Cases Of Fetal Alcohol Syndrome Research Articles

The frequency of severe Fetal Alcohol Spectrum Disorders in the neonatal period using data from the French hospital discharge database between 2006 and 2013

BackgroundsAt birth, only complete Fetal Alcohol Syndrome (FAS) can be properly diagnosed. However, other Consequences of prenatal Alcohol Exposure (CAE) can also be recorded. Our objective was to describe the frequency of diagnoses highly suggestive of “potential Fetal Alcohol Syndrome Disorder” (pFASD, i.e., FAS and CAE) among hospitalized neonates, during the neonatal period, in France, between 2006 and 2013. MethodsWe used the French national hospital discharge database to identify the Q86.0 (FAS) and P04.3 (CAE) ICD-10 codes in hospital stays occurring in the first 28 days of life. FAS, CAE and pFASD rates were estimated per 1000 live births at the national level for the 2009–2013 period. We compared the 2006–2009 and 2010–2013 rates. The pFASD rates were also estimated at the regional level. ResultsOverall, 3,207 cases of pFASD were diagnosed during the neonatal period (i.e., 0.48 cases per 1000 live births, including 0.07 cases of FAS per 1000). Between 2006–2009 and 2010–2013, pFASD remained stable, despite a moderate decrease in reported FAS (0.08 vs 0.06 cases per 1000, p < 0.001). At the regional level, pFASD rates varied between 0.13 and 1.22 cases per 1000. ConclusionsThis study provides the first national estimate of neonatal diagnosis of FAS, and more broadly pFASD, in France. Although our data certainly underestimate the real prevalence of FASD, they provide a minimal estimate of the burden of alcohol use during pregnancy. Observed variations deserve to be analyzed in the light of concomitant prevention and public information campaigns.

The comorbidity of fetal alcohol syndrome and sleep apnea/hypopnea syndrome in a 7‑year-old girl (a clinical case)

Fetal alcohol syndrome is the result of prenatal effect of alcohol on the fetus and manifests as disorders of neural and mental development and various congenital developmental disorders leading to comorbid diseases. Among congenital developmental disorders for the pathology, adenotonsillar pathology was described. Narrowing of the nasopharyngeal opening, faciomaxillary dysmorphias and muscle hypotony can lead to sleep apnea syndrome. The article presents a clinical case of fetal alcohol syndrome and sleep apnea in a 7‑year-old girl with multiple developmental disorders born form alcohol-abusing mother. Breathing abnormalities during sleep must be differentiated per character and cause. Cardiorespiratory monitoring is used to diagnose respiratory abnormalities, the results determine patient management tactics. Interdisciplinary approach to observation and treatment of a child with fetal alcohol syndrome is necessary to increase the effectiveness of rehabilitation measures and patient’s quality of life.

The Prevalence of Fetal Alcohol Spectrum Disorders in An American Indian Community.

The prevalence of fetal alcohol spectrum disorders (FASD) differs among populations and is largely unknown among minority populations. Prevalence and characterization of FASD is necessary for prevention efforts and allocation of resources for treatment and support. However, prevalence data are lacking, including among many minority populations. The aim of this study was to obtain an FASD prevalence estimate in a Southern California American Indian community employing active case-ascertainment. In 2016, American Indian children aged 5–7 years and their caregivers were recruited in collaboration with Southern California Tribal Health Clinic. Children were assessed using physical examinations and neurobehavioral testing. Parent or guardian interviews assessed child behavior and prenatal exposures including alcohol. Of 488 children identified as eligible to participate, 119 families consented and 94 completed assessments to allow a classification for FASD. Participating children (n = 94) were an average of 6.61 ± 0.91 years old and half were female. Most interviews were conducted with biological mothers (85.1%). Less than one third (29.8%) of mothers reported consuming any alcohol in pregnancy and 19.1% met study criteria for risky alcohol exposure prior to pregnancy recognition. Overall 20 children met criteria for FASD, resulting in an estimated minimum prevalence of 41.0 per 1000 (4.1%). No cases of fetal alcohol syndrome (FAS) were identified; 14 (70.0%) met criteria for alcohol related neuro- developmental disorder (ARND). Minimum prevalence estimates found in this sample are consistent with those noted in the general population.

Comparing diagnostic outcomes of children with fetal alcohol syndrome in South Africa with diagnostic outcomes when using the updated Institute of Medicine diagnostic guidelines.

