length. We show that mechanistically, ethanol is antagonistic to retinol (Vitamin A) and retinal conversion to retinoic acid, and that the organizer is active in retinoic acid signaling during early gastrulation. The model suggests that FASD is induced in part by an ethanol-dependent reduction in retinoic acid levels that are necessary for the normal function of Spemann's organizer.

Animals↗

PubMed2006

Health-related quality of life of Canadian children and youth prenatally exposed to alcohol.

BACKGROUND: In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 in 100 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of neuro-developmental disabilities among Canadian children, and youth. OBJECTIVE: To measure the health-related quality of life (HRQL) of Canadian children and youth diagnosed with FASD. METHODS: A prospective cross-sectional study design was used. One-hundred and twenty-six (126) children and youth diagnosed with FASD, aged 8 to 21 years, living in urban and rural communities throughout Canada participated in the study. Participants completed the Health Utilities Index Mark 3 (HUI3). HUI3 measures eight health attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Utilities were used to measure a single cardinal value between 0 and 1.0 (0 = all-worst health state; 1 = perfect health) to reflect the global HRQL for that child. Mean HRQL scores and range of scores of children and youth with FASD were calculated. A one-sample t-test was used to compare mean HRQL scores of children and youth with FASD to those from the Canadian population. RESULTS: Mean HRQL score of children and youth with FASD was 0.47 (95% CI: 0.42 to 0.52) as compared to a mean score of 0.93 (95% CI: 0.92 to 0.94) in those from the general Canadian population (p < 0.001). Children demonstrated moderate to severe dysfunction on the single-attributes of cognition and emotion. CONCLUSION: Children and youth with FASD have significantly lower HRQL than children and youth from the general Canadian population. This finding has significant implications for practice, policy development, and research.

Adolescent↗

PubMed2006

Postnatal environmental or experiential amelioration of neurobehavioral effects of perinatal alcohol exposure in rats.

Fetal alcohol spectrum disorders (FASDs) in children are characterized by life-long compromises in learning, memory, and adaptive responses. To date, there are no clinical remedies for the treatment of global fetal alcohol effects, although interventions for specific outcomes are available. Here we review basic research in animal models of perinatal alcohol exposure to assess the potential of global environmental manipulations to ameliorate the neurobehavioral effects associated with FASD. Enhancement of the postnatal environment via neonatal handling, environmental enrichment, or rehabilitative or "therapeutic" motor training, can improve behavioral performance and ameliorate or even eliminate some deficits in perinatal alcohol-exposed rats and mice. While neuroanatomical changes associated with the behavioral improvements have been reported in some models, there generally appears to be a persistent impairment in neuronal plasticity. Such research suggests that it may be possible to manage the postnatal environment or experience of children with FASDs to improve function. It is, however, necessary to consider the difficulties in translating findings from research in animals to the clinic, school or home because sex-, postnatal age- and species-specific differences are critical factors in how specific environments may influence brain development. Continued study of the potential ameliorative effects of neonatal handling, environmental enrichment, and rehabilitative training as "therapies" in animal models will remain a valuable source of information for eventually devising treatments for children with FASDs.

Animals↗

PubMed2005

Prenatal alcohol exposure causes attention deficits in male rats.

Children with fetal alcohol spectrum disorder (FASD) are often diagnosed with attention-deficit/ hyperactivity disorder (ADHD). These children show increases in reaction time (RT) variability and false alarms on choice reaction time (CRT) tasks. In this study, adult rats prenatally exposed to ethanol were trained to perform a CRT task. An analysis of the distribution of RTs obtained from the CRT task found that rats with a history of prenatal ethanol exposure had more variable RT distributions, possibly because of lapses of attention. In addition, it was found that, similar to children with FASD, the ethanol-exposed rats had more false alarms. Thus, rats with prenatal ethanol exposure show attention deficits that are similar to those of children with FASD and ADHD.

Animals↗

PubMed2006

Damage to the human cerebellum from prenatal alcohol exposure: the anatomy of a simple biometrical explanation.

