Conferencia Europea Saf 2012

J Popul Ther Clin Pharmacol Vol 19(3):e391-e459; October 17, 2012© 2012 Canadian Society of Pharmacology and Therapeutics. All rights reserved.

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Available online at: www.jptcp.com www.cjcp.ca

2ND EUROPEAN CONFERENCE ON FASD

“FETAL ALCOHOL SPECTRUM DISORDERS:CLINICAL AND BIOCHEMICAL DIAGNOSIS

SCREENING AND FOLLOW-UP”

OCTOBER 21-24, 2012

BARCELONA, SPAIN

PARC DE RECERA BIOMEDICA

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2nd

EUROPEAN CONFERENCE ON FASD – OCTOBER 21-24, 2012 BARCELONA SPAIN


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WHAT IS HAPPENING IN MY COUNTRY ?

CHAIR: GISELA MICHALOWSKI

1Promoting alcohol free pregnancy and preventingFASD in Norway

Marianne Virtanen

The Norwegian Directorate of Health, Norway

Objective: The national guidelines for pregnancy carewere renewed in Norway in 2005, and it wasrecommended that women abstain from alcohol duringpregnancy. Our task has been to make thisrecommendation well-known amongst health careprofessionals, to inform women in childbearing ageand to motivate them to an alcohol free lifestyle duringpregnancy. The Directorate of Health in Norway hasworked to increase awareness, change attitudes andbehaviour according to the recommendation.Materials & Methods: There was an expert committeewhich wrote the report Alkohol og graviditet (Alcoholand Pregnancy) in 2005. They proposed severalmeasures to prevent FASD. Norway has an action planfor alcohol and drugs field 2007-2012, and it gives themandate to our work. There have been four mass mediacampaigns and the fifth one will be in October. Thecampaigns have been highly visible ones and themessage has been spread on many channels:magazines, cinema, television, interviews, films,internet, folders etc. Health professionals have beeninformed about the campaigns in advance.Results: We have started our campaigns with aseminar to journalists, and they have written a lot ofarticles (more than 100 last year) and the message ofalcohol free pregnancy has got wide publicity. We haveexperienced that opinion towards alcohol in pregnancyis restrictive now. Marketing research shows thatwomen, who are pregnant or have got babies, answerthat they don’t drink alcohol after they got to know thatthey are pregnant. However one of three women wasworried because she had been drinking before thepregnancy test. After the very first campaign therewere people who meant that it was an extreme messageto propose total abstinence from alcohol – today wedon’t hear those voices.Conclusion: After six years of continuous work wecan say that there is an awareness of the risk of FASD.The message of alcohol free pregnancy has reachedmost women thru mass media. We are now proposingscreening and early consulting in the health care. Ourgoal is to ensure that all women will be asked aboutdrinking of alcohol. Furthermore every woman shouldget information from her midwife or MD about alcohol

and other substances which are dangerous for theirunborn child. Women who drink can be identified andget a proper follow-up locally or to be sent to a clinicfor rehabilitation.

2What is happening in Italy concerning Fetal AlcoholSpectrum Disorders?

Simona Pichini

Istituto Superiore di Sanità, Rome, Italy

Objective: In 2012, in Italy there is not yet a nationalnetwork on problems related to Fetal AlcoholSyndrome (FAS) and Fetal Alcohol SpectrumDisorders (FASD). No national no-profit (parental)organization exists and no national data on FAS/FASDprevalence.Materials & Methods: The past September 9th 2011,for the first time Italy celebrated the Awareness Day onFASD and we had a press release at the NationalInstitute of health in Rome, where the Italian Societiesof Neonatologists, Paediatricians and ofGynaecologists and Obstetricians jointly presented the“Guide for Early Diagnosis of FASD” which has beendistributed in 2000 copies to different hospitals, localhealth services and regional health offices. The firstnational cohort study on newborns in utero exposed tomaternal alcohol has been published this year andshowed an overall prevalence of newborns prenatallyexposed to maternal ethanol was 7.9% with aconsiderable variability in the prevalence of fetalexposure to ethanol in different Italian cities, asdetermined by the objective measurement ofbiomarkers in meconium.Results: In September 2010, a scientific society for theformation, information and coordination of healthpersonnel involved in prevention, diagnosis andfollow-up concerning FASD has been created, theSIFASD. Thanks to the involvement of differentstakeholders interested in FASD, the EuropeanAlliance on FASD decided to celebrate the 3rd

European FASD Conference in Rome.

3Towards FASD prevention in Russia

Elena A Varavikova1, Julia Krikorian2, Galina BDikke3

1Public Health Research Institute for organization andinformation CNIIOIZ, Moscow, Russia; 2Head ofRepresentative Office, Medicines du Monde (France),Russia; 3Association “Population and Development”,Russia

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Objectives: Alcohol consumption in Russia triggersfor serious risk for the population health and health ofthe future generations. There are research (T.Balachova et al, 2012) data on extremely dangerousdrinking patterns among pregnant and non-pregnantwomen of childbearing age in Russia. These resultsraised concerns among health researchers in Moscow.We faced the need for immediate information andorganisation of medical and social community. Theaim was to develop mechanism for collaboration forthe development of FASD prevention inside the healthsystem, as the first step towards development of theNational FASD prevention programme.Materials & Methods: The International Board forprevention of FAS/FASD and alcohol harm wasorganised in the early 2011 in Public Health ResearchInstitute CNIIOIZ in Moscow. Collaboration with ourcolleagues from other countries and organizations:WHO, NIAAA, USA; Medicines du Monde, INPES,SAF France (France), brought the information,knowledge and created the platform for thediscussions. Related research groups and Institutionswere invited and become devoted collaborators for theFASD prevention. Now we are actively working withobstetricians, gynaecologists, planning to work withjournalists. Among the activities were seminars,conferences, First School for FAS/FASD preventionand research projects.Results: In the absents of the National statistics andprevalence data for FAS/FASD in the country theprevention strategy is being introduced through thecollaboration of the Public Health and medical researchinstitutes, professional societies and regional healthauthorities. Ministry of Health supports thisdevelopment. International collaboration, best expert’sinvolvement and attention from WHO, were importantfor the success of the collaboration for FASDprevention in Russia. This framework allows us toimprove management of implementation research andpractise for FASD prevention in Russia.Conclusion: The framework for productivecollaboration for FASD prevention in Russiadeveloped in the form of the International Board in thePublic Health research Institute.

4Universal prevention is associated with lowerprevalence of FASD in Northern Cape, SouthAfrica: a multicentre before – after study

Leana Olivier1, Matthew F Chersich2,3, MichaelUrban4, Leigh-Anne Davies5, Candice Chetty6, DenisViljoen1

1Foundation for Alcohol Related Research (FARR),Cape Town, South Africa, 2Centre for Health Policy,

School of Public Health, Faculty of Health Sciences,University of the Witwatersrand, Johannesburg,3International Centre for Reproductive Health,Department of Obstetrics and Gynaecology, Universityof Ghent, Belgium, 4Division of Molecular Biologyand Human Genetics, Faculty of Health Sciences,University of Stellenbosch, Tygerberg, South Africa,5Department of Psychology, School of Human andCommunity Development, University ofWitwatersrand, Johannesburg, South Africa, 6TheArum Institute, Johannesburg, South Africa

Objectives: The purpose of this study was to assess theeffectiveness of comprehensive community-basedinterventions to reduce fetal alcohol spectrum disordersin two populations from the Northern Cape Province inSouth Africa.Materials & Methods: Changes in the prevalence ofFASD, and in maternal knowledge and drinkingbehaviour, were assessed in De Aar and Upington,Northern Cape Province, before and after an intensivecommunity-level intervention. Eight communityworkers implemented educational activities to raiseawareness of the risks of maternal drinking and to altercommunity norms about alcohol use in pregnancy. Allchildren were examined by two dysmorphologists at 9months of age and those with evidence of FASD werereassessed at 18 months. Neuropsychometristsevaluated infant neurodevelopment. Structuredmaternal interviews with FASD cases and matchedcontrols determined patterns of alcohol use andknowledge about FASD.Results: At baseline, 809 children were evaluated, 751after intervention. FASD prevalence pre-interventionwas 8.9% (72/809) and 5.7% post intervention (43/751;P=0.02). In multivariate logistic regression, controllingfor maternal age and ethnicity, FASD prevalence was0.73 fold lower post-intervention than pre-intervention(95%CI=0.58-0.90; P=0.004). Dysmorphology scoresreduced from 4 at baseline (IQR=2-7) to 3 (IQR=1-6;P=0.002). After intervention, a large proportion ofwomen reported having received educational messages,levels of knowledge about alcohol increased and somechanges were detected in attitudes to drinking.Conclusion: Comprehensive community-levelinterventions might reduce the burden of FASD inheavily-affected areas of South Africa, by about 30%.This, the first study ever to document the effectivenessof FASD prevention using clinical outcomes, suggeststhat comprehensive community-level services shouldbe implemented in similar settings to reduce this verycommon, oft neglected, disorder.

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5What’s happening in the Netherlands?

Martha Krijgsheld1, Nickie van der Wulp2, Rudi Kohl3

1Fetal Alcohol Syndrome Foundation of theNetherlands, Uithuizen, the Netherlands; 2DutchInstitute for Alcohol Policy, Utrecht, the Netherlands;3FAS Clinic, Jonx/Lentis,Winschoten, the Netherlands

Background: Activity concerning the issues of alcoholand pregnancy has grown in the Netherlands over thepast two years, with several key players.Materials & Methods: The FAS Foundation hasseveral areas of action. First, the Foundation promotesprevention, by providing gratis information packets toprofessionals as well as gratis folders and flyers for usein counseling pregnant women. Second, the Foundationsupports parents raising children with FAS with an e-mail support group, and books in the Dutch language.here is also a support group for adults with FASD. Thefirst Dutch family weekend will be held in September2012. Third, the Foundation works to promote widerawareness of FASD, for example, by participating inthe European level labelling action and working withfree-lance photographer Allard de Witte to create aphoto exhibition on the lives of children with FASD.Results: These photos won the prestigious SilverCamera award. Finally, the Dutch television show “DeWandeling” [The Walk] interviewed a birth motherover her alcoholism and birth of a child with FAS. TheDutch Institute for Alcohol Policy is also active in FASprevention, through a website, flyers and supportingresearch. For her doctoral research, Nickie van derWulp has developed educational materials formidwives and an internet program for pregnant womento inform pregnant women about the dangers ofdrinking during pregnancy. In addition, Nickie hasinvestigated the determinants of Dutch pregnantwomen using alcohol and the determinants of partnersupport in alcohol abstinence during pregnancythrough questionnaires. Furthermore, she interviewedDutch midwives about their attitude towards alcoholuse during pregnancy. The FASD clinic fromJonx/Lentis in Winschoten is one of only two dedicateddiagnostic centres in the Netherlands. It provides amultidisciplinary one-visit diagnostic service. As it isrun from a mental health institution, in addition itprovides long term guidance and support in a broadersense. Furthermore, additional neuropsychologicaltesting is provided to specify strengths and weaknessesfor each individual. The two FASD clinics and the FASFoundation are working together to create aninformative brochure for parents of children who havejust received a diagnosis, “So you have FAS—andwhat now?”Conclusions: Unfortunately, all activity around FASD

in the Netherlands, that still remains only the domainof the clinics and foundations. Though the HealthMinistry advised in 2005 that pregnant women shouldnot drink, there is still no governmental support forpublic education or for labelling.

6Improving FASD knowledge in general populationand healthcare professionals in Murcia (SE Spain)

Maria Falcón1, Miguel F Sánchez2, Ana. B Villar3,Juan Jimenez-Roset3, Virtudes Gomariz2, AliciaCánovas2, Juan A. Ortega2, Aurelio Luna1

1Legal Medicine Department, University of Murcia,Spain; 2Pediatric Environmental Health Specialty Unit,Virgen de la Arrixaca University Hospital, Murcia,Spain, 3Regional Drug Plan for the Region of MurciaSpain.

Background: The University of Murcia, the RegionalDrug Plan for the Region of Murcia, the PediatricEnvironmental Health Specialty Unit. (PEHSU), andthe fetal unit in the Virgen de la Arrixaca UniversityHospital are working together to increase theawareness on the FASD issue in this MediterraneanSpanish area. This multidisciplinary team (clinic,research, public health and university professionals) isdeveloping different projects to reach a main objectivefocused on reducing alcohol and other drug abusesubstance consumption during pregnancy.Objectives: The aim of this presentation is tosummarize the results of this collaboration and toimprove the general public/health professionalknowledge about consequences of alcohol use duringpregnancyMaterials & Methods: Review of the activities andprograms developed by these institutions (2010-2012).Results: The interventions include among others:1) Teaching and training network for healthprofessionals (pediatricians, gynecologist,obstetricians, nurses, midwives, general practitionersand social workers) to make easier for them to prevent,detect and diminish alcohol exposure during pregnancyand give advice and treatment when necessary towoman-family, to reduce risk and harm to the fetus.Training courses and conferences:a) Continuing Education Courses: 5 Courses.Attendance: 101 general practitionersb) Courses “Training Course for Trainers”: Attendance:60 general practitionersc) Pediatric Environmental Health: training program forresidents of pediatrics in our hospital. 50 studentsd) Workshop: “Reproductive Environmental Healthprevention of alcohol and other abuse substancesexposure during pregnancy and lactation”. 40 students.

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e) Specific curricula subjects in Medicine, nursery andsocial work degrees.f) Specific curricula subjects in PhD students (50students)g) Courses for dissemination of prevention messagesand health education purposes: 85 persons2) Media publications and presentations to improvegeneral population awareness of alcohol exposureconsequences during pregnancy and fostering thewhole community involvement in the protection of thenewborn. Information materials for pregnant womanand professionals reaching all the health areas of theRegion with more than 13.713 families targeted.Radio interviews: 2.Newspapers interviews: 4.Conclusion: The synergy between different institutionsmakes easier the implementation of educationalinitiatives to reach both general population and healthrelated professionals.

PLENARY SESSION I

PROGRESS IN PREVENTION

CHAIR: JOAN COLOM

7Progression of French national plan for FASDPrevention (2010/2020)

Denis Lamblin1

1Medical Director of the CAMSP (Fondation du PèreFAVRON) Reunion Island, Saint Louis, France, SAFFrance President

Objectives: Initially review the actions put in placeduring the first 2 years of the “ten-year plan”.Materials & Methods: Firstly it will highlightSAFFRANCE strategies to enhance the awarenessnationwide:1. The tools already tested (regional and internationalconferences, the dissemination of a guide to facilitateidentification of women at risk),2. The tools in process of development (training centerfor instructors, public access website),3. The national partnerships: INPES (National Instituteof Prevention and Education for Health), CNSA(National Solidarity Fund for Autonomy), IAD(International Adoption Service), CFA (FrenchAdoption Agency).4. The international Partnerships (Canada, USA, Israel,Brazil, Russia ...) the obstacles that SAFFRANCE isfacing are institutional, political, economical; medias...

Secondly, there will be discussion regarding thepriority actions for the next 2 years (creation of centersof reference ...)

8Making a difference: twenty three years of FASDpolicy and prevention in the United States

Kathleen Tavenner Mitchell

Objectives: Participants will hear a personal andmotivational testimonial about the speaker’s journeythrough years of addiction and her discovery that her16 year old daughter had FAS, not Cerebral Palsy. Thepresenter, Kathy Mitchell, will describe how herfamily’s story led her to become an advocate and avoice of change. She will describe over two decades ofinvolvement with the National Organization on FetalAlcohol Syndrome (NOFAS). Attendees will beprovided with an overview of the historical timeline ofNOFAS and FASD policy and prevention efforts in theUnited States.Materials & Methods: The speaker will use a PowerPoint presentation including personal photos whiledescribing her personal journey, 23 years of photos andcampaigns from NOFAS projects, and policy andhistorical timelines. Participants will receive freeFASD prevention materials from NOFAS and theCenters for Disease Control (Fact Sheets, brochures,FASD Diagnostic publications, posters, DVD’s –English and Spanish).Results: Conference participants will be able todescribe the history of NOFAS and how the U.S. hasadapted policy and programs to address FASD. Theaudience will be introduced to innovative approachesto FASD prevention designed to for specific targetgroups.Conclusion: The audience will learn twenty threeyears of lessons learned about FASD prevention effortsin the U.S. and will be able to discuss how even a smallgroup of committed individuals can make a differenceto create change.

9Developing FASD prevention in Russia

Tatiana Balachova1, Barbara Bonner1, Mark Chaffin1,Galina Isurina2, Larissa Tsvetkova2, Elena Volkova3

1The University of Oklahoma Health Sciencesn Center;2St. Petersburg State University; 3Nizhny NovgorodState Pedagogical University

Objectives: Prenatal alcohol consumption can result ina range of adverse pregnancy outcomes includingstillbirth and Fetal Alcohol Spectrum Disorders

http://www.wordreference.com/es/translation.asp?tranword=PhD

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(FASD). Russia is a country with high alcohol use andhazardous drinking in women. FASD prevention anddata on risk for alcohol-exposed pregnancies (AEP) inRussia are limited. The study is aimed at developingFASD prevention in Russia.Materials & Methods: An assessment-based strategywas used to translate knowledge and develop culturallyappropriate FASD prevention in Russia. A line ofresearch projects has been designed by researchersfrom the University of Oklahoma Health SciencesCenter (OUHSC), St. Petersburg State University, andNizhny Novgorod State Pedagogical University(research grants NIAAA/Fogarty International CenterR21TW006745 and R01AA016234 and CDC/NCBDDD/AUCD RTOI 2005-999-01 and RTOI 2007-999-02 to Balachova and Bonner at OUHSC). Thestudies involved mixed methods including:1) Formative assessment to collect data critical todeveloping FASD prevention,2) Development and evaluation of FASD educationmaterials, and3) Designing and evaluating a prevention intervention.

The first study (2003-2005) involved focus groups anda cross-sectional survey exploring knowledge,attitudes, behaviors, and receptivity to preventionamong women and physicians in two regions in Russia.The second (2006-2007), developed and evaluated inrandomized trials FASD education for women andphysicians. The third study (2007-2012) is a two-armsite-randomized controlled clinical trial at 20 women’sclinics in two regions. A total of 1,889 women and 341physicians participated in the studies.Results: The initial study found that although manywomen reduced alcohol consumption after pregnancyidentification, few recognized the risks involved incombining alcohol use with the potential to becomepregnant. Among nonpregnant women, 43% weredrinking at-risk along with a possibility to becomepregnant posing risk for AEP. Based on the studyfindings, a preconceptional intervention to reduce theAEP risk was indicated. The intervention componentswere drawn from a brief physician intervention (NIH,2005) and a motivational AEP prevention intervention(Project CHOICES, 2003) to design a dual-focusedbrief physician intervention (DFBPI). Physicians whowere trained in DFBPI demonstrated significantlyimproved skills and competency in FASD prevention.Preliminary results of the DFBPI clinical trial will bereported.Conclusions: AEP prevention is an important publichealth issue. The study is the first randomized trialtargeted at AEP and preventing FASD in Russia. Theresearch collaboration highlights importance offormative assessment for international translationalresearch. Assessment driven translational research is a

promising approach for developing preventioninterventions.

PLENARY SESSION II –

POLITICSAND STRATEGIES IN PREVENTION

CHAIR: PAUL PETERS

10The politics of alcohol and pregnancy campaigns

Nancy Poole1,2, Tasnim Nathoo1

1BC Centre of Excellence for Women's Health,Vancouver, Canada; 2Canada FASD ResearchNetwork, Vancouver, Canada

Objectives: Research evidence suggests that alcoholand pregnancy awareness campaigns increaseknowledge of the risks of drinking during pregnancybut have little impact on women's behaviours. Yet,awareness campaigns remain a popular preventionstrategy for governments, public health and FASDadvocacy groups and are frequently supported andfunded by the alcohol industry. The purpose of thispresentation is to begin a conversation about thechallenges and controversies associated with alcoholand pregnancy campaigns and to discuss strategies formore effective broad-based prevention efforts.Materials & Methods: Using examples fromcampaigns around the world (including but not limitedto Italy, Canada, South Africa, and Norway), differentmessages (e.g., fear-based vs. support-based),approaches (e.g., zero-tolerance vs. harm reduction-oriented) and intended audiences (e.g., all women vs.pregnant women and their partners vs. women withaddiction concerns) will be explored.Results: Alcohol and pregnancy campaigns areuniquely developed to reflect the concerns, resources,and natural partnerships within local communities andregions. However, many campaigns may haveunintended "side effects" such as increased stigmaabout alcohol use in pregnancy, increased fear ofdisclosure of alcohol use in pregnancy, andoveremphasis on individual choice around alcohol usewithout adequate supports and policies.Conclusion: Individuals and groups who are planningor expanding FASD prevention activities may benefitfrom the examining the efforts and outcomes of alcoholand pregnancy campaigns in other jurisdictions. Giventhe dearth of evidence on effective messaging, long-term outcomes, and preferred types of media, futurecampaigns should strive to incorporate an evaluationcomponent that explicitly examines changes inwomen's drinking behaviours on a population level.

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11New strategies of intervention to createempowerment and involvement in the citizens

Francesco Marini1, Giuliana Moino2, Patrizia Riscica2,Stefania Bazzo3, Giuseppe Battistella4, MariasoleGeromel5, Gianluigi Scannapieco1, Giuseppe DalPozzo6, Loredana Czerwinsky3

1Department of Innovation, Development andPlanning, Local Health Authority of Treviso, VenetoRegion, Italy; 2Addiction Department, Local HealthAuthority of Treviso, Veneto Region, Italy; 3Doctoralschool in Sciences of Reproduction and Development,University of Trieste, Italy; 4Epidemiologic Unit, LocalHealth Authority of Treviso, Veneto Region, Italy;5University of Udine, Italy; 6Obstetrics andGynaecology Unit, Local Health Authority of Treviso,Veneto Region, Italy

Objectives: The campaign ‘Mamma Beve, BimboBeve’ in 2010 was based on a strong visual and itsimpact. The year 2011 was devoted to maintenance ofattention: the project organized a short film involvingtwo local well-known comedians and sportsmen todeliver the message. To produce the short film, we alsostarted involving citizens for ‘guest appearances’ in thevideo.Materials & Methods: In 2012, we based our actionon two concepts: empowerment of the citizen with agoal of giving them awareness of the risks of alcoholduring pregnancy; active citizenship, by involving thecitizens in spreading the health message in thecommunity. So we created the role of ambassador ofthe message. To achieve this goal, we developed a viralmarketing action in public bars, restaurants, and discos,inviting people to take a photo with the visual of thecampaign and send it to a dedicated web-site. Allpeople who send the photo will be the protagonists ofan event on 29 June 2012, the ‘M’ama day’. This bigfestival includes entertainment by eight comediansengaging in a cabaret championship on the theme ofwomen. During this event, we plan a choral action ofthe participants to create engaging, viral videos. On 9September (the International Day for Prevention ofFASD), the video will be launched and shown onvarious media. This project was sponsored through anetwork of partners and sponsors, like ‘FondazioneZanetti’ (foundation of Segafredo Zanetti Group),‘Ascom’ (syndicate of restaurants, bars and discos).The ‘Gruppo Alcuni’ provided the locations andproduced the final video, while ‘Claim Adv.’ was acreative partner. Furthermore, the project has thepatronage of the most important associations for healthprofessionals.Conclusion: This campaign has two innovative

concepts: the active role of the citizen, andmaintenance and development of the network createdtwo years ago. New partners were chosen for differentrequirements of the project, thus keeping the cost atzero for the community.