During fetal alcohol spectrum disorder (FASD) prevalence studies in South Africa, cases of fetal alcohol syndrome (FAS) were identified that presented differently from the 2016 Hoyme et al. modified Institute of Medicine (IOM) criteria. We compared diagnostic outcomes of children diagnosed with FAS using a combination of the 2005 Hoyme et al. criteria and the "gestalt method" in South Africa to the diagnosis they would have received using the latest Hoyme et al. criteria. The frequency with which dysmorphic features presented was compared to the frequency with which they were reported in the revised criteria which drew on a larger sample. Data were gathered from four South African FASD prevalence studies. Dysmorphology data, anthropometric data, and final diagnosis for participants (N = 917) were extracted. Of the 390 participants with diagnoses of "full FAS," 175 would not have received a "full FAS" diagnosis using the 2016 criteria. Of these, 21 would have received a pFAS diagnosis, and 154 would have received a diagnosis of ARND or a "no-FASD" diagnosis. The frequency of all but five dysmorphic features differ significantly between this sample and the sample examined for the 2016 criteria. There is more variability in the features present in the current sample. Differences regarding diagnostic outcomes and prevalence of dysmorphic features suggest that strict application of the diagnostic criteria may miss children who present with FAS. We recommend including gestalt-based screening in a research setting where the clinical experience is available to inform future guidelines.

Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis.

Alcohol use during pregnancy is the direct cause of fetal alcohol syndrome (FAS). We aimed to estimate the prevalence of alcohol use during pregnancy and FAS in the general population and, by linking these two indicators, estimate the number of pregnant women that consumed alcohol during pregnancy per one case of FAS. We began by doing two independent comprehensive systematic literature searches using multiple electronic databases for original quantitative studies that reported the prevalence in the general population of the respective country of alcohol use during pregnancy published from Jan 1, 1984, to June 30, 2014, or the prevalence of FAS published from Nov 1, 1973, to June 30, 2015, in a peer-reviewed journal or scholarly report. Each study on the prevalence of alcohol use during pregnancy was critically appraised using a checklist for observational studies, and each study on the prevalence of FAS was critically appraised by use of a method specifically designed for systematic reviews addressing questions of prevalence. Studies on the prevalence of alcohol use during pregnancy and/or FAS were omitted if they used a sample population not generalisable to the general population of the respective country, reported a pooled estimate by combining several studies, or were published in iteration. Studies that excluded abstainers were also omitted for the prevalence of alcohol use during pregnancy. We then did country-specific random-effects meta-analyses to estimate the pooled prevalence of these indicators. For countries with one or no empirical studies, we predicted prevalence of alcohol use during pregnancy using fractional response regression modelling and prevalence of FAS using a quotient of the average number of women who consumed alcohol during pregnancy per one case of FAS. We used Monte Carlo simulations to derive confidence intervals for the country-specific point estimates of the prevalence of FAS. We estimated WHO regional and global averages of the prevalence of alcohol use during pregnancy and FAS, weighted by the number of livebirths per country. The review protocols for the prevalence of alcohol use during pregnancy (CRD42016033835) and FAS (CRD42016033837) are available on PROSPERO. Of 23 470 studies identified for the prevalence of alcohol use, 328 studies were retained for systematic review and meta-analysis; the search strategy for the prevalence of FAS yielded 11 110 studies, of which 62 were used in our analysis. The global prevalence of alcohol use during pregnancy was estimated to be 9·8% (95% CI 8·9-11·1) and the estimated prevalence of FAS in the general population was 14·6 per 10 000 people (95% CI 9·4-23·3). We also estimated that one in every 67 women who consumed alcohol during pregnancy would deliver a child with FAS, which translates to about 119 000 children born with FAS in the world every year. Alcohol use during pregnancy is common in many countries and as such, FAS is a relatively prevalent alcohol-related birth defect. More effective prevention strategies targeting alcohol use during pregnancy and surveillance of FAS are urgently needed. Centre for Addiction and Mental Health (no external funding was sought).

Reduced DNA methylation at the PEG3 DMR and KvDMR1 loci in children exposed to alcohol in utero: a South African Fetal Alcohol Syndrome cohort study.

