Disease affecting during pregnancy

1. Fetal
Alcohol
Syndrome
Arunraj
Group-10

2. Definition:
Fetal alcohol syndrome is growth, mental, and physical
problems that may occur in a baby when a mother drinks
alcohol during pregnancy.
In the United States, alcohol is the leading known preventable
cause of birth defects, both physical and developmental.
Many women drink alcohol while pregnant. It is estimated that
each year in the US, 1 in every 750 infants are born with FAS,
while another 40,000 are born with fetal alcohol effects (FAE).

3. Types of Fetal Alcohol
Spectrum disorder
Fetal Alcohol Syndrome (FAS)
Alcohol-Related Neurodevelopmental
Disorder (ARND)
Alcohol-Related Birth Defects (ARBD)

4. Fetal Alcohol Syndrome (FAS):
FAS represents the severe end of the FASD . Fetal death is the most extreme outcome
from drinking alcohol during pregnancy. People with FAS might have abnormal
facial features, growth problems, and central nervous system (CNS) problems.
People with FAS can have problems with learning, memory, attention span,
communication, vision, or hearing. They may have one or more of these problems.
This is one of the number one causes for mental retardation.
Alcohol-Related Neurodevelopmental Disorder (ARND):
People with ARND might have intellectual disabilities and problems with behavior and
learning. They might do poorly in school and have difficulties with math, memory, attention,
judgment, and poor impulse control.
Alcohol-Related Birth Defects (ARBD):
People with ARBD might have problems with the heart, kidneys, or bones or with hearing.
They might have a mix of these.

5. PATHOPHYSIOLOGY
Alcohol crosses the placenta and rapidly reaches the
fetus
Fetus liver does not have significant
alcoholdehydrogenase(ADH), ALDH and other
antioxidants like glutathion
Also amniotic acts as reservoir for alcohol, prolonging
fetal exposure.
Acetaldehyde( metabolite of ethanol) disrupt cellular
differentiation and growth, disrupting DNA and protein
synthesis and inhibits cell migration.
Acetaldehyde and ethanol modify metabolism of
carbohydrate, protein and fats
They both also decrease the transfer of amino acids,
glucose, folic acid, zinc and other nutrients across the

6. Alcohol in a pregnant woman's bloodstream circulates
to the fetus by crossing the placenta. There, the
alcohol interferes with the ability of the fetus to
receive sufficient oxygen and nourishment for
normal cell development in the brain and other body
organs.

7. Alcohol Exposure During the
Pregnancy Trimesters
First: During the first trimester, alcohol interferes with the
migration and organization of brain cells and the formation
of the CNS.
Second: Heavy drinking during the second trimester,
particularly from the 10th to 20th week after conception,
seems to cause more clinical features of FAS than at
other times during pregnancy.
Third: During the third trimester, the hippocampus is
greatly affected, which leads to problems with encoding
visual and auditory information (reading and math) and
the inability to form or retain new memories.

9. Brain of Child with FAS
http://www.come-
over.to/FAS/FASbrain.htm

10. CELLS THAT SHOULD FORM MIDLINE STRUCTURES
OF THE BRAIN AND FACE ARE
KILLED BY ALCOHOL
Developing
brain and
face
Heart
Mouse embryo (viewed from
the front) at a stage corresponding
to a 22-23 day old human.
A close-up view of an alcohol-exposed
mouse embryo shows cells killed by alcohol
that have taken up a dark blue stain.

11. EYE EYE
A C
B D
MOUTH
MOUTH
NOSTRILS
NOSTRILS
MIDLINE STRUCTURES OF THE FACE AND BRAIN ARE DEFICIENT IN
ALCOHOL-EXPOSED MOUSE EMBRYOS AND IN INDIVIDUALS WITH FAS
THE FACE OF A CHILD
WITH FULL-BLOWN FAS
HAS FEATURES THAT
CAN BE CAUSED BY
DAMAGE TO MIDLINE
STUCTURES.
COMPARISON OF THE FACE (A) AND INTERIOR OF THE BRAIN (B) OF A NORMAL
MOUSE EMBRYO AND ONE DAMAGED BY ALCOHOL (C&D) SHOWS THAT THE NOSTRILS
ARE ABNORMALY POSITIONED (C) AND THE BRAIN IS MISSING MIDLINE STRUCTURES (D).