12Effect of participating in a survey on women’sattitudes toward alcohol consumption

Elena Kosyh2, Elena Volkova2, Tatiana Balachova1

1University of Oklahoma Health Center, OklahomaCity, USA; 2Nizhny Novgorod State PedagogicalUniversity, Nizhny Novgorod, Russia

Background: Alcohol use is a major public healthconcern in Russia and permissive attitudes towardalcohol and drug use, s, smoking, and other unhealthybehaviors may contribute to unhealthy life styles.Increasing alcohol consumption in women changestraditional roles in the society, can affect women’shealth, and increase the risk of fetal alcohol spectrumdisorders in children. This study is part of arandomized controlled clinical trial aimed at evaluatingan FASD prevention intervention for nonpregnantchildbearing age women at risk for alcohol-exposedpregnancies (1).Objectives:1) Explore attitudes toward alcohol amongchildbearing age women2) Determine if women who consume larger amountof alcohol have a more favorable attitude towardalcohol use during pregnancy3) Examine if answering a survey questions focusedon women’s alcohol use and their risk for alcohol-exposed pregnancy results in changes in social attitudestowards alcohol consumptionMaterials & Methods: A subset of women recruitedfor the clinical trial at clinics was used for this study.Women assigned to the study control condition(assessment only) in the Nizhny Novgorod region(N=175) were included in this analysis. Womencompleted four waives of a survey: baseline atenrollment to the study and at 3,6, and 12 months afterthe baseline. The survey included demographicquestions (living environment, marital status,education, employment, age, ethnicity etc.), questionsabout family planning/contraception, attitudes towardalcohol consumption, and alcohol consumptionmeasures including quality-quantity questions,Timeline Follow Back (TLFB), and AUDIT,Results:1) Women’s responses indicated negative attitudestoward drinking hard liquor during pregnancy;however their attitudes toward drinking wine were

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more permissive.2) Women with higher alcohol consumptiondemonstrated significantly more favorable attitudes toalcohol use in general and toward drinking wine.3) There were significant changes in attitudes ofwomen who participated in assessment only conditionwith attitudes toward drinking wine becoming morerestrictive.Conclusions: Previous studies reported that womenmay reduce alcohol consumption after answeringquestions about their alcohol use. The current studyindicated changes in problematic attitudes towardalcohol consumption during pregnancy, particularlywine drinking. The role of these changes in attitudes inreducing alcohol use among women, possiblemechanisms, and implications to prevention arediscussed.

13UK Midwives FASD prevention programme

Susan Fleisher

NOFAS-UK (National Organisation for Foetal AlcoholSyndrome); International FASD Medical AdvisoryPanel, Member: European FASD Alliance. Publisher:International e-publication: FETAL ALCOHOLFORUM, Member: UK Department of HealthAdvisory Group on Fetal Effects of Alcohol. Member:Alcohol Health Alliance (Royal College of Physicians).Proud Adoptive Mother of a 24 year old daughter withFAS

NOFAS-UK, National Organisation for Fetal AlcoholSyndrome-UK, 165 Beaufort Park, LondonWebsite: www.nofas-uk.org

Objectives: THE UK MIDWIVES FASDPREVENTION PROJECT was created to providespecialist FASD Education for midwives who supportpregnant women. Midwives are on the front lines ofFASD Prevention.Materials & Methods: The Project is delivered as aconference in three major cities each year to enablemidwives attend from around the UK. The programmeis delivered by FASD Experts, Doctors adoptiveparents and birth mothers of children with FASD.Films are shown of the fetus under the influence ofalcohol, parents, children with FASD and we screenthe new film: NO ALCOHOL, NO RISK – Informationfor Midwives. Midwives also take part in discussiongroups and develop strategies to talk to pregnantwomen. To help understand the impact FASD mayhave on later life, rolls are reversed and midwives aretreated like children who have FASD to see how itfeels on the other side.

Results: Midwives report that, before the training, theyhad some knowledge of alcohol in pregnancy.However, they were unaware of the long-termprognosis. They found the trainings informative,powerful and empowering. They felt they now had theconfidence to discuss alcohol with pregnant women.Invariably they reported that, as a result of the training,they would change their practice to include alcoholeducation for pregnant women, as well as fellowmidwives.Conclusion: There is no doubt that FASD preventionis vital. It will literally save lives, lifelong hardship forindividuals, their families and their communities. Forevery child born with FASD it is estimated that theywill cost the government between $200,000 and$2,000,000 over their lifetime. FASD is costly to all ofus. The debate will go on, but the conclusion isforegone: We must strive to prevent FASD wheneverand wherever we can, to save human and financialhardship. Midwives stand on a powerful platform toreach pregnant women and their families. By 2015NOFAS-UK will have provided FASD information to10,000 UK Midwives who, in turn, are expected toprovide FASD information to one million pregnantwomen.

PLENARY SESSION III

ISSUES IN DIAGNOSIS

CHAIR: DENIS LAMBLIN

14Enhancing early detection of newborns exposed toalcohol

Natalya Zymak-Zakutnia1,2, Lyubov Yevtushok1,3,Kenneth Lyons Jones4, Christina Chambers4, WladimirWertelecki1

1OMNI-Net Birth Defects Program, Ukraine; 2PerinatalCentre, Khmelnytsky, Ukraine; 3Medical DiagnosticCentre, Rivne, Ukraine; 4Department of Pediatrics,University of California San Diego, La Jolla, CA, USA

Objectives: To prompt earlier detection byneonatologists and pediatricians of newborns andinfants exposed to alcohol.Materials & Methods: In 2000, we established theOMNI monitoring system, a population-based birthdefects surveillance program inclusive of FAS, in theRivne and Khmelnytsky regions of Ukraine. From theonset, professional and public education programsincluded an emphasis on the imperative to preventFAS. In 2005, the OMNI monitoring system became afull member of the European Surveillance of

http://www.nofas-uk.org/

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Congenital Anomalies (EUROCAT) which facilitatescross-comparisons of FAS rates in Europe. Also in2005 the OMNI system became a partner of theCollaborative Initiative on Fetal Alcohol SpectrumDisorders (CIFASD). For all infants born in Rivne andKhmelnytsky, neonatologists are mandated to completea report including indication of risks of fetal alcoholexposure that has been designed by OMNI andapproved by the Ministry of Health. All reports areforwarded for review by OMNI medical geneticists.We conduct ongoing training of neonatologists tofulfill this mandate as well as small group diagnosisskills training sessions. We analyzed 177,149prospectively collected neonatal reports, clinical dataregarding the diagnosis, and the type of clinician whofirst suspected FAS. We also analyzed the results ofsystematic screening of 7,218 pregnant women foralcohol use.Results: The 2005-2010 population rates of FASdetected by OMNI are among the highest in Europe.The average population rate from 32 other partners ofEUROCAT is 0.44 per 10,000 births and in theUkraineit is 5.1. OMNI detected 97 FAS individuals in 28cases. The diagnosis was suspected during the initialneonatal examination and in only 18 cases FAS wasfirst suspected by medical geneticists. Notably in 50%of cases FAS is suspected by other health careprofessionals. The importance of children’s statehomes (former orphanages) is underscored in that 32(33%) of FAS children are not cared for at home andthat 9 are deceased (9%). The screening of pregnantwomen indicates that in Rivne and Khmelnitsky 3.3%and 4.6% fetuses respectively were exposed to riskylevels of alcohol and require thorough neonatalexamination and pediatric developmental follow-up.Conclusion: Population rates of FAS in Ukraine areamong the highest in Europe. Primary careneonatologists have an important role in the earlydetection of FAS. The screening of pregnant womenfor alcohol use is likewise effective. Further investmentto enhance and link such implementations is justifiedand the impacts statistically testable.

15Diagnosing adolescents and young adults with FASis ethically challenging

Ilona Autti-Rämö

The Social Insurance Institution, Research Department,Helsinki, Finland

Objectives: The true prevalence of FASD is so farunknown and the current estimate (1/100) may be anunderestimate. Knowledge of the long-term effects ofFASD has increased during the recent years and special

interest has been focused on adolescents and youngadults with neurobehavioral and psychosocial problemswithout any prior FASD diagnosis. There are, however,no specific systems to diagnose FASD in young adultswithout the facial features related to FASD.Diagnosing FASD in young adults is not onlymedically but also ethically challenging.Method: The ethical challenges when making orexcluding the diagnose FASD in young adults isanalyzed using the EunetHTA core model fordiagnostics (www.eunethta.eu)Results: Several ethically important issues wereidentified that are of concern not only for the patientbut also for the multi-professional team and the patient-physician relationship. The moral values in the societyare also reflected in the willingness to provideresources for diagnostic possibilities that are based onmultiprofessional expertise. The psychosocial and legalconsequences of FASD diagnosis in adult age may beunpredictable, and misdiagnosing either way may leadto unintended consequences.Conclusion: The medical and ethical challenges whendiagnosing FASD in young adults need to be taken intoaccount when deciding on the resources required for aFASD clinic.

FAMILIES LIVING WITH FASD

CHAIR: SUSAN FLEISHER

16European Birth Mother Support network - FASD

Philippa Williams

European Birth Mother Support network FASD

Objectives: Brief History of the European BirthMothers Network. Presenting how the networkis increasing understanding and support for birthmothers in Europe and decreasing the stigma that birthfamilies may experience. Including a brief story of mypersonal journey as a birth mother, along with thegrowing numbers of birth mothers contacting us inEurope.Materials & Methods: PresentationResult: European Birth Mother Support Network –FASD taking part in conference, raising awareness andunderstandingConclusion: The more awareness is raised, the more itdecreases stigma. We are aware and focused on theneed for support for mothers.

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17The shame can disappear, dare to ask for help

Debby KroonBirth mother, Netherlands

Background: I have a seven-year-old son with FAS.During my pregnancy, I was an alcoholic andcontinued drinking throughout the pregnancy. Whenmy son was seven months old, I succeeded in stoppingdrinking. I also became aware then of the damage I hadcaused. From that moment, I was honest with the socialworkers and have done everything to make my son’slife as worthwhile as possible. When my son was threeyears old, I had another child, a boy, and decided toleave my partner (their father). In the last few years, Ihave been solely responsible for bringing up and caringfor the children (now I have a new partner). This hasbeen a difficult period in my life, but also a time inwhich I could invest a lot in my children. Now I haveregular contact with the FAS Foundation of theNetherlands, and they have put me in contact withjournalists who want to know more about FAS andhaving a child with FAS.Conclusions: My son is doing well, but one of the bigproblems in our daily life is the lack of knowledgeamong doctors, teachers, etc. Examples of this are theschool doctors, the medical kindergarten, andpersonnel in special education (teachers,physiotherapists and speech therapists). Due to myopenness over the fact that I am a mother who drankduring her pregnancy, I hope to be able to help otherpeople. My motto is that the shame can disappear, dareto ask for help, the child deserves it.

18Living and learning with Fetal Alcohol Syndrome

Robert Yves WybrechtFirst infant diagnosed with Fetal Alcohol Syndrome inthe United States in 1973, FAS activist

Objectives: The goal of this presentation is to sharehow it has been growing up with FAS. It will includewhat works and doesn’t work when living with,teaching, and employing a person with an FASD.Emphasis on early diagnosis will illustrate that greatersuccess is achieved when diagnosis occurs in the pre-school years.Materials & Methods: Rob will participate as amember of a panel which will include birth parents,adoptive parents and an adult with full FAS. He willshare concrete tools that help him learn and thenremember what he has learned.Results: This presentation will give hope to bothparents and professionals as well.

as researchers. With life long interventions andsupports many individuals with anFASD can live productive lives.Conclusion: Living and Learning with Fetal AlcoholSyndrome continues to be a life long challenge.Listening to an adult, diagnosed at birth, makes theresearch come alive, and will hopefully inspire newresearch in the areas of diagnosis and interventions, aswell as prevention.

19Challenges of being a mother with FAS

Lena Larsson, Norway

Background: Lena Larsson is a 35 year oldSwedish/Norwegian woman with FAS. She is also themother of a 9-year-old son. Lena will talk about herchildhood in foster care and the many challenges of herlife as an adult woman and mother. The challenges ofrunning a home, the challenges of being a parent andset boundaries for her son and the challenges of sociallife. Lena will also discuss: the physical and mentalhealth problems FAS gives her; and the effects of a dietfree from gluten; milk and soy; and last but not least,what gives her the strength to cope with her situation.

PARALLEL SESSION I.A.

DIFFICULTIES WITH DIAGNOSIS

CHAIR: ILONA AUTTI-RÄMÖ

20Using facial analysis software to identify facialfeatures of Fetal Alcohol Syndrome in newborninfants

Ewan Gourlay1, Katrine Thorup1, Verity Monk1, NeilAiton2

1Brighton & Sussex Medical School, Brighton, UnitedKingdom; 2Brighton & Sussex University Hospitals,Brighton, United Kingdom

Objectives: Diagnosis of Fetal Alcohol Syndrome(FAS) is complex, with numerous competingdiagnostic systems. All recent diagnostic systemsrequire the presence of growth restriction, mentalretardation and 3 characteristic facial features.Software developed at the University of Washingtonhas been created to objectively analyse digitalphotographs, measuring for the unique triad of FASfacial features: small palprebral fissure length (PFL),thin upper lip and smooth philtrum. This software has

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been validated in older children, but has not been usedin neonates. We are unable to find neonatal normalreference ranges for measures except PFL. Earlydiagnosis in children has been associated with betteroutcomes. This study aims to determine the feasibilityof using the facial analysis software to identify featuresassociated with fetal alcohol exposure in normalneonates and if successful to develop normal referenceranges for Caucasian neonates.Materials & Methods: Ethics approval and informedconsent was obtained. Healthy Caucasian neonateswere photographed according to a standardisedprotocol. Mothers were asked to fill out an anonymouslifestyle questionnaire including questions on alcoholconsumption in pregnancy. Standard physicalmeasurements of the baby were taken. PFL and upperlip circularity (LC) were measured using the software.Philtrum smoothness and LC was assessed on a 5 pointlikert scale using reference photos. Statistical analysiswas performed using SPSS.Results: 33 neonates were recruited. PFL wasmeasurable in 24 photographs (72.7%). Mean PFL was15.5mm (95% C.I 13.1 – 17.9mm).LC was measurablein 33 photographs (100%). Mean LC was 59.4 (95%C.I. 18.1 – 100.5). Median LC and philtrumsmoothness Likert ranks were both 3. 4 neonates wereassessed as having FAS type features according toLikert ranking including 2 with abstinent mothers. 7mothers (21.2%) reported drinking alcohol duringpregnancy.Conclusion: It was possible to measure a full data seton just over ¾ of neonates, demonstrating thefeasibility of this method at this age. Mean PFL fromthis pilot study was significantly below previouspublished reference ranges. Current Likert scalereference photos may not be appropriate for neonates.Further data collection is required for development ofrobust reference ranges using this method.

21Difficulties in diagnosing adolescents and adultswith FASD

Jessica Wagner1, Hans-Ludwig Spohr1

1FASD-Center, Berlin, Charité university hospital,Berlin

Objectives: The diagnosis of FASD in adolescents andadults is often difficult due to missing data fromchildhood and lack of normative data. Therefore, thediagnosis of adults is more challenging than ofchildren. Nevertheless, there is a growing demand fordiagnosis in this population not only in Germany,which can be attributed to a growing awareness ofFASD. In this study, diagnosis of adolescents and

adults were compared to investigate the differences andproblems arising in the diagnostic process of FASD atdifferent ages. Additionally, patients with FAS andother FASD-diagnoses were compared with respect totheir neuropsychological outcome.Materials & Methods: All patients were diagnosed atthe FASD-center in Berlin. Subjects included 20adolescents (ages 14-17, 11) and 20 adults (ages 18-29,11) with fetal alcohol spectrum disorders. 19 patientswere diagnosed as FAS, 21 patients as partial FAS,ARND or static encephalopathy (alcohol-exposed).FASD-diagnosis was based on the 4-digit diagnosticcode (Astley, S. et al., 2004). A variety of standardizedneuropsychological tests were administered to evaluatethe CNS-score, including a verbal learning andmemory test (VLMT), the developmental test of visualperception for adolescents and adults (DTVP-A), aword fluency test, a computer-based test battery to testattention and executive functioning (TAP) and thechild-behavior checklist (CBCL). IQ-scores wereavailable from earlier reports.Results: Results indicated that the different age groupsdid not differ significantly with regard to theirneuropsychological outcome. This shows that the samedeficits can also be detected in older patients withconsequences for daily living. Only 3 patients wereable live on their own; most patients lived either intheir foster family or in assisted living residences. In 95% severe behavioural disorders were reported. Severedeficits in executive functioning occurred in 67, 5 %;in attention and visual perception in over 30 % andsevere learning and memory problems were shown in15 %. Further results will be presented in Barcelona.Conclusion: In our center, we all have an increasingproblem to deal with the diagnosis of adult patientswithout having clear diagnostic instruments at hand.The 4-digit diagnostic code is of limited use in adultsand we have to increase our knowledge in this newpopulation..22FASD multidisciplinary diagnostic clinic model in arural setting and outcome of first 100 pediatricpatients seen in clinic 10 years from diagnosis

Hasu Rajani1, Brent Symes1, Audrey McFarlane2

1Edmonton, AB Canada; 2Lakeland Centre for FASD,Cold Lake, AB Canada

Objective: To share the results of satisfaction of thediagnostic process, the value of diagnosis and theoutcomes of the patients after 10 years past diagnosisfrom a rural multidisciplinary team. In Canada wherethere are large areas of sparsely populated regions thedevelopment of a Multidisciplinary clinic presents its

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own unique challenges. In addition to the look back atthese patients, an overview of the rural communitybased multidisciplinary team approach will bedescribed.Materials & Methods: We have visited the first 100children who went through the diagnostic process from2000 to 2003. A review was conducted of files andfollow interviews with families was completed for 100patients diagnosed at the Lakeland Centre for FASD.Results: FASD diagnosis is a complex processrequiring a multidisciplinary team. The review andinterviews revealed some very interesting results:including where the individuals are today, how manycompleted school, trouble with the law, commonpsychological profiles, the value of the diagnosis, andwhether the families were satisfied with the process ofdiagnosis/assessment.Conclusion: The Lakeland Centre for FASD hasdeveloped a unique model that has sustained 12 yearsand we are eager to share our findings.

23Drugs consumed by Roma, non-Roma and Latin-American female adolescents: comparing twoSpanish areas

Carmen Meneses1, Eugenia Gil2, Nuria Romo3

1Departamento de Sociología y Trabajo Social,Universidad P Comillas, Madrid, SPAIN;2Departamento de Enfermería, Universidad de Sevilla,Sevilla. SPAIN; 3Departamento de Antropología.Instituto Universitario de Estudios de la Mujer.Universidad de Granada, Granada. SPAIN

Objectives: National Surveys show high consumptionof legal drugs in female adolescents as a group. Thiswork describes and analyzes the drugs consumed byfemale adolescents of different ethnic groups (Romahost society, non-Roma in host society and Latin-American), what do you mean by “host society”?pointing out differences in two areas of Spain(Andalucía and Madrid).Materials & Methods: We carried out a survey amongsecondary school students where the student had toidentify herself as belonging to one ethnic group. Thesample was constructed from this ethnic identification.The questionnaire was collected in different schoolswhere there were many Roma and Latin-Americanadolescents. The survey had the approval of parentsand school principals. Data were analysed by bivariateanalysis with chi square and Student’s t test. P-valuessmaller than 0.05 were considered statisticallysignificantResults: The sample consisted of 1,532 femaleadolescents, belonging to Roma (n=223), non-Roma

(n=862) and Latin-American ethnicity (n=447), with anaverage age of 15 years old. In the last year, 58% haddrunk alcohol, without any difference by ethnicity;35.8% got drunk in the last year, with a higher rate innon-Roma;10.5% drank alone in the last year; 21.9%drank in the family context, and 48.2% outside; mostRoma females drank with family, and the non-Romaand Latin-Americans drank more outside the family(p=0,000). About 15.6% of the girls smoked, this valuebeing higher in the Roma (18.8%). About 9.8%smoked daily, and this number was higher among non-Roma girls (12.2%). 50,9% of the adolescents’ parentssmoked, being higher in Roma (64%) and-non Romaparents (61,6%); The mothers of non-Roma (27,3%)and Latin-American (23,5%) girls smoked more thanthe Roma girls´ mother (15,8%). The boyfriends ofRoma girls (45,4%) smoked more than in other groups(21.8% Latina, 31.6% non-Roma). Female adolescentsused cannabis in the last year; there was no differenceby ethnicity. The illegal drug consumption was smaller.Analgesics (22,5%) or tranquilizers (7,2%) were morefrequently consumed by Latin-American females.Conclusions: The drugs consumed by femaleadolescents were legal drugs. The cultural differencesfound were modeled on the parents and/or peer groupof each ethnic group. Family cohesion is moreimportant for Roma and alcohol use occurs in thefamily context. It is essential to address the health anddevelopment needs of adolescents to make a healthytransition to adulthood. Societies must tackle thefactors that promote potentially harmful behaviors in

relation to sex and ethnicity.*This work belongs to a National Project I+D+I, “Risk,Adolescents and ethnicity: comparing three Spanish areas”subsidized by the Ministerio de Ciencia e InnovaciónRef.CSO2009-07732.

24Evidence- and consensus-based guideline for thediagnosis of Fetal Alcohol Syndrome in Germany

Mirjam Landgraf1, Florian Heinen1

1Department of Pediatric Neurology, DevelopmentalNeurology and Social Pediatrics, Hauner Children'sHospital, Ludwig-Maximilians-University of Munich,Germany

Objectives: Fetal Alcohol Syndrome (FAS) is a verycommon and completely avoidable disease. FAS hassevere consequences not only for the individual and itsdirect environment but also for the health and socialsystem in Germany.Aims: The first aim of the development of the Germanguideline was the determination of evidence-based andin practice easily applicable diagnostic criteria for the

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identification of FAS in children and adolescents inGermany. With help of the defined diagnostic criteriaFAS should be diagnosed and treated earlier, sosecondary complications can be reduced. The secondaim was to create awareness in the German society ofthe severe complications of intrauterine alcoholexposition in order to decrease the prevalence ofalcohol consumption during pregnancy and diminishthe incidence of FAS.Materials & Methods: A steering group in Munichand a consensus group consisting of representatives ofthe German Federal Ministry of Health, the GermanProfessional Societies of Pediatrics, Neuropediatrics,Social Pediatrics, Gynecology, Neonatology, Child andAdolescent Psychiatry, Addiction Research andTherapy, Addiction Medicine, Addiction Psychology,Midwife Sciences, Midwives, Doctors of the PublicHealth Service, of the Patient Support GroupFASworld Germany and additional FAS experts havebeen established in 2011. The AWMF (Association ofthe scientific medical societies) was responsible for themethodological guidance. Systematic literatureretrieval and determination of levels of evidence wereconducted by the ÄZQ (Medical Center for Quality inMedicine).Results: The methodological quality of theinternational and especially the German publicationsabout the diagnostic criteria are rather poor. Most ofthe existing international guidelines for the diagnosis ofFAS are consensus- but not strictly evidence-based.Evidence-and consensus-based criteria for thediagnosis of FAS were evaluated and established forGermany. The methodological process is described.The implication of the guideline is performed byalgorithms for pediatricians and general practitionersfor the referral of children with suspected FAS.Another algorithm including the defined diagnosticcriteria of FAS has been developed for expertsConclusion: There is great need for a standardized,multidisciplinary, quality assured and implementableprevention of FAS in Germany. The first step was thedevelopment of an evidence- and consensus-baseddiagnostic guideline for children with FAS inGermany.