Fetal alcohol syndrome (FAS) is a devastating developmental disorder resulting from alcohol exposure during fetal development. It is a considerable public health problem worldwide and is characterized by central nervous system abnormalities, dysmorphic facial features, and growth retardation. Imprinted genes are known to play an important role in growth and development and therefore four imprinting control regions (ICRs), H19 ICR, IG-DMR, KvDMR1 and PEG3 DMR were examined. It is proposed that DNA methylation changes may contribute to developmental abnormalities seen in FAS and which persist into adulthood. The participants included FAS children and controls from the Western and Northern Cape Provinces. DNA samples extracted from blood and buccal cells were bisulfite modified, the ICRs were amplified by PCR and pyrosequencing was used to derive a quantitative estimate of methylation at selected CpG dinucleotides: H19 ICR (six CpG sites; 50 controls and 73 cases); KvDMR1 (7, 55, and 86); IG-DMR (10, 56, and 84); and PEG3 DMR (7, 50, and 79). The most profound effects of alcohol exposure are on neuronal development. In this study we report on epigenetic effects observed in blood which may not directly reflect tissue-specific alterations in the developing brain. After adjusting for age and sex (known confounders for DNA methylation), there was a significant difference at KvDMR1 and PEG3 DMR, but not the H19 ICR, with only a small effect (0.84% lower in cases; p = 0.035) at IG-DMR. The two maternally imprinted loci, KvDMR1 and PEG3 DMR, showed lower average locus-wide methylation in the FAS cases (1.49%; p < 0.001 and 7.09%; p < 0.001, respectively). The largest effect was at the PEG3 DMR though the functional impact is uncertain. This study supports the role of epigenetic modulation as a mechanism for the teratogenic effects of alcohol by altering the methylation profiles of imprinted loci in a locus-specific manner.

Fetal alcohol syndrome surveillance: age of syndrome manifestation in case ascertainment.

Fetal alcohol syndrome (FAS) is a leading cause of developmental disability (Abel & Sokol, ). Active public health surveillance through medical record abstraction has been used to estimate FAS prevalence rates, typically based on birth cohorts. There is an extended time for FAS characteristics to become apparent in infants and young children, and there are often delays in syndrome recognition and documentation. This methodological study analyzes the age at case ascertainment in a large surveillance program. The Fetal Alcohol Syndrome Surveillance (FASSLink) Project, funded by the Centers for Disease Control and Prevention, sought to estimate FAS prevalence rates in eight U.S. states. FASSLink used linked abstractions from multiple health care records of suspected cases of FAS. The present study analyzed data from this effort to determine the child's age in months at confirming abstraction. The average age at abstraction for confirmed/probable FAS cases (n = 422) was 48.3 (±19.5) months with a range of 0 to 94 months. Age of ascertainment varied by state and decreased with each birth year; the number of cases ascertained also decreased in a steep stepwise gradient over the 6 birth years in the study. FAS surveillance efforts should screen records of children who are much older than is typical in birth defects surveillance. To best establish rates of FAS using medical records abstraction, surveillance efforts should focus on 1-year birth cohorts followed for a fixed number of years or, if using multi-year cohorts, should implement staggered end dates allowing all births to be followed for up to 8 years of age.

2. Fetal alcohol spectrum disorder: Epilepsy and neuropsychiatric disorders

The Fetal Alcohol Syndrome (FAS) is a congenital disorder due to prenatal exposure to alcohol, leading to a dysmorphic infant: microcephaly, developmental delay and often seizures. Many offspring at risk are non-dysmorphic, referred to as Fetal Alcohol Spectrum Disorder (FASD), including possible and probable FAS and FRND, requiring high diagnostic acumen. Aim A retrospective analysis of 400 cases of FAS, FASD and FRND revealed an unexpectedly high incidence of seizure disorder in 20%, including frequent epileptic seizures in 12% (Bell et al. ACER 2010). The current study examines a cohort for neuropsychiatric difficulties encountered in the management of these adolescents and adults ( N =10). Methods Only those subjects that came to medical attention and/or psychosocial intervention had detailed neuropsychiatric assessment. Hence there is a bias towards over-estimating the prevalence of neuropsychiatric difficulties. They were all examined by the same neuropsychiatrist (MGS), had EEG recorded with electrodes in the 10–20 system plus zygomatics, almost always with sleep: spontaneous, after sleep-deprivation or overnight polysomnographic recording with video-EEG in a sleep lab. All EEGs were read blind by the same board-certified clinical neurophysiologist (PAH). Representative subjects are reviewed. Results In addition to a high prevalence of seizure disorder (approximately 10 times normal), recurrent afebrile unprovoked seizures (epileptic) were found in 12% of the study cohort (>10×normal), requiring long-term follow-up and treatment with AEDs appropriate for the seizure types: CBZ, OxCBZ, VPA, LMT or TPM. Breakthrough seizures require (BZDs) benzodiazepines for acute management, loading doses of PHT and/or PB for status epilepticus. Neuropsychiatric issues included attention deficit +/− hyperactivity, mood instability, dysprosody and depression, often responding to the same AEDs as above, plus SSRI or antipsychotics. The adolescents experienced learning difficulties in school and/or at work, requiring cognitive behavior therapy, speech therapy and possibly EEG biofeedback. Conclusion The FASD is associated with increased seizure risk, learning disorder, neuropsychiatric difficulties that require further intervention. Whether these are due to developmental cerebral dysgenesis, neurotoxicity of ethanol or metabolites in utero, or sequelae of postnatal traumatic brain injuries, vitamin deficiency or a disorder in brain metabolism as a result of epigenetic response to a hostile neural environment, remains to be determined in future studies.

