Fetal alcohol syndrome

Question 1

What is the diagnostic criteria for fetal alcohol syndrome?

Answer 1

• Facial anomalies (2 of 3: short palpebral fissure, thin vermillion border, smooth philtrum)
  AND
• Growth retardation (before/after birth)
  AND
• Neurological abnormalities (structural, neurological, functional)

WITH OR WITHOUT HISTORY OF ALCOHOL USE IN PREGNANCY

Question 2

What % of infants are affected by FAS?

Answer 2

1-5%

Question 3

What effect does heavy alcohol use have on fetal development?

Answer 3

• All gestations: neurobehavioural abnormalities.

1st trimester:

• Congenital heart disease (2% vs 1% general population)
• Skeletal: contractures, chest wall deformities, scoliosis, digit issues.
• Auditory: conductive and SNHL
• Renal
• Ocular

2nd trimester: miscarriage

3rd trimester: IUGR, brain growth

Question 4

What other effects does heavy alcohol use have on pregnancy outcomes?

Answer 4

• IUGR
• PTB
• Low BW

Question 5

What screening tool can you use to identify women drinking sufficiently to potentially injure fetus?

Answer 5

T-ACE:
○ Tolerance: How many drinks does it take to make you feel high? How many drinks can you hold?
○ Annoyed: Have people annoyed you by criticising your drinking?
○ Cut down: Have you felt you ought to cut down on your drinking?
○ Eye opener: Have you ever had to drink first thin in the morning to steady your nerves or to get rid of a hangover?

CAGE:
Consider cutting down?
Angry if drinking noted by others?
Guilty?
Eye opener?

Question 6

Outline management of woman with heavy drinking in pregnancy

Answer 6

○ Screen all pregnant women for alcohol use.
○ Cessation and/or reduction with counselling regarding risks of use: even midpregnancy can benefit. Organise inpatient or outpatient treatment and support.
○ No consensus on safe level of alcohol consumption in pregnancy and lactation.
○ Thiamine supplementation 100 mg daily (IM or IV).
○ Ultrasound monitoring if complications e.g. growth restriction, bleeding, maternal withdrawal
○ Inform paediatrician of possibility of neonatal withdrawal.
○ Always screen for domestic abuse.

Question 7

WHAT ARE THE FACIAL FEATURES OF FASD

Answer 7

Facial abnormalities include:

• small palpebral fissures
• indistinct or absent philtrum
• epicanthic folds
• flattened nasal bridge
• short nose length
• thin upper lip
• low-set unparallel ears
• retarded midfacial development.

Question 8

WHAT IS FASD?

Answer 8

An umbrella term for a range of physical, mental health, behavioural, and cognitive effects that can occur in individuals with prenatal alcohol exposure.

FASDs include fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND), alcohol-related birth defects (ARBD), and neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE).