Reducing Adverse Outcomes from Prenatal Alcohol Exposure: A Clinical Plan of Action

Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities, Fetal Alcohol Syndrome Prevention Team, Atlanta, Georgia, USA.
Alcoholism Clinical and Experimental Research (Impact Factor: 3.21). 09/2006; 30(8):1271-5. DOI: 10.1111/j.1530-0277.2006.00175.x
Source: PubMed


Fetal alcohol spectrum disorders (FASDs) are among the leading preventable causes of developmental disorders in the United States; however, recognition and prevention of these conditions cannot be achieved without informed and educated health providers. This commentary addresses the importance of recognition and prevention of FASDs through the use of well-established standardized practices of diagnosis, screening, and brief alcohol reduction counseling. It is hoped that more knowledge on currently available procedures will encourage their use in the provision of routine health care to all women of childbearing age.

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    • "The T-ACE, a simple clinical screen for problem drinking validated in pregnant women (Sokol et al., 1989; Russell et al., 1994; 1996), is recommended by the CDC (2002) and ACOG (2004; 2006; Floyd, et al., 2006) and NIAAA (2004). The current study assessed the utility of different applications of the T-ACE and the results confirmed our a priori hypothesis that increasing the total T-ACE score cut-point from 2 to 3 improved specificity while maintaining high sensitivity in detecting maternal risk alcohol consumption during pregnancy. "
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    ABSTRACT: Preventing fetal alcohol spectrum disorders (FASDs) requires detection of in-pregnancy maternal risk drinking. The widely used T-ACE screen has been applied in various ways, although the impact of those different uses on effectiveness is uncertain. We examined relations among different T-ACE scoring criteria, maternal drinking, and child outcome. Self-reported across-pregnancy maternal drinking was assessed in 75 African-American women. The different T-ACE criteria used varied the level of drinking that defined tolerance (two or three drinks) and the total T-ACE score cut-points (two or three). Receiver operator curves and regression analysis assessed the significance of relations. Increasing the total T-ACE score cut-point to 3 almost doubled specificity in detecting risk drinking whereas maintaining adequate sensitivity, equivalent to that in the original report, and identified substantially more neurobehavioral deficits in children. Redefining tolerance at three drinks did not improve T-ACE effectiveness in predicting outcomes. This study is among the first to show the ability of an in-pregnancy T-ACE assessment to predict child neurodevelopmental outcome. In addition, increasing the total T-ACE score criterion (from 2 to 3) improved identification of non-drinking mothers and unaffected children with little loss in detection of drinkers and affected children. Efficient in-pregnancy screens for risk drinking afford greater opportunities for intervention that could prevent/limit FASDs.
    Alcohol (Fayetteville, N.Y.) 11/2010; 44(7-8):595-603. DOI:10.1016/j.alcohol.2009.08.009 · 2.01 Impact Factor
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    • "" There is also considerable evidence from the testimonies of family and teachers to support this conclusion [e.g., several chapters in Kleinfeld and Wescott, 1993]. Finally, O'Connor and others have examined the impact of social skills training and have suggested that this type of training is effective as long as the children with FASDs have relatively intact executive functioning [Floyd et al., 2006; Frankel et al., 2006; O'Connor et al., 2006; Schonfeld et al., 2009]. The literature on environmental enrichment in rodent models of FASD and treatment of individuals with FASD suggests that enrichment and other treatment interventions must be designed with the capability of the individual in mind and people with FASDs often have limitations on their cognitive ability and may well have limitations on their ability to process the sensory stimulation of enrichment. "
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    ABSTRACT: Animal models of fetal alcohol spectrum disorder (FASD) have been used to demonstrate the specificity of alcohol's teratogenic effects and some of the underlying changes in the central nervous system (CNS) and, more recently, to explore ways to ameliorate the effects of alcohol. The main point of this review is to highlight research findings from the animal literature which point to the impact of the social context or social behavior on the effect(s) of alcohol exposure during development, and also to point to research questions about the social environment and effects of prenatal alcohol exposure that remain to be answered. Alcohol exposure during early development alters maternal responding to the exposed pup in a variety of ways and the alteration in maternal responding could alter later stress responsivity and adult maternal and social behavior of the exposed offspring. Environmental enrichment and voluntary exercise have been shown to ameliorate some of alcohol's impact during development, but the roles of enhanced social interactions in the case of enrichment and of social housing during voluntary exercise need to be more fully delineated. Similarly, the role of social context across the lifespan, such as social housing, social experiences, and contact with siblings, needs further study. Because of findings that alcohol during development alters DNA methylation patterns and that there are alterations in the maternal care of the alcohol-exposed offspring, epigenetic effects and their relationship to social behavior in animal models of FASD are likely to become a fruitful area of research. Because of the simpler social behavior and the short lifespan of rodents, animal models of FASD can be useful in determining how the social context impacts the effects of alcohol exposure during development.
    Developmental Disabilities Research Reviews 01/2009; 15(3):200-8. DOI:10.1002/ddrr.69 · 2.75 Impact Factor

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