PARALLEL SESSION I.B.

CHARACTERIZATION OFWOMEN WHO DRINK

CHAIR: MIREIA JANÉ

25A socio-psychological model of risky drinkingamong childbearing age women in the NizhnyNovgorod Region in Russia

Larisa Skitnevskaya2, Elena Volkova2, TatianaBalachova1

1University of Oklahoma Health Center, OklahomaCity, USA, 2Nizhny Novgorod State PedagogicalUniversity, Nizhny Novgorod, Russia

Objectives: Alcohol consumption is one of the mostpressing medical and social problems in Russia. Thisstudy is part of an ongoing clinical trial.. One of thegoals of the study is to identify socialand psychological factors have an impact on alcoholconsumption in childbearing women.1) To describe socio-demographic characteristics ofchildbearing age women who drink at risk2) To study some personality characteristics of womenwho drink at risk3) Identify if partner’s alcohol consumption affectswomen’s alcohol consumption levels4) Propose a socio-psychological model of at-riskdrinking among childbearing age women.

Materials & Methods: The studies used self-reportmeasures of alcohol consumption. Self-report measuresof alcohol consumption are well-supported when usedin healthcare settings (Babor et al., 2000; Fleming &Manwell, 1999; Sobell & Sobell, 2003). The surveyincluded demographic questions (living environment,marital status, education, employment, combinedyearly income per person in the family, age, ethnicity),alcohol consumption measures, identifying partners’alcohol consumption and women’s’ personalitycharacteristics.Results: A subset of non-pregnant women recruited forthe study in the Nizhny Novgorod Region (N=360)were included in this analysis. Analysis of socio-demographic characteristics of women showed thatsome characteristics including residence (rural vs.urban), age, and having a child/children had an effecton women’s consumption. Women living in smalltowns, between 23 to 44 years of age were more likelyto drink at risk. Women who have a child/childrenwere less likely to drink at-risk. Women whoreported at-risk alcohol use reported more intenseemotions, emotional instability, lower self-control of behaviors, and expressiveness. The levelandfrequency of alcohol consumption in women wereassociated with the characteristics of "introversion-extraversion" Risky aalcohol use in women wasassociated with women’s higher perceptions of alcoholuse by others including alcohol use by spouses, friends,and girlfriends. These perceptions significantlyaffected women’s own consumption (p <0.01, p <0.05).Conclusions: Socio-psychological factors affectwomen’s alcohol consumption level. A model ofalcohol use among women has been proposed to

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increase understanding of at-risk alcohol use amongchildbearing age women.

26Patterns of alcohol use among women ofchildbearing years in Canada: Implications forFASD prevention

Nancy Poole1,2, Gerald Thomas3, Lorraine Greaves1,Lauren Bialystok1, Colleen Dell3, Anne-Marie Bedard4,Heather Caughey4

1BC Centre of Excellence for Women's Health,Vancouver, Canada; 2Canada FASD ResearchNetwork, Vancouver, Canada; 3Canadian Centre onSubstance Abuse, Ottawa, Canada; 4Public HealthAgency of Canada, Ottawa, Canada

Objectives: Alcohol use in pregnancy arises against acomplicated backdrop of social and economicinfluences on women’s drinking patterns throughoutthe childbearing years. The objective of this study wasto analyze population-level health data and trends andto synthesize academic literature on influences onwomen’s drinking in order to describe the factors thatinfluence women’s patterns of alcohol use before andduring pregnancy.Materials & Methods: Available regional andnational survey data, including the CanadianCommunity Health Survey (2003, 2005, 2007/08 &2009/10) and the Canadian Maternity ExperiencesSurvey (MES) (2006-07), were used to explore trendsand patterns in alcohol consumption among women intheir childbearing years (ages 15-44) from 1989 to2010. Findings from a review of academic and greyliteratures were used to contextualize the analysis.Results: Both occasional and regular risky drinking bywomen of childbearing ages is a large and growingconcern in Canada. Further, the distribution of alcohol-related risk in women ages clearly embodies theprevention paradox (i.e., a large number of drinkersexposed to a moderate risk). The proportion of womenwho reported drinking alcohol during pregnancy was10.5%, compared with 62.4% of women who reporteddrinking alcohol during the three months prior topregnancy. Interestingly, alcohol use during pregnancyincreased as age and income of the woman increases.Conclusion: This study suggests that there are threegroups of women of particular interest in efforts toreduce the harms and costs associated with alcohol use:underage girls, occasional risky drinkers whoexperience increased risk of acute harms, and regularrisky drinkers who incur greater risk of both acute andchronic harms. Efforts to reduce alcohol related riskmust necessarily include both policy interventions tolower consumption across the population and

programmatic interventions to address the needs ofgirls and women who drink in high-risk patterns.Implications of these findings for multilevel FASDprevention efforts will be discussed.

27Preventing FASD in Catalonia: From raisingawareness to promoting antenatal professionals'intervention

Lidia Segura, Ana Ibar, Mireia Jane i Joan Colom

Public Health Agency of Catalonia on behalf of theworking team of the alcohol and drugs freepregnancies programme

Background: The consumption of alcohol and drugs isone of the main causes of morbidity-mortality indeveloped countries. The number of women whoconsume alcohol and drugs at levels which areconsidered unhealthy has risen and a significantnumber continue to do so during pregnancy. Sincemany pregnancies are unplanned, many foetuses mayhave been exposed to drugs before the pregnancy hasbeen confirmed. The consumption of alcohol and drugsis directly related with a series of alterations towomen’s reproductive health and with adverse effectson gestation and the development of the baby. Themost severe forms of harm are produced at high dosesbut also at lower doses, and particularly during the firsttrimester of the pregnancy, there is an increased risk ofmiscarriage, premature birth, etc. The harm caused bypre-natal exposure such as the disorders of the foetalalcohol spectrum (TEAF) which “presumably” affect1% of the population of Europe (5 million people), canbe completely prevented with an adequate intervention.Aims: In Catalonia, the “Alcohol and Drug FreePregnancy” programme is set to be launched next year,seeking to raise the awareness of the generalpopulation regarding the harm associated with theconsumption of alcohol during pregnancy, to trainprofessionals with regard to how to carry out earlydetection and brief interventions in order to reduce thenumber of pregnancies and newborns exposed.Materials & Methods: The programme, which isinspired by the already existing Smoke Free PregnancyProgramme and which has been agreed upon by aspecific work group, consists of an implantationprotocol, a guide with recommended courses of actionfor professionals and information leaflets for thegeneral public. Its implementation includes anexhaustive evaluation protocol which includes a beforeand after study of the attitudes, behaviour andknowledge of professionals and of the general publicand an evaluation of the effectiveness of theintervention by means of biological markers. We will

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present the main lines of action proposed and thecurrent baseline situation.

28Alcohol consumption during pregnancy and riskfactors

Daniela Fiorentino1, Maria Concetta MarcellaScamporrino1, Simona Solombrino1, Paola Ciolli2,Mauro Ceccanti1,3

1Lazio Regional Reference Center for alcohol, Rome,Italy; 2Obstetrics and gynaecological Department,University of Rome “Sapienza”, Italy; 3ClinicalMedicine Department, University of Rome “Sapienza”,Italy

Objectives: 1) to screen alcohol consumption in apopulation of pregnant women attending an antenatalclinic in a major hospital in Rome. 2) to identify riskfactors for alcohol consumption in pregnancy.Materials & Methods: a screening system has beenestablished in an antenatal clinic in PoliclinicoUmberto I in Rome. Each woman attending the clinicwas asked to participate to the survey. Through a semi-structured interview they were asked about theiralcohol consumption before and during pregnancy,according to a quantity-frequency method. The T-ACEquestion about tolerance was also embedded in thequestionnaire.Results: 991 pregnant women, aged from 17 to 47(mean=32,3; SD=5,7) were screened during a 18months period. Among them 73,2% were Italian. Themajority (67,3%) was interviewed during the thirdtrimester of pregnancy. Participation was voluntary and100% of women accepted it. Main results are presenteddivided by trimesters of pregnancy. While 68,6% drankbefore pregnancy, 33,9% were still drinking during thefirst trimester, 36,4 during the second one and 38,7during the third; 2,3%, 2,1% and 1.3% drank morethan one drink per occasion, respectively during thefirst, the second and the third trimester. Women werealso asked to answer to the question “How many drinksdoes it take to make you feel high?”, as stated in the T-ACE questionnaire: 55,6% scored positive (more thantwo drinks) during the first trimester, 40,5% during thesecond and 38,5% during the third one. Frequency ofconsumption decreased by trimester: from 13,5%drinking at least 4 times a week in the first trimester to6,4% in the second and 3,6% in the third one. The mostrecurrent risk factors, significantly correlated with anumber of variables measuring drinking behaviour (i.e.drinking more than one drink per occasion, positivescore to the tolerance question, number of alcoholicbeverages consumed) were: being younger (under 30),having an unplanned pregnancy, being unemployed,

having a lower educational qualification, being singleand being Italian compared to foreigners.Conclusions: a significant number of women keep ondrinking during pregnancy. Their drinking behaviourput their babies at risk for FASD, as resulting also fromthe high percentage of women scoring positive to thetolerance question. Implications for prevention includetargeting young women, recommending the adoption ofbirth control methods, informing that even smallquantities can affect the baby as there is not a safe andfirm threshold.

29Features of maternal alcohol consumption and FetalAlcohol Syndrome in the Sakha Republic

GI Sofronova1, AB Palchik2

1Pediatric Center of Republic Hospital N1 – NationalMedical Center of Republic of Sakha (Yakutia),Russia; 2Department of Psychoneurology of Post-Graduate Faculty, Pediatric Medical Academy, St.Petersburg, Russia

Email: [email protected]

Objectives: This investigation’s aim is to studyfeatures of maternal consumption of alcohol and FetalAlcohol Syndrome (FAS) in the Sakha Republic(Yakutia, Russia).Materials & Methods: Quality and rate of MaternalAlcohol Consumption observation in 11 regions(uluses) by means of the interviews, physicalassessment and study of case histories according toCDC recommendations (2004). Incidence and clinicalfeatures of FAS study in 13 uluses, orphanages andNational Medical Center. 26 caucasian, 18 sakha and12 native (evens, evenks) with FAS aged from 40postmenstrual weeks to 7 years detailed observation bymeans of 4-digit Diagnostic Code, routine and age-dependent developmental neurological assessment,brain ultrasonography, MRI, Denver test and ZhurbaScale.Results: Analysis of maternal alcohol consumptionshows that from 0.7 to 6.1% of pregnant women indifferent uluses used alcohol, and from 0.2 to 4.5%drank heavily. There are no significant differences inmaternal alcohol consumption in different ethnicalgroups. Incidence of FAS varies from 0.06 to 0.9% inchild population of different uluses. We haven't foundsignificant correlation between maternal alcoholconsumption level and incidence of FAS in the uluses(r = 0.559; p = 0.093).Incidence of FAS varies from0.3% in National Medical Center to 11.3–34.0% inorphanages. Our investigation demonstrates that nativebabies with FAS were born pre-term much oftener than

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sakha infants (χ2 = 4.54; р = 0.033). Sakha children with FAS have smaller birth weight and height thancaucasian ones (χ2 = 4.35–5.90; р = 0.037–0.015). Clinical assessment and neurovisualization show thatcaucasian patients have ptosis and ventriculodilatationsignificantly more frequently than sakha babies (χ2 =5.11–5.97; р = 0.024–0.015); sakha infants have much more frequently muscle tone deviations, inborn heartdefects, visual nerve atrophy and subarachnoid spacedilatation than other ones (χ2 = 11.55–4.10; р = 0.0007–0.043). Native children demonstrate betterquality of social adaptation than caucasian babies (χ2 =10.26–4.10; р = 0.0014). Conclusion: Our investigation shows the necessity oftaking into account ethnical and regional features ofmaternal alcohol consumption and FAS manifestationin epidemiological and clinical study.

30Recognition of alcohol-use disorders in pregnantwomen: a population-based cohort study 1985-2006

Colleen O’Leary1, Jane Halliday2, Anne Bartu3,Heather D’Antoine4, Carol Bower5

1Centre for Population Health Research, CurtinUniversity, Perth, Western Australia; 2Public HealthGenetics, Murdoch Children’s Research Institute,Melbourne, Victoria, Australia; 3School of Nursing andMidwifery, Curtin University, Perth, WesternAustralia; 4School of Health Research, Darwin,Northern Territory, Australia; 5Division of PopulationSciences Telethon Institute for Child Health Research,Perth, Western Australia

Objectives: We examined the trends and extent ofunder-reporting of maternal alcohol-use disordersduring pregnancy using Western Australian linkedhealth, mental health, and drug and alcohol data (1985-2006).Materials & Methods: Women with an InternationalClassification of Diseases 9/10 alcohol-relateddiagnosis, indicating heavy alcohol consumption,recorded on population-based health datasets (1985-2006) were identified through the Western Australiandata-linkage system. These mothers and all theirchildren whose birth was recorded on the WesternAustralian Midwives Notification System, a statutorynotification system, comprised the ‘exposed’ cohort(Mothers n=8422; Children n=21,336). A randomlyselected cohort of mothers without an alcohol-relateddiagnosis was frequency matched (on maternal age,year of birth of offspring, Aboriginal status) withexposed mothers. These mothers and their childrencomprised the comparison cohort (Mothers n=41,984;Children n=54,963). Children with Fetal Alcohol

Syndrome (FAS) were identified through linkage withthe Western Australian Register of DevelopmentalAnomalies (n=114).Results: The proportion of Aboriginal mothers inWestern Australia with an alcohol diagnosis (23.1%) is10-times greater than for non-Aboriginal mothers(2.3%). Three-quarters of the women had an alcoholdiagnosis indicating acute alcohol intoxication;however only a small proportion had an ICD codeindicating counselling/rehabilitation. There have beensteep increases in the proportion of births where themother had an alcohol diagnosis recorded on healthdatasets during pregnancy, particularly for Aboriginalbirths. There was evidence that maternal alcohol-usedisorders during pregnancy were not well detected,with over two-thirds (70%) of the mothers of childrendiagnosed with FAS not having an alcohol diagnosisrecorded during pregnancy.Conclusions: Maternal alcohol exposure duringpregnancy is significantly under-ascertained. Heavyprenatal alcohol exposure increases the risk of fetaleffects so assessment and recording of alcohol useshould be routinely undertaken in maternity and otherhealth settings. Brief interventions, counselling, andrehabilitation should be provided where indicated.

PARALLEL SESSION I.C.

INTERVENTIONS FOR FASD

CHAIR: MIGUEL DEL CAMPO

31Toward enhanced teacher preparation for meetingthe needs of students with FASD: A comparison oftwo professional learning approaches in Alberta,Canada

Jacqueline Pei, Cheryl Poth, Stephanie Hayes

Department of Educational Psychology, University ofAlberta, Edmonton, Alberta, Canada

Objectives: This presentation compares twoapproaches to enhancing teacher preparedness formeeting the individualized needs of students withFASD in the classroom. Students with FASDexperience a wide range of serious and lifelongchallenges including cognitive, behavioural, andacademic difficulties. Although teachers andeducational assistants have identified the need foropportunities for them to collaboratively gainknowledge and skills related to FASD, there is apaucity of research to guide how to go aboutstructuring these professional learning opportunities.

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Materials & Methods: Two approaches wereundertaken through partnering with local schoolboards. Common across both approaches was theidentification of key contacts who contributed to theplanning and recruitment of teachers and educationalassistants. Whereas one approach involved a school-wide initiative the other was based out of one school.For the latter, we conducted three sessions whereas theformer involved four sessions during the winter term2012.Altogether, 30 participants were involved anddata was collected using four sources to assess theimpact and document the process: field notes, meetingsummaries, focus groups, and a final survey. Eachapproach was first analyzed separately using constantcomparison inductive procedures and then a crosscomparison of the approaches was conducted.Results: We have completed the separate analysis andthe cross analysis is currently ongoing. Preliminaryresults highlight the positive impact a collaborativeapproach has on supporting the individualized needs ofparticipants and reducing their feelings of isolation.Specifically, participants generated tools that they thenused in their classrooms and made available publically.Following the final session, participants reportedfeeling supported and that the experience of workingcollaboratively with others who have a similarbackground increased their confidence in their abilitiesas educators, and advocates for the needs of theirstudents with FASD.Conclusion: In contrast to traditional models ofprofessional learning where the experience is faciliated,this project sought to compare two approaches to amore “grassroots” collaborative initiative. Workingtogether, researchers and educators had an opportunityto discuss and brainstorm, provide feedback about whatis helpful and relevant to classroom-practice, andgenerate tools to support their work with students withFASD.

32The Fetal Alcohol Questionnaire (FASQ)

Reinhold Feldmann

Department of Pediatrics, University HospitalMuenster

Objective: The Fetal Alcohol Syndrome (FAS) isdiagnosed throughout measuring physical issues asfacial stigmata, growth, head circumference, CNSabnormalities and, if data are available, prenatalalcohol exposure. There are few diagnostic instrumentsmeasuring the behavioral phenotype of FAS. Thisseems to be a diagnostic flaw as children with FAS(and their environment) suffer much more from the

burdening behavioral problems of the FAS childrenrather from their facial alterations.Materials & Methods: We collected 100 typicalparental reports on behavior and social and emotionalproblems in their children with FAS. Factor analysisreduced the data to two behavioral factors yielding aquestionnaire (FASQ) that consists of 38 items. Thequestionnaire was administered to parents of childrenwith FAS, Autism, Attachment disorder, and to parentsof healthy children.Results: Children with FAS scored significantly higherthan children with no or other disorders. Scores showeda typical behavioral phenotype in FAS (including lackof social distance, careless risk behavior, no concept oftime or money, would go with anyone, easily talkedinto things) that was not reported for other disorders.Conclusions: The FASQ may contribute to adiagnostic process that is not restricted to bodymeasures. This may be true particularly in case ofchildren with FAS who suffer from severeconsequences of the prenatal alcohol exposure butshow minor stigmata only, and who, thus, still obtainan insufficient diagnosis, if any.

33Use of visual methods for capturing themultifaceted and complex nature of work withindividuals with FASD: Practical guidelines forweaving quilting and photography

Jenelle Job1, Teresa O’Riordan2, Lin Taylor3, David St.Arnault1, Cheryl Poth1, Jacqueline Pei1

1Department of Educational Psychology, University ofAlberta, Edmonton, Alberta, Canada; 2NorthwestCentral Alberta FASD Services Network, Edmonton,Alberta, Canada; 3Edmonton, Alberta, Canada

Objectives: This presentation reports a study usingvisual methods with program personnel providingservices for individuals with Fetal Alcohol SpectrumDisorders (FASD). Through detailing our experiences,we will provide practical guidelines for implementingquilting and photography as appropriate methods forcapturing the multifaceted and complex nature of workwith individuals with FASDs. This project extends thenotion: “Our lives are like quilts - bits and pieces, joyand sorrow, stitched with love” Author Unknown.Materials & Methods: Visual methods within thefield of qualitative research have been gainingmomentum because of its usefulness of documentingand representing the social world. The result has beenimproved understanding of participant experiences andrelationships (Banks, 2001; Rose, 2001). Two suchvisual methods are quilting and photography—innovative techniques that allow the researcher to

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integrate participants’ stories into a meaningfulcollective experience (Koelsch, 2008). Specifically,this research embedded the process of engaging inquilting as a means for service providers to relay theirprogrammatic experiences working with womanengaged in high-risk behavior to prevent future birthsof children prenatally exposed to alcohol and drugs.Photographs of this exercise were taken as a means ofdocumenting the process.Results: Constant comparison and inductive qualitativeanalysis across methods reveals participants’ emotion,candor, and passion, emphasizing their commitment tothe care and advocacy of at-risk women and children.The analysis of quilting squares (n = 46) andphotographs revealed six themes: healing, love,connectedness, grief and pain, growth, and hope andvision. Despite the challenges experienced in workingwith this specialized population, an overall message ofoptimism was apparent. This demonstratedparticipants’ belief in the potential for change andimportance of their work. Key factors and relatedresearch and practice implications will be discussed.Conclusions: Used in combination with focus groups,visual methods were employed to allow for thetriangulation of data sources in order to generate acomprehensive and shared understanding related tobest practices in FASD planning and service deliveryfrom the perspective of frontline workers.

34A gluten-free casein-free diet can be beneficial forpersons with FASD

Diane Black

FAS Foundation of the Netherlands, European FASDAlliance

Objectives: Gluten, the major protein found in wheat,rye, oats, and barley, is increasingly being linked withvarious neurological and psychiatric disorders.Research reports have shown a relation with ataxia,epilepsy, autism, schizophrenia and elderly dementia,and various trials have shown that a diet free of bothgluten and casein, the major milk protein, is beneficialin many cases. A number of parents of children with aFASD have found that the gluten-free casein-free dietimproves physical health, behavior, and developmentof their children. However, no properly designedstudies have been carried out to test the widerapplicability of this diet for persons with FASD. Here,I report a small pilot study, based on parental reportsbefore and after stabilization on the GFCF diet.Materials & Methods: Parents were asked to fill inthe FASQ based on the child’s behavior beforebeginning the diet, and after a period of stabilization on

the diet. The FASQ is a questionnaire developed byReinhold Feldmann of the University Hospital ofMuenster to define the behavioral phenotype of FASD.Results: Scores on the FASQ diminished significantlywhen the child was on the GFCF diet, showing animprovement in behavior and learning.Conclusions: The GFCF diet appeared to be beneficialfor the children in the study group. It should, however,be recognized that the small study group were self-designated, and that the evaluation of behavior beforegoing on diet was based on recall, in some cases, of thesituation years previously. Based on the promisingresults of this small study, it would be desirable toimplement such a study in a larger, randomly assignedgroup of children with FASD, to see if the results canbe generalized.

WHAT IS HAPPENING IN MY COUNTRY? II

CHAIR: KATARINA WITTGARD

35What is happening in my country? Germany

Gisela Michalowski

FASD Deutschland e.V.

