7/28/2019 Website Alcohol Pregnancy and Fas d 2008
1/45
www.faseout.ca 2008
A lcoho l Use and Pregnancy
and Fetal Alcoho l Spectrum
Disorder
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
2/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
3/45
www.faseout.ca 2008
Teratology:
Four Outcomes to Exposure
Malformations (facial, heart, skeletal)
Growth Deficiency (small)
Functional Deficits (learning and behaviouralproblems)
Death (stillbirth, miscarriage)
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
4/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
5/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
6/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
7/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
8/45
www.faseout.ca 2008
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
9/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
10/45
www.faseout.ca 2008
No one can predict which infants born to mothers
who drink will be affected, nor can anyone
predict how severe these effects will be.
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
11/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
12/45
www.faseout.ca 2008
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 )
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
13/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
14/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
15/45
www.faseout.ca 2008
What is Fetal Alcohol Spectrum
Disorder?
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
16/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
17/45
www.faseout.ca 2008
Diagnostic Terms
Fetal Alcohol Syndrome (FAS)
Partial Fetal Alcohol Effects (pFAS)
Alcohol Related Neurodevelopmental Disorder(ARND)
Alcohol Related Birth Defects (ARBD)
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
18/45
www.faseout.ca 2008
Fetal Alcohol Syndrome
Recognized and documented in Nantes, France
and Seattle, Washington
1968 1973
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
19/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
20/45
www.faseout.ca 2008
FAS Features
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
21/45
www.faseout.ca 2008
ARND/pFAS:
The invisible disability
Physical characteristics FASD unremarkable
Disappear: become less prominent over time Adolescent & Adult Diagnosis often more difficult
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
22/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
23/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
24/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
25/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
26/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
27/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
28/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
29/45
www.faseout.ca 2008
Primary Disabilities:
Organ Anomalies
Cardiac anomalies
Joint and limb anomalies
Neurotubal defects
Anomalies of the urogenital system
Hearing disorders
Visual problems
Severe dental malocclusions
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
30/45
www.faseout.ca 2008
Primary Disabilities:
Central Nervous System
Tremors
Poor suck
Hypotonic/Hypertonic
Irritability
Developmental delay
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
31/45
www.faseout.ca 2008
Primary Disabilities:
Central Nervous System
Cognitive problems
Fine motor issues Hyperactivity
Restlessness
Poor ability to focus attention
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
32/45
www.faseout.ca 2008
Primary Disabilities
Generalized damage to the brain typically has a
significant impact on:
cognitive processing
emotional regulation
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
33/45
www.faseout.ca 2008
Primary Disabilities:
Central Nervous System
Cognitive problems
Verbal IQPerformance IQ
Scatter in Cognitive Skills
Specific Learning Disabilities
Memory DeficitsExecutive Functioning
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
34/45
www.faseout.ca 2008
Primary Disabilities:
Central Nervous System
Fine motor issues
Hyperactivity
Restlessness
Poor ability to focus attention
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
35/45
www.faseout.ca 2008
Primary Disabilities:
Central Nervous System
Poor Judgement
Impulsiveness
Sleep disturbances
Extreme anxiety
Depression
Aggressiveness
Other Behavioural Problems
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
36/45
www.faseout.ca 2008
Executive functions of
the prefrontal cortex
working memory
planning
time perception
internal ordering
self-monitoring
regulation ofemotion
motivation
inhibition
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
37/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
38/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
39/45
www.faseout.ca 2008
Strateg ies Need to Address the
Whole Being
Mental, physical,emotional,
spiritual andsexual well being
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
40/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
41/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
42/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
43/45
www.faseout.ca 2008
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
7/28/2019 Website Alcohol Pregnancy and Fas d 2008
44/45
www.faseout.ca 2008
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/fas7/28/2019 Website Alcohol Pregnancy and Fas d 2008
45/45
www.faseout.ca 2008
Thank you!