Children who face development risks due to maternal addiction during pregnancy require extra medical and psychosocial resources

AIM

This study examined medical and psychosocial risk factors in children born to women with addiction problems during pregnancy and the children's needs for extra medical and psychosocial resources.

METHODS

Swedish midwives routinely screen pregnant women for drugs and alcohol and refer women with addictions to the Maternity and Child Healthcare Resource Team. We investigated the medical records of 127 children (51% girls) whose mothers were referred to the Resource Team from 2009 to 2015. Additional data were obtained from local child healthcare services (CHS), which provide routine paediatric care.

RESULTS

More than three-quarters (76%) of the children had prenatal exposure to alcohol and drugs, and 17% were born with withdrawal symptoms. The mothers had a high rate of psychiatric diagnoses (38%) and were more likely to smoke after delivery and less likely to breastfeed than the general population. However, adherence to the CHS programme was generally high. Additional visits to the nurse, referrals to specialists, collaboration meetings and reports of concerns to social services decreased when the children began attending ordinary CHS centres.

CONCLUSION

Children born to women with addictions during pregnancy faced a high risk of developmental problems and should be offered additional CHS resources to minimise negative long-term consequences.

Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families

Background

Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD.

Methods

Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists.

Results

Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the social services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition.

Conclusions

The value for the concerned individuals of obtaining a FASD-related description of their condition – for instance, in terms of wellbeing – is not established. Nor is it established that allocating resources based on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.

Neurological and neuropsychological effects of low and moderate prenatal alcohol exposure

Several explanations for the diverse results in research on foetal alcohol spectrum disorders or alcohol-related neurodevelopmental disorder might be at hand: timing, amount and patterns of alcohol exposure, as well as complex epigenetic responses. The genetic background of the offspring and its interaction with other prenatal and post-natal environmental cues are likely also of importance. In the present report, key findings about the possible effects of low and moderate doses of maternal alcohol intake on the neuropsychological development of the offspring are reviewed and plausible mechanisms discussed. Special focus is put on the serotonergic system within developmental and gene-environment frameworks. The review also suggests guidelines for future studies and also summarizes some of to-be-answered questions of relevance to clinical practice. Contradictory findings and paucity of studies on the effects of exposure to low alcohol levels during foetal life for the offspring's neuropsychological development call for large prospective studies, as well as for studies including neuroimaging and multi-omics analyses to dissect the neurobiological underpinnings of alcohol exposure-related phenotypes and to identify biomarkers. Finally, it remains to be investigated whether any safe threshold of alcohol drinking during pregnancy can be identified.

[Fetal alcohol syndrome is not the only consequence of prenatal alcohol exposure]

Fetal alcohol syndrome is not the only consequence of prenatal alcohol exposure  The prevalence of fetal alcohol syndrome and fetal alcohol spectrum disorders in larger communities in USA is now updated to 0.4 % and 4.8 % respectively. Affected individuals bear witness to disease symptoms from many organ systems in addition to the brain and behavioural dysfunctions. In the light of modern epigenetic research, early alcohol exposure appears to play a hidden role in fetal reprogramming. The underlying mechanisms explain the »developmental origin of health and disease«, which has an impact on complex interactions between genome, environment and epigenetics.

Self-reported health, use of alcohol and illicit drugs, and criminality among adults with foetal alcohol syndrome

Aims

To investigate self-reported physical and psychiatric problems, use of alcohol and illicit drugs, as well as conviction, and being a victim, of crime in adults with foetal alcohol syndrome (FAS).

Methods

Interviews with 20 adults, aged 30±8 years with FAS diagnosis (65% female) and an age-and-gender-matched comparison group. Measures used were the Addiction Severity Index interview, the Beck Depression Inventory Scale and the Beck Anxiety Inventory Scale.

Results and conclusions

Adults with FAS need healthcare for depression and suicidal ideation, which occurred commonly, but problems with use of alcohol and illicit drugs were not more common in the FAS group. Although self-reported physical health problems were not more common in the FAS group, their number of days with sickness leave indicated that they are often in too poor a physical condition to work. A majority of the FAS group had been victims of crime, which makes this an important topic for further research. The groups did not differ in crime conviction rates. Everyone in the study group had been diagnosed with FAS; a diagnosis may give access to social welfare interventions. More individuals within the FAS disorders spectrum need to be identified to be given access to efficient interventions.

Cognitive and executive functions, social cognition and sense of coherence in adults with fetal alcohol syndrome

BACKGROUND

Primary disabilities in children with fetal alcohol syndrome (FAS) are the results of alcohol's teratogen effect on the fetal brain. Reduced cognitive and executive functions and social cognition are examples of such disabilities. Little is known about primary disabilities in adults with FAS as well as their sense of coherence (SoC). There is thus a need for knowledge about FAS in adulthood.

AIMS

To investigate cognitive and executive functions, social cognition and SoC in adults with FAS.

METHODS

Twenty adults with FAS (mean age: 30 years) were compared with 20 individuals matched on gender and age. Berg's Card-sorting Test-64, the Tower of Hanoi, Raven's Coloured Progressive Matrices, Digit Span, Faux Pas and the Swedish version of Antonovsky's Sense of Coherence Scale (SoC-29) were used.

RESULTS

The FAS group had a weak SoC and displayed deficits in the neuropsychological tests sensitive to cognitive and executive functions and social cognition. The FAS group's median SoC score was 112, lower than the comparison group's median of 133 (P < 0.001). The FAS group had median scores of 29.0 on Raven's Matrices. The median for Digit Span was 5 forwards and 3 backwards, lower than in the comparison group (P < 0.001).

CONCLUSIONS

Reduced cognitive and executive functions and impaired social cognition are assumed to have a major impact on life for adults with FAS. We suggest that the findings showing that adults with FAS had a weak SoC, with particularly low scores on the manageability scale, reflect their experiences of living with those primary disabilities.

CLINICAL IMPLICATIONS

This study may enhance healthcare for individuals prenatally exposed to alcohol. In general, it contributes with knowledge about this group of individuals who need to be more visible in healthcare, and particularly, it demonstrates some of the neuropsychological disabilities they might have.

Psychosocial outcomes of fetal alcohol syndrome in adulthood

BACKGROUND AND OBJECTIVE

Primary disabilities in children prenatally exposed to alcohol have a major impact on their daily life. It is suggested that these issues persist into adulthood, but few studies have addressed the outcome in adults with prenatal exposure, especially those with fetal alcohol syndrome (FAS). The aim of this follow-up study was to investigate outcome variables, such as education, employment, health, and criminal acts, in 79 adults diagnosed with FAS.

METHODS

We carried out a national register-based study of 79 adults with an FAS diagnosis, at a mean age of 32. Education, social adjustment, and mental health outcomes were analyzed and compared with 3160 comparison individuals matched on age, gender, and place of birth.

RESULTS

The FAS group was much more likely to have received special education (25% vs 2%), be unemployed (51% vs 15%), and receive a disability pension (31% vs 3%) than the comparisons, but the levels of criminal offenses were similar. The FAS group had higher hospital admission rates for alcohol abuse (9% vs 2%) and psychiatric disorders (33% vs 5%) and was more likely to be prescribed psychotropic drugs (57% vs 27%).

CONCLUSIONS

Swedish children with FAS have quite diverse psychosocial outcomes in adulthood, considerably worse than for majority population peers. Potential risk and protective factors within the FAS group deserve study to enable development of effective interventions.