Background: In September 2011, FASworld changedits name and became FASD Deutschland e.V. We nowhave our own logo and our own name. FASD Germanye.V is a non-profit parent support group. We helpeducate people about FASD - the causes, how it couldbe eliminated and how to deal with people who haveFASD. A wealth of information can be found on ourweb site which is well-visited. We give lectures,organize workshops and pass on expert knowledge e.g.the latest scientific findings from around the world aswell as our own experience. In addition, we run aclosed online support group where members really canfind support - here they find answers to specificquestions and problems relating to FASD and of coursemoral support - there is always someone ready to listenand who is willing and able to help. This group has inturn led to the formation of regional support groupsthroughout Germany in which people really help oneanother - it's not just about moral support, practicalhelp plays an important role too. The Federal Ministryof Health - in particular, the Federal Drug Commission- has supported us since 2011. This is a great help andcontributed to the success of the last two symposia.2011 was the first year in which we were able topublish symposium proceedings: FASD 2011 facets ofa syndrome. Many professionals, including members ofFASD Germany, are working on guidelines to beimplemented for making the diagnosis of FASD. Here

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too it was Mrs. Dyckmans, the Federal DrugCommissioner, who initiated this commission.Members of the executive board of FASD wrote aguide on how to deal with people with FASD. Far toofew people are knowledgeable about FASD and sothere is a great need to educate people in Germany andpromote awareness about FASD among professionalsand the general public alike. Schools must also takeaction and inform pupils about the life-longconsequences caused by alcohol abuse duringpregnancy. In Germany there are numerous problemsrelated to young people and adults with FASD in thefield of education and when seeking employment. Theproblems of children affected by FASD becomeobvious at school. As these youngsters become adultsthey want to be independent, they want to have a joband yet desperately need help and support in shapingtheir daily lives. Unfortunately, they are too oftendeprived of this help because they are judged purely byappearance and without knowledge of FASD theirhandicap is simply not recognized.

36What is happening in my country? -Israel

Yehuda Senecky

Child Development and Rehabilitation Institute,Schneider Children’s Hospital of Israel, Kaplan 14 St',Petah Tikva, Israel

Objectives: In our previous searches we revealed thatalcohol consumption is frequent among pregnantIsraeli women. We found that lack of knowledgeregarding alcohol damage and risk and about FASDextends to physicians and other medical staff whoattend women during the pregnancy.Materials & Methods: Over the last two years, weconcentrated a lot of effort to stimulate interest andspread knowledge among print and electronic media.We have written articles in professional magazines andwe held the first conference of its kind in Israel on thetopic of FASD.Results: Information and knowledge about the risk ofalcohol consumption during pregnancy and thepotential damage caused to the future newborn arespreading slowly but steadily.Conclusion: In Israel improved educational programson the risk of alcohol consumption during pregnancyare needed for both professionals and the generalpublic in conjunction with legislations steps. We workin close cooperation with the Anti-Drug and AlcoholAuthority of Israel and get great support.

37What is going on in Finland?

Ilona Autti-Rämö

Research Professor, Chief of Health Research, TheSocial Insurance Institution, Finland

Objectives: The focus of this presentation is tosummarize the current attempts in Finland to minimize.Materials & Methods: New initiatives to changelegislation that could have an effect on1) Alcohol availability,2) Alcohol advertising, and,3) Treatment of pregnant women with alcohol abuseare currently in progress and under debate. Theinitiatives were started by the Ministry of Social andHealth Affairs and will be presented shortly.Results: The moral values of society and and itsresponsibilities to protect the unborn and the offspringare emphasized by the health and social servicesauthorities. The public debate is centered both onsecuring the health of the unborn baby and children ingeneral and on ensuring the rights of the public tomake lifestyle choices. However, a gradual changetowards a more favourable attitude to restrictions canbe observed among the public, especially with regardto the content of alcohol advertising and partly also toalcohol availability. Commercial and industrialorganizations, however, oppose the changes inlegislation. They also see themselves as having animportant economic impact on society andunderestimate alcohol related health problems. Theproposed law on the forced treatment of pregnantwomen with alcohol problems has raised a lot ofcriticism, mainly due to the lack of voluntary treatmentoptions. The updated situation as of October 2012 willbe summarized at the conference.Conclusion: In Finland, several initiatives arecurrently in progress that could have a marked effecton alcohol availability and consumption especially inyoung adults. Their potential to lead to statutoryrestrictions remains to be seen.

38Canadian FASD prevention programs: results of anational environmental scan

Jessica Moffatt, Egon Jonsson

Institute of Health Economics and Department ofMedicine, University of Alberta

Objectives: Considerable progress has been made tounderstand Fetal Alcohol Spectrum Disorder(FASD) in

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Canada; however, much work is needed in regards toprevention.The objective of this study:1) document what initiatives are occurring in acrossCanada to prevent FASD; and 2) document the level offormal evaluation occurring within preventativeinitiatives.Materials & Methods: An environmental scan wasconducted to capture the FASD preventative programsoccurring across Canada. Three online directories weresearched to establish an initial list of stakeholders, withsnowball sampling used to connect to any additionalstakeholders not captured within these databases. Eachstakeholder was sent a brief email questionnaire, andstakeholders from each provincial government receiveda follow-up telephone call to verify informationcaptured through these surveys.Results: Provinces and territories of Canada differgreatly in their level of activity in FASD prevention. Inparticular, gaps were identified in Québec and theAtlantic provinces, where there are few programs thatspecifically address FASD. Programs also vary widelyin their approach, target audience, scale and scope.Most prevention initiatives are aimed solely at womenand do not address the supportive role that malepartners, family members and the wider communitymay play in preventing FASD. Few, if any, programsaddress the specific needs of immigrants, particularlywomen from countries in which public awareness ofFASD is low. The environmental scan showed that anoverwhelming majority of the FASD-preventionprograms currently practiced in Canada have neverundergone formal evaluation.Conclusion: Many innovative initiatives are occurringacross Canada to prevent FASD; however thereremains wide variation in the scope, size, andorganization of prevention programs across thecountry.

39Developing policy for FASD in Scotland

Maggie Watts

FASD Co-ordinator for Scotland, Child and MaternalHealth Division, Children and Families Directorate,The Scottish Government, Edinburgh, UK

Objectives: The appointment of a national coordinatorfor FASD was made by the Scottish Government inJanuary 2010. The stated aim of the post is to lead onthe development of the FASD strategy in Scotland. Itsobjectives include working across government andother agencies to embed FASD in emerging andexisting policies, driving forward improvements in the

prevention of FASD, encouraging surveillance andsupporting screening approaches, promoting thetreatment of FASD and working with the voluntarysector to enhance support for families.Materials & Methods: The post is part-time and issupported by a Policy Officer in the ScottishGovernment. A governmental working group,incorporating officers from teams for alcohol, drugs,justice, children and young people andcommunications, and including the national agenciesfor health promotion and health information has beenestablished. This group has developed an action planwhich it is now implementing.Results: After eighteen months we are beginning tosee some success. Awareness raising events have beensupported across the Government departments and at arange of events across Scotland. These events havebeen developed by local groups including alcohol anddrug partnerships, child protection committees,voluntary sector agencies for children and for alcoholrelated harm, and adoption and fostering groups. Thereare the beginnings of a greater understanding of theharm associated with maternal drinking and that effortson prevention must be increased.Conclusion: Developing a strategy to address fetalalcohol harm has presented huge challenges. Workingacross so many different sectors both within andoutside of Government requires considerable time,effort and patience. Whilst there has been fundingallocated to the co-ordinator post and to support avoluntary surveillance programme within paediatricservices, there is no specific funding stream for widerFASD work, so the challenge of working withinexisting resources has been ever-present. The nextsteps will include engagement across social care andeducation sectors to raise awareness, review practiceand endeavour to incorporate prevention of fetalalcohol harm and the management of disabilityassociated with FASD into everyday practice.

40What is happening in my country?

Magdalena Borkowska

The State Agency for Prevention of Alcohol RelatedProblems, Warsaw, Poland

Objectives: Prenatal exposure to alcohol is a leadingpreventable cause of the birth defects, which caninclude physical, mental, behavioral and or learningdisabilities with possible lifelong complications.Unfortunately many of Polish women are not aware ofthat and according to data from 2009, 14% of all youngwomen and 29% of those who have been drinking in

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the past 12 months, have been drinking alcohol duringpregnancy. The goal of PARPA is to increase socialawareness in the issue of FASD.Materials & Methods: The ways of sharing theinformation of FASD by social events, campaigns,educational programs or publications, and also bygiving the assistance of experts to all the groupsinvolved in the topic. PARPA is expanding theknowledge by conducting and participating in theinternational projects.Results: Research on FASD issue will increase theknowledge, the social awareness and will lead to betterprevention. During the current year, the Training andDiagnosing Center will start its work in The Child St.Louis Hospital in Cracow.Conclusion: What PARPA is planning to obtain is theinformation about the prevalence of FASD in Polandamong children (7-9 years old) and gain the mostproductive tool for diagnosing children with FASD.Moreover, we are planning to conduct second editionof nationwide education campaign “Pregnancy WithNo Alcohol”.

41Case report of a woman consuming alcohol duringpregnancy and the support given by the StockholmCounty and Health Services: lessons of failures andsuccess!

Ihsan Sarman1, Asa Magnusson2, Hanna Eklund2

1Sachsska Children Hospital in Stockholm; 2AntenatalCare Unit for drug dependent women in Stockholm

Background: A 26 year old women, encounters thedelivery unit, for premature rupture of membranes(PROM). She admits drinking issues and use of drugs.She has not attended the regular antenatal care.Ultrasonic examination reveals a foetus correspondingto 25th weeks of gestation in accordance with themenstrual date. No PROM is diagnosed. Despite theattempt to make her stay, the woman leaves thehospital.Social worker comes in contact with her aweek later. The woman explains that she is not usingdrugs regularly, but that she had a relapse with anintake of “some glass of wine”. She intended to gothrough with an abortion at 16th weeks but regret toundergo a late abortion. She already had a child infoster care. First antenatal visit a month later, at aspecialist antenatal care for pregnant women withaddiction problems in Stockholm County is arranged.She describes problems with lack of energy since longtime. She has difficult to remember how much alcoholshe consumed.Materials & Methods: AUDIT reveals 25 points andTime Line Follow Back shows consumption of over 10

drinks on the same occasion at least once last month.She admits previous treatment with Disulfiram. Thework at the unit focuses on weekly contact with themidwife, drug tests, treatment with B-vitamininjections, and contact with social welfare authorities,(SWA). The drug tests showed that she had continuedto consume alcohol. The antenatal care unit applied forcoercion care in SWA for treatment, resulting in dailyalcohol test (breathalyse) at the SWA, which all werenegative. However, the blood tests at the antenatalclinic show positive results on Phosphatidyl Ethanol(PETH). The patient and SWA decide that the childshould be taken care off by a foster family after thedelivery.Results: The delivery is uneventful at full time withnormal somatic proportions. The birth and the fostermother both stay at the maternity the first two daystaking care for the baby. The girl has no external traitsof FAS but shows difficulties in self regulation after aweek. The birth mother is given contraceptive implantfor the next 3 years.Conclusion: Based on a real life story we illustratedifferent problems in our country when treating womenwith alcohol dependency during pregnancy. Questionsconcerning diagnostic, legislation and health care arecentral issues to face. Moreover it is important tounderstand specific neuropsychological problemsalcohol dependent woman may bear.

PLENARY SESSION IV

BIOCHEMISTRY AND ANIMAL STUDIES

CHAIRS: RAFAEL DE LA TORRE ANDAURELIO LUNA

42Determination of maternal-fetal biomarkers ofprenatal exposure to ethanol

O Garcia-Algar1, X Joya1, S Pichini2

1URIE Group, Hospital del Mar Research Institute-IMIM-Parc de Salut Mar, Barcelona, Spain; 2DrugResearch and Evaluation Department, IstitutoSuperiore di Sanità, Rome, Italy

Background: The deleterious effects exerted byprenatal ethanol exposure include physical, mental,behavioural and/or learning disabilities that areincluded in the term fetal alcohol spectrum disorder(FASD).Objectives: Assessment of exposure to ethanol at bothprenatal and postnatal stages is essential for earlyprevention and intervention. Since pregnant women

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tend to underreport alcohol drinking by questionnaires,a number of biological markers have been proposedand evaluated for their capability to highlightgestational drinking behaviour.Materials & Methods: These biomarkers includeclassical biomarkers (albeit indirect) of alcohol-induced pathology (mean corpuscular volume (MCV),gamma glutamyltransferase (GGT), aspartateaminotransferase (AST) and alanine aminotransferase(ALT)) acetaldehyde-derived conjugates, and finallyderivatives of nonoxidative ethanol metabolism (fattyacid ethyl esters (FAEEs), ethyl glucuronide (EtG),ethyl sulphate (EtS) and phosphaditylethanol (PEth)).Since ethanol itself and acetaldehyde are onlymeasured few hours after ethanol intake inconventional matrices such as blood, urine and sweat,they are only useful to detect recent ethanol exposure.In the past few years, the non-oxidative ethanolmetabolites have received increasing attention becauseof their specificity and in some case wide time-windowof detection in non-conventional matrices from thepregnant mother (oral fluid and hair) and fetus-newborn (neonatal hair, meconium, placenta andumbilical cord).Conclusions: This presentation reviews the markers ofethanol consumption during pregnancy and relatedprenatal exposure. In addition, clinical toxicologicalapplications of these procedures are presented anddiscussed.

43The use of animal models for study Fetal AlcoholSpectrum Disorders (FASD) and theneuroteratogenic effects of alcohol

Consuelo Guerri

Prince Felipe Research Center, Avda Eduardo PrimoValencia, Spain

Objectives: Although studies in humans have beenvery important in identifying the spectrum of disorderswhich cause the consumption of alcohol duringpregnancy, the use of animal models have been criticalfor addressing the mechanisms of the actions of ethanolduring fetal development and to demonstrate theteratogenic effects of ethanol.Results: Neurodevelopmental damage, as a result ofprenatal alcohol exposure is a significant healthproblem. Studies in animal and in neural cell culturehave also provided evidence of the vulnerability of thecentral nervous system to the effects of ethanol. Thesestudies revealed that ethanol interferes e with importantontogenetic stages of the mammalian brain, and thatthe levels of ethanol reaching the foetal brain, and thedevelopmental timing of ethanol exposure are

important determinants of the specific brain structuresaffected and the resulting degree of damage. The invitro generation of neural cells from human embryonicstem cells has provided new insights into the effects ofethanol on early human embryogenesis and thegeneration of neuroprogenitors. These findings supportthe conclusion that alcohol acts by differentmechanisms depending on the dose, pattern ofexposure, and timing of exposure relative to fetaldevelopment. Experimental models have been alsoused to identify structural damage to specific brainregions and the neural pathways that are responsiblefor many of these functional/behavioral deficits. Mostof the neurobehavioral deficits identified in childrenwith FASD have been documented in animal studieswith a variety of models. Researchers now areexploiting this knowledge to develop screening toolsfor prenatal alcohol exposure injury by testing forspecific functional deficits. Finally, a number ofpromising approaches to achieve neuroprotection arenow under investigation, including the use of retinoids,antioxidants, neuromodulatory compounds, peptidesand nutritional/nutriceutical interventions.Environmental enrichment and voluntary exercise havealso been shown to ameliorate some of alcohol's impactduring development.Conclusions: Animal models of FASD have been usedto demonstrate the specificity of alcohol's teratogeniceffects and some of the underlying changes in thecentral nervous system (CNS) and, more recently, toexplore treatments that could ameliorate the effects ofalcohol. Animal models will continue to be invaluablefor the development of protective and treatmentstrategies, and for providing a greater understanding ofFASD.

44Maternal ethanol consumption alters theepigenotype and the phenotype of offspring in amouse model

A Nyman1, H Marjonen1, A Ahola2, E Whitelaw3, SChong4, V Rogojin5, S Hautaniemi5, N Kaminen-Ahola1

1Department of Medical Genetics, University ofHelsinki, Finland, 2Department of Biological andEnvironmental Sciences, University of Helsinki,Finland, 3Division of Genetics and Population Health,Queensland Institute of Medical Research, Brisbane,Australia, 4Mater Research Institute, Brisbane,Australia, 5Computational Systems BiologyLaboratory, University of HelsinkiObjectives: Recent studies indicate that environmentalfactors like nutrition and toxic agents affect theepigenome of the developing embryo. In our study we

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are investigating how alcohol, by modifying theepigenetic reprogramming, would lead to acompromised epigenetic state, altered fetaldevelopment and adult disease. Because adverse brainand behavioural outcomes are the most devastatingconsequences of prenatal alcohol exposure, we arefocusing on the brain tissue.Materials & Methods: We have developed a model ofgestational ethanol exposure in the mouse based onmaternal ingestion of 10% ethanol for eight days afterfertilization. We have also investigated the effects ofethanol exposure before fertilization. Female micewere given 10% ethanol for four days per week for tenweeks prior to fertilization. In both studies, we used theepigenetically sensitive Agouti viable yellow (Avy)allele as a biomarker: the methylation level of thisallele correlates with gene expression, resulting in micewith a range of coat colours.Results: We observed expression changes in the Avy

allele in offspring, resulting in changes in coat colourin both experiments. Our model of gestational ethanolexposure produces offspring with postnatal growthrestriction and craniofacial changes that arereminiscent of fetal alcohol syndrome (FAS) inhumans. These findings and our preliminary resultsfrom gene expression arrays of hippocampus suggestthat moderate ethanol exposure in utero is capable ofinducing changes in the expression of genes other thanAvy.Conclusion: Our data suggest that ethanol modifies theestablishment of epigenetic marks in the preovulatoryoocyte and in the embryo, and that this can alter adultphenotype. After the mouse studies we will proceedwith human samples. We have already establishedcollaboration with Finnish clinical specialists whoenable the collection of tissue samples from affectedindividuals. In this way, we hope to gain a betterunderstanding of the molecular processes underlyingthis syndrome. Our aim is to find biomarkers forestimating the severity of damage and enable earlyinvention and appropriate therapy.

PLENARY SESSION V

MANAGEMENT OF FASD

CHAIR: LEOPOLD CURFS

45The utilization of various health care services byFetal Alcohol Syndrome and Fetal AlcoholSpectrum Disorder-affected individuals and theassociated costs

Svetlana Popova1,2,3, Shannon Lange1,2, Larry Burd4,Jürgen Rehm1,2,5

1Social and Epidemiological Research Department,Centre for Addiction and Mental Health, Toronto,Ontario, Canada; 2Dalla Lana School of Public Health,University of Toronto, Toronto, Ontario, Canada;3Factor-Inwentash Faculty of Social Work, Universityof Toronto, Toronto, Ontario Canada; 4Department ofPediatrics, University of North Dakota School ofMedicine, North Dakota, United States;5Epidemiological Research Unit, KlinischePsychologie and Psychotherapie, TechnischeUniversität Dresden, Dresden, Germany

Objectives: To examine the utilization rates of varioushealth care services among individuals with FetalAlcohol Syndrome (FAS) and Fetal Alcohol SpectrumDisorder (FASD) and compare these rates with those ofthe general population of Canada, as well as with therates observed in other countries. Also, to estimate theassociated costs attributable to the health careutilization of FAS and FASD-affected individuals.Materials & Methods: The utilization rates of healthcare services (number of admissions and length of stay)in Canada were obtained from various officialdatabases, including: Canadian Institute of HealthInformation (CIHI), provincial ministerial officials, anddrug addiction program coordinators. Quantificationmethods were used to calculate the economic impactthat FAS and FASD have on the Canadian health caresystem. For comparison purposes, the burden and costof health care associated with FAS and FASD in othercountries were obtained from the available literature.Results: Health care utilization rates (number ofhospitalizations and days in acute inpatient andpsychiatric care; number of emergency department andday surgery visits and hours of care; and substance-attributable specialized inpatient and outpatientadmissions and days of treatment) and the associatedcosts were estimated. The official data (from CIHI)pertaining to the utilization of health care services byindividuals diagnosed with FAS are likely to beunderreported. It was found that the rate of acute carehospitalizations among individuals with FAS is 3.6times lower than that of the general population ofCanada. This is very unlikely, given that FAS isassociated with a much higher rate of morbidity thanthe general population.Conclusion: The quantification of the health care costsassociated with FAS and FASD is crucial for policydevelopers and decision makers alike, to understand ofthe impact of prenatal alcohol exposure. The ultimategoal of such research is to initiate preventiveinterventions. The challenges of estimating the burden

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and health care cost associated with FASD will bediscussed.Acknowledgement: This work was supported by thePublic Health Agency of Canada.

46The importance of expert physical diagnosis inFASDMiguel del Campo

Genetics Unit, Hospital Vall d’Hebron, Department ofLife Science, Universidad Pompeu Fabra, Barcelona,Spain; Department of Obstetrics, Gynecology andReproduction, Institut Univ Dexeus, Barcelona, Spain.

Background: FASD is the term used to describedifferent categories of consequences of prenatalalcohol exposure. Abnormal growth and characteristicphysical features can be present in FASD, and then thediagnostic term is the fetal alcohol syndrome withcomplete or partial features.Materials & Methods: All systems used to establishdiagnostic criteria for FASD (Institute of Medicine,Canadian guidelines, 4 digit coding system), assess thepresence or absence of the 3 major physical features(short palpebral features, smooth philtrum and upperlip) growth deficits (height and weight <10%) andphysical evidence of central nervous systeminvolvement (microcephaly) to identify the differentdiagnostic categories. In order to identify the physicalfeatures associated with FAS, several important factsshould be taken into account: 1). Expert physicaldiagnosis can be necessary. FAS is a dysmorphicsyndrome with similar features to several genetic orother teratogenic syndromes with intellectual disabilityand behavioral problems. A differential diagnosis withother conditions should always be made, especiallywhen the full pattern of malformation characteristic ofFAS is not present. Genetic tests may be needed to ruleout other causes. 2). Several studies have proven thatadditional facial features such as abnormal ears(railroad track ears), ptosis of the eyelids, midfacehypoplasia and a long philtrum, are all characteristicfeatures or FAS. Other characteristic non-facialfeatures include contractures of one or multiple joints(camptodactyly and others), limitation of pronation andsupination of the elbow, clinodatyly of the 5th finger ofthe hands, and most importantly, abnormal handcreases (hockey stick crease and others) are also veryspecific to FASD and should be taken into account forthis diagnosis. 3) It has been proven that all thesephysical features together in a pattern are very specificto FAS, and their presence should be a firm indicatorthat the etiology of learning or behavioral problems isin fact prenatal exposure to alcohol. In the absence ofphysical findings, firm recognition of exposure or the

presence of a very characteristic neurobehavioralprofile are necessary in order to make a diagnosis ofFASD. 4) Many of these features are predictors ofmore severe neurobehavioral involvement, and lowerIQs are seen in patients with the most prominentphysical features. They can be predictors of outcome,according to the number (dysmorphology scores) andseverity of the growth deficits and the dysmorphicfeatures.Conclusions: We believe the identification of thesephysical features should be part of the knowledge ofany pediatrician of other professional dealing withchildren at risk for FASD, but only expert physicaldiagnosis can assess some difficult cases and makesure no other condition is present, especially in theabsence of known prenatal exposure to alcohol.