Dental Hospital Admissions in the Children of Mothers with an Alcohol-Related Diagnosis: A Population-Based, Data-Linkage Study

To investigate the relationship between maternal alcohol-use disorder and dental hospital admissions in children up to 5 years of age. Mothers with an International Classification of Diseases, 9th revision/10th revision alcohol-related diagnosis, a proxy for alcohol-use disorder, were identified through the Western Australian data-linkage system. Exposed mothers were frequency-matched by maternal age, Aboriginal status, and child's birth year to randomly selected comparison mothers without an alcohol diagnosis. Linkage with the Midwives Notification System (1983-2002) identified all births of these mothers; "exposed" (non-Aboriginal, n = 11,171; Aboriginal, n = 8145) and comparison cohorts (non-Aboriginal, n = 32,508; Aboriginal, n = 16,719). Dental hospital admissions were identified through linkage with Hospital Morbidity Data (1983-2007) (3.2% exposed; 3.0% comparison) and cases of fetal alcohol syndrome (n = 84) through linkage with the Western Australian Register of Developmental Anomalies. ORs and 95% CIs for having a dental admission (International Classification of Diseases, 9th revision: 520-529; International Classification of Diseases, 10th revision: K0-K14.9) were generated by the use of generalized estimating equations, which we adjusted for potential confounding factors (aOR). Children of mothers with an alcohol-related diagnosis had increased adjusted odds of gingivitis and periodontal diseases (aOR 1.67; 95% CI 1.12-2.51) and "other" diseases of the lip and oral mucosa (aOR 1.56; 95% CI 1.21-2.01). Diseases of the salivary glands were increased only in Aboriginal children of mothers with an alcohol-related diagnosis (aOR 2.65; 95% CI 1.09-6.44). Children diagnosed with fetal alcohol syndrome had increased ORs of any dental admission (aOR 2.58; 95% CI 1.30-5.11). Maternal alcohol-use disorder was associated with dental admissions related to disorders of the soft tissues, but questions remain regarding perinatal influences on dental admissions and disease.

Critiquing Fetal Alcohol Syndrome Health Communication Campaigns Targeted to American Indians

It is widely recognized American Indians and Alaska Natives have suffered from far worse health status than that of other Americans. Health communication campaigns directed to American Indians and Alaska Natives and their outcomes must be grounded in an understanding of the historical and ongoing marginalization and cultural dislocation of these groups. The authors draw upon the specific case of health communication campaigns to reduce cases of fetal alcohol syndrome among American Indians and Alaska Natives. Counteracting stereotyping of American Indians and alcohol consumption by mainstream American popular culture and mediated discourses, coverage of fetal alcohol syndrome in the media is assessed. The study analyzes 429 American Indian news articles from 1990 to 2010. Mainstream American and American Indian media should cover health concerns such as fetal alcohol syndrome more extensively. Researchers, health communication campaign developers, health policy makers, and mainstream media must be knowledgeable about American Indian and Alaskan Native identity, cultures, and history, and diversity across Nations. Last, and most important, health communication strategists and health policy makers must welcome American Indians and Alaska Natives to take leadership roles in communicating culture- and Nation-specific health campaign strategies to eliminate health disparities.

