What do we know about KY numbers?

• 1997 report from 37 Public Health Clinics– 1/3 reported drinking

in past month– over 40% reported

ever using illicit drugs with higher numbers for current use in 11 - 17 year olds

Why focus so much attention on effects associated with prenatal alcohol

exposure?

Fetal Alcohol Syndrome

Fetal alcohol syndrome is among the most commonly known causes of mental retardation and is a major public health problem.

It is the leading preventable cause of mental retardation!

Historical view of alcohol as a teratogen

• Foolish, drunken, or harebrain women most often bring forth children like unto themselves

Aristotle in

Problemata

Rosett, 1984

Historical view of alcohol as a teratogen

• Foolish, drunken, or harebrain women most often bring forth children like unto themselves

Aristotle in Problemata

• Behold, thou shalt conceive and bear a son: And now, drink no wine or strong drink.

Judges 13:7

Rosett, 1984

FAS – Only the tip of the icebergFetal Alcohol Spectrum Disorder

• Fetal alcohol syndrome

• Fetal alcohol effects

• Clinical suspect but appear normal

• Normal, but never reach their potential

Adapted from Streissguth

Incidence and Prevalence of FAS and other effects

• FAS - .5 to 3 cases/1000 live births– (U.S. 2 - 12,000 FAS births/year)

• variations in pockets/locations

– International Studies ongoing in Moscow, S. Africa

• Affected but not full blown FAS - 3-6 cases /1000 live births

*** **

Cerebrum Cerebellum

75

80

85

90

95

100

PEA

FAS <p 0.001

p < 0.010

Cerebrum

CerebellumCorpus Callosum

Mattson et al., 1994

Change in brain size

General Intellectual Performance

FSIQ VIQ PIQ40

55

70

85

100

115

Sta

nd

ard

sco

re

IQ scale

NC

PEA

FAS*

**

**

**

Mattson, S.N., 1997.

2

1

3

1

2

3

Group0

2

4

6

Ru

le V

iola

tio

ns

NC

PEA

FAS

P<0.001

Move only one piece at a time using one hand and never place a big piece on top of a little piece

Starting position

Ending positionMattson, et al., 1999

Executive functioning deficits

Behavioral characteristics associated with Fetal Alcohol Spectrum Disorder

• hyperactivity, response inhibition deficits, attentional problems, motor coordination deficits, executive function (planning) problems,

Secondary DisabilitiesIndividuals with FAS/FAE have a range of secondarydisabilities – disabilities that the individual is not born with,

and which could be ameliorated withappropriate interventions.

Streissguth, et al., 1996

Animal models – Example of the comparability of effects

• Growth retardation• Facial characteristics • Heart, skeletal

defects• Microcephaly• Reductions in basal

ganglia and cerebellar volumes

• Callosal anomalies

• Hyperactivity, attentional problems

• Inhibitory deficits• Impaired learning• Perseveration errors• Feeding difficulties• Gait anomalies• Hearing anomalies

Driscoll, et al., 1990; Samson, 1986;

Smoking and nicotine during pregnancy

• 25-35% of women smoke cigarettes during pregnancy although clearly there are regional differences

• Cigarette smoking during pregnancy is one of the most important preventable risk factors for SGA pregnancies, as well possibly for late fetal death

Cigarette smoke contains more than 2000 pharmacologically active substances including carbon monoxide (which could lead to fetal hypoxia), cyanide, nitrous oxide

Increased obstetric complications such as spontaneous abortion

Dose-dependent reductions in birthweight, possible increased risk of SIDS

Passive smoking

What about nicotine?

• animal models – data is mixed

Cocaine

• Confounding factors– polydrug use (alcohol and nicotine most

common – 72% used alcohol; 73% used nicotine 59% used marijuana, 42% used heroin or methadone (n of 101 studies)

– Sociodemographics– data mixed; variations in caregiving –

“boarder babies”

Crack cocaine

– demographic controls AND crack exposed babies all below “normal” means

– influence of other drugs…..

– possible attention problems

cocaine and methamphetamine

• no classic withdrawal syndrome– increased reactivity - cocaine

• idea of cumulative risk

• not as much known about methamphetamine – – preliminary data that smoked is associated

with reduced birth weight

marijuana

• Fried (Ottawa study)– data – mixed; – possible cognitive effects although varies with

age and may be related to polydrug interactions

heroin or other opiates

• neonatal abstinence syndrome– often more protracted for methadone treated

infants• symptoms: CNS, GI, respiratory and autonomic

NS involvement– heroin – begins within 24 – 72 hours after birth– methadone – sometimes takes longer

» can also be associated with prolonged abstinence syndrome (up to 8+ months)