Since 1973, it has become clear that exposure of otherwise normal human fetuses to high levels of alcohol damages a substantial number of the exposed brains in a wide variety of ways nowadays referred to collectively as the fetal alcohol spectrum disorders (FASDs). Averages of images and measurements of brains with these disorders are quantitatively different from normal, and the cerebellum is one of the structures at which differences are typically noted. The present article extends these techniques to a simple, practical, and enlightening detection rule for fetal alcohol damage in adolescents and adults known to have been heavily exposed. The data arise from 180 clinical MR brain images (half of adolescents, half of adults; half male, half female; one-third each fetal alcohol syndrome, fetal alcohol effects, and unexposed). The 180 cerebellums were represented by 328-semilandmark triangulations covering most of the cerebellar surface. Statistical analysis exploited the now-conventional methods of Procrustes analysis in three dimensions, along with a recent extension to incorporate size information explicitly. If we reduce the data complexity even further, to just 23 points along the silhouette of the cerebellum as viewed from above along the aqueductal axis, the analysis becomes more precise. Now a single multivariate summary score, very strongly correlated with size, supports a discrimination (diagnosed vs. unexposed) with about 75% accuracy. About one-quarter of our FASD sample overlaps with the central range of the unexposed in the distribution of this size-based score, with the other three-quarters distinctly showing cerebellar damage. The finding, which corresponds quite closely to the fundamental finding of cerebellar hypoplasia in animal experiments, bears implications for fetal alcohol epidemiology, for geometric morphometrics, and for the geometric complexity of useful data structures derived from clinical brain imaging.

Adolescent↗

PubMed1998

Mental illness in adults with fetal alcohol syndrome or fetal alcohol effects.

OBJECTIVE: The authors' goal was to use structured clinical interviews to characterize the type and frequency of mental illness in adults with fetal alcohol syndrome or fetal alcohol effects. METHOD: Twenty-five subjects who met criteria for fetal alcohol syndrome or fetal alcohol effects, who were older than 18 years old, and who had an IQ of greater than 70 were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders and the Structured Clinical Interview for DSM-III-R Personality Disorders. RESULTS: Eighteen of the 25 subjects had received psychiatric treatment. The most common axis I disorders were alcohol or drug dependence (15 subjects), depression (11 subjects), and psychotic disorders (10 subjects). The most common axis II disorders were avoidant (six subjects), antisocial (four subjects), and dependent (three subjects) personality disorders. CONCLUSIONS: This study suggests that adults with fetal alcohol syndrome or fetal alcohol effects suffer from substantial mental illness.

Adult↗

PubMed2006

Fetal alcohol syndrome disorders: experience on the field. The Lazio study preliminary report.

In Italy, little is known about the problems related to alcohol drinking during pregnancy. In this paper, the Italian literature about this subject is briefly reviewed. This first Italian experience of a field study, aimed to the assessment of the prevalence of fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD) in an area in the Rome province (Lazio region) is reported. This in-field study was performed in the school years 2003-2004 and 2004-2005 in cooperation with American researchers, most from University of New Mexico (Albuquerque), and Italian researchers from University "la Sapienza" of Rome. First grade children (n(o) = 1,086) of primary school were contacted to enter in the in-school study for the detection of FAS and FASD and were examined by the experts team of clinicians, pediatrics, psychologists. Preliminary consideration and the implications of this study for FASD prevention are discussed.

Adult↗

PubMed2006

Letter and category fluency in children with fetal alcohol syndrome from a community in South Africa.