Prevalence, predictors and perinatal outcomes of peri-conceptional alcohol exposure - retrospective cohort study in an urban obstetric population in Ireland

BackgroundEvidence-based advice on alcohol consumption is required for pregnant women and women planning a pregnancy. Our aim was to investigate the prevalence, predictors and perinatal outcomes associated with peri-conceptional alcohol consumption.MethodsA cohort study of 61,241 women who booked for antenatal care and delivered in a large urban maternity hospital between 2000 and 2007. Self-reported alcohol consumption at the booking visit was categorised as low (0-5 units per week), moderate (6-20 units per week) and high (>20 units per week).ResultsOf the 81% of women who reported alcohol consumption during the peri-conceptional period, 71% reported low intake, 9.9% moderate intake and 0.2% high intake. Factors associated with moderate alcohol consumption included being in employment OR 4.47 (95% CI 4.17 to 4.80), Irish nationality OR 16.5 (95% CI 14.9 to 18.3), private health care OR 5.83 (95% CI 5.38 to 6.31) and smoking OR 1.86 (95% CI 1.73 to 2.01). Factors associated with high consumption included maternal age less than 25 years OR 2.70 (95% CI 1.86 to 3.91) and illicit drug use OR 6.46 (95% CI 3.32 to 12.60). High consumption was associated with very preterm birth (<32 weeks gestation) even after controlling for socio-demographic factors, adjusted OR 3.15 (95% CI 1.26-7.88). Only three cases of Fetal Alcohol Syndrome were recorded (0.05 per 1000 total births), one each in the low, moderate and high consumption groups.ConclusionsPublic Health campaigns need to emphasise the importance of peri-conceptional health and pre-pregnancy planning. Fetal Alcohol Syndrome is likely to be under-reported despite the high prevalence of alcohol consumption in this population.

Is Pregnancy the Time to Change Alcohol Consumption Habits in France?

Although it is well known that France has a cultural history of alcohol use, no recent French data on alcohol consumption during pregnancy in a large sample are available. To determine the alcohol consumption patterns among pregnant women in France, we analyzed data from a 1-year multicenter self-survey. Sociodemographic profile, obstetrical history, neonatal data, and a self-report for assessing drinking patterns during pregnancy including AUDIT were recorded from women who delivered recently. Cases of fetal alcohol syndrome (FAS) were also reported. A total of 837 pregnant women have described all parameters. The mean age at delivery of our sample was 29.7 years (SD = 4.8 years). A total of 52.2% of women indicated that they had consumed alcohol at least once during their pregnancy, and among abstainers 54.5% had a positive AUDIT score. Of the pregnant women who consumed alcohol, 13.7% reported at least one binge drinking episode (5 or more drinks on 1 occasion) during pregnancy. Binge drinking is significantly more frequent than regular alcohol consumption (at least 1 drink more than 1 time per week) during pregnancy. A prevalence rate of FAS of 1.8 per 1,000 live births was observed. There is a large population of women who still drink alcohol during pregnancy, particularly in binge drinking episodes. This underlines the need to clearly inform women of childbearing age about the dangers of alcohol during pregnancy as related to all types of consumption. Moreover, acting to prevent alcohol consumption prior to pregnancy may also greatly influence prenatal drinking.

Fetal alcohol syndrome: a prospective national surveillance study

Objective:To describe the epidemiology of cases of fetal alcohol syndrome (FAS) seen by Australian paediatricians.Methods:Active, national case-finding using the Australian Paediatric Surveillance Unit (APSU). Monthly reporting of incident cases aged...

A Case of Fetal Alcohol Syndrome with Secondary Amenorrhea

Alcohol ingestion during pregnancy can be damaging to embryon ic and fetal development. A specific pattern of malformation, identified as Fetal alcohol syndrome, has been documented in 1~2 of every 1,000 live infant births Fetal alcohol syndrome is characterized by growth deficiency, facial abnormalities, cardiac defects, minor joint and limb abnormalities, as well as central nervous system dysfunction, including microcephaly, mental retardation and abnormal neurobehavioral development. However, there are few reports of fetal alcohol syndrome associated with hormonal abnormality or amenorrhea. Recently, a case of secondary amenorrhea, which developed in a 19-year-old woman with fetal alcohol syndrome, was experienced at our institute, but the exact cause of the amenorrhea was difficulty to find. Herein, this case is reported, with a review of the literature (J Kor Soc Endocrinol 20:524～530, 2005).