47UK Consensus statement on the clinicalmanagement of FASD in the UK: Clinical pathways

Raja Mukherjee1,2

1National FASD Specialist Behaviour Clinic, Surreyand Border’s Partnership NHS Foundation Trust; 2UKFASD Professionals Network

Objectives: To present developed and proposedclinical pathways to stimulate discussion in other areasre clinical interventions for people with FASDMaterials & Methods: Over two days on the 12th and13th of October 2011 70 Doctors from around the UKattended a residential conference to educate each otherand develop a consensus statement regarding how torecognise FASD at different stages from birth toadulthood. (5 stages Peri natal 0-0.5, Early years 0.5- 4,Primary school 4-11, Secondary School 11-18 andAdulthood 18+)The groups covered areas related to theabove age groups based on semi structured questionsbefore the feedback was analysed thematically toextract recommendations. Preliminary findings werecommented on by the membership as part of aconsultation before the final document was finished.Results: Recommendations about the following wereestablished, and these will hopefully be discussed aswell as clinical pathways proposed will be presented.Conclusions: Other countries have developed similarstatements, however the needs of each country requirethese to be modified to be relevant to each setting andhealthcare system. These findings offer a practicalapproach to FASD in the UK at different ages meetinga direct clinical need. The aim is to share clinicalpathways to falcate similar debates across Europe

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48The 1st Canadian FASD & sleep consensus paper

Osman Ipsiroglu1, Gail Andrew2, Heather Carmichael-Olson3, Maria Chen4, Jean-Paul Collet5, JacquelinePei6, Jennifer Garden1, Ana Hanlon-Dearman7,Roderick Houben8, James Jan1, Kathy Keivers9,Dorothy McNaughton10, Christine Loock11, LoriVitale-Cox12, Wayne Yo13, Dorothee Veer1, JoanneWeinberg13, Manisha Witmans14

1FASD & SLEEP RESEARCH GROUP, University ofBritish Columbia, Vancouver, Canada;2FASD ClinicalServices at Glenrose Rehabilitation Hospital,University of Alberta, Edmonton, Canada; 3Psychiatryand Behavioral Sciences, University of Washington,Seattle, USA; 4University of Washington School ofMedicine, Seattle, USA; 5Child and Family ResearchInstitute, British Columbia Children’s Hospital,Vancouver, Canada; 6Canada NorthWest FASDResearch Network, University of Alberta, Edmonton,Canada; 7 Manitoba FASD Centre/ Children's Hospitalof Winnipeg, Winnipeg, Winnipeg, Canada;8Health2Media, Vancouver, Canada 9University of theFraser Valley, Abbotsford, Canada; 10Social Work,Children's & Women's Health Centre of BritishColumbia, Vancouver, Canada; 11British ColumbiaChildren’s Hospital, Vancouver, Canada; 12ElispogtogFirst Nation Education Division EHWC Eastern DoorDiagnostic Team, New Brunswick, Canada13Department of Cellular and Physiological Sciences,University of British Columbia, Vancouver, Canada;14Stollery Children's Hospital, University of Alberta,Edmonton, Canada

Objectives: Although up to 85% of children withFASD experience SP which significantly impactfunctioning and quality-of-life (QoL), sleep problems(SP) are rarely addressed by health care providers(HCP). In order to develop a framework for astructured approach to SP and to determine skills andknowledge necessary to diagnose and treat childrenwith SP and/or disorders, an interdisciplinaryconsensus meeting was organized prior to the 4thInternational FASD Conference in Vancouver (2011).Materials & Methods: Existing published/submittedclinical research exploring the problem and trends ofmedical treatment (medication) were reviewed. Basedon the Canadian Health Care Systems’ universalservices philosophy, a 3-Level-Curriculum wasproposed and the needs for future research andknowledge dissemination were discussed as a guidelinefor screening/assessing SP.Results: Level I includes screening with a focus onbehaviour, day- and night time situations and a simplemeasure for quality-of-life. All HCPs should be

“empowered to close the screening based sleep-service-related gaps at the level of care they offer”.Level II includes assessments by HCPs (e.g.occupational/behavioural therapist or communitypaediatrician) using sleep-logs/-diaries as clinicalmonitoring/evaluation tools and validated sleepquestionnaires, thus requires a formal training. LevelIII represents regional health care services and is thehighest level of the curriculum in regards to structuredknowledge dissemination.Conclusion: Knowledge dissemination is needed toenable this proposed approach and will be providedthrough the collaboration of the Consensus Group withthe Intervention Team of the Canada Northwest FASDResearch Network. Evaluation of activities will guideand coordinate future research needs.Source of Funding: Victoria Foundation FASD-Action-Fund

PARALLEL SESSION II.A.

PSYCHOSOCIAL DEVELOPMENT

CHAIR: RAJA MUKHERJEE

49Fetal Alcohol Spectrum Disorders in childrenadopted from Poland: Neurobehavioral functioningand early detection

Sandra Knuiman1,3, Catharina Rijk2, RenéHoksbergen3, Anneloes van Baar1

1Utrecht Centre for Child and Adolescent Studies,Utrecht University, Utrecht, The Netherlands;2Department of Developmental and ClinicalPsychology, Tilburg University, Tilburg, TheNetherlands; 3Adoption Department, Faculty SocialSciences, Utrecht University, Utrecht, The Netherlands

Objectives: In some populations, an increasedprevalence of Fetal Alcohol Spectrum Disorders(FASD) exists, for example in children adopted fromCentral Eastern European countries. This studyinvestigates the prevalence of possible neurobehavioralindicators for FASD in a group of children adoptedfrom Poland to the Netherlands, and to what degreethese indicators can detect children with FASD.Materials & Methods: Participants were Dutchfamilies with 121 children (63 boys; response rate67%) adopted from Poland between 1999 and 2006. Onaverage the children were 3.0 years old (SD = 1.6) atadoption, and 10.9 years old (SD = 2.7) at the time ofstudy. Adoptive parents completed a questionnaireconcerning background variables of the child, the

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Behavior Rating Inventory of Executive Function(Gioia et al., 2000) and the Fetal Alcohol SyndromeQuestionnaire, developed by Feldmann (Scheffner,2012), measuring FASD related behavioral problems.Parents of three children did not know what FASD isand were excluded from analyses.Results: Three groups were distinguished: childrenwith a diagnosis in the FASD spectrum (n = 36; 31%),children whose parents suspected FASD (n = 26; 22%),and children without a FASD diagnosis or suspicionfor FASD (n = 56; 47%). The three groups differedsignificantly on the eight combined clinical scales forexecutive functioning (partial _2 = .136) and on FASDrelated behavior problems (_2 = .086). Post Hoccomparison of the subscales on executive functioningindicated that children with a FASD diagnosis hadmore problems with Inhibition and Emotional Controlthan children without FASD. For FASD relatedbehavior problems Post Hoc analyses indicated thatFASD group scored significantly higher than childrenwithout FASD. On both behavioral measures thesuspected group scored between the other two groupsand did not differ significantly from either group.Conclusion: FASD is prevalent in children adoptedfrom Poland. Children diagnosed with FASD showmore difficulties in neurobehavioral functioning thanchildren without this diagnosis. Because of theimportance of early diagnosis of FASD, children fromhigh risk populations need to be screened for FASD. Inadopted children multiple confounders might bepresent that complicate screening with a behavioralmeasure. Even though not all children with FASD canbe detected solely based on their neurobehavioralprofile, screening based on behavior might be ahelpful tool.

50Very early pregnancy binge exposure may affectchild behavior

Astrid Alvik

Child and Adolescent Mental Health Research Unit,University of Oslo, Norway

Objectives: In a population-based study, representativeof pregnant women in Oslo, the alcohol consumptionbefore and during pregnancy are described. In addition,a potential association between binge drinking mainlybefore recognition of pregnancy and child developmentand behavioral symptom scores has been explored.Materials & Methods: Questionnaires Q1-Q4 wereanswered at 17 (N=1749) and 30 weeks of pregnancy,6 months after term and at child age 5 ½ year, withrelatively high response rate. In addition to birth dataand child development and behaviour, maternal alcohol

use, smoking and demographic and mental healthvariables were included.Results: In this sample, little alcohol use and littlebinge drinking was reported after pregnancyrecognition. Change in alcohol use occurred mostly atrecognition of pregnancy, also for those with plannedpregnancy. Approximately one fourth of the samplereported very early binge drinking (≥ 5 drinks). In adjusted analyses, frequent very early binge drinkingpredicted more behavioural problems, and was thestrongest predictor of such problems. However, bingefetal exposure did not predict motor development.Conclusion: Behavioral problems may be sensitivemeasures of early binge exposure. Women should beadvised to avoid binge drinking when planningpregnancy.

51Profile of executive and attention functions in asample of 31 Russian adopted ADHD childrencompared with 31 probable genetic ADHD children

Alba Corredera1, Cristina Boix1, Roser Colome1, AnnaLopez- Sala1, Laura Callejon- Poo1, Anna Sans1

1Neurology Service. Sant Joan de Déu’s Hospital.Barcelona

Objective: In recent years there has been a significantincrease in the rates of international adoption in ourcountry. Children from the Russian Federation between1997 and 2007 accounted for 60% of all adoptions(Callejón- Poo et al 2011). Several authors (Gray et al2006, Miller et al 2009) have reported that ADHD isthe cognitive-behavioural disorder diagnosed morefrequently in this population. ADHD is aneurodevelopmental disorder that impairs executivefunction as a primary neuropsychological deficit.During the past decade the incidence of alcoholismamong Russian childbearing age women has increasedby 48% (Gonzalvo- Oliván 2004), so that thesechildren represent a risk factor, along with theinstitutionalization time prior to adoption. Our goal isto compare the profile of executive and attentionfunctions in a sample of children adopted from Russiawith a diagnosis of ADHD, with probable geneticADHD children.Materials & Methods: Thirty one adopted childrenwho consult the Learning Disabilities Unit (UTAE) ofthe Neurology’s Department of Sant Joan de Deu’sHospital (Barcelona), diagnosed of ADHD accordingto DSM-IV, age ranged between 6 and 10 years, werecompared with 31 probable genetic ADHD childrenwho consult in the same unit. We analyze theIntelligence Quotient (IQ), the executive and attentionfunctions and the results of Achenbach’s

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questionnaires and ADHD’s ratings scales both forparents and teachers.Results: Preliminary data suggests that ADHD Russianadopted children have higher internalizing andexternalizing problems (according to Achenbach’sQuestionnaire), lower IQ scores and higher difficultiesin executive and attention functions than the sample ofprobable genetic ADHD children.Conclusions: Russian adopted children tend to havemore cognitive and behavioural problems compared toprobable genetic ADHD children. This profile is theone described in the Fetal Alcohol Spectrum Disorders.Given the importance of cognitive and behaviouralaspects within the family environment, school andsociability, we recommend a routine monitoring ofRussian adopted children to implement therapeuticinterventions as early as possible.

52Sensory processing disorder in children with FetalAlcohol Syndrome Disorders

Bàrbara Viader Vidal

Centre d'Estimulació Infantil de Barcelona (CEIB),Barcelona, Spain

Objectives: The aim of this communication is todescribe Sensory Integration Disorder in childrenaffected by FASD. The main goal is to analyze theeffects of FASD and sensory deprivation in the processof sensory integration. Taking in account that one ofthe main needs for proper neurological developmentare sensory stimuli: what happens when a child doesnot receive the necessary sensory stimuli becausehe/she is living in an orphanage? Moreover, what aboutif this child also is affected by FASD?Materials & Methods: We use the data obtained withSensory Profile Test by Winnie Dunn, administered to500 adopted children, who lived in orphanages. Theanalysis took place in the Centre d'Estimulació Infantilde Barcelona. The recollection date began January2006, and ended June 2012. The children were agedfrom 3 to 12 years old.Results: The lack of sensory stimulation of a childliving in an orphanage has a severe impact ondevelopment. The impact is more severe if the child isaffected by FASD. The sensory processing disorderobserved in adopted children with FASD, affectsbehavior, motor maturity, learning ability, interactionand communication skills.Conclusion: After the data analysis of the SensoryProfile Test, we get different profiles that indicate thatsensory processing disorder is severe in adoptedchildren, and even more severe in children affected byFASD. Both sensory deprivation and FASD have

negative impacts in sensory integration neurologicaldevelopment.The most common sensory processing disorders are:1) Sensory seeker behavior2) Disorganized and disruptive behavior3) Disorders in level of arousal4) Sensory hypersensitivity5) Coordination and praxis disorder

Conclusion: Children adopted from Bulgaria andRomania were the most affected group. Childrenadopted from Russia and Ukraine were the nextaffected group.

53Fetal alcohol exposures and psychiatric symptomsin Brazilian school age children

Maria Luiza Zamboni, Sarah Teófilo de Sá Roriz,Matheus Andrea Angelucci, Erikson Felipe Furtado

School of Medicine of Ribeirao Preto, University ofSao Paulo, Ribeirao Preto, Brazil

Objectives: Children with FASD are at risk forbehavioral and mental health problems. Research in thelast decade describes associations between prenatalalcohol exposure and psychiatric symptoms inchildhood. As far as we know, there was no studyabout this subject for Brazilian children. Therefore, ourmain goal was to investigate in a Brazilian communitysample the relationship between maternal alcoholconsumption in pregnancy and psychopathology in theschool-age offspring.Materials & Methods: The study design was of alongitudinal study, which, started at the third trimesterof pregnancy with the assessment of alcoholconsumption in 449 pregnant women and thatcontinues till to the present with the follow-up of thechildren. This sample had 22.1% of women identifiedas risky alcohol drinkers by means of screening usingthe short questionnaire T-ACE. From the originalsample we have evaluated 59 children of the cohort.Child mental health problems were assessed with theAchenbach Child Behavior Checklist (CBCL) andthrough semi-structured psychiatric interview (K-SADS-PL).Results: We found a statistically significant (p < 0.05)difference for the average total CBCL score whencomparing children of mothers who did not consumealcohol in pregnancy (M = 41 ± 24.3) compared tochildren of mothers with at least once per weekconsumption of alcohol (M = 60.7 ± 36.0), as well astatistically significant difference for the prevalence ofpsychiatric diagnoses (K-SADS-PL) among groups(34.8% x 77.8%; p= 0.017).

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Conclusion: These results suggest an associationbetween regular consumption of alcohol in at leastonce per week pattern during pregnancy withpsychiatric symptoms and diagnoses in the school ageoffspring. This study is most probably the first for aBrazilian sample. The research project will continueforward aiming to expand the assessment of thisBrazilian sample with the inclusion of biochemical,neuroimaging and neuropsychological methods.

54An environmental adaption, a school successguarantee for children with FASD?: the case of theReunion Island

Denis Lamblin1, Eva De Oliviera2, Géraldine Nogrix3,Stéphanie Toutain4

1Early Medical and Social Care Center, Saint-Louis,Reunion Island, France; 2Early Medical and SocialCare Center, Saint-Louis, Reunion Island, France;3Early Medical and Social Care Center, Saint-Louis,Reunion Island, France; 4University Paris CitéSorbonne, Paris, France

Objectives: This communication aims at showing thesocial, demographic and academic characteristics of acohort of 30 children from the Reunion Island, between4 and 15 years old, all diagnosed as FASD. Then, thecriteria for diagnosis used to classify the children arestudied. Last, the characteristics enabling better schoolintegration for these children are identified.Materials & Methods: A retrospective cohort of 30children with FASD was constituted using the data ofthe CAMSP (Centre d’action medico-social précoce,Medico Social Center for diagnosis, rehabilitation andsupport for disabled children from 0 to 6 years old andtheir parents) of Saint-Louis. A questionnaire for eachchild has been filled in information from the data base.The pediatrician met with every child to complete thecriteria for diagnosis and the tests required tocharacterize the syndrome.Results: Three children's profiles emerge from afactorial analysis.Conclusion: A large part of FASD children is enrolledin mainstream classes according to their age but not totheir school level. This gap between schooling classand school level increases as they grow up. Thesyndrome’s invisibility explains FASD childrenpresence in mainstream classes as teachers are lured bytheir "deceiving appearance". Their IQ interpretation isoften misguided, and therefore prevents them fromtheir handicap acknowledgement, and from specialeducational classes integration. And last, their - relative- school success is also better with foster families butwith their biological mother’s approval.

PARALLEL SESSION II.B.

TARGETED PREVENTION

CHAIR: THIERRY MAILLARD

55Cross-disciplinary specialist care for substance-abusing pregnant women and their infants inGothenburg, Sweden, and what the women tell usabout their experience of the care

Antonia Reuter, Thomas Arvidsson

Maternity-Child Healthcare Team in Haga, PrimaryHealth Care, Region Västra Götaland, Department ofHealth Care, Sweden

Objectives: Sweden´s comprehensive, free-of-chargeantenatal and paediatric health care services havealmost 100% attendance and high credibility amongwomen and families. Local antenatal care routines inwestern Sweden now entail a first visit to a midwifeone week after positive pregnancy test and very earlyAUDIT screening and narcotics/nicotine/medicationcounselling for all pregnant women. The specialistteam serves Greater Gothenburg´s substance-abusingpregnant women and their infants with specialistantenatal and paediatric care. The aim of the study wasto evaluate this specialist care.Materials & Methods: Women are referred byantenatal care centres, substance abuse facilities, socialservices or the criminal justice system and some comeon their own initiative. During pregnancy, women seemidwives weekly and most are tested fornarcotic/alcohol regularly. Team members aremidwives, paediatric nurse, social worker, psychiatricnurse, gynaecologist, paediatrician, psychiatrist,assistant nurse. Team conferences determineindividualised care and support for each woman andthe follow-up for infants/women. Extensivecollaboration with social services, psychiatry and thepaediatric health care system is essential. Long-termfollow-up is often required.A quality study will be performed including semi-structured interviews with women that have attendedthe specialist unit, focusing on their experience of thecare.Results: A majority of the patients stay substance-freeduring pregnancy, and no cases of FASD (fetal alcoholsyndrome) or other serious neonatal effects ofsubstance abuse have been diagnosed so far. Furtherresults will be presented.Conclusion: The evaluation shows the benefits of themultidisciplinary team, continuity, treatment and theindividualised, structured but at the same time flexible

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support for the women. The women narrated about thereception, not being stigmatized and they did not feelbelittle.

56Evaluation of Fetal Alcohol Spectrum Disorder(s)training & education events in three European sites

Liam Curran

Certified Fetal Alcohol Specturm DisorderEducator/Senior Supervising Social Worker, FosteringPeople (Ireland)

Objectives: Fetal alcohol spectrum disorders (FASDs)are preventable birth defects directly linked toconsumption of alcohol during pregnancy, resulting in asignificant public health cost burden. Current estimatessuggest that 1% or 5 million people are living with fetalalcohol brain injury in Europe. Many medical and alliedhealth professionals are key to (1) primary prevention ofFASDs through working with women of childbearingage and (2) secondary prevention through working withaffected individuals whose lives can be greatly improvedwith knowledge based interventions. The aim of this workwas to demonstrate the pressing and urgent need forEuropean health and allied health service providers toupskill their employees with the knowledge and ability todeal and manage FASD affected children & adults.Materials & Methods: Participants were drawn fromSocial Work, Psychology and Foster & AdoptiveParents who participated in FASD training in threedifferent European sites (Ireland, United Kingdom, andPoland) during 2011. Training was delivered usingcore material from Fetal Alcohol Spectrum Disorder(s)Competency – using Curriculum Development Guidefor Medical and Allied Health Education and Practice(CDC) alongside relevant local data of prevalence ratesof FASD and drinking rates in pregnancy as applicableto the site of the training. Data was collated usingstructured evaluation questionnaires along with themedgroup work within the training events.Results: Evaluations from these multi-site trainingevents suggest that Training, Education and Policydevelopment concerning FASD is sought by alliedhealth professionals, Foster & Adoptive Parents inorder to properly respond to the needs of individualsliving with FASD. The data suggests that there is anincreased need for awareness of the life long disabilityof FASD and the complex problems faced byprofessionals to respond in a professionally competentmanner.Conclusion: The evaluation of three Europeantraining events suggest that competence, especially whenviewed separately in terms of knowledge versus capacityfor application of information, in the area of FASDs is

lacking in both the provider and caring professionals.Addressing this may be best achieved through theundertaking of a structured ‘Training Needs Analysis’ inmultiple sites throughout the EU.

57Preventing prenatal alcohol use via healthcounseling by midwives and Internet-basedcomputer tailored feedback: a randomizedcontrolled trial

Nickie Y van der Wulp1,2, Ciska Hoving2, Wim vanDalen1, Hein de Vries2

1Dutch Institute for Alcohol Policy (STAP), Utrecht,The Netherlands; 2MaastrichtUniversity/CAPHRI/Department of Health Promotion,Maastricht, The Netherlands

Objective: It is estimated that 35 to 50% of the Dutchpregnant women continue to consume alcohol inpregnancy despite the accumulating evidence that evenlow levels of prenatal alcohol exposure can causeadverse neurobehavioral effects in children. We usedan RCT to test the effectiveness of a health counsellingmethod by midwives (HC) and an Internet-basedcomputer tailored method (CT) in reducing prenatalalcohol use.Materials & Methods: Sixty midwife practicesrecruited 400 pregnant women who had consumedalcohol since they knew they were pregnant. Nineteenpractices (138 respondents) were assigned to the HCcondition and provided brief health counseling andself-help materials to stop drinking alcohol. Twenty-one practices (118 respondents) were assigned to theCT condition. Pregnant women of these practicesreceived personalized tailored feedback via theInternet. Twenty practices (144 respondents) wereassigned to the control group (CG); respondents ofthese practices received routine alcohol advice. Themain outcome measures were alcohol abstinence andalcohol use three months after baseline. Multilevelmultivariate logistic and linear regression analyseswere conducted to investigate whether HC and CT inaddition to potential confounding and moderatingvariables had an effect on the outcome variables.Results: Multilevel logistic analyses with alcoholabstinence at T1 as outcome variable showedsignificant differences between CT and CG. CTsignificantly decreased alcohol use at T1 (odds ratio0.379, 95% confidence interval 0.145 – 0.990)compared to CG. Differences between HC and CGwith regard to alcohol abstinence at T1 were notsignificant. Multilevel linear analyses with averagealcohol consumption at T1 showed a significantinteraction effect between condition and alcohol use

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before pregnancy. HC was more effective forrespondents with a lower alcohol use before pregnancycompared to respondents with a higher alcohol usebefore pregnancy (regression coefficient B 0.027, 95%confidence interval 0.014 – 0.041).Conclusions: More research is needed to understandwhy HC interacts with alcohol use before pregnancy.This significant interaction may imply that midwivesprovide different educational messages on alcohol inpregnancy to different clients. Another explanationmay be that the effectiveness of HC for pregnantwomen who used a small amount of alcohol beforepregnancy is due to the content of the intervention.Nevertheless, this research has shown that CT is aneffective intervention to increase alcohol abstinence ofpregnant women. A nationwide launching of thisrelatively inexpensive method has high potential todecrease the number of Dutch pregnant women usingalcohol.