OBJECTIVE: This study investigated whether there were differential effects of substantial prenatal alcohol exposure on letter and category fluency in children. Given that children with prenatal alcohol exposure are often impaired in executive functioning and that letter fluency taxes executive processes more than category fluency, it was expected that children with fetal alcohol syndrome (FAS) would be more impaired in letter than in category fluency. A second objective of the study was to examine the developmental trends in the two types of fluency in children with prenatal alcohol exposure. It was hypothesized that between the ages of 6 and 9 years, these FAS children would show age-related changes in category fluency but not in letter fluency. METHOD: As part of a neuropsychological test battery designed for an international collaborative study of FAS in South Africa, tests of letter and category fluency were administered in Afrikaans. The participants were 62 children with FAS and 61 controls matched with respect to age, gender (58 boys and 65 girls), ethnicity, and socioeconomic status. RESULTS: Results showed that the FAS group had relatively greater difficulty with letter fluency than with category fluency and that the FAS group generated fewer words in both fluency conditions. Contrary to the expectation, however, alcohol-affected children demonstrated age-related linear trends in both letter and category fluency. CONCLUSIONS: This is the first study of verbal fluency involving a large sample of well-diagnosed children with FAS conducted in a nonwestern environment. The results are nonetheless consistent with those obtained in western countries in studies of children with various levels of prenatal alcohol exposure and various levels of fetal alcohol spectrum disorder. This study suggests that at least some aspects of the cognitive profile associated with prenatal alcohol exposure may be generalizable across cultural and ethnic boundaries.

Child↗

PubMed2004

Fetal, infant, and child mortality in a context of alcohol use.

Alcohol is an important element in the causal chain of risk for fetal, infant, and childhood mortality. Mortality risk is influenced by interactions of alcohol with other environmental and genetic factors and temporal periods of susceptibility. In this paper we discuss four time periods (preconceptual, gestational, infancy, and childhood) where alcohol use may create a context of risk. Alcohol use in one period increases the risk of alcohol use in subsequent periods. Gestational alcohol use can influence risk of mortality from abuse of mother/fetus, can cause other adverse outcomes, and can result in fetal alcohol spectrum disorders (FASDs). In infancy alcohol use can increase risk from impairment of arousal in adults who use alcohol. Infants with gestational exposure can be behaviorally difficult with sleep disturbance, irritability, and colic. This can increase the risk of harm or death, especially during periods of caretakers' alcohol use. Caretakers' alcohol use and smoking are strongly correlated. The all-cause mortality rate in people diagnosed with fetal alcohol syndrome (FAS) is over 5%. All-cause mortality in siblings of diagnosed cases of FAS is increased 530% compared to siblings of matched controls. We recommend that a context of alcohol use be considered as a marker for multifactorial risk in all fetal, infant, and child deaths. A schema to collect data on alcohol use is provided to increase awareness of alcohol use as an environmental risk marker for mortality.

Alcohol Drinking↗

PubMed2004

Recognition of facial features of fetal alcohol syndrome in the newborn.

The diagnosis of an infant, especially a newborn, with fetal alcohol spectrum disorder is difficult due to the fact that not all of the features are apparent at that time. Many cases are also missed due to inadequate knowledge of the mother's drinking pattern and because of the examining physician's lack of experience with the disorder. While conducting a study of the use of maternal blood markers to determine alcohol use in pregnancy, we have evaluated systematically the effects of alcohol on the newborn infant. We have developed a facial scoring system consisting of six of the features commonly seen in children with fetal alcohol syndrome (FAS) and present preliminary data about its use. By using a cutoff of four or more of these six features, there is a significant correlation with the presence of these features and the mother's self-reported alcohol use. In addition, there has been no significant difference in the frequency of positive scores between newborns of Caucasian or Black ancestry. We propose that this system may be useful in the assessment of newborn infants at high risk because of alcohol exposure during pregnancy.

Alcohol Drinking↗

PubMed2006

Reducing adverse outcomes from prenatal alcohol exposure: a clinical plan of action.

Fetal alcohol spectrum disorders (FASDs) are among the leading preventable causes of developmental disorders in the United States; however, recognition and prevention of these conditions cannot be achieved without informed and educated health providers. This commentary addresses the importance of recognition and prevention of FASDs through the use of well-established standardized practices of diagnosis, screening, and brief alcohol reduction counseling. It is hoped that more knowledge on currently available procedures will encourage their use in the provision of routine health care to all women of childbearing age.

Alcohol Drinking↗

PubMed2005

Effects of prenatal alcohol exposure on fine motor coordination and balance: A study of two adult samples.

