1) Alcohol use during pregnancy can cause fetal alcohol spectrum disorders (FASDs), which include fetal alcohol syndrome (FAS) and other conditions involving physical abnormalities, developmental delays, and cognitive impairments. 2) Clinical manifestations of FASDs can include facial anomalies, growth retardation, central nervous system anomalies affecting both structure and function of the brain, and other issues affecting organs like the heart, kidneys and skeleton. 3) FASDs are preventable if a woman does not consume any alcohol during pregnancy, as there is no known safe amount of alcohol use when a woman is pregnant.

1. ALCOHOL IN PREGNANCY
JEONG SHIN OK
Mothersafe round
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology,
Cheil General Hospital & Women 's Healthcare Center,
Dankook University College of Medicine

2. Contents
Introduction
Fetal alcohol spectrum disorders
Clinical manifestations of FASD
Conclusion

3. Alcohol…
 Teratogen
 Alcohol passes through the placenta directly to the
baby’s bloodstream
 No known safe amount of alcohol use during pregnancy
 No safe time during pregnancy to drink
 All types of alcohol are equally harmful
 Binge drinking is especially harmful
Introduction

4. What is a standard drink?
Binge drink : 4 or more standard drinks on
one occasion for women
Introduction
about 14 gm of pure alcohol (about 0.6 fl oz/17.7ml)

5. Alcohol use during pregnancy
 Fetal alcohol spectrum disorders (FASDs)
 Birth defects
 Developmental disabilities
 Other pregnancy problems
 Miscarriage
 Stillbirth
 Prematurity
Introduction

6. Fetal alcohol spectrum disorders(FASDs)
 Not diagnostic term
 Group of conditions that can
occur in a person whose
mother drank alcohol during
pregnancy
FASD

7. Discovery of FASD (I)
 1960’
 “alcohol embryopathy” – Lemoine et al.
 1970’
 Fetal alcohol syndrome – Jones and Smith
 Fetal alcohol effect – Clare and Smith
 1996, Institute of Medicine(IOM)
 FAE  ARBD and ARND
FASD

8. Classification of FASDs (IOM)
 Fetal alcohol syndrome
 Most severe end outcome of FASDs
 Partial FAS
 Alcohol related birth defect
 Alcohol related neurodevelopmental disorders
FASD

9. Discovery of FASD (II)
 2005
 Chudley et al.
 Canadian diagnostic guidelines
 IOM system + 4-Digit diagnostic code system
 Hoyme et al.
 Revised IOM diagnostic classification system
FASD

10. Comparison of diagnostic criteria
FASD
Susan J. Astly, 2006

11. Revised IOM criteria for diagnosis of FASD (I)
I. FAS With Confirmed Maternal Alcohol Exposure (all of A–D)
(A) Confirmed maternal alcohol exposure
(B) Minor facial anomalies (≥2)
(1) Short palpebral fissures (p10%)
(2) Thin vermilion border of the upper lip (score 4 or 5)
(3) Smooth philtrum (score 4 or 5)
(C) Prenatal and/or postnatal growth retardation
(1) Height and/or weight p10%
(D) Deficient brain growth and/or abnormal morphogenesis (≥1)
(1) Structural brain abnormalities
(2) Head circumference p10%
II. FAS Without Confirmed Maternal Alcohol Exposure
IB, IC, and ID as above
FASD

12. Revised IOM criteria for diagnosis of FASD (II)
III. Partial FAS With Confirmed Maternal Alcohol Exposure (all A-C)
(A) Confirmed maternal alcohol exposure
(B) Minor facial anomalies (≥2)
(1) Short palpebral fissures (p10%)
(2) Thin vermilion border of the upper lip (score 4 or 5)
(3) Smooth philtrum (score 4 or 5)
(C) One of the following other characteristics:
(1) Prenatal and/or postnatal growth retardation
(a) Height and/or weight p10%
(2) Deficient brain growth or abnormal morphogenesis (≥1)
(a) Structural brain abnormalities
(b) Head circumference p10%
(3) Complex pattern of behavioral or cognitive abnormalities
IV. Partial FAS Without confirmed Maternal Alcohol Exposure
IIIB and IIIC, as above
FASD