58A randomized trial: telephone vs. in-person briefintervention to reduce the risk of an alcohol-exposed pregnancy

Georgiana Wilton1, D Paul Moberg2, Kit R VanStelle2

1University of Wisconsin-Madison School of Medicineand Public Health, Department of Family Medicine,Madison, Wisconsin, USA; 2University of Wisconsin-Madison Department of Population Health Sciences,Madison, Wisconsin, USA

Objectives: The adverse effects of alcoholconsumption during pregnancy have been widelyreported, and represent a leading preventable cause ofphysical and cognitive birth defects in the UnitedStates (Bertrand, 2009; Hoyme et al., 2005; Wilton andPlane, 2006). Brief, effective interventions are neededto reduce the risk of an alcohol-exposed pregnancy insexually active women who drink and do not useeffective contraception.Materials & Methods: The Healthy Choices studycompared the efficacy of a brief intervention deliveredeither over the telephone or in-person. In addition toindicators of alcohol use, contraception methods andcompliance were examined, along with measures ofmood and domestic violence. Women between the agesof 18 and 44 who were drinking above recommendedlevels and not using effective contraception wererandomly assigned to either a telephone interventiongroup (n=68) or in-person intervention group (n=63).Results: Overall, participants showed significantreductions in alcohol use, and increases in effective useof contraception (thus reducing their risk of an alcohol-exposed pregnancy). There was no significant

difference in success of the intervention between thetwo conditions (telephone vs. in-person).Conclusion: Telephone-based brief intervention can besuccessful and cost-effective in reducing the risk of analcohol-exposed pregnancy and the incidence of fetalalcohol spectrum disorders.

59Preventing FASD by supporting pregnant,substance using women with FASD: new evidence-based promising practices from Canada

Lynda Dechief1,2, Deborah Rutman2,3,4

1Equality Research & Consulting, Nelson, Canada;2Canada Northwest FASD Research Network,Preventing FASD from a Women’s SocialDeterminants of Health Perspective Network ActionTeam; 3Faculty of Human and Social Development, &Senior Research Associate, School of Social Work,University of Victoria, Canada; 4Substance UsingWomen with FASD and FASD Prevention Project

Objectives: Participants will leave the workshop with:1) Increased knowledge regarding emerging/promisingpractices in supporting substance using women withFASD2) Enhanced understanding of what women with FASDfind helpful when accessing health and social care,including substance use treatment3) Improved understanding of what are FASD-informed approaches and accommodations to practiceand programming4) Improved capacity to make FASD-informedaccommodations to their own communication andpractice and in their ownprograms/organizations/research.

Materials & Methods: Participants will activelyengage with the workshop material through a variety offormats and media, including:1) Small and large group discussion/interaction,2) Presentation and discussion of video clips profilingthe experiences of women with FASD in accessingsupport and services,3) An interactive ‘case scenario’ activity,4) An exercise on applying the workshop learnings intheir own service or program,5) As well, handouts and resources materials will beprovided so that participants are able to take keyinformation away with them.

Results: This skill building workshop will engageparticipants in interactive knowledge transfer of thefindings from the Substance Using Women with FASD

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and FASD Prevention Project, a three-yearcommunity-based research project which involved acomprehensive literature review, interviews withservice providers regarding their perspectives onpromising approaches in working with women withFASD, and voices of women with FASD regardingwhat had worked for them in addressing theirsubstance use problems.Conclusion: Through engaging in this workshop,participants will learn to put promising approaches intopractice in their own service or program.

60Results for babies of mothers who wereinvoluntarily hospitalized during pregnancybecause of alcohol and substance abuse

Egil Nordlie

Borgestadklinikken, Skien, Norway

Objectives: Norwegian legislation gives theopportunity to hospitalize substance abusing pregnantwomen against their own will if there is a highprobability that the substance abuse will cause damageto the child. Reducing the risk of FASD is one of theintentions of this legislation. The former NorwegianSocial Services Act, section 6.2a – from January 2012incorporated in a new Community Health Care Act,Section 10.3 – was carried into effect in 1996 andNorway is probably the only country in the worldhaving an act like this. Borgestadklinikken, located inSkien, Norway, has a special treatment unit for thesewomen.Materials & Methods: Birth weights, lengths andhead circumferences of the babies of 54 voluntarily and110 involuntarily hospitalized mothers were comparedand both categories were compared to the nationalaverage. Alcohol and substance abuse of their motherswere charted. Birth weight is a significant indicationrelated to health conditions for the child duringpregnancy, including alcohol exposition. Birth weightswere also correlated to the duration of thehospitalization.Results: The progress of the coercion is described. Thetreatment of the women and the women’s health factorsare described. Exclusively alcohol abuse was thereason for compulsory treatment in five cases andtwenty-five women had been drinking alcohol as asupplement to other drugs in their pregnancies. Birthweight of the babies of involuntarily hospitalizedmothers was in average 3165g and 3362g for babies ofvoluntarily hospitalized women. When involuntarilyhospitalized mothers stayed in the clinic for more than140 days, the average birth weight of their children was3512g. When their stays were shorter, the average birth

weight was 483g lower. During the last years theduration of the stays increased and deliveries occurredcloser to expected birth.Conclusions: If necessary to use this act, it will havepositive effect on the child when sanctions are made asearly as possible during pregnancy, which willconsequently reduce the risk of developing FASD.However, fewer pregnant women with alcohol abusethan expected have been hospitalized atBorgestadklinikken – considering alcohol being a legaland the most common substance, and despite the factthat alcohol is the most toxic substance for the fetus.The reasons why relatively few pregnant women withalcohol abuse are hospitalized against their own will,compared with the number of women with othersubstance abuse, will be discussed. Attitudes amonghealth staff is an important factor.

PARALLEL SESSION II.C

PREVALENCE OF FASD

CHAIR: MAURO CECCANTI

61Prevalence of FAS in Germany

Reinhold Feldmann

Department of Pediatrics, University HospitalMuenster, Germany

Background: In several studies, the prevalence of theFetal Alcohol Syndrome (FAS) is reported to be 1:300in the western countries. No data for the prevalence ofFAS in Germany, however, have been published yet.Materials & Methods: We assessed the prevalence ofFAS in 267 German foster children using the FetalAlcohol Syndrome Questionnaire (FASQ).Results: FAS was found in 23.4% of the assessedfoster children. Eighty percent of children with FASare living in foster or adoptive families or inorphanages/special care. Assuming that the percentageof FAS is the same for all these forms of care, thenumber of children with FAS in Germany is 47.000.This is one in 282 newborn children.Conclusion: The prevalence study, althoughperformed on a sample of foster children only, isyielding some evidence for a prevalence of FAS inGermany that is comparable to those reported for otherwestern countries.

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62Fetal Alcohol Spectrum Disorder in a preadoptionclinic in Israel – the tip of the iceberg?

Ariel Tenenbaum, Pnina Hertz, Talia Dor, Yael CastielAlon Sapir, Isaiah D Wexler

Medical Unit for Adoption and Foster Care,Department of Pediatrics, Hadassah UniversityMedical Center, Mount Scopus Campus, Jerusalem,Israel

Objectives: To determine the number of children withFASD or at risk for FASD in a select population ofhigh risk patients seen at a clinic evaluating foster andadopted children in Israel. Israel is a country in whichrelatively few cases of FASD have been formallydiagnosed and the prevalence has not beensystematically evaluated.Materials & Methods: Israeli children under 2 yearsold who were candidates for domestic adoption or infoster care were prospectively evaluated for clinicalmanifestations of FASD based on modified Institute ofMedicine criteria, and information was obtainedregarding parental use of alcohol or other illicit drugs.Results: Of the 100 patients prospectively evaluated, 8had mothers with a known history of alcoholconsumption during pregnancy. Two of the childrenhad fetal alcohol syndrome (FAS) without knownmaternal exposure to alcohol and two had partial FAS.Eleven other children were at risk for development ofone of the diagnostic categories of FASD.Conclusions: In a population of pre-adoption andfoster children, 15% either had manifestations ofFASD or were at risk for developing FASD. Althoughthis is a select high risk population, the data from thisstudy strongly suggest a greater prevalence of FASD inIsrael than previously assumed. This increase may berelated to the increasing consumption of alcohol amongadolescents and young adults living in Israel. Under-diagnosis of FASD is detrimental to affected childrenwho could benefit from early and targeted interventionsespecially designed for FASD. Implementation ofpublic health educational programs for the populationas well as formal updates for the medical personnelmay reduce the prevalence of FASD and prevent itsdetrimental affects.

63FASD diagnostic detection rate in Germany

Ekkehart Paditz1

1Zentrum für Angewandte Prävention - Centre forApplied Prevention, Rähnitzgasse, Dresden, Germany

Email: [email protected],

Objectives: Systematic epidemiological data forFAS(D) from Germany are not yet available (Spohr,2008). We were interested in determining what numberof patients should be assumed to exist in Germany,based on international incidence data, and whatproportion of patients with FAS(D) has already beendiagnosed.Materials & Methods:1) Analysis of the number of patients per year officiallydetermined in Germany in the context of DiagnosisQ86.0 (www.gbe-bund.de).2) Additional determination of the number of livebirths per year in Germany as well as the number andage distribution of deaths with Q 86.0.3) Analysis of previously published case series andcase reports from Germany (PubMed etc.). In thepresence of case series of a study group publishedseveral times under different aspects, the publicationwith the highest case number was considered.Results:1) In the years 2001 to 2010, in the hospitals ofGermany 11-62 cases per year were registered with theDiagnosis Q 86.0. Assuming a FAS(D) frequency of0.5/1,000 live births for FAS and of 2.0 and 5.0 forFASD, in Germany one can assume an incidence of367 FAS and up to 3,672 FAS(D) cases per year. Witha year-by-year observation, therefore, in Germany only0.3-16.4% of all assumed FAS (D) cases per yearamong inpatient conditions were diagnosed (detectionrate regarding FAS 3.3 to 16.9%, regarding FASDincluding FAS 0.3-4.2% per year).2) The mortality rates that can also be determined inGermany, with 4.71% per year for children 0-10 yearswith Q 86.0, reflect international data. From theincidence and mortality figures for Germany, aprevalence of 3,298 cases with FAS at the age of 0-10years can be determined; for FASD there were 33,037cases.3) Between 1974 and 2012, in case series and casecontributions from Germany (including East Germany,former GDR) reports on 628 patients with FAS(D)were published. This corresponds to 16-17patients/year.Conclusion: In Germany since 1974, particularlythrough the work of Spohr, Majewski, Löser andSteinhausen, a considerable amount of medicalknowledge about FASD has been accumulated. Inhospitals, only 0.3 to 16.4% of all assumed FAS(D)cases were registered under the ICD 10 No. Q 86.0.This suggests that the attention of physicians must bemore intensively drawn to the issue. On aninternational level it is necessary that the ICD 10 beupdated with respect to FAS (D), because with the

mailto:[email protected]

http://www.gbe-bund.de/

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diagnosis No. Q 86.0 the diagnosis FAS(D) is notadequately covered.

64The prevalence of fetal alcohol spectrum disordersand concomitant disorders among orphanagechildren in Lithuania

Erika Kuzmenkovienė1, Audronė Prasauskienė2, MildaEndzinienė1

1Neurology Department, Lithuanian University ofHealth Sciences, Kaunas, Lithuania; 2Children’sRehabilitation Department, Lithuanian University ofHealth Sciences, Kaunas, Lithuania

Objectives: According to the WHO, Lithuania is in a12th position of adult (15+) per capita alcoholconsumption in the world. There is no data on theprevalence of fetal alcohol spectrum disorders (FASD)and concomitant disorders in the country. The purposeof this study were to determine the actual prevalence ofFASD and concomitant somatic disorders among thepre-school age children living in orphanages inLithuania, and to assess the prevalence of pre-studydiagnosed cases.Materials & Methods: A cross-sectional study wasperformed in 5 orphanages (Babies’ homes) where 337children were examined. The pediatric examinationincluded anthropometric measurements (height,weight, occipito-frontal circumference) and phenotypicscreening. Perinatal and postnatal clinical anddevelopmental history, also cognitive/behaviouralaspects were assessed from medical documentation,interviews with caretakers and nurses. Revised IOMcriteria for the diagnosis of FASD were used (Hoymeet al., 2005). In addition, 16 children diagnosed withfetal alcohol syndrome (FAS-16 group) underwentmore detailed investigation: cranial CT scan,audiometry, auditory brainstem response (ABR),abdominal ultrasound, ophthalmoscopy, sleep EEG,evaluation by endocrinologist.Results: FASD was identified in 40% (134) ofchildren; FAS was found in 22%, partial FAS in 7%,and alcohol-related neurodevelopmental disorders in11%. FASD diagnoses prior to the study have beensuspected in 29.9% of these children. In the FAS-16group, the following findings have been recorded:cerebral dysmorphism in 7/16 (43.8%); hearingdisorders confirmed by audiography in 9/14 (64.3%),with a medium or severe hearing disorder in fivechildren; abnormal ABR in 7/13 (53.8%); retinalchanges in 5/16 (31.2%); nonspecific changes on sleepEEG in 9/16 (56.3%); one child was diagnosed withhepatomegaly and one with hypopituitarism.Conclusion: This study, being the first one in

Lithuania focused on FASD, has shown that FASD ishighly prevalent in children at orphanages, however,underdiagnosed. Also, awareness and knowledge ofspecialists in the topic seems to be insufficient. Hearingdisorder is worthy of note for its high prevalence inFASD population and for its possible impact onneurodevelopment.

65Anthropometric birth data, sex, and fetal alcoholexposure in a Brazilian community sampleFabiana Spineti dos Santos1,2, Poliana Patrício Aliane2,Patrícia Maria dos Santos D'Andrea Parpinelli2, LarissaHorta Esper2, Erikson Felipe Furtado2

1Faculdade de Ciências Farmacêuticas de RibeirãoPreto, Ribeirão Preto, Brazil; 2Faculdade de Medicinade Ribeirão Preto, Ribeirão Preto, Brazil

Objectives: Alcohol consumption by pregnant womenis related to fetal damage resulting in a large spectrumof physical and behavioral problems in the offspring.This study aimed to assess fetal exposure to alcohol inpregnant women through questionnaires, interviewsand postpartum data in a Brazilian sample of pregnantwomen.Materials & Methods: Data were collectedlongitudinally from 66 pregnant women since the firsttrimester of pregnancy as well from their newborns. Allparticipants are living in the region of Ribeirao Preto,State of Sao Paulo, Brazil. The questionnaires T-ACE(Tolerance, Annoyed, Cut down, Eye-Opener) andAUDIT (Alcohol Use Disorders Identification Test)were employed as screening instruments for alcoholuse. Postpartum information was collected such as:birth weight and length, childbirth delivery type andnewborn gender.Results: T-ACE positive pregnant women scored 2.69 ±0.79 and 9.2 ± 4.1 in the questionnaires T-ACE andAUDIT (N = 36), respectively. The average numberof drinks in the first, second and third trimester was50.4, 12.6 and 15.7, respectively for the T-ACE positivegroup. Two thirds (66.67%) of the sample of pregnantwomen were found as AUDIT positive (cut-off ≥ 7.0). A statistically significant inverse Spearman correlation wasfound only for newborns of female sex for birth lengthand AUDIT total score (N = 16, rho = - 0.556, p = 0.025).No newborn was found as a clinical FAS case, and allother birth parameters were found in the normal range.Conclusion: No statistical differences were observedin relation to anthropometric variables except for birthlength in the female newborn. Meconium samples havebeen collected and will help to complement this study,allowing comparison of these values with theinformation provided by pregnant women and

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providing an objective measure in order to validate thefindings.

PARALLEL SESSION III.A

4-DIGIT CODE

CHAIR: RUDI KOHL

66The diagnosis of FASD using the 4-digit code

Rudi Kohl

FASD clinic, Jonx/Lentis, Winschoten, Netherland

Objectives: The only biographic study performed inEurope (Italy) to date suggests that FASD has a muchhigher prevalence than previously suspected. FASDremains difficult to diagnose and requires a multidisciplinary approach. Since 2004 at the 1st FAS clinic,Zutphen, Netherland; and subsequently since 2008 atthe 2nd FASD clinic, Winschoten, Netherland; we haveused the 4-digit code as diagnostic basis. The maingoal is to share our experience and demonstrate thepractical application of the 4-digit code in a workshopapproach.Materials & Methods: The workshop will cover adiscussion of teratogens, embryology, and toxicologyof alcohol to better understand the application of the 4-digit code. The tools and application of the 4-digit codewill be demonstrated. The incidence with reference topossible genetic preventive factors and socialconsequences with guidelines to further managementwill be discussed.Results: The participants will be able to establish thediagnosis with greater confidence.Conclusion: The 4-digit code is a practical and usefultool in establishing the diagnosis of FASD

PLENARY SESSION VI

THE FUTURE OF FASD

CHAIR: DIANE BLACK

67Fetal Alcohol Spectrum Disorders: Past, present,future

Kenneth R Warren

National Institute on Alcohol Abuse and Alcoholism,NIH, USA

Background: In a worldwide context, attitudestowards the alcohol consumption in general, and morespecifically the use of alcohol in pregnancy, has beeninfluenced by the events surrounding temperancemovements arising in the late 19th and early 20thcentury. These movements resulted in theimplementation of temperance policies in manyEuropean countries and total alcohol sale orconsumption prohibition in some European counties aswell as in Canada and the United States. The societalrejection of prohibition and some of the morerestrictive aspects of temperance lead to changes inpublic attitudes on alcohol including the unwarrantedrejection of existing research findings on alcohol’seffects in pregnancy. The unjustified acceptance ofalcohol as an agent totally devoid of any potential riskto fetus in the mid-twentieth century has created asignificant public health dilemma that those who aretoday involved in education and clinical care still striveto overcome. There are challenges that researchersmust face as well for these historical events.

68The Collaborative Initiative on Fetal AlcoholSpectrum Disorders (CIFASD): an update

Edward P. Riley

Center for Behavioral Teratology and Department ofPsychology, San Diego State University, San Diego,CA, USA

Objectives: The Collaborative Initiative on FetalAlcohol Spectrum Disorders (CIFASD) wasestablished by the National Institute on Alcohol Abuseand Alcohol (NIAAA) in 2003 with the overall goal ofimproving the diagnoses of fetal alcohol spectrumdisorders (FASD). It is a multidisciplinary, multisite,international project combining both clinical and basicscience projects. To date, CIFASD it has involvedprojects in seven different countries, including four inEurope. The major objective is to provide an overviewand update on CIFASD, highlighting majoraccomplishments to dateMaterials & Methods: CIFASD utilizes acomprehensive approach to many of the criticalquestions in FASD research including improveddiagnosis and enhanced understanding of thedysmorphology, neurobehavioral phenotypes, andneuropathology associated with prenatal alcoholexposure. One goal of CIFASD is to integrateinformation from three modalities (brain, face, andbehavior) at a variety of ages, to guide earlyrecognition of FASD with greater sensitivity. Ourresearch projects utilize state-of-the-art techniques in

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brain imaging, craniofacial image analysis, behavioralphenotyping, and genetics.Results: Our brain imaging project is examining datalongitudinally, as preliminary data suggest a differencein the trajectory of brain developmental betweenalcohol-exposed and control children. Our behavioralprojects are refining the profiles of cognitive deficitsfollowing prenatal alcohol exposure, and showingsimilarities and differences between behaviors ofchildren with an FASD compared to those with ADHD.Our work on facial imaging may better identify notonly individuals with FAS, but also those withsubclinical features. We are examining potentialbiomarkers of alcohol exposure, and how genetic andnutritional variables modify FASD to better identifyindividuals with, or at risk for FASD.Conclusion: Our efforts are accelerating progress inidentifying children with prenatal alcohol exposure,which we envision will lead to earlier and improvedinterventions. This work should inform promisingpractices in the identification and treatment ofindividuals exposed to alcohol prenatally.

69FASD as an important topic in Europe wide alcoholpolicy

Lauri Beekmann

Eurocare, NordAN, Estonian Temperance Union,Estonia

Background: This presentation will introduce thecurrent situation of European alcohol policy from thepoint of a Europe-wide alliance of NGOs. As theEuropean alcohol strategy, which has protection ofunborn children as one of the priority themes, is endingthis year, the presentation will explore the futureoutlook for the next strategy and how it could influencethe FASD situation in EU States.Methods: The presentation will also focus onEurocare, which is the leading alcohol policy orientedNGO alliance in Europe and has been focused onFASD for several years. It will introduce the ways howthis wider network could help to decrease alcoholrelated harm, including the prevalence of FASD.

70Reducing alcohol related harm – the role ofmidwives

Susanne Simon,

European Midwives Association (EMA)

Background: The European Midwives association(EMA) is a non-governmental organization ofmidwives, representing midwifery associations from allmember states across Europe. EMA is an activemember of the European Alcohol and Health Forum.To reduce alcohol related harm midwives are gatekeepers and can play an essential health promotion anddisease prevention role in the provision ofpreconception and antenatal care. Results of a surveyundertaken by EMA showed that discussion aboutalcohol related harm with women and their partners is acommon practice undertaken by midwives sometimesalready pre-conceptually but mainly during pregnancy.Midwives are ideally placed to educate and informwomen and their partners about the harmful effects ofhazardous alcohol consumption preconception, duringpregnancy and the whole childbearing period.

POSTERS

71Berliner EvAS - A new tool for detection andcategorization of alcohol consumption in pregnancy

Jan-Peter Siedentopf1, Manuela Nagel1, DieterHüseman2

1Infektionsambulanz, Klinik für Geburtsmedizin,Campus Virchow-Klinikum, Charité –Universitätsmedizin Berlin, Berlin, Germany; Klinikfür Neonatologie, Campus Virchow-Klinikum, Charité– Universitätsmedizin Berlin, Berlin, Germany

Objectives: Early detection of maternal alcoholconsumption in pregnancy is the crucial point inprevention and/or early diagnosis of FAS and FASD.The tools currently in use for patient interrogation arethe same tools used for detection of alcohol usedisorders in non-pregnant subjects. Questionnaires likethe CAGE, T-ACE, AUDIT and TWEAK are wellestablished to detect a high and/or regular consumptionof alcohol, whereas they can cause denial in subjectswith low alcohol consumption leading to false negativescreening results. Our aim was to develop a newquestionnaire with reduced risk for false negativeresults.Materials & Methods: We developed a questionnairethat includes an evaluation system for immediate riskstratification. In retrospective testing using patient filesas well as a prospective study applicability of the“Berliner EvAS”-questionnaire has been tested.Results: “Berliner EvAS”-questionnaire is an easy touse, non-stigmatizing tool to detect alcoholconsumption in pregnancy. In our retrospective

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analysis, risk stratification by “Berliner EvAS” showsgood consistency with data from biochemical screeningresults for alcohol.Conclusion: Early detection of FAS and FASD relieson diagnosis of maternal alcohol consumption. Withthe risk stratification of “Berliner EvAS”, pregnancycounseling can focus on patients at risk for alcoholrelated birth defects. At the second EuropeanConference on FASD, we present an Englishtranslation of our tool.

