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Elsa AACN > Ch 21 Toxic exposure in utero > Flashcards

Ch 21 Toxic exposure in utero Flashcards

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1
Q

Alcohol

A

teratogen that passes through the placental barrier and affects the developing fetus throughout gestation

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2
Q

fetal alcohol spectrum syndrome (FASD) is a diagnostic term T or F?

A

False, it’s not a diagnostic term, it’s an umbrella term

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3
Q

FASD describes

A

craniofacial
cardiovascular
skeletal
neurological deficits

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4
Q

FASD includes what syndromes

A

Fetal alcohol syndrome
Partial FAS (PFAS)
alcohol-related birth defects (ARBD)
alcohol-related neurodevelopmental disorder (ARND)

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5
Q

Leading cause of preventable ID

A

Fetal alcohol syndrome

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6
Q

Small amount of alcohol consumption is safe during pregnancy. T or F

A

False - no level of alcohol consumption is safe during pregnancy

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7
Q

prenatal alcohol exposure leads to alterations in

A

size and structure across brain regions

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8
Q

during 1st and 2nd trimester, prenatal alcohol consumption interferes with what?

A

migration, proliferation, organization of brain cells

results in varying craniofacial and brain malformations

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9
Q

during the 3rd trimester, prenatal alcohol consumption interferes with what?

A

damage to the cerebellum, hippocampus, prefrontal cortex

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10
Q

neurochemical effects of alcohol

A

increased turnover of norepinephrine and dopamine
decreased transmission of acetylcholine
increased transmission in GABA system
increased production of beta endorphin in the hypothalamus

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11
Q

Which part of the brain is affected in FASD?

A

white matter!!

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12
Q

Structural abnormalities in FASD

A

microcephaly
migrational anomalies
disproportionate reduction in gray and white matter volume (frontal, parietal, temporal)
white matter hypoplasia > gray matter hypoplasia

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13
Q

Diagnosis of FAS (4 criteria)

A

growth deficiency
craniofacial features
CNS dysfunction
prenatal alcohol exposure

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14
Q

FAS Criteria 1 - growth deficiency

A

below average height and or weight
small for gestational age
show growth deficiency as adolescents and adults

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15
Q

FAS Criteria 2 - craniofacial features

A 
short palpebral fissures (eye width decrease with increase prenatal alcohol)
flat midface
short upturned nose
smooth or long philtrum (ridges between lip and nose)
thin vermilion (upper lip thinner with more alcohol)
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16
Q

FAS Criteria 3 - CNS dysfunction

A 
microcephaly (2+ SD below the mean)
callosal agenesis
cerebellar hypoplasia
seizure
fine and gross motor problems
hearing loss
cognitive deficits (memory, EF, attention, LD)
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17
Q

FAS Criteria 4 - Prenatal Alcohol Exposure

A

confirmed ur unknown

no biochemical marker can confirm consumption

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18
Q

Alcohol-related birth defects (ARBD)

A 
congenital anomalies in
cardiac
skeletal
renal
ocular
auditory
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19
Q

alcohol related neurodevelopmental disorder (ARND)

A

A. CNS abnormalities such as structural brain abnormalities

B. behavior or cognitive abnormalities inconsistent with development

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20
Q

ND-PAE (neurodevelopmental disorder associated with prenatal alcohol exposure)