13. Revised IOM criteria for diagnosis of FASD(III)
V. ARBD (all of A-C)
(A) Confirmed maternal alcohol exposure
(B) Minor facial anomalies (≥2)
(1) Short palpebral fissures (p10%)
(2) Thin vermilion border of the upper lip (score 4 or 5)
(3) Smooth philtrum (score 4 or 5)
(C) Congenital structural defect (≥1)
(if the patient displays minor anomalies only, ≥ 2 must be present)
cardiac/skeletal/renal/eyes/ears/minor anomalies
FASD

14. Revised IOM criteria for diagnosis of FASD(IV)
VI. ARND (both A and B)
(A) Confirmed maternal alcohol exposure
(B) At least 1 of the following:
(1) Deficient brain growth or abnormal morphogenesis (≥1)
(a) Structural brain abnormalities
(b) Head circumference p10%
(2) Complex pattern of behavioral or cognitive abnormalities
FASD

15. Variability of Adverse Fetal Outcomes
Clinical manifestations
 Amount of alcohol
 Genetic variation
 Maternal nutrition
 Maternal age
 Socioeconomic status
 Timing of exposure

16. Facial anomalies (I)
Clinical manifestations

17. Facial anomalies (II)
 8 months – 8 years of age
 Not smiling
Clinical manifestations

18. Growth retardation
 Usually presents in the prenatal period and persists as
a consistent impairment over time
 Below 10 percentile
 Diminish in adolescence and adult
Clinical manifestations

19. CNS anomalies - structural
 Cerebrum
 Volume reduction
 Lt. > Rt.
 White matter hypoplasia
 Cerebellum
 Reduction in the anterior vermis
 Basal ganglia
 Caudate nucleus
 Corpus callosum
 Agenesis, thinning, hypoplasia
 Role in the coordination of various function
Clinical manifestations

20. CNS anomalies - functional (I)
 Cognitive defects
 General intelligence ↓
 Low IQ (70 for FAS, 80 for nondysmorphic individuals)
 Learning disabilities
 Significant relation between general cognitive function and
degree of dysmorphic features and growth deficiency
Clinical manifestations
Ervalahti et al. 2007

21. CNS anomalies - functional (II)
 Executive function deficits
 Executive function
 Maintain an appropriate problem-solving set for attainment of a
future goal
 Related to frontal-subcortical circuit
 Difficulty set-shifting
 Poor inhibitory control
 Poor organization and planning
 Poor judgment
 Difficulty following multistep direction
 Deficits working memory(verbal/visuo-spatial)
Clinical manifestations
Stroop test
Green Red Blue
Purple Blue Purple
Blue Purple Red
Green Purple Green

22. CNS anomalies - functional (III)
 Motor function delay
 Affect muscle control
 Gross motor skill – delay in walking
 Fine motor skill – difficulty writing or drawing
 Balanced problems
 Tremors
 Dexterity
 Poor sucking
Clinical manifestations

23. CNS anomalies - functional (IV)
 Attention problems and hyperactivity
 Higher rate of ADHD
 Hyperkinetic disorders
 Difficulty complete tasks
 Difficulty moving from one activity to the next
Clinical manifestations

24. Other abnormalities
Clinical manifestations
Skeletal
Joint contracture, scoliosis, hemivertebrae
brachydactyly, clinodactyly, high arched palate
Cardiac
ASD, VSD, hypoplastic pulmonary artery, TOF,
pectus excavatum or carinatum
Renal
Pyelonephritis, hydronephrosis, dysplastic kidney,
ureteral duplications, hypoplasia
Ocular Strabismus, retinal vascular anomalies
Auditory Conductive hearing loss, SNHL

25. Secondary Disabilities
 Wide range of maladaptive, behavioral and emotional
disturbances
 Psychiatric problem
 ADHD
 Schizophrenia, depression, PD
 Disrupted school experience
 Dependent living
 Trouble with the law
 Addiction
Clinical manifestations

26. Conclusions
 Fetal Alcohol Syndrome (FAS) is the leading cause of
preventable mental retardation
 FASD is a lifelong disability that causes health,learning and
behavioural problems
 Awareness about dangers of drinking alcohol during pregnancy
can help to prevent FAS
FAS is 100% preventable if a woman does not
drink alcohol while she is pregnant

27. Thank you for your attention!!!!!