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fetal alcohol syndrome

Etiology: - exposure to alcohol during pregnancy - materinal comorbidities [2] - peripheral nervous system diseases - conduct disorder - receptive language disorder - expressive language disorder - chronic serous otitis media Epidemiology: - 1st described in 1973 - leading preventable cause of birth defects & intellectual & neurodevelopmental disabilities in children [1] - prevalence 1-10% in 4 U.S. communities 2010 to 2016 [4] - prevalence: 11-50 per 1000 children [4] - 12% of pregnant women reportconsuming alcohol in the past 30 days [5] - 4% of pregnant women report binge-drinking (consuming >= 4 drinks on one occasion) - average 4.5 binge-drinking episodes in the past 30 days - unmarried women more likely than married women to drink (15 vs 9%) & binge-drink (6 vs 2%) - prevalence of any drinking highest among a group comprising American Indian/ Alaska Native, Asian/Pacific Islander, * multiracial respondents (19%) & lowest among Hispanic women (9%) [5] Pathology: - prenatal exposure to alcohol can damage the developing fetus - intellectual & neurodevelopmental disabilities from in utero alcohol exposure are lifelong [1] Diagnostic criteria: - neurobehavioral plus cognitive or behavioral impairment [3] - neurodevelopment & neuropsychology assessment >= 1.5 standard deviations below the mean [3] - cutoffs for height, weight, head circumference, & palpebral fissure length are <= 10th percentile [3] Complications: - psychological disorder (RR=77) - chronic serous otitis media (RR=77) - sensory & conductive hearing loss (RR=126) - blindness (RR=71) [2] Management: - no amount of alcohol is safe during pregnancy [1]

Related

alcoholism (includes binge drinking)

General

pregnancy disorder; obstetric disorder; pregnancy complication syndrome

References

  1. Williams JF, Smith VC for COMMITTEE ON SUBSTANCE ABUSE American Academy of Pediatrics Fetal Alcohol Spectrum Disorders Pediatrics. Oct 19, 2015 PMID: 26482673 http://pediatrics.aappublications.org/content/early/2015/10/13/peds.2015-3113
  2. Popova S et al. Comorbidity of fetal alcohol spectrum disorder: A systematic review and meta-analysis. Lancet 2016 Jan 5 PMID: 26777270 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901345-8/abstract - Burd L. Fetal alcohol spectrum disorder: Complexity from comorbidity. Lancet 2016 Jan 5 PMID: 26777271 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901346-X/abstract
  3. Adler C, Fairchild DG, Di Francesco L Updated Guidelines Issued for Diagnosing Fetal Alcohol Spectrum Disorders Physician's First Watch, July 27, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Hoyme HE, Kalberg WO, Elliott AJ et al Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders. Pediatrics Jul 2016, e20154256 PMID: 27464676
  4. May PA, Chambers CD, Kalberg WO et al Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities. JAMA. 2018;319(5):474-482 PMID: 29411031 https://jamanetwork.com/journals/jama/article-abstract/2671465 - Lange A, Rehm J, Popova S. Implications of Higher Than Expected Prevalence of Fetal Alcohol Spectrum Disorders. JAMA. 2018;319(5):448-449 PMID: 29411016 https://jamanetwork.com/journals/jama/article-abstract/2671448
  5. Denny CH, Acero CS, Naimi TS, Kim SY. Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18-44 Years - United States, 2015-2017. MMWR Morb Mortal Wkly Rep 2019;68:365-368 https://www.cdc.gov/mmwr/volumes/68/wr/mm6816a1.htm