Fetal alcohol syndrome prevention: annual and cumulative cost savings

Fetal alcohol syndrome (FAS) is a common developmental disability. FAS is thought to be 100% preventable. While this is a theoretical truth, a prevention rate of 100% appears unlikely in the near future. However, several prevention strategies are available. In this paper, we examine the potential cost savings from prevention of one case of FAS each year in the state of North Dakota. We utilized the North Dakota Health Claims Database to examine annual cost of health care for children birth through 21 years of age with FAS and controls. The mean annual cost of health care for children birth through 21 years of age with FAS was US$2842 ( n=45). This is US$2342 per capita more than the annual average cost of care for children in North Dakota who do not have FAS (US$500 per year). Prevention of one case of FAS per year in North Dakota would result in a cost savings of US$128,810 in 10 years and US$491,820 after 20 years. After 10 years of prevention, the annual savings in health care costs alone for one case of FAS would be US$23,420.

Incidence of fetal alcohol syndrome in northeastern Manitoba.

The incidence of fetal alcohol syndrome (FAS) in northeastern Manitoba was investigated by examining all 745 live births occurring in Thompson General Hospital in 1994. Birth records were screened with criteria designed to capture all potential FAS cases. Cases were then eliminated if follow-up records indicated the child was not developmentally delayed or no longer had the small head or body size identified at birth. Cases still meeting criteria were personally examined. Five cases of FAS were identified among the 46% of eligible children screened at age 2, roughly an incidence of 7.2/1,000. However, because only 46% of the high risk cases were personally examined, incidence could be as high as 14.8/1,000. Only 1/5 FAS cases had been identified prior to our investigation. The results indicate the incidence of FAS in northeastern Manitoba is very high and that much greater effort needs to be made in its prevention and early detection.

Historical misrepresentation in science: the case of fetal alcohol syndrome.

The history of the fetal alcohol syndrome (FAS) provides a microcosm in which to explore the larger ramifications of historical citations in biomedical publications. Though some historical references such as Biblical writings may hint at a rudimentary understanding of the relationship between maternal drinking and fetal development, no definitive case can be made for an understanding of FAS dating back hundreds of years. Authors who claim an impressive history for FAS misrepresent that history. The modern history of FAS raises a question concerning citations of original discoveries. The first paper describing ethanol-induced damage to the fetus appeared in 1968 yet most researchers cite one of two papers from 1973. Both ancient citations and modern references to original discoveries pose difficult questions for the scientist. Both dilemmas may be solved by a better reading of the literature and a more judicious wording when writing about history.

Effects of Alcohol and Other Drugs on Children

Children are affected by alcohol and other drug use along three primary paths: in utero through the mother's use, environmentally through both family and community influences, and through their own use. Children who are prenatally exposed are put at risk both through physiological insults and through caregiving deficits in their immediate family. The number of cases of Fetal Alcohol Syndrome (FAS) in the western world has been estimated at 0.33 cases per 1,000 live births; 200 babies are born with FAS per year in California. The National Institute on Drug Abuse (NIDA) estimates that 7.62 million babies (18.6%) were exposed to alcohol during gestation. Current prevalence estimates show about 28.6 million children of alcoholics in the United States, while in California it is estimated that about 17.6% of children lived with a parent who used illegal substances during the past year. Although all the prenatal effects of alcohol are not known, it is clear that there is no safe amount of alcohol to be consumed during pregnancy. There is little consensus, however, on long-term effects from in utero exposure alone because of the influence of adverse environmental factors; prenatal exposure is usually not the final influence, but is reinforced by years of neglect, deprivation, negative behavioral models, and other adverse conditions. And although society places most emphasis upon the negative effects of illicit substances, use of alcohol is strongly associated with crime and family violence. The consequences of use of alcohol and tobacco are more costly to society in terms of health care, accidents, days of work lost, and other social costs.

Fetal gammaglutamyl transferase activity: clinical implication in fetal medicine.

In a retrospective study of 3,129 fetal blood samples, we first determined normal values for gammaglutamyl transferase (GGT) activity and found 33 cases with a mean GGT level of 961.8 U/l (prevalence 1.05%) corresponding to more than 10-fold normal values. In such extreme cases, elevations of GGT activity in fetal blood have been poorly studied. The goal of this work was to correlate this highly abnormal biological finding with pathological fetal conditions and try to better understand the pathophysiological mechanisms. The most frequent underlying disorders were infections (n = 11), renal or bowel malformations (n = 12) and genetic abnormalities (n = 5). Two cases of cystic fibrosis and one case of fetal alcohol syndrome were also encountered. In another 2 cases, no explanation was found.