Motor coordination was assessed in two samples of adult subjects: one sample (n = 90) included adults previously diagnosed with one of a number of Fetal Alcohol Spectrum Disorders (FASD) and comparison peers, the second was a prospective longitudinal study of adults who were exposed to varying levels of alcohol as fetuses (n = 402). This comparative analysis sought to determine whether motor effects seen in both clinical and nonclinical children persist into adulthood, whether any individual motor tasks show significant effects of prenatal alcohol exposure across the age range, and whether motor assessments of adults have any role in diagnostic strategies for adults suspected of FASD. Motor tests included balance and unilateral, bilateral, finger, hand and foot coordination. Three-quarters of the subjects with FASD demonstrated deficits in motor function outside the range of comparison subjects. Adults with FASD performed more poorly, on average, on all individual tests including balance and fine motor control. In the prospective longitudinal sample, only subjects who had been previously identified in childhood as having a possible diagnosis on the Fetal Alcohol Spectrum were still in deficit as adults on motor tasks, relative to comparison subjects. Thus, the dose-dependent motor coordination effects of alcohol previously found in children do not appear to persist into adulthood, except in those most highly exposed children who also have other accompanying neuropsychological effects in childhood.

Adult↗

PubMed2004

The challenge of fetal alcohol syndrome in the criminal legal system.

People with fetal alcohol spectrum disorder (FASD) present challenges to those who work in the criminal legal system. Prenatal exposure to alcohol can cause physical, neurological, and psychological impairments. It is vital to understand the individual offender in order to address the underlying reasons for criminal behavior. Individuals with FASD often come from dysfunctional backgrounds, and may have mental illnesses and substance use disorders. A comprehensive medical-legal report, prepared by a professional experienced with FASD, can help judges and lawyers understand how complex the interactions are among brain damage, genetics, and the environment. The person with FASD can be misunderstood in court, victimized in jails, and mismanaged in the transition back to the community, unless those working with the individual are aware of FASD and its implications.

Canada↗

PubMed2006

FASD: what types of intervention and rehabilitation are useful?

Fetal alcohol spectrum disorders (FASD) occurs worldwide when children are prenatally exposed to alcohol. This paper discusses recent findings regarding the neuropsychological and behavioral effects of prenatal alcohol exposure and how it impacts the developmental and functional abilities of children with FASD. Specifically, recent research focus has concentrated on studies to elucidate a neurobehavioral phenotype for the alcohol-exposed population. As a result, the FASD field has learned what types of neurobehavioral issues occur most frequently with these children. This paper discusses how that information can be used to inform school assessment, intervention planning, and support. Strategies for functional assessment, individualized planning, structured teaching, and developments in cognitive-behavioral methods are described.

Cognitive Behavioral Therapy↗

PubMed2004

Bimanual coordination in alcohol-exposed children: role of the corpus callosum.

The corpus callosum (CC) is one of several brain structures affected in children prenatally exposed to alcohol. This structure plays a major role in coordinating motor activity from opposite sides of the body, and deficits in bimanual coordination have been documented in individuals with agenesis of or damage to the CC, particularly when the task is performed without visual feedback. The Bimanual Coordination Test was used to assess speed and accuracy on a task where both hands must coordinate to guide a cursor through angled pathways providing measures of interhemispheric interaction or the ability of the two hemispheres to coordinate activity via the corpus callosum. Twenty-one children with fetal alcohol spectrum disorders (FASD) and 17 non-exposed control children (CON), matched closely in age, sex, and ethnicity were tested. For trials with visual feedback (WV), children with FASD were slower than CON children but were equally accurate. Although statistically significant group differences were not observed on most trials completed without visual feedback (WOV), accuracy of the FASD group on WOV trials was highly variable. Group differences in accuracy on WOV angles approached significance after accounting for performance on the WV angles, and children with FASD were significantly less accurate on an individual angle believed to be particularly sensitive to interhemispheric interaction. These results indicate that children with FASD are slower than CON children but equally accurate on basic visuomotor tasks. However, as task complexity and reliance on interhemispheric interaction increases, children with FASD demonstrate variable and inaccurate performance.

Adolescent↗