72Learning how to live one’s own life: growing up isstill a major challenge for young adults with FASD

Heike Hoff-Emden

KMG Rehabilitation Center, Ellrich/OT Sülzhayn,Germany

Objectives: Growing up is for FASD patients verydifficult because they lack autonomy and professionaltraining, which are a precondition for leading anindependent life. Reasons are deficits in executivefunctions (for example working memory,concentration, alertness) and permanent high stresslevel/stress intolerance caused by the alcohol-harmedbrain during pregnancy and harmful postnatal familysituation.Materials & Methods: We developed an anti-stresstraining for young adults, who live in a high-frequentlyserved care group. First, the social caregiver filled outthe SDQ-questionnaire in order to be informed aboutsocial, emotional, health problems. Initially, threefemale and three male FASD–adults, aged between 19and 24, were supposed to join a single training once aweek for 5 times in their own premises. As explicitlywished by the subjects, one social caregiver wasalways present at the training. In order to learn how torelax, we asked the participants to describe theirfeelings and to acquire certain methods for reduce theirstress level.Results: Only one or two of the FASD-residents tookpart in this training. The result showed that only onewell prepared activity at a time is possible. Moreover,FASD adults constantly need someone to support themthroughout the day. Finally, to be sustainable thetraining needs to be repeated every day.Conclusion: Adults suffering of FASD need a longtime before becoming 18, a concept of transition totheir adult life that includes autonomous living,acquiring professional skills and accepting theirdisability. As a consequence, it is very important tointroduce objectivities to carry out certain functionsand disabilities, for example supported by ICF-CY

(independent from IQ). National authorities have to beinformed and have to accept this fact. Social rightsneed to be adapted and practiced well enough to makeyoung FASD adults benefit most. These ideas can befound in one of our papers for the German ministry ofhealth. Additionally, a fully functioning network needsto be installed. National guidelines are in progress.Insummary, the ideas mentioned above seem to be theonly possible way to support young adults with FASDin the process of growing up.

73Creating a circle of hope: supporting birth mothersto prevent FASD


Objectives: Women who have used alcohol or otherdrugs while pregnant are likely to drink in their nextpregnancy without support. Women need a safeenvironment to discuss and share their feelingsregarding their use while pregnant. Mothers thatdiscover that their drinking has caused problems fortheir children will experience tremendous guilt andshame, and a long process of grief.Participants will be able to describe the model of theNational Organization on Fetal Alcohol Syndrome(NOFAS) Circle of Hope (COH), birth mothersnetwork. The attendees will be able to discuss many ofthe successes of the program including the peermentorship component, the Women in RecoverySummits, the COH annual meeting, and the COHnational speaker’s bureau.Materials & Methods: The speaker will use a PowerPoint presentation, photos and graphics, and a DVDRecovering Hope. The audience be provided with anoverview of the history of the network, the componentsof the program and will learn from the many stories ofthe members of the COH. Participants will receive freeNOFAS COH FASD prevention materials andmaterials from the Centers for Disease Control (FactSheets, brochures, FASD Diagnostic publications,posters, and Recovering Hope DVD’s).Results: Conference participants will be introduced tothe steps that NOFAS and a U.S. government agencytook to educate the highest risk group for having achild with FASD, women with alcohol dependencies,about FASD. They will learn how NOFAS organizedtheir peer mentoring program for birth mothers andtaught them how to speak in open forums about theirprenatal alcohol use.Conclusion: The audience will discover theimportance of developing programs that support birthmothers and address the stigma associated withdrinking while pregnant. Reaching birth mothers has

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global reach and countries from across the seas can beconnected to work together to support women toprevent FASD.

74Towards an evaluation framework for community-based FASD prevention and FASD supportprograms

Deborah Rutman1,2, Nancy Poole2,3, Sharon Hume1,Marilyn Van Bibber1,2, Carol Hubberstey1

1Principal, Nota Bene Consulting Group, Victoria,Canada; 2Canada FASD Research Network, PreventingFASD from a Women’s Social Determinants of HealthPerspective Network Action Team; 3British ColumbiaCentre of Excellence for Women’s Health, VancouverCanada

Objectives: This presentation will share findingsarising from a project in Canada that aims to identifypromising evaluation methods and create commonevaluation frameworks and tools for FASD preventionprograms serving pregnant women and mothers, andsupportive intervention programs for youth and adultsliving with FASD.In this conference session, participants will have theopportunity to:1) Enhance their knowledge about evaluation

practices and frameworks, particularly in relationto FASD prevention and support programs

2) Discuss and provide feedback on this project’semerging conceptual ‘maps’ and web-based‘toolkit’ for FASD-related programming andinitiatives

3) Be linked to web based resources related to theproject.

Methods & Materials: Following an extensive reviewof existing frameworks, methods and indicators ofsuccess being used by FASD programs, in the fall of2011 the project team facilitated day-long consultationswith program providers and researchers in threeregions of Canada. We received input on keyoutcomes, indicators, and respectful and effectiveapproaches and tools for collecting evaluation andoutcome data. The team then created three ConceptualMaps, which may be used as tools for conceptualizingevaluation and describing the connection betweenprogram philosophy and program activities, formativeoutcomes, and client, community, and systemicoutcomes.Results: In this conference session, we will present theConceptual Maps, and session participants will beinvited to provide feedback and discuss theirexperiences of promising practices in evaluation, as

well as policy and ethical implications for FASDprogram development, delivery and evaluation.Conclusion: The importance of strong evaluation inthe development and delivery of FASD-relatedprograms and services cannot be overstated. Throughparticipation in this workshop, participants will learnabout FASD prevention and intervention programming,and will build understanding about useful and use-ableapproaches to evaluation practices – i.e., what works,for whom and in what context.

75Morbidity in children of mothers who have receivedin-patient health or social care due to an alcohol ordrug related diagnosis

Ilona Autti-Rämö1, Kirsimarja Raitasalo2, MarjaHolmila3

1Research Professor, Chief of Health Research, TheSocial Insurance Institution, Research Department,Helsinki, Finland; 2Researcher, PhD, National Instituteof Health and Welfare, Alcohol and Drugs; 3ResearchProfessor, National Institute of Health and Welfare,Alcohol and Drugs

Objectives: The focus of this study is to analyzewhether maternal alcohol or drug related diagnosesleading to in-patient health or institutional social carewere related with higher prevalence of diagnosessuggestive of abnormalities in neurological,neurobehavioral or visual development in the offspringduring their first 7 years of life.Materials & Methods: The data of this study consistsof the entire cohort of children born in Finland in 2002(n=55547) and their biological mothers (n=54686). Thefollowing register based data covering the years 1998-2009 for the mothers and 2002-2009 for the childrenwere used in this study: 1) Information on in-patientmedical treatment of the mother due to an alcohol ordrug related diagnosis, 2) mother's use of institutionalsocial care due to substance use problems and relateddiagnoses, and 3) children’s predefined diagnosticgroups (F70-79, F80-89, F90-99, G40, G80 and Q86)requiring in-patient care.Results: 856 (1.56%) of mothers had been treated foralcohol or drug related diagnoses either in a health orsocial care setting. Their children had a significantlyhigher frequency of diagnoses in the ICD-10 diagnosticcategories F 80-89 (pervasive and specificdevelopmental disorders, 9.93% vs. 4.48%, p<0.001), F90-99 (behavioral and emotional disorders, 9.00% vs.3.15%, p< 0.001), G80 (cerebral palsy and otherparalytic syndromes, 0.82% vs. 0.2%, p=0.001), andQ86 (teratogenic dysmorphic syndromes, 1.87% vs.0.02% p<0.0001). No significant differences were

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observed for the diagnostic groups F70-79 (mentalretardation, 0.23% vs. 0.35%) or G40 (epilepsy, 0.9%vs. 0.7%)Conclusion: Maternal alcohol and/or drug abuserequiring in-patient health or social care was connectedwith a substantial increase in offspring morbidity bothin neurological and neurobehavioral disorders as wellas dysmorphic syndromes caused by teratogenicagents.

76Choices are simple...there’s no safe time for liquor;not with a baby in the picture

Alaina Thursby1

1Fetal Alcohol Spectrum of Services, Bissell Centre,Edmonton, Canada

Objectives: Awareness, education, and prevention arekey to eliminating Fetal Alcohol Spectrum Disorder(FASD), which is a 100% preventable lifelongdisability. The aim of this presentation is to shareresources and ways that the community is beingengaged in Edmonton, Canada. The main goals are toraise awareness, provide new resources, and to getconversations started so that we can put forth a clearmessage that no alcohol is best during pregnancy. Amusic video and cell phone ringtone have just beencreated and released in order to target youth and youngadults. This video is a unique resource that is beingused in various settings and has received extensivepositive feedback. Prevention initiatives and a publichealth message will be at the forefront of thisinteractive presentation.Materials & Methods: A power point presentationwill be used. Also, print materials will be handed out,the music video ‘You Can Choose’ will be shown thathas been created in partnership with the Fetal AlcoholSpectrum of Services (FASS) and the Edmonton FetalAlcohol Network (EFAN), and information will beprovided on how to access the free ringtone.Results: The presentation shared resources andprovided information on what new and unique tacticsare being used in the Edmonton community to raiseawareness about this invisible, preventable disability.Conclusion: As a community it is our responsibility towork together to raise awareness and to educate onFASD. By providing information and having an opendiscussion we can help to start these much neededconversations and begin to break down the stereotypes,misconceptions, and stigma associated with alcohol,pregnancy, and FASD.

77Whole body composition analysis using air-displacement plethysmography in children withprenatal alcohol exposure

Nora Dörrie1, Inga Freunscht1, Manuel Föcker1,Michelle Margold1, Lena Janssen1, Sebastian Wölfle1,Özgür Albayrak1, Johannes Hebebrand1

1Department of Child and Adolescent Psychiatry andPsychotherapy, University of Duisburg-Essen,Germany

Objectives: Numerous studies indicate that asignificant number of patients exposed to alcoholprenatally suffer from deficits in weight and/or inheight from birth into adulthood. However, especiallyin animal studies, prenatal alcohol exposure was shownto cause alterations in glucose and lipid metabolismsimilar to those observed in obese patients developinga metabolic syndrome. We hypothesize disturbances inbody composition in children with prenatal alcoholexposure and set out to measure fat free and fat mass inchildren and adolescents with Fetal Alcohol Syndrome(FAS).Materials & Methods: We measured bodycomposition in 18 patients with full or partial FASaccording to the 4-Digit Diagnostic Code (Astley,2004) using whole body air-displacementplethysmography (BOD POD method, COSMED USA,Inc.). 23 patients were recruited from our outpatients’clinic. In five cases, it was not possible to completebody composition analysis due to excessive motorrestlessness during the measuring process.Additionally, body composition was measured in 142children and adolescents without FAS. As controlgroup and study group differed significantly in age andbody mass index (BMI), a matched-pair analysis wasperformed, matching for BMI, sex and age.Results: No statistically significant difference in bodycomposition was found between children with partialor full FAS and controls. In accordance with previousresearch, BMI-for-Age percentiles in the study groupwere significantly lower than in the control group.Conclusion: Our findings show that growth deficiencyin FAS or partial FAS affects body fat mass and fat-free mass to a similar extent. We cannot exclude thatsignificant differences in body composition will appearupon enlargement of the sample size.

78FASD multidisciplinary diagnostic clinic model in arural Canadian setting and the use of “MAP”(Multi-Action Plan) for assigning responsibility andmonitoring follow up of recommendations andutilization of resources

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From FASD clinic recommendations to results: a“MAP” of our path

Hasmukhlal Rajani1,2, Teresa O’Riordan1, KellyCameron1

1Northwest Central FASD Services Network, Barrhead,Alberta, Canada; Department Of Pediatrics, UniversityOf Alberta, Alberta, Canada

Objectives: Accessing multidisciplinary FASDassessment and diagnostic services in Canada, givenour large geography and sparse population createsunique challenges that require innovation. Follow up ofclinic recommendations and assigning responsibilityand resources depend on location and availability. Wehave used the “MAP” (Multi-Action Plan) tofacilitate a community response to the client’s needsand to track the follow up of recommendations andaccess to resources.Materials & Methods: Members of themultidisciplinary diagnostic clinic, Report templatesincluding the “MAP”. The NWC FASD network hasbeen diagnosing children with prenatal exposure toalcohol for three years, and using the MAP template tofollow up and coordinate servicesFASD is nowrecognized as one of the leading causes ofdevelopmental disability. The prevalence rate of “FAS”is quoted from 1-3/1000 with “FASD” being estimatedto be 3-9 times greater. Arriving at a FASD diagnosisis a complex process. It is recognized that a diagnosisis not only important to better determine prevalencerates but also crucial for clients to be able to accessneeded and eligible services. Similarly,multidisciplinary assessments are necessary for anaccurate diagnosis and are equally important forinforming interventions. Accessing multidisciplinaryFASD assessment and diagnostic services in Canada,given our large geography and sparse populationcreates unique challenges that require innovation. Andthese challenges must be met in order to develop toprovide a comprehensive understanding of theindividual’s areas of deficit and areas of strength.Follow up of clinic recommendations and assigningresponsibility and resources depend on location andavailability. We have used the “MAP” (Multi-ActionPlan) to facilitate a community response to the client’sneeds and to track the follow up of recommendationsand access to resources.Results: We present the development and utilization ofthe map to assign responsibility, facilitatecommunication and coordinate resources among healthprofessionals and agencies.Conclusion: The presentation will outline thedevelopment of the rural diagnostic clinic, use of the

map and the will also report on client outcomes anddiscuss the uptake of recommendations and services.

79The power of networking – highlights of the work ofCanada’s network action team on FASD preventionfrom a women’s health determinants perspective

Nancy Poole1,2, Tasnim Nathoo1

1BC Centre of Excellence for Women's Health,Vancouver, Canada; 2Canada FASD ResearchNetwork, Vancouver, Canada

Objectives: The aim of this presentation is to profileCanadian examples of FASD prevention activities fromacross research, policy, and practice which are linkedthrough a Network Action Team (NAT) on FASDPrevention, funded by the CanFASD ResearchNetwork. In addition, the presentation will describe thevirtual strategies that have allowed the NAT to workcollaboratively across time and geographies, whichmay be of inspiration to others working on FASDprevention around the world.Materials & Methods: Over the past six years, theNAT has been building a virtual network of over 40researchers, health care/other service providers,community based advocates and parents, and decisionmakers/health system planners from across Canada.Team members lead academic and community-basedresearch projects, hospital and community basedprograms, evaluation studies, a blog on women,alcohol, and pregnancy, and other local and nationalinitiatives.Results: The NAT has utilized a virtual Community ofPractice (CoP) model as a mechanism for knowledgeexchange, engaging researchers, policy makers, civilservants, clinicians, community-based serviceproviders, advocates, and women concerned withFASD prevention. As the Network continues to growwith interest from new communities and stakeholders,additional strategies for maintaining effective workingrelationships and for ensuring the smooth uptake ofknowledge into program and policy development arebeing explored.Conclusion: Virtual and collaborative approaches topromoting women's health can be an effective strategyfor preventing FASD and allows researchers, policymakers, and advocates from multiple sectors to betteraddress the range of proximal and distal factors thatinfluence alcohol consumption during pregnancy.

80FASD multidisciplinary diagnostic clinic model in arural setting and outcome of adult patients seen inclinic in the last 10 years

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Hasu Rajani, Monty Nelson, Audrey McFarlane

Lakeland Centre for FASD

Objective: To share results of the outcomes for ruraladults with a diagnosis of FASD, those that werediagnosed as children and are now adults; and thosediagnosed as adults. These individuals have beendiagnosed with a multi-disciplinary team that has beenuniquely developed to meet a rural need.Materials & Methods: This involved a file review andinterview process with families and individualscovering the areas of school completion, legalinvolvement, employment, addictions, and mentalhealth issues.Results: FASD is a complex disorder and even morecomplex to address in rural communities of less than20,000 people. This work focuses on the role of ruralservices and meeting the needs of adults diagnosedwith FASD. Adult diagnosis presents its own issuesrequiring creative partnerships to optimize thediagnostic process to drive recommendations andservices for the client.Conclusion: Rural areas have capacity to meet theneeds of adults with FASD. The news about theoutcomes for adults is not all negative.

81FASD multidisciplinary diagnostic clinic model in arural setting and neuropsychological profiles for thelast 250 patients

Hasu Rajani1, Brent Symes1, Vanna Thiel2

1Edmonton, Alberta, Canada; 2Cold Lake, Alberta,Canada

Objective: Individuals with FASD present a uniquepsychological profile which has many implications fordiagnosis. We will share the results of 250 patientsdiagnosed with FASD and their psychological profilesfrom work done on a rural FASD diagnosticmultidisciplinary team.Materials & Methods: Pediatrician, psychologist andspeech Language pathologist have reviewed fileinformation from the last 250 patients.Results: The file review and clinical expertise hasshown some surprising results that reveal the need for astandardized test battery for clinical teams; and theunique results of a rural multidisciplinary diagnosticteam.Conclusions: Over the past 12 years, we have beenusing a multidisciplinary model to diagnose childrenexposed to alcohol. Over the past five years, we havestandardized the battery of neuropsychological testing

performed on these patients. Here we present theneuropsychological profile of these patients.

82Addressing FASD in remote and ruralcommunities: A case example

Audrey McFarlane

Cold Lake, Alberta, Canada

Objective: FASD is a complex disorder encompassingmany factors of prevention, diagnosis, intervention,education, stigma and community capacity. Explorehow a rural northern community has managed toaddress such complex problems.Materials & Methods: This case study explored thework of the Lakeland Centre for FASD in Cold LakeAlberta Canada which has developed an uniqueorganizations that serves individuals prenatallyexposed to alcohol across the lifespan and theirfamilies.Results: Community capacity is available in ruralcommunities but it needs to be tapped into withpassion, a good plan, and patience. The LakelandCentre for FASD has been operating for over 12 yearsas an agency and 6 years before that as a generalcommunity committee. Offering diagnosis; postdiagnostic supports such as transition planning,employment supports, training, education; and workswith the women at high risk of having a child withFASD.Conclusions: Learn the community development planas well as the current models of the Lakeland Centrefor FASD that has made it a leader in Canada.

83Improving knowledge and practice behaviors inmedical and allied healthcare providers: resultsfrom the Great Lakes FASD Regional TrainingCenter

Georgiana Wilton1, David Wargowski2, KristiObmascher3, Barbara Vardalas1, Ronald Prince1, RainaHaralampopoulos1

1University of Wisconsin-Madison School of Medicineand Public Health, Department of Family Medicine,Madison, Wisconsin, USA; 2University of Wisconsin-Madison School of Medicine and Public Health,Department of Pediatrics, Madison, Wisconsin USA;3University of Wisconsin-Madison Division ofContinuing Studies, Department of ProfessionalDevelopment and Applied Studies, Madison,Wisconsin, USA

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Objectives: The adverse effects of alcoholconsumption during pregnancy have been widelyreported, and represent a significant public health risk.Many physicians and other medical professionals feelinadequately prepared to provide appropriate servicesto reduce the risk of an alcohol-exposed pregnancy orprovide the clinical care required for individualsaffected by fetal alcohol spectrum disorders (FASDs).The overarching goal of the project was to increaseknowledge and improve clinical skills and practicebehaviors of medical and allied health practitioners andstudents around the prevention, identification, andtreatment of FASD.Materials & Methods: Utilizing the content of theFASD Competency-Based Curriculum DevelopmentGuide for Medical and Allied Health Education andPractice (Centers for Disease Control and Prevention,2009) the project conducted and evaluated 215trainings in a seven-state region reaching 5,250participants. Data was collected at four time points:pre-training, immediate post-training, 3-months post-training and 6-months post-training.Results: Our findings demonstrated that trainingactivities were effective in significantly increasingparticipant knowledge about FASD over time.Significant increases were also seen in confidencelevels for screening, educating and referring women atrisk for alcohol abuse as well as screening, diagnosingand treating individuals at risk for fetal alcoholspectrum disorders. No quantifiable changes were seendetected in clinical practice.Conclusion: While knowledge and confidenceincreased significantly from pre-training to all post-training evaluation timepoints, this did not translateinto a quantifiable change in clinical practice.Knowledge and confidence alone may not be enough toeffect institutional change as practicing professionalsface growing demands on increasingly limited timeallotted for patient and client interaction. Changes intraining format, content, and target audience wereinstituted within the training center to better targetclinical practice behaviors.

84Prenatal alcohol exposure and hypothalamic-pituitary-adrenal axis dysfunction: a systematicreview

Isela Iveth González Rodríguez1,2, Aristides QuinteroRueda3, Erikson Felipe Furtado1,2

1Department of Neurosciences and Behavior, School ofMedicine of Ribeirao Preto, University of Sao Paulo;Ribeirao Preto, SP, Brazil; 2Postgraduate Program ofToxicology, Faculty of Pharmaceutical Science ofRibeirao Preto, University of Sao Paulo - Brazil;

3Department of Chemistry, Faculty of Natural Sciencesand Exacts, Autonomous University of Chiriquí(UNACHI), Chiriqui, Panamá

Objectives: To investigate the relationship betweenprenatal alcohol exposure and dysfunction of thehypothalamic-pituitary-adrenal (HPA) axis, as aprobable etiological factor for neuropsychologicaldeficits and late behavior problems in the offspring ofalcohol abuse mothers.Materials & Methods: A systematic review wasperformed by searching scientific articles through thebibliographic databases Pubmed, Lilacs, Web ofKnowledge and Science Direct using the followingsearch terms: “Prenatal Alcohol Exposure ANDCortisol”. Thirty-two papers were selected.Results: Thirty two studies were identified, alls wrotein English; most of them published in the United Statesof America (11) and Canada (15). Other studies werepublished in United Kingdom (2), Norway (1),Germany (1), China (1) and Netherlands (1). Theoldest paper was written in 1994 and a total number oftwenty four was produced in the last decade. Thisresearch found that HPA axis is highly susceptible toprogramming during fetal and neonatal developmentand that prenatal alcohol exposure programs the fetalHPA axis such that HPA tone is increased throughoutlife. This work also detected that maternal alcoholconsumption increases HPA activity in both motherand the offspring. Therefore, this increment, byexposing the fetus to endogenous glucocorticoids alongthe lifespan, can alter the behavioral and physiologicsensibility increasing vulnerability to sickness anddisorders later in life. Furthermore, we find possibledifferential effects of subjacent mechanisms of alcoholon male and female offspring, with special emphasis oneffects at different levels of the HPA axis, and onmodulatory influences of the hypothalamic-pituitary-gonadal hormones and serotonin.Conclusion: Considering the amount of scientificevidence it seems very plausible to admit the influenceof prenatally alcohol exposure to developmentalchanges in the maturation of the hypothalamic-pituitary-adrenal axis leading to its late dysfunction inlife and, therefore,

85The voices of youth with Fetal Alcohol SpectrumDisorder: transitioning from child welfare care toadulthood

Linda Burnside1,2

1Avocation Counselling, Consulting, Research &Training, 2University of Manitoba, Faculty of SocialWork, Canada

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Objectives: Fetal Alcohol Spectrum Disorder (FASD)is increasingly recognized as a serious disabilityaffecting a significant number of children in childwelfare care in Canada. Since 2004, researchers inManitoba, Canada have examined the experiences ofchildren in care with FASD, learning about theirplacement experiences, health care needs, educationaloutcomes, and financial costs to the system. Thisworkshop will provide a brief overview of the resultsof this research, with an emphasis on their most recentstudy: the experiences of youth with FASD as theytransition to adulthood from child welfare care.Materials & Methods: Qualitative interviews wereconducted in 2009 – 2010 with 20 youth with FASDwho had grown up in child welfare care.Results: This study provides a rare opportunity to heardirectly from youth with FASD about their needs. Theyouth shared poignant information about their lives,their hopes and fears for the future, and what they needto transition to adulthood successfully. In particular,youth demonstrated that there is a mismatch betweenagencies’ efforts to prepare them for adultresponsibilities when they are developmentally unableto make use of these services until well into earlyadulthood. Their perspectives hold compelling insightsfor child welfare agencies who work with youth as theyemancipate from care, both adolescents with FASD aswell as other youth in care.Conclusions: The impact of FASD is devastating forthe children affected by the condition and hasconsiderable implications for child welfare agenciesthat support them to adulthood. This research points tothe need to develop unique transitional services tofacilitate emancipation for these vulnerable youth,including a reformation of traditional child welfareservices. These recommendations for reformation willbe identified, outlining the benefits for youth withFASD and the implications for child welfare servicedelivery.