12. SYMPTOMS
Growth Retardation
Facial Features
 Smooth philtrum
 Thin upper lip (thin vermilion)
 Small eyes
 Short upturned nose
 Flattened cheeks
 Small jaw ( maxillae or mandible)

13. Facial
Features
NORMAL FEATURES ABNORMAL FEATURES

14. Facial Features
NORMAL FEATURES ABNORMAL FEATURES

15. SYMPTOMS
Central nervous system features
 Microcephaly
 Mental retardation
 Hyperactivity
 Impaired language development
 Delayed development of gross motor skills like rolling over,
sitting up, crawling and walking
 Delayed in development of fine motor skills such as grasping
objects with the thumb and index fingers and transfer objects
from one hand to the other.
 Seizures

16. OTHER SIGNS
 Cardiac
• Heart murmur; usually disappears by one year of age
• VSD
• ASD
 Skeletal: Joint abnormalities, altered palmer crease
pattern, small distal phalanges and small fifth fingernail.
 Renal: Horseshoe, aplastic, dysplastic or hypoplastic
kidney.
 Ocular: Strabismus, optic nerve hypoplasia
 Low birth weight

17. DIAGNOSIS
The diagnostic criteria includes;
 Growth deficiency
 FAS facial features
 Central nervous system damage
 Prenatal alcohol exposure

18. Treatment Options:
There's no cure or specific treatment for fetal
alcohol syndrome. The physical defects and
mental deficiencies typically persist for a lifetime.
Heart abnormalities may require surgery.
Learning problems may be helped by special
services in school. Parents often benefit from
counseling to help the family with a child's
behavioral problem.

19. Examples of Successful Programs
 Behavioral Regulation Training (BRT)
BRT teaches parents ways to modify the child’s
environment to reduce excess stimulation, use
appropriate social reinforcement, and communicate
choices rather than commands.
 Parent Child Interaction Therapy (PCIT)
Behavioral specialists conduct group sessions with
parents to teach them appropriate and effective
behaviors and interaction techniques
 Parent-Assisted Social Skills Training
Children participate in didactic training sessions,
behavior rehearsal, and coaching to reduce
maladaptive behaviors and promote pro-social

20. Parenting and Teaching
Try differently, not harder!

21. Alcohol-related
birth defects
last a lifetime.
So Don’t
drink while
pregnant

23. References
Emory University (n.d.). Maternal Substance Abuse and Child
Development.
Retrieved December 28, 2009 from
http://www.psychiatry.emory.edu/
PROGRAMS/GADrug/fasqa.htm#does
Graefe, Sara. (2004). (Ed.). Living with FASD: A Guide For Parents.
British Columbia: Special Needs Adoptive Parents. Groundwork
Press. Retrieved December 23, 2009 from website:
http://www.faslink.org/strategies_not_solutions.pdf
Kellerman, Teresa (2005). Symptoms of Fetal Alcohol Spectrum
Disorders.
Retrieved December 28, 2009 from http://www.come-
over.to/FAS/faschar.htm
Kellerman, Teresa (2008). Prenatal Alcohol Exposure and the Brain.
Retrieved December 28, 2009 from http://www.come-
over.to/FAS/FASbrain.htm

24. References Continued
Kock, Gregory C. &Kupesky, Regina H. (2002). Parenting the Hurt Child:
Helping Adoptive Families Heal and Grow. Pinon Press. Retrieved
December 23, 2009 from website:
http://www.faslink.org/strategies_not_solutions.pdf
Learning about FASD (2009). Retrieved December 31, 2009 from
http://www.fasdoutreach.ca/elearning/learning-about-fasd
Look Who’s in Jail! (n.d.). Retrieved December 29, 2009 from
http://www.come-over.to/FAS/jailbaby.htm
Mayo Clinic (2009). Fetal Alcohol Ayndrome. Retrieved December 28, 2009,
from http://www.mayoclinic.com/health/fetal-alcohol-
syndrome/DS00184/ DSECTION=symptoms.
National Institute on Alcohol Abuse and Alcoholism (n.d.). Module 10K Fetal
Alcohol Exposure. Retrieved January 2, 2010 from
http://pubs.niaaa.nih.gov/publications/Social/Module10KFetaExposure
/Module10K.html