SUBSTANCE ABUSE -A closer look at Fetal Alcoholic

SUBSTANCE ABUSE -A closer look at “Fetal Alcoholic Syndrome” BY: THEMBI ZUNGU (RN, POST GRAD CERTIFICATE IN PUBLIC HEALTH) FOR SOUTH AFRICAN PEER EDUCATORS CONFERENCE MANGAUNG , 12 OCTOBER 2012

PRESENTATION OUTLINE Definition of Terms. News about FAS. Prevalence. Pathophysiology Clinical diagnosis Maternal risk factors Prevention Consequences of FAS in child development Conlusion

DEFINITION OF TERMS Substance Abuse: Can be defined as a pattern of harmful use of any substance for mood altering. (http: //alcoholism. about. com/cs/drugs/a/aa 030425 a. htm) • Alcohol, illegal drugs including marijuana are some of the substances that can be abused and might have detrimental effects to children, families and community. Fetal Alcohol Syndrome (FAS): A birth defect caused by heavy alcohol consumption during pregnancy

NEWS ABOUT FAS. “GOOD NEWS” FAS is 100% preventable “BAD NEWS” “It’s 100% irreversible”

FAS PREVALENCE According to FARR prevalence in certain areas in South Africa is the highest reported anywhere in the world ( 0. 1 – 0. 2% in developed countries to 1% in some Native American Populations) FAS research has been done in: Western Cape – Wellington (a steady increase noted in school entry level; prevalence rates of 4. 8%(1997) increased to 7. 6 % (1999), with recent reports in 2001 Gauteng – Soweto (2. 2%), Lenasia(1. 2) & Westbury (3. 7%) Northern Cape: De Aar (10. 2%)

PATHOPHYSIOLOGY Alcohol and acetaldehyde are known tissue toxins which can interfere directly with cellular growth metabolism. When consumed in pregnancy, alcohol is carried to all the woman’s organs and tissues and to the placenta. Placenta functions to protect the foetus and provide nourishment from mother to the child. Problem : alcohol is able to cross the placental membrane and is transported directly to the growing baby.

PATHOPHYSIOLOGY CONTND HOW AND WHEN IS THE FETUS AFFECTED ? 1 st Trimester (0 – 12 weeks) This is the most critical period in pregnancy where foetal structures are formed thus causing abnormalities of the face, heart, brain , limbs and urogenital system 2 nd Trimester (12 – 24 weeks)) Fetal exposure to alcohol may result in miscarriage 3 rd Trimester ( 24 weeks - to delivery) Alcohol impacts on the overall growth, as the foetus undergoes rapid and substantial growth during this period.

CLINICAL DIAGNOSIS OF FAS with confirmed maternal alcohol exposure A – Confirmed maternal exposure B - Evidence of characteristics of facial abnormalities including palpebral fissures and maxillary zone abnormalities; flat upper lip, flat midface and flattened philtrum. C - Evidence of growth retardation; low birth weight for gestational age, failure to thrive, disproportionate weight for age. D – Evidence of Central Nervous System abnormalities (decreased head circumference at birth, structural brain abnormalities e. g. microcephaly & cerebellar hypoplasia neurological hard or soft signs (as age appropriate), such as impaired fine motor skills, neurosensory hearing loss, poor tandem gait, poor hand-eye coordination FAS without confirmed maternal alcohol exposure. B, C, D above. Partial FAS with confirmed maternal alcohol exposure. A, B, C and D – plus Evidence of a complex pattern of behaviour or cognitive abnormalities that are inconsistent with developmental level and cannot be explained by familial background or environment alone. For an example, evidence of a complex pattern of behaviour or cognitive abnormalities that are inconsistent with developmental level and cannot be explained by familial background or environment alone Alcohol related Birth Defects (ARBD) Alcohol Related Neurological Defects(ARND)

MATERNAL RISK FACTORS May et al (2005) identified the following maternal risk factors in a case control study done in Western Cape. Being born an alcohol abusing family where alcohol abuse is universal. Current and past abuse of alcohol by mothers with history of heavy binge (3 or more drinks per episode) drinking during weekends. Combination of alcohol with other addictive substances e. g. cigarette Smaller height, head circumference and body mass index in case mothers indicating poor nutrition and second generation FAS. In describing the socio – economic status for the cases May and colleagues found that case mothers were: Employed on the farms, have lower incomes, primary level of education, had low religious practices (frequency of church attendance and praying)

CLINICAL DIAGNOSIS CONTINUED… Source: http: //www. encyclopedia. com/topic/fetal_alcoholsy ndrome. aspx http: //www. encyclopedia. com/topic/fetal_alcohol_synd rome. aspx

HOW CAN FAS BE PREVENTED MOTHER: When PLANNING for pregnancy ABSTAIN from drinking any alcohol. If you not planning to conceive or abstain from alcohol, use EFFECTIVE BIRTH CONTROL. DO NOT CONSUME any alcohol during pregnancy It is essential to gain sufficient weight during pregnancy A balanced diet, specifically foods containing folate, iron, calcium and vitamin C BABY: Weigh child regularly to ensure sufficient weight gain A child who us distracted easily must be feed small amounts in order to reduce all stimuli. Patience is key to a mother of a child with FAS. Use trial and error to decide which method is appropriate for feeding Where signs are visible, refer to paediatrician for diagnosis an further multidisciplinary management

MANAGEMENT OF FAS

CONSEQUENCES OF FAS IN CHILD DEVELOPMENT Slow weight gain. Physical problems: cleft palate. weak suckling and these infants might be easily distracted. Brain and nerve abnormalities: Hyperactivity, irritability, attention deficit hyperactivity disorder. Distractibility and taking longer to complete tasks. Adolescents with FAS: Over eating related to abnormalities of the satiety centre in the brain, infants with FAS might be of short stature and might also develop obesity later in life.

CONCLUSION 1 million adults and children are affected by advanced FAS effects. “The consumption of alcohol may cause pregnancy” (author unknown). THANK YOU!!!

References http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 2582739/figure/f 2 -0120081/ http: //www. encyclopedia. com/topic/fetal_alcohol_syndrome. aspx May PA, Gossage JP, Brooke LE, Snell CL, Marais a, Hendricks LS, Croxfford JA & Viljoen DL (2005). Maternal Risk Factors for Fetal Alcohol Syndrome in the Western Cape Province of South Africa: A Population Based study. Research and Practice: 95(7); 1190 - 1199 Nutrition Information Centre: http: //www. sun. ac. za/nicus/ South National Council on Alcoholism and Drug Dependence (SANCA)