the beginning of recorded history Alcohol relatedbiomedical and other - PDF document

the beginning of recorded history. Alcohol relatedbiomedical and other consequences of women’ssame amount of alcohol used(2). Alcohol is knownto cause many ill effects. It can affect the developingalcohol syndrome (FAS)(3,4). The adverse effects offetal alcohol spectrum disorders (FASD). Currentlyit is known that FAS is not a single entity but aor FASD) and FAS represents one end of thespectrum, representing the most severe form ofIn general population studies throughout the world,doing so(1). However, in the US, approximately 60decline steadily with age. In the United States, Fetal Alcohol Spectrum DisorderAGHAVENDRAHEEMAPPAAYAKRATIMAURTHYFrom the Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 29, India.Correspondence to: Dr Raghavendra Bheemappa Nayak, Assistant Professor, Department of Psychiatry,J N Medical College, and Consultant Psychiatrist, KLE Hospital and Medical Research Center, Belgaum 10, India.Maternal alcohol use during pregnancy leads to fetal alcohol spectrum disorder (FASD) intheir children. FASD is characterized by typical facial features, growth retardation, intellectual dysfunctionand behavioral problems. : Alcohol is neurotoxic to the brain during the developmental stage.Behavioral problems in children with FASD start at an early age and progress to adulthood. It is an importantpreventable cause of intellectual d

ysfunction and behavioral problems. This article reviews currentprevalence, clinical features, pathogenesis and differential diagnosis of FASD. It also highlights the need forphysicians to be aware of this condition. : Articles were searched on the internet using ‘fetalalcohol syndrome’, ‘fetal alcohol spectrum disorders’, ‘women and alcohol’. Following links were used tolocate journals; EBSCO, OVID, Science Direct, PubMed and NIAAA. : Alcoholconsumption during pregnancy can lead to a spectrum of deficits. Though physical features are essential tomake the diagnosis of FAS, it is important to note that neurocognitive and behavioural deficits can be presentin the absence of physical features (alcohol related neurodevelopmental disorder or ARND). Because there isno known safe amount of alcohol consumption during pregnancy, abstinence from alcohol for women whoare pregnant or planning a pregnancy must be strongly advised.Alcohol related neurodevelopmental disorder, Fetal alcohol syndrome.977V 978Vhigher, exceeding 50%(6). In a study in the WesternCape Province of South Africa, 34% of urbanpregnancy. Their drinking pattern was characterizedregular pattern(8). According to the “Gender, FASDThe National Organization on FAS (NOFAS 2004),range of effects that can occur in a person whosemother drank alcohol during pregnancy, includingdisabilities, with possible lifelong implications. As

fetal alcohol syndrome (FAS),are subsumed under the term FASD. When signs ofexposure in the absence of other indications of FAS,neurodevelopmental disorder” (ARND)(11). FASback to the period of Aristotle(12). It has also beenmentioned in the Bible(13). Later, it was mentioneddescription on adverse effects of alcohol on birth wasby Sullivan in 1899 where he described the offspringwhen gestation occurred in prison (thus indicatingabstinence as prevention). These children were notdiagnosing FAS or FASD. Later, in 1973, Jones,condition they termed FAS.FASD a town or state), yields much lowernumbers than those from other methods. Active caseseek, find, and recruit children who may have FASwithin the population under study, they generallyyield the highest number of cases and rates of FASgenerally conducted in prenatal clinics of large 979Vtheir pregnancies. The prevalence of FAS variesof FAS in the US from passive surveillance data isActive ascertainment methods suggest that FAS,ARBD, and ARND may affect 10 per 1,000 births (ordiagnostic methods and criteria used(16). The12 of the 13 elementary schools in a South AfricanTable provides prevalence data of FASD in a few countries.incidence and prevalence of FAS, according to theprevalence data is available from Asian population.FAS denotes a specific pattern of malformations alsocalled as triad of FAS, with a confirmed history ofmaternal

alcohol abuse during pregnancy, they areweight) that persists postnatally, a specific pattern ofwithout FAS with 100% accuracy(23). Other facial: Atrial septal defects, aberrant great vessels,SkeletalSyndrome, hemivertebrae, camptodactyly, scoliosis,hypoplastic nails, clinodactyly, shortened fifth: Aplastic kidneys, dysplastic kidneys, ureteral: Strabismus, refractive problems secondarysome patients with FASD. The etiologic specificity Neuropsychologicalimpairments in FASD include lower IQ,in memory, attention, visual-spatial abilities,with FASD also have deficits in executivefunctioning in the areas of cognitive flexibility,set-shifting, working memory, and fluency(25).psychiatric disorders, trouble with the law, alcoholdisruptive, impulsive, or delinquent. They also sufferand are less likely to be living independently. AmongFASD children, 48% of them have ADHD as co-TABLE IREVALENCE FASDCountryPrevalence/1,000 birthsUS(16)*10.0* Active case ascertainment; 980Vpregnancy develops FAS or ARND. Moreover, thedegrees to which people with FAS or ARND areimpaired differs from person to person. Factorsdrinking pattern, difference in maternal metabolismof alcohol, difference in genetic susceptibility,timing of the alcohol consumption during pregnancy,In developing organisms, a readily observabletriggers apoptotic neurodegeneration by a dualand excessive activation of GABA A receptors).

Withrespect to the typical facial features of FAS and theCNS abnormalities that develop concurrently, cellularpostgastrulation stages as an organizer for theFAS is that the epithelium that lines the nasal cavities that associated with the medial nasaldeath(31). In the presence of the typical FAS face, it iscommissural plate. In addition to the ANR, other cellsensitive to ethanol-induced cell death. Theseduring the early, mid or late phase of synaptogenesis,ethanol triggers different patterns of neuronaldisorders. The CNS (neurobehavioral) effects arebe operative in the first trimester.brain of FAS children. The main areas affected inEmission Computed Tomography (SPECT) imagingin FAS children exhibited similar metabolic activity infindings of verbal or language deficits in FASchildren(33). A functional MRI (fMRI) studyprefrontal cortex in the FAS subjects but not in controlsubjects(34). This suggests working memory deficit.Many children with FASD show continueddrug related problems. A study done byStreissguth(35) assessed life outcomes of the Seattlecohort (all the FAS patients evaluated in FASWashington, Seattle) during adolescence andknowledgeable informants. These investigatorsthe law, 50% confinement, 49% inappropriate sexualThose children receiving the diagnosis of FAS orFAE (fetal alcohol effects) at an earlier age and living 981Vmemory, auditory memory, spatial memory,Func

tional issues (cognition-based difficultiesand emotion-related difficulties) related toto alcohol during pregnancy, treatment will behandling them appropriately. Some of thechildren with FAS.particular disorder. Care should be taken that asbe started at low doses and built up slowly. Animalspecific to FASD are coming up but are still atFASD is the one of the preventable causes ofwith women and alcohol(38). So efforts should bebehavioral problems. As there is no known safeamount of alcohol consumption during pregnancy,the American Academy of Pediatrics recommendspregnant or who are planning a pregnancy. None.Competing Interests: None stated.1.Wilsnack RW, Wilsnack SC, Obot IS. Why study2.Murthy NV, Benegal V, Murthy P. Alcohol3.Jones KL, Smith DW, Ulleland CN, Streissguth P.4.Clarren S K, Smith DW. The fetal alcohol•Prevalence of alcohol consumption among women in India is ~ 5.8% in general population.•There is no known safe amount of alcohol consumption during pregnancy.•Neurocognitive and behavioural deficits can be present in the absence of typical physical features.•Fetal alcohol spectum disorder is a preventable cause of intellectual dysfunction and behavioral problems. 982V5.Wilsnack SC, Wilsnack RW, Hiller-Sturmhofel S.6.May PA, Gossage JP, Brooke LE, Snell CL, Marais7.Abel EL. Fetal Alcohol Abuse Syndrome. New8.Maier SE, West JR. Drinking patterns and alcohol-9.Benegal V,

Nayak M, Murthy P, Chandra P,10.Mohan D, Anita C, Ray R, Sethi H. Alcohol11.Stratton K, Howe C, Battaglia FC. Fetal Alcohol12.Krous HF. Fetal alcohol syndrome: a dilemma of13.Holy Bible: New International Version, 1978.14.Royal College of Physicians of London. Annals.15.Calhoun F, Warren K. Fetal alcohol syndrome:16.May PA, Gossage JP. Estimating the prevalence of17.May PA, Gossage JP, Marais AS, Adnams CM,18.Warren KR, Calhoun FJ, May PA, Viljoen DL, Li19.Habbick BF, Nanson JL, Snyder RE, Casey RE,20.Ceccanti M, Spagnolo AP, Tarani L, Attilia LM,21.Cordero JF, Floyd RL, Martin ML, Davis M,22.Hoyme HE, May PA, Kalberg WO, Kodituwakku A practical23.Astley SJ, Clarren SK. A case definition and24.Streissguth AP, Barr HM, Sampson PD, Bookstein25.Olson HC, Feldman JJ, Streissguth A P, Olson HC,26.Mattson SN, Riley EP. A review of the27.Burd L, Carlson C, Kerbeshian J. Fetal alcohol28.Goodlett CR, Horn KH. Mechanisms of alcohol- 983V29.Kotch LE, Sulik KK. Patterns of ethanol-induced30.Dunty WC Jr, Chen SY, Zucker RM, Dehart DB,31.Sulik KK. Genesis of alcohol-induced craniofacial32.Mattson SN, Schoenfeld AM, Riley EP.33.Riikonen R, Salonen I, Partanen K, Verho S. Brain34.Connor PD, Mahurin R. A preliminary study of35.Streissguth AP, Bookstein FL, Barr HM,36.Kalberg WO, Buckley D. FASD: What types of37.Thomas JD, Biane JS, O’Bryan KA, O’Neill TM,38.Blume SB. Women, alcohol and drugs. Mi