86“to matter, to be heard, to make sense of oneself”

Marsha Wilson

Douglas College, Vancouver, Canada


Objectives: Parents who are raising a child with FASDoften feel alone and misunderstood. This presentation,“to matter, to be heard, to make sense of oneself” willoutline a model of support for families that is based onapplied research which has been validated and affirmedin the North American context. Through a look at thissupport group model, attendees will gain knowledge of

the importance of parental support as an essentialcomponent to long term success for individuals withFASD.Materials & Methods: The author conducted researchwith a basic study group comprised of adoptive andfoster parents and investigated how essential it is thatparents receive appropriate support from professionalsin order to be able to fulfill their roles and preventfamily breakdown.Results: This study has been reviewed by governmentand local community agencies and is considered amodel to be replicated. The author has a co-written acurriculum based on this work for government andpresented it to local practitioners.Conclusion: Parents are vital stakeholders in the livesof individuals with FASD; however, they are oftenmisunderstood, criticized, and isolated. Asprofessionals and paraprofessionals help them “tomatter, to be heard and to take sense of oneself”,parents are better equipped to be the lifelong advocatesthat their children need them to be.

87Canada Fetal Alcohol Spectrum Disorder researchnetwork: a provincial partnership model’s evolutionto a national entity

Jocelynn L Cook1,2, Sterling K Clarren1,3

1Canada Fetal Alcohol Spectrum Disorder ResearchNetwork, Vancouver, BC, Canada; 2Department ofObstetrics and Gynecology, University of Ottawa,Ottawa, ON, Canada; 3Department of Pediatrics,University of British Columbia, Vancouver, BC,Canada

Objectives: Internationally, Fetal Alcohol SpectrumDisorder (FASD) is a significant issue and it isanticipated that generation and sharing of research datawill have a positive impact on the lives of thoseaffected by FASD through a better understanding ofetiologies and interventions and through more effectiveprogram/policy development. Although there havebeen attempts to consolidate and coordinate efforts,FASD research remains fragmented in Canada and thereciprocal translation of knowledge from the researchfield that impacts policy and program development,and back, is inadequate. To address this, a new CanadaFASD Research Network (CanFASD) was formed tosupport Canada's leadership in addressing theextraordinary complexities of FASD. The mission is toproduce and maintain national, collaborative researchdesigned for sharing with all Canadians, leading toprevention strategies and improved support services forpeople affected by FASD. The efforts of the Network


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focus on generating/translating knowledge, buildingcapacity and creating partnerships.Materials & Methods: CanFASD evolved from aunique provincial partnership model with priorities thatparalleled those of Canadians. The Canada NorthwestFASD Research Network was established in March of2005 through support of seven Provincial/territorialMinisters. Recognizing the importance of coordinatingrelevant research along thematic areas, the network ledthe cross jurisdictional coordination of FASD research.The outcome was collaborative Network Action Teamsworking in areas important to Canadians: diagnostics,intervention and prevention. Teams have been verysuccessful at leveraging resources, creating researchcapacity and have made significant contributions to theFASD field.Results: With increased capacity for FASD researchand with the Network’s facilitation and stimulation ofresearch, Canada has developed a National vision andhas demonstrated International leadership in the fieldof FASD The Network will begin to work globally tobuild and share expertise, tools, platforms andexperience that will ultimately improve the lives ofaffected individuals and their families.Conclusion: Lessons learned from the evolution of thisunique provincial partnership model can be applied inother jurisdictions to significantly increase capacityand knowledge related to policy-relevant FASDresearch.

88To what extent is research informing serviceplanning and delivery for individuals with FetalAlcohol Spectrum Disorders in Alberta, Canada?

David St. Arnault, Jenelle Job, Cheryl Poth, JacquelinePei, Ellis Chan, Erin Atkinson, Wence Leung, LauraGould, Kendra McCallum

Department of Educational Psychology, University ofAlberta, Canada

Objectives: This poster reports a research projectassessing the impact of a cross-sectorial strategic planfor enhancing service delivery for individuals withFASD in Alberta, Canada. Specifically this poster isfocused on the methods and findings related to theextent to which research informs the planning anddelivery of provincial services from the perspectives ofpolicy makers, program coordinators, programmanagers, and direct service providers.Materials & Methods: A qualitative approachinvolving multiple focus groups (n=20) and semi-structured interviews (n=15) was employed with FASDspecialists from across the province (total n=150).Participants included government officials who were

members of the FASD Cross-Ministry Committee,FASD Service Network coordinators, assessment anddiagnosis FASD clinic managers and FASD serviceproviders. Focus groups and interviews weretranscribed verbatim, analyzed using thematic analysis,and compared within followed by across roles.Results: Analysis is ongoing and preliminary resultssuggest that FASD specialists in Alberta are engaged inknowledge utilization (that is making researchaccessible and using it to inform decision-making) inboth the planning and delivery of services. However,the method of access and the frequency of use variesby role. For example, policy makers generally reportedhaving close relationships with academic researchersand research networks; while, service providersreported receiving much of their research informationthrough their training sessions. Anticipated analysisincludes further examination of the challenges toaccessing and utilizing research knowledge for serviceplanning and delivery for individuals with FASD.Conclusion: Access and use of research as key forservice planning and delivery decision-making has thestrong potential for more relevant policy and servicesfor individuals with FASD. This study provides atemplate for other jurisdictions to assess the extent ofaccess and research use in their own organizationaldecision-making process.

89A qualitative investigation of alcohol use adviceduring pregnancy: experiences of Dutch midwives,pregnant women and their partners

Nickie Y van der Wulp1,2, Ciska Hoving2, Hein deVries2

1Dutch Institute for Alcohol Policy (STAP), Utrecht,The Netherlands; 2MaastrichtUniversity/CAPHRI/Department of Health Promotion,Maastricht, The Netherlands

Objective: Two studies aimed to explore the adviceDutch midwives give and the information Dutchpregnant women and partners of pregnant womenreceive about alcohol consumption in pregnancy.Materials & Methods: Study 1 included individualsemi-structured interviews with midwives. Study 2involved focus groups and individual semi-structuredinterviews with pregnant women and partners.Interview content was based on the I-Change Model.Study 1 was conducted nation-wide; Study 2 wasconducted in the central and southern regions of theNetherlands. Respondents were ten midwives in Study1; 25 pregnant women and 9 partners in Study 2.Results: Study 1 showed that midwives intended toadvise complete abstinence, although this advice was

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mostly given when women indicated to consumealcohol. Midwives reported to lack good screeningskills and sufficient knowledge about the mechanismsand consequences of prenatal alcohol use and did notinvolve partners in their alcohol advice. In Study 2,pregnant women and partners confirmed the findings ofStudy 1. In addition, pregnant women and partnersconsidered midwives as an important source ofinformation on alcohol in pregnancy. Partners wereinterested in the subject, had a liberal view on prenatalalcohol use and felt ignored by midwives and websites.Pregnant women indicated to receive conflictingalcohol advice from their health professionals.Conclusions: Midwives’ alcohol advice requiresimprovement with regard to screening, knowledgeabout mechanisms and consequences of prenatalalcohol use and the involvement of the partners inalcohol advice during pregnancy. This research impliesthat training should be given to Dutch midwives toincrease their screening skills and their alcohol relatedknowledge to pregnant women. Research is needed todetermine how the midwife’s alcohol advice to thepartner should be framed in order to optimize thepartner’s involvement concerning alcohol abstinence inpregnancy.

90Testing ethylglucuronide in maternal hair and nailsfor the assessment of fetal exposure to maternalalcohol: comparison with neonatal meconiumtesting

Luca Morini1, Emilia Marchei2, Luigi Tarani3, MarziaTrivelli3, Gherardo Rapisardi4, Maria Rosaria Elicio4,Juan E Ramis5, Oscar Garcia-Algar5, Luigi Memo6,Roberta Pacifici2, Simona Pichini2

1Department of Legal Medicine and Public Health,Pavia, Italy; 2Istituto Superiore di Sanitá, Roma, Italy;3Policlinico Umberto I, Roma, Italy; 4Ospedale SantaMaria Annunziata, Bagno a Ripoli, Italy; 5Hospital delMar, Barcelona, Spain; San Martino Hospital, Belluno,Italy

Objectives: The deleterious effects exerted by prenatalethanol exposure include physical, mental, behaviouraland/or learning disabilities that are included in the termfetal alcohol spectrum disorder (FASD). Themeasurement of ethylglucuronide (EtG) in alternativebiological matrices, including neonatal and maternalhair, neonatal meconium, and maternal nails isreceiving increasing interest for the accurate evaluationof the utero exposure to alcohol.Aims: The aim of the present study was to evaluate thecorrelation between EtG in maternal hair and nails withEtG in neonatal meconium to further explore the

suitability of these biomarkers in disclosing prenatalexposure to ethanol.Materials & Methods: A total of 151 maternal hairstrands (0-6 cm), nail clips (2-6 mm) andcorresponding neonatal meconium and nails sampleswere obtained from neonatal wards of 4 Mediterraneanpublic hospitals: Rome, Florence and Belluno in Italyand Barcelona in Spain. Hair, nails and meconiumwere analyzed for the presence of EtG by validatedliquid chromatography mass spectrometry assay.Meconium was also analyzed for the presence of fattyacid ethyl esters (FAEEs) as a complementarybiomarker of in utero exposure to alcohol.Results: On the basis of the accepted cut-off for EtGand FAEEs in neonatal meconium, 18 newbornsresulted in utero exposed to maternal alcoholconsumption. Unfortunately, none of these cases wereconfirmed by the presence of EtG in maternal hair andnails, which resulted all negative to this biomarker.Conversely, one high positive result in nails (24 pgEtG/mg nail) was obtained in Pakistan woman, whosehair resulted negative to EtG likewise the meconium ofher newborn. Low maternal education level wasassociated with biomarker scores over the cutoff. Therewas also a significant correlation between the highestpercentage of prenatal exposure in the capital andcertain maternal sociodemographic characteristics.Conclusion: Obtained results confirm that EtG andFAEEs in meconium are the best biomarker to assess inutero exposure to maternal alcohol. The 18 newbornsexposed to maternal ethanol came from mothers whodeclared alcohol consumption through the entirepregnancy, but not on daily basis and with no morethan 1 drink per day.This fact led us to suppose thatfirstly EtG in hair and nails is not a good biomarker todisclose an alcohol consumption lower than on dailybasis and lower than one alcoholic unit per day.Secondly that both in case of hair and in that of nails,the amount of collected sample is crucial to obtain apositive result, since available methods are yet notenough sensitive for less than 20 mg keratin matrices.

91“A Pregnancy Without”, a public awarenesscampaign for women about the incompatibility ofalcohol consumption during pregnancy

Juan Luis Delgado

Fetal Medicine Unit - Hospital “Virgen de la Arrixaca”(Murcia)

Objectives: According to a study at the HospitalVirgen de la Arrixaca of Murcia, only 29% of womendon`t drink any alcohol in the preconception period(the most critical to the fetus). The Royal College of

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Obstetricians and Gynaecologists has announced that alow level consumption of alcohol (1 or 2 units once ortwice a week) has not yet been found to be harmful towomen or their babies(http://www.rcog.org.uk/index.asp?PageID=1996).However, the Spanish Society of Obstetrics andGinecology (SEGO), in cooperation with theAssociation of Brewers of Spain, has launched, since2009, the educational campaign "A pregnancywithout", which aims to raise awareness amongpregnant women about the incompatibility of alcoholconsumption during the pregnancy period, with theslogan "Because he drinks what you drink". Thecampaign is proposed to beer drinkers; who arepregnant; plan to become pregnant or breastfeeding,choose non-alcoholic variety.Materials & Methods: During the campaign messagesare disseminated through information materials,supervised by the Spanish Ministry of Health,gynecologists across the country providing usefulinformation about alcohol-free beer as an alternative tothe traditional one and how could integrated into thehabits of the pregnant woman. Additionally, thecampaign also includes the dissemination ofinformation brochure that is aimed at pregnant womenthat has collected various recommendations to helpthem follow a complete and balanced diet. In order toincrease the dispread of messages among pregnantwomen, and society in general, there was a widebroadcasting of campaign messages in the media.Results: All members of SEGO (with 6,300 nationalpartners) have received some information and materialson the properties of non-alcoholic beer as an alternativeto traditional beer during pregnancy, emphasizing thedangers of drinking in this period. Also weredistributed over 500,000 information brochure amongpregnant women and women who want to be.Conclusion: This campaign is an example of goodpractice in prevention and public health and scientificcollaboration between an association whose objectiveis to ensure the health and individual sectors committedto preventing cases of inadequate intake of beer.Thanks to it has been possible to achieve satisfactoryresults in relation to the spread, helped by theinformation campaign in the media where the SEGOwarned of fetal alcohol syndrome.

92When nobody is there for you, it's the best thingthat can ever happen": the role of mentoring in thelives of Canadian women with high risk substancemisuse

Linda Burnside1,2, Audrey McFarlane2

1Avocation Counselling, Consulting, Research &Training, 2University of Manitoba, Faculty of SocialWork, 3Lakeland Centre for FASD

Objectives: Mentoring has been found to be a criticalintervention for women with high risk substance abuseissues, which can lead to giving birth to children withFASD. This presentation will provide an overview ofthe history of mentoring mothers with high risksubstance misuse in Canada, focusing on theestablishment of one of the first mentoring programs, atthe Lakeland Centre for FASD in Cold Lake, Alberta,and describing the development of mentoring programsin northwestern Canada. Research regarding theexperiences of women who have completed amentoring program will also be shared, with anemphasis on the voices of women who participated ininterviews about how mentoring changed their lives.Materials & Methods: The presenters are theExecutive Director of the Lakeland Centre for FASD,who will speak about the history of mentoring from aCanadian perspective, and a researcher who hadconducted a qualitative study into the experiences ofwomen who have a completed a mentoring program inCanada.Results: Both the program experience at the LakelandCentre for FASD and the results of the qualitativestudy demonstrate how mentoring is making a positivedifference in women's lives, leading to healthier andmore stable lives, better parenting, and reduced risk ofusing substances, especially during pregnancy.Conclusions: Mentoring is an important strategy thatshould be expanded in Canada and implemented inother jurisdictions to prevent FASD and help womendeal with substance abuse.

93Patients with FAS: the significance of an earlydiagnosis

Reinhold Feldmann


Background: Alcoholism during pregnancy is one ofthe most common factors in western societies causingpersisting congenital and multiple physical as well asneurological impairments. Finding the diagnosis at firstsight puts medical professionals into a demandingsituation. Therefore, the objective of this study was todetect patients’ developmental characteristics with themain focus on the necessity of the diagnosis itself.Patients: 125 young patients, whose diagnosis of fetalalcohol syndrome (FAS) was made at the MuensterUniversity Hospital, were followed up.

http://www.rcog.org.uk/index.asp?PageID=1996

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Materials & Methods: Biographic details such asliving conditions, health, developmental problems andeducational career were gathered using a structuredinterview. The diagnosis itself and the impact of this onthe patients were also explored.Results: Patients displayed characteristics of a lessmature trait of character. The majority were lookedafter by foster parents. High rates of social anddevelopmental problems could be found. The diagnosiswas identified as a protective factor, with significantlybetter outcomes for patients being diagnosed in earlychildhood. A diagnosis established later in life wasparticularly helpful for the families and caregivers.Feelings of failure and self-blame could be diminished.Conclusions: The early detection of affected childrenhas to be improved as receiving the correct diagnosis,despite the persistent impairments, is of major benefitfor both patients and their families.

94Preterm birth: effects of patients with FAS

Reinhold Feldmann


Objective: For children with Fetal Alcohol Syndrome(FAS) preterm birth (PTB) is frequently reported.Preterm birth may cause a variety of motor andcognitive deficits in the premature infant. The effect ofpreterm birth on the motor cognitive outcome inpatients with FAS is unknown.Matierals & Methods: We assessed the mental andmotor development of 48 children with PTB and 30children with FAS using the Bayley Scales of InfantDevelopment (BSID-II). Groups were matched for age(PTB: M = 25 months, SD = 3 months; FAS: M = 27months, SD = 6 months). Of the children with PTB, 31had bronchopulmonary dysplasia and/or intracranialhemorrhage, 17 had no birth complications. Of theFAS children, 12 had PTB (all without birthcomplications).Results: In the BSID-II, PTB children without birthcomplications had a mean mental (MDI) andpsychomotor development index (PDI) that were closeto normal (MDI = 98, PDI = 92). PTB children withbirth complications had a mean MDI of 85 and a meanPDI of 81. Children with FAS had a mean MDI of 79and a mean PDI of 80. MDI was higher in FASchildren with PTB compared to FAS children withoutPTB (81 vs. 77).Conclusions: PTB, although frequently in FAS, seemsnot to contribute to the mental or motor developmentdeficits in children with FAS. Deficits are causedpredominantly by the prenatal alcohol exposure (PAE).

Moreover, in children with FAS, PTB withoutcomplications seems to moderate the effects of PAE.

95Challenges and possibilities for learners with FASDthrough literacy interventions

Linda Wason-Ellam1, Rae Mitten2

1College of Education, University of Saskatchewan,Saskatoon, Saskatchewan; 2Native Law, University ofSaskatchewan, Saskatoon, Saskatchewan

Objectives: The main objective of the research was toexplore early literacy interventions for children withFASD to prevent secondary disabilities and resultingadverse life outcomes. Early diagnosis, strengths andweaknesses revealed in brain domains, and MRI andFMRI’s are evolving sources of information about howbrain structure and functioning is affected by fetalalcohol exposure, resulting in different pathways oflearning. Learning theories, on which education isbased, are grounded on assumptions that may notmatch age-based functioning level of those with FASD.Some of these assumptions include: short term memoryskills; ability to focus and sustain attention, self-regulate, multi-task; sequence, appreciate cause andeffect or consequences; and ability to think abstractly,generalize, predict, problem-solve and comprehendabstract concepts all of which are often problematic forlearners with brain-based disabilities such as FASD.Materials & Methods: Most children with FASD havevaried cognitive and academic profiles, with strengthsand weaknesses which present a myriad of educationalchallenges. This naturalistic inquiry addresses dynamicassessments, which are mediated learning experiencesand observations of the actual processes by which alearner participates and make meaning in literacyactivities. The purpose is to estimate learning potentialof a learner with FASD, assessing maximal activitythrough the presentation of learning tasks. Rather thannorms, comparison of individual skills and strategiesoccur across time within a learner’s personal profile.Results: Approaches that can engage the learner mustbe cognizant of and responsive to their brain-baseddifficulties in order to be effective. Children withFASD may be able to read the words, but not alwayscomprehend the meaning conveyed. Their executivefunctioning skills are also impaired, so they will needassistance in order to predict, sequence, organize,synthesize, remember, and apply what they havelearned. One to one instruction, role-modeling andmetacognitive strategies, learning through real lifelearning experiences, visual representations, “drawing-while-storying” and other multi-modal approaches tolearning, are important factors in their learning. Due to

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the plasticity of the brain, multi-modal instruction canhelp to stimulate the creation of new synapses or thefinding of alternate neural pathways for learning.Conclusions: Stimulating comprehension "beforereading and during reading” through drawings,storyboards, concept maps, plot diagrams, charts,models, and digital images assists learners in focusingon, understanding, and comprehending what they readwhile they read. It is when the FASD learner becomesan active, engaged, multimodal, metacognitive, andmeaning-making reader and learner that transformationoccurs.

96Systematic review on the effectiveness of preventionapproaches for fetal alcohol spectrum disorders

Maria B Ospina1,2, Carmen Moga1, Liz Dennett1,3,Christa Harstall1, Egon Jonsson1

1Institute of Health Economics, Edmonton, Canada;2University of Alberta School of Public Health,Edmonton, Canada; 3John W Scott Health SciencesLibrary, University of Alberta, Edmonton, Canada

Objectives: Preventing fetal alcohol spectrumdisorders (FASD) is a public health priority. FASDprevention programs can be broadly categorized intouniversal, selective and indicated based upon thebreadth of the target population, the risk of havingchildren with FASD, and the cost-benefit ratio ofcommitting resources. Establishing and strengtheningpolicies and plans for FASD prevention require aninformed consideration of what is known to beeffective. The objective of this systematic review wasto evaluate the scientific literature on the effectivenessof FASD prevention on prenatal alcohol use- andFASD-related outcomes.Materials & Methods: Searches in biomedicalelectronic databases and the grey literature wereconducted for the period from 1970 to February 2012to identify studies (i.e., randomized controlled clinicaltrials (RCTs), observational analytical cohort studies,and uncontrolled trials) assessing universal, selective,and indicated prevention interventions targeting thebroad community, pregnant women, women ofchildbearing age, women at risk of an alcohol-exposedpregnancy (AEP) or of having a child with FASD.Results: From 3,455 references retrieved, 59 studiesmet the eligibility criteria and were included in thereview (Universal = 19, Selective = 30; Indicated =10). The best scientific evidence on the effectiveness ofuniversal FASD prevention is derived from two studiesof moderate-to-weak methodological quality thatevaluated a multimedia education program targetingyouth in the community. Multimedia and macro-level

education programs produced a statistically significantimprovement in the level of knowledge regardingFASD and the effects of alcohol drinking duringpregnancy. Studies assessing universal interventionssuch as alcohol-related warning messages, healtheducational activities and alcohol bans were of poorquality; and, overall, did not show that theseinterventions lead to significant modifications inknowledge, attitudes and perceptions of risksassociated with drinking during pregnancy. Comparedto universal preventive interventions, the followingselective preventive interventions have a betterscientific evidence base (overall strong and moderatequality) for their effectiveness: motivationalinterviewing, counselling activities and healtheducation programs for women of childbearing agewho consume alcohol, pregnant women, and women atrisk of AEP. The scientific evidence supporting theeffectiveness of indicated approaches is weak andinconclusive.Conclusion: The scientific base to support theeffectiveness of universal and indicated approaches forprevention of FASD is limited. Moderate evidence forselective prevention activities such as counselling,motivational interviewing and health education forpregnant women and women at risk of AEP isencouraging.

97What do we know from systematic reviews aboutprