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• W59893176 abstract "Of all forms of substance abuse, alcohol abuse is the most serious in pregnancy, whether judged by its frequency or capacity to harm the fetus (1). Prenatal alcohol exposure is the most prevalent, single cause of intellectual impairment in children in the western world (2,3).Although alcohol’s role in human teratogenicity was not systematically studied until the 1970s, adverse effects of alcohol consumption during pregnancy have been noted throughout history, dating back to the Bible and Greek history (4). The first scientific study of children of alcoholic mothers was conducted by a British physician, Dr William Sullivan, in 1899. However, until the past few decades, little attention was paid to the plausibility of alcohol being a teratogen. In 1968, an article in France by Lemoine and Lemoine (5) provided the first description in the medical literature of the effects of alcohol on the fetus. Jones and Smith (6) coined the term ‘fetal alcohol syndrome’ (FAS) in 1973, after recognizing a distinct dysmorphic syndrome associated with gestational alcoholism.The criteria for the diagnosis of FAS is based on the presence of the following: evidence of excessive maternal drinking during pregnancy;characteristic facial dysmorphology (ie, microcephaly, poorly developed philtrum, thin upper lip and flattened maxillary area);pre-and/or postnatal growth retardation (weight, length and/or height below the 10th percentile); andcentral nervous system (CNS) damage (signs of neurological abnormality, developmental delay, intellectual impairment or neurobehavioural anomalies) (4).However, very few alcohol-exposed children present with the full-blown syndrome, especially with all the facial features listed for FAS. Moreover, of the dysmorphic characteristics listed, most are not ‘disfiguring’, and in fact, many lead to appealing or attractive-looking faces. Further, these facial features often tend to fade with age and may become undetectable in adolescence (7,8), whereas the associated CNS damage is life-long and debilitating.Full-blown FAS encompasses a relatively small proportion of children prenatally affected by alcohol (9,10). It is estimated that only 10% to 40% of the offspring of alcohol-abusing women meet the criteria necessary for a diagnosis of FAS (11). As a consequence, the term ‘alcohol-related neurodevelopmental disorder’ (ARND) is used to describe the large number of children affected by prenatal alcohol exposure who do not fit all of the criteria for a diagnosis of full-blown FAS (1).The combined incidence of fetal alcohol-related abnormalities has been estimated to be about 0.91% in the general population and up to 10% to 20% of the population in some Native communities in which drinking in pregnancy is a common lifestyle activity (12). A slightly more conservative estimate of one to three children in a general obstetric population of 1000 was reported by Korkman et al (3) for European communities. The incidence of FAS appears to vary both within and between countries, and was reported to be more than 20 times higher in the United States than in other countries (13)." @default.
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• W59893176 title "Fetal alcohol spectrum disorder – New diagnostic initiatives" @default.
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