NIH Updates Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders

NIH Updates Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and fetal alcohol spectrum disorders (FASD) experts, have written a new guideline proposal for the diagnosis of FASD, an umbrella term for a range of child disabilities, such as epilepsy, that result from alcohol drink consumption by pregnant mothers.

The first research describing impact of drinking during pregnancy appeared in the late 1960’s. In 1996, the Institute of Medicine identified four diagnostic categories within FASD: fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (PFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD).

The four categories represent the leading causes of preventable development disabilities worldwide. Disabilities include myriad problems such as lower IQ, restricted growth, microcephaly (small head size), facial deformities, behavioral issues or even epilepsy.

In a study, “The remarkably high prevalence of epilepsy and seizure history in fetal alcohol spectrum disorders,”  published in 2010 in the Alcoholism Clinical and Experimental Research journal, researchers found that 5.9% of the FASD patient population studied had confirmed epilepsy, and 11.8% had at least one documented seizure episode — revealing an overall prevalence of 17.7%.

The researchers concluded that a significantly high prevalence of epilepsy and seizures in the FASD population exists.

Other studies of school-age children suggest that the prevalence of FASD might be more frequent than previously thought, with 2% to 5% of American children showing signs of prenatal alcohol exposure.

According to the American Academy of Pediatrics, there is no safe amount of alcohol intake during pregnancy, no safe trimester to drink alcohol, all types of alcohol can pose a risk for fetus, and binge drinking adds a dose-related risk.

Exposure can be confirmed when a mother, or reliable source, reports alcohol consumption above six drinks per week for at least two weeks during pregnancy; or three or more drinks per occasion, on two or more occasions during pregnancy; and other measurement indicators.

“We’re hopeful that the improved specificity of these guidelines will help clinicians to assess FASD better, thereby leading to early intervention for affected children,” Dr. H. Eugene Hoyme, first author of the new proposed guidelines and a professor of pediatrics at the University of South Dakota, said in a press release.

The guideline proposal can be accessed online under the title “Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders.”

The new guidelines aim to clarify and expand guidelines from 2005. The 2016 version is based on the analysis of 10,000 individuals involved in studies of prenatal alcohol exposure and include a new definition of the documented condition; guides to evaluate facial and physical deformities that are characteristic of FASD; and updated information about the cognitive and behavioral impairments that have been studied in different FASD patients.

“These new guidelines will be a valuable resource for clinicians to accurately diagnose infants and children who were affected by alcohol exposure before birth,” said George F. Koob, Ph.D., director of NIAAA. “They represent the most data-driven diagnostic criteria for fetal alcohol syndrome and fetal alcohol spectrum disorder produced to date.”

The authors note that diagnosing FASD is best accomplished by a multidisciplinary approach, requiring a medical assessment of the child by a pediatrician and a neuropsychological and behavioral assessment. A trained interviewer should evaluate the mother, if needed, to determine when, how much, and for how long during pregnancy that the drinking of alcoholic beverages occurred.

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