A

some exposure to alcohol

impaired neurocognitive fx, self regulation, adaptive fx

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21
Q

prevalence of FAS

A

10%

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22
Q

USA prevalence of FAS higher than Europe by

A

2x

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23
Q

FASD rates in USA

A

9/1000 births

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24
Q

Risk factors of FAS in USA

A 
Race and SES are confounded
higher maternal age
low education
low econ background
MH issues
social isolation
abuse hx
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25
which racial group has the highest FAS rate
Black or native americans | 10x more than whites or high SES
26
factors that determine severity of FAS
``` quantity consumed pattern of exposure timing of exposure additional risk factors - multiple drugs - high maternal age - maternal Health issues - lower education, reduced access, nutrition, stress, abuse ```
27
quantity consumed definition
no consensus but 3 risk levels - high risk - BAC > 100mg/dL (average size woman drinking 6-8 beers in one sitting) - some risk - use less than high risk - unknown risk - no risk (no use)
28
pattern of exposure
``` chronic consumption (4-5 drinks daily) binge drinking (5 or more standard drinks) 9 or more a week ```
29
timing of exposure
drinking in 1st trimester - increases FASD by 12x drinking in 1st and 2nd trimester - increases FASD by 61x drinking in ALL trimester - increases FASD 65x
30
children with FAS have CNS damage, true or false
TRUE
31
FASD NP - IQ
great variability, IQ 20-120 more dysmorphic features = lower IQ 25% FAS and 10% ARND IQ <70
32
FASD NP LD
learning difficulties, reading and spelling and math low school performance school attendance
33
FASD NP Attention
60-95%ADHD 3-9x higher than normal kids impaired visual sustained attention, auditory verbal attention
34
FASD NP processing speed
deficits on challenging tasks and complex | working memory deficits
35
FASD NP speech and language
oral motor function and speech production naming expressive and receptive language disorder comprehension higher level pragmatics
36
FASD visuospatial
deficits in local vs global analysis of visual stimuli | VS construction deficits (maybe due to motor deficits)
37
FASD Executive function
deficits many domains
38
FASD sensorimotor
delay motor development deficits in fine motor (reduced cerebellar size) tremor, weak grasp, poor eye hand coordination balance sensory integration
39
FASD emotion and personality
``` restless, impulsive, disruptive, aggressive, delinquent antisocial behaviors juvenile delinquency sleep disturbance adaptive behavior ```
40
% of cases that get diagnosed with FASD
only 25% due to limited expertise | only 11% diagnosed by age 6
41
early intervention is important with diagnosis because it can..
mitigate development of secondary disability have appropriate intervention, counseling get support
42
comorbid dx with FASD
ADHD CD ODD OCD
43
protective factors for FASD
early dx services stable home protection from violence
44
how does cocaine affect the CNS in utero exposure?
effects on monoamine system dopamine exposure in early gestation affects neural proliferation and migration exposure in late gestation affects neuronal maturation and synaptogenesis
45
brain abnormalities 2/2 cocaine exposure in utero?
abnormalities in frontocingulate cortex | anterior cingulate gyrus
46
% of pregnant women worldwide using cocaine
0.5-3%
47
consequences of maternal cocaine use on infants?
``` Small head circumference low birth weight Poor sleep cycle abnormal startle response abnormal brain stem evoked potential impulsivity emotional lability low frustration tolerance ```
48
NP results for cocaine exposure in utero
Lower overall IQ Deficits in academic achievement (parent education, SES) Impairment in sustained and selective attention Slow processing speed (due to poor attention regulation) Language delay (esp expressive) visual spatial deficits working memory and executive function
49
marijuana
psychoactive and medicinal use
50
Predominant psychoactive constituent in marijuana
THC
51
What pathway is associated with the rewarding property of cannabis
Meso cortical limbic dopamine system
52
What changes are produced by THC use
``` mood perception motor coordination short-term and working memory concentration ```
53
Does THC cross the placenta during gestation?
yes It is secreted in maternal milk during lactation 8x higher concentration in breast milk than in plasma
54
Effects of prenatal cannabis exposure
``` Fetal growth restriction in mild in late pregnancy Low birth weight Increased risk of stillbirth altered sleep patterns irritability excitability and arousal ```
55
Infants exposed to cannabis in utero have increased risk of birth defects, true or false
false
56
Heavy marijuana exposure effects
Delay in visual maturation and visual attentiveness Heightened tremors exaggerated startle and visual responses poor habituation to novel stimuli exaggerated moro reflex athetoid movements disinhibition in motor tests (like in narcotic withdrawal)
57
Which is the third most used drug after alcohol and tobacco during pregnancy
Marijuana
58
Percentage of pregnant women using marijuana during pregnancy
2-6%
59
Heavy marijuana use has been associated with what changes in length of gestation
Reduction in length of gestation by one week
60
Which gender is more vulnerable on testing after prenatal cannabis exposure
male
61
Neuropsychological assessment results for prenatal cannabis exposure (PCE)
IQ unaffected underachievement in reading, spelling math problems with attention and concentration (could be confounded by alcohol use hyperactivity, inattention, impulsivity executives functions deficit, working memory Visual spatial processing sensorimotor - unaffected by age 1 but - decreased rate of visual habituation - increased tremor (4 day olds) mood: delinquent behavior in middle adolescence depression behavioral dysregulation