Does routine prenatal ultrasound (US) examination detect fetal alcohol syndrome (FAS)?

359 DOES ROUTINE PRENATAL ULTRASOUND (US) EXAMINATION DETECT FETAL ALCOHOL SYNDROME (FAS)? KS ruder, SS Martier', B Gonik, RJ Sokol, Dept, of and Fetal Alcohol Research Center, Wayne State University. Detroit, ML OBJECTWE: To determine the value of roudne US screening in the antenatal detection of FAS. STUDY DESIGN: A ample ofaU pregnant heavy drinkers, randomly selected lighter drinkers and abstainers (n=2282) were identified and followed prospectively through delivery. Repeated, detailed maternal drug and alcohol histories were obtained antonatally, and neonates had dysmorphologic amsessment for FAS, by examination blinded to fetal alcohol exposure. 32 singleton births with s diagnosis of FAS and prenatal US examinations were each matched with two non-FAS neonates of comparable gu~----tationsi age at the time of US. Fetal biomsl~/and US detected anomalies were compared between the FAS and non-FAS groups using t-tosto end discriminent function analysis. RESULTS: The mean geatational age at the time of scanning (29.3+5.1 wks ve 27.0~7.2 wks) was no different. The identification of anomalies was similar (FAS 9.4% ve non-FAS 5.1%). In this sample, we were unable to identify gestations affected with FAS using US measurement of bi-pariatal diameter, orbito-frontsi diameter, abdominal cimurnferenco and percentile, femur kmgth, estimated fetal weight and percentile, and outer orbital diameter. Specif'¢ dysrnorphic features for FAS were not noted by US in any of the affected fetuses. CONCLUSIONS: While we have previously shown a higher rate of anomalies detected on prenatal US in fetuses heavily-exposed to alcohol, detecting anomalies in FAS cases is more difficult. FAS has specific dysmorphic features that are identifiable in the neonate, but dre subtle and may go unrecognized in the antenatal period with clinical US. FAS is rare and even in these ~,'wersiy affected fetuses only a limited proportion can be expected to have substantial, easily recognizable anomalies. Targeted US using intra-crenial and facial measurements, may improve detection of FAS in utero in an at-risk population. 361 FETAL BIni)IIOIEPIIROSlS~ 0UTCOIE & PRO~TIC INDICATORS. A.H. Adra,XlAqA. Mejides x , ~.S. Oennaoui x¢, S.N. Beycloun ~. D'e~pt. of Ob/Gyn & Pediatr ics , Universi ty of Miami, Miami, FL. OBJECTIVE: To study the outcome of fe te | hydronephrosis & ident i fy prognostic indicators. STUDY OESIGII: A tota l of 40 cases were retrospectively collected. Serial sonogralas were perfomed to assess the progression of hydronephrosis & evatuate amniotic f l u i d votumo (AFV). In cases of bladder out let obstruction (BOg), antenatal intervention consisted of bladder end/or kidney decompression. Postnatal evaluation consisted of renal ultrasound, voiding cystourethrogram and renal f low studies. Twenty nine infants were followed up to § years of age. Resutts: l l lpa|red Kidney b r i e r y Observation Function UPJ Obstruct. 22(55X) 14 8 1/16 BLadder Outlet Obstruction 9(23%) 5 0 515 VUJ Obstruct. 4 1 3 0/3 Double Collect. system 3 2 1 013 VU Reflux 2 0 2 0/2 Totat 40 22(61%) 14(39/.) 6•29 ALL patients had normal AFV except for 7/9 cases of BOB. Nean iestst ionat age at del ivery was 37.8 weeks. Fetal urine electrolytes & osmatarity correlated with kidney function at b i r th in 6/7 cases of 60Bt there 4 neonatal deaths occurred. The degree of feta l hydrenephrosis in UPJ obstruction dfd not correlate with Long term kidney function af ter b i r th . Conclusion: 1) The majori ty of infants born with congenital hydronephrosis do well with term del ivery except for those with bladder out let obstruction, where survivors invariably show various degrees of renal insuf f ic iency. 2) Infants with UPJ obstruction, the most common etiology of fe ta l hydrone~nrosis, usually have e favorable tong term prognosis i rrespect ive of the severi ty of intrauter ine hydronephrosis.3) AFV remains the best prognostic indicator for kidney function in utero.