Epidemiology of fetal alcohol syndrome among American Indians of the southwest

Abstract

The epidemiological features of Fetal Alcohol Syndrome (FAS) were examined among American Indians in the southwestern United States. All FAS suspects were screened in specific populations of Navajo, Pueblo, and Plains culture tribes. A total of 115 alcohol‐affected children were identified. The incidence of FAS was found to be highly variable from one cultural group to the next, ranging from 1.3 per 1,000 births (1/749) for the Navajo to 10.3 (1/97) for the Plains. The pattern of age‐specific prevalence indicates an increase over the past fifteen years. The overall rate of mothers who have produced fetal alcohol children was 6.1 per 1,000 women of childbearing age with a range of 4 to 33 per 1,000. These maternal prevalence rates were important for the accurate prediction of public health risk because 25 per cent of all mothers who had produced one affected child had also produced others. The average per mother was 1.3 alcohol‐affected children. Other findings indicate that the mothers of these children led highly disruptive and chaotic lives and were frequently isolated from mainstream social activities. In general, the gross social and cultural patterns of the tribes studied can readily explain the variation in incidence of FAS.     

Polymicrogyria in fetal alcohol syndrome

BACKGROUND: Intrauterine exposure to alcohol may result in a distinct pattern of craniofacial abnormalities and central nervous system dysfunction, designated fetal alcohol syndrome (FAS). The spectrum of malformations of the brain associated with maternal alcohol abuse during pregnancy is much broader than the relatively uniform clinical phenotype of FAS. Among these malformations the most striking abnormalities involve the impairment of neuronal cell migration. However, polymicrogyria (PMG) has so far been reported only once in a human autopsy study of a child with FAS. CASE: A 16‐year‐old girl with confirmed maternal alcohol consumption during pregnancy and full phenotype of FAS presented after two generalized epileptic seizures for neurologic assessment. Cranial magnetic resonance imaging revealed bilateral PMG in the superior frontal gyrus with asymmetric distribution. History, clinical features, and genetic investigations provided no evidence for any of the known genetic or acquired causes of PMG. Therefore, we propose that prenatal alcohol exposure is the cause of PMG in this patient rather than a mere coincidence. CONCLUSION: Our observation represents only the second patient of PMG in FAS and confirms the phenotypic variability of cerebral malformations associated with maternal alcohol abuse during pregnancy. In patients with clinical features of FAS and neurologic deficits or seizures neuroimaging is recommended. Furthermore, FAS should be considered as a differential diagnosis for PMG. Birth Defects Research (Part A), 2010. © 2009 Wiley‐Liss, Inc.     

Abortion is incommensurable with fetal alcohol syndrome

A recent article argued for the immorality of abortion regardless of personhood status by comparing the impairment caused by fetal alcohol syndrome to the impairment caused by abortion. I argue that two of the premises in this argument fail and that, as such, one cannot reasonably attribute moral harms to abortion on the basis of the moral harms caused by fetal alcohol syndrome. The impairment argument relies on an inconsistent instantiation, which undermines the claim that personhood is irrelevant, and it does not fulfill its own ceteris paribus clause, which demands that no additional benefit be gained from abortion that would not be gained from causing fetal alcohol syndrome.     

Craniofacial and oral manifestations of fetal alcohol syndrome

Six representative patients with fetal alcohol syndrome (FAS) were studied for craniofacial and oral anomalies, dental development, and long-term bodily growth patterns. The craniofacial features observed were reduction of total head size, increased head-body ratio, the existence of upper and middle craniofacial asymmetry and telecanthus in some instances, and the features of a long face syndrome with a large gonial angle. Dental development was mildly to moderately delayed, and enamel anomalies were present. Analysis of growth patterns demonstrated compensatory growth in stature, weight, or head circumference and a delayed bone age in some instances. It is suggested that the semiquantitative score system for fetal alcohol syndrome study may fail to diagnose individual cases and that craniofacial features are more important in diagnosis than seems to have been appreciated in the past.     

The Klippel-Feil anomalad as part of the fetal alcohol syndrome

A brother and sister and described with malformations and handicaps consistent with both the Klippel-Feil Anomalad and the Fetal Alcohol Syndrome. The mother was known to be a chronic alcholic throughout both pregnancies. It is suggested that these anomalies are not purely fortuitous but rather that maternal alcoholism may cause errors in cervical vertebrae segmentation.     

Premature development of cardiac sympathetic neurotransmission in the fetal alcohol syndrome

The development of the ability of hypoglycemia to evoke centrally-mediated reflex activation of sympathetic efferent pathways was studied in rats whose mothers received ethanol. Hypoglycemia was elicited by insulin administration, and sympathetic stimulation was assessed by measuring heart ODC activity and depletion of adrenal catecholamines. In control rats, cardiac sympathetic neurotransmission was absent at 4 days of age and matured toward the end of the first week of postnatal age. In contrast, pups from ethanol-treated mothers displayed fully functional reflex responses as early as 4 days. This acceleration appeared to be independent of nutritional or body weight-related factors. In contrast, enhanced maturation of peripheral sympathetic neurotransmission in pups born to ethanol-fed mothers was not seen in the sympatho-adrenal pathway.     

Lipid peroxidation changes in the brain in fetal alcohol syndrome]

The study was performed upon three groups of 12-week-old male rats. The first group of rats received ethanol/9 g/kg/day as 6% aqueous solution/during pregnancy and lactation, the second group received ethanol only during lactation and the third group, controls, received equicaloric sucrose solution. The concentrations of LPO products were determined in the homogenates of tissue from frontal cortex, striatum, hypothalamus, hippocamp and cerebellum. The concentration of fluorescent products in the brain structures of rats treated perinatally with ethanol was several-fold increased as compared with controls. The levels of diene conjugates were increased in most brain structures of rats with FAS. It should be pointed out that there was the same degree of increase of the levels of both fluorescent products and diene conjugates in two groups of rats with FAS. Having in mind that in the rat the increased growth of the brain occurs during the first 10 postnatal days, it might be assumed that this period is favorable for LPO.     

Psychiatric investigations among American Indians and Alaska natives: A critical review

This review of psychiatric investigations among Native Americans opens with a discussion of the dominant theoretical perspectives in psychiatric anthropology in order to provide an analytic framework with which to assess the substantive findings of researchers in the field. Studies of culture-specific disorders, service utilization and patient population studies, psychiatric epidemiological studies, and studies designed to test the validity of certain diagnostic instruments are scrutinized for evidence of the nature of the role of indigenous cultures in the manifestations of psychiatric disorders among these populations. The review reveals that a universalist theoretical perspective, which tends to obscure the role of local interpretations in the phenomenology of psychiatric illness, dominates this field of inquiry. Nonetheless, evidence has accumulated which indicates the importance of native understandings for a more reliable and valid explanation of the nature of mental disorder among these peoples. The inadequacies of our current knowledge are examined and suggestions for directions in future work are presented in the concluding section. Recommendations include the direct investigation of the local meanings of the signs, symptoms, and syndromes of Western psychiatry; the concentrated search for potentially unique and powerful local signs of distress; and the study of the culturally-constituted social processes of illness.