Lauren D. Williams, M.D.
University of Miami School of
Medicine
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• FAS is a serious developmental disorder caused by prenatal alcohol exposure of the fetus and characterized by
- Prenatal and/or postnatal growth retardation
- Central nervous system dysfunction
- Characteristic craniofacial abnormalities
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• FAS:
- First described by Lemoine in 1968
- Term coined by Jones and Smith in 1973
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Source: Streissguth and Little 1994
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Source: Aase 1994
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Source: Aase 1994
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No Effect
Prenatal Alcohol Exposure
Fetal Alcohol
Effects
Fetal Alcohol
Syndrome
Alcohol Related
Birth Defects
(ARBD)
Alcohol Related
Neurodevelopmental
Disorders
(ARND)
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Death
7

• Prenatal and/or postnatal growth retardation
< 10 th percentile
• Central nervous system dysfunction: neurological, developmental, cognitive
• At least 2 facial features
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• Direct toxic effects of alcohol
• Toxic effects of acetaldehyde
• Placental dysmorphology/function
• Prostaglandin synthesis
• Early cell death (Apoptosis)
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• Incidence
- 0.26-4.6 per 1000 live births
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• Risk Factors
- Alcohol intake pattern/quantity
- Maternal age /parity
- Race/socioeconomic status
- Genetic susceptibility
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Morphological Abnormalities
Source: Streissguth et al. 1991
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Morphological Abnormalities
Source: Streissguth et al. 1991
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Morphological Abnormalities
Source: Streissguth et al. 1991
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Morphological Abnormalities
Source: Streissguth et al. 1991
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• Neurobehavioral Effects
Newborn/Infants
-
Disturbed sleep patterns
-
Excessive arousal
-
Feeding difficulties, failure to thrive
- Preschool/School age
-
Hyperactivity
-
Attention difficulties
-
Mental retardation
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• Neurobehavioral Effects (cont.)
- Adolescence
-
Academic problems
-
Independent living problems
-
Conduct problems
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• Neurobehavioral Effects
- Adulthood
- Mental problems
- Memory problems
- Behavior problems
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• Secondary Disabilities
- School failure
- Delinquency
- Difficulty with employment
- Difficulty with independent living
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• Medical care
• Cognitive rehabilitation and special education
• Structured environment and supervision
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• Identification
- History
- Screening instruments-AUDIT,TWEAK
-
T = Tolerance
-
W = Worried
-
E = Eye-openers
-
A = Amnesia (Blackouts)
-
K (c) = Cut-down
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• Identification (cont.)
– Biological markers
- Gamma-glutamyl transpeptidase (GGT)
- Carbohydrate-deficient transferrin (CDT)
- Mean corpuscular volume (MCV)
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• Intervention
- Universal approaches
- Selective strategies
- Indicated approaches
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• FAS
- Severe developmental disability resulting from prenatal alcohol exposure
- One of the leading causes of mental retardation
- Not just a childhood problem
- Early diagnosis and intervention important
- Preventable
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