62
Primary human exposure of methylmercury
eating contaminated fish (shark, tuna, swordfish) | shellfish
63
Consumption of mercury can be done through what ways
Ingested inhaled absorbed through the skin
64
Organs commonly affected in mercury exposure
Neurologic gastrointestinal renal systems
65
How does methyl mercury gain access to brain tissues
By active transport into the endothelial cells in the blood brain barrier Methylmercury destroys neurons and causes cerebral atrophy in both hemisphere
66
Deadliest of the Mercury compounds
dimethylmercury
67
What happens when exposed to dimethylmercury
It can cause acute mercury poisoning by permeating the skin, getting into the bloodstream, and depositing in the brain, kidneys and other organs
68
Symptoms of exposure to dimethylmercury
``` Paresthesia deterioration in fine motor coordination restriction of visual fields severe ataxia dementia death ```
69
which barrier can methylmercury cross
placenta barrier | blood brain barrier
70
prenatal exposure to mercury results in
``` atrophy of cerebral cortex and corpus callosum dysmyelination of pyradmidal tract ID poor motor coordination blindness seizure inability to speak progressive cortical degenerative disease cerebral palsy sensory deficits microcephaly limf malformationlumb ```
71
common exposure to mercury
fish consumption vaccine dental amalgams
72
why do fetuses have greatest risk to mercury exposure?
because they can't secrete it
73
which brain structures are affected in infants or children when mother is exposed to mercury
occipital cortex | cerebellum
74
Neuropsych assessment results in mercury exposure
``` deficits in attention motor skills language VS memory expressive language overall IQ reduction in activity level in boys ```
75
Environmental toxicant - polychlorinated biphenyl (PCB))
used in transformers, adhesives, tapes, plastic and rubber products, oil based pain, electrical devices, carbonless copy paper
76
primary human exposure of PCB
highly contaminated fish and sea mammals
77
neuropathology of PCB
disruption of endocrine system changes in thyroid hormone level in infants decreased size of splenium of corpus callosum
78
effects of PCB in utero exposure
low birth weight | delays in sensorimotor and cognitive abilities
79
NP results of PCB
deficit in verbal ability | EF
80
Inorganic lead exposure through what means
drinking water from lead pipes imported candies, toys, cosmetics, pottery paint chips and paint dust
81
lead can pass through what barrier
blood brain barrier
82
what happens after lead reaches CNS?
CNS -> interferes with neurulation, migration, synaptogenesis, neurotransmission
83
what happens when lead reaches the fetus
crosses the placenta and accumulates in fetal organs
84
how is the brain impacted by lead exposure
``` decreased cerebral volume in: frontal gray matter ACC prefrontal cortex possible neuronal loss ```
85
incidence rate of lead exposure up or down
declined sharply but high in low income areas, minority
86
determinants of severity of lead exposure
ACTION LEVEL = blood lead level of 5 mg/dl or higher
87
different lead levels and classification of deficits
<30 low lead level >44 pharmacological intervention CHELATION Therapy >80 can lead to lead encephalopathy
88
signs of elevated lead level?
``` headache irritability abdominal pain vomiting weight loss attention problems hyperactivity learning problems slowed speech ```
89
NP results in lead exposure
``` decline in IQ decline in academic achievement EXECUTIVE FUNCTION most affected visual spatial skills restless, impulsivity, inattentive, aggressive ADHD ODD antisocial behaviors ```
90
% of lead that can be absorbed by children
50%
91
% of lead that can be ingested by adults
10-15%
92
more severe effects are seen when lead is exposed during what stage of development?
in utero and infancy (more severe than later childhood and adulthood)!
93
What is chelation therapy
treatment for children whose blood lead level is >44 trap lead in the blood and remove it through urine helps with reducing lead level but NOT reverse cog deficits
94
in utero exposure to Nicotine and Tobacco results
reduced fetal oxygen supply fetal undernourishment vasoconstrictor effects on placenta and umbilical cord
95
in utero exposure to amphetamine results in
motor deficits during infancy EF deficits in childhood poor emotional regulation
96
in utero exposure to opiates results in
``` decrease in neural plasticity increase in cell death lower birth weight motor deficits in infancy deficits in EF and ADHD in childhood ```
97
in utero exposure to pesticides results in
enzymes that regulate acetylcholine
98
in utero exposure to air pollution results in
lower IQ poorer academics behavioral problems
99
in utero exposure to antiepileptic meds in 1st trimester
major anatomical birth defects
100
in utero exposure to antiepiletic meds in 3rd trimester
behavioral and cognitive deficits
101
in utero exposure to valporic acide and polytherapy
verbal deficits | increased risk for adhd, ASD
102
in utero exposure to Coumadin/blood thinner
developmental delay | dandy walker syndrome
103
in utero exposure to accutane (acne meds)
birth defect | ID
104
in utero exposure to SSRI
neonatal abstinence syndrome | -excessive crying, irritability, hyperactive reflex, seizure, increased muscle tone
105
Acrodynia
affects young children exposed to mercury misdiagnosed as measles, kawasaki disease sx = irritability, photophobia, pink discoloration, edema of hands and feet, hair loss...
106
reference dose
exposure without recognized adverse effects
107
Lead NP
EF!!!
108
Tobacco NP
Adhd | Externalizing
109
Cocaine NP
Attention
110
PCB potentiates by
Mercury!
111
Alcohol
Affects parietal > temporal and occipital

Elsa AACN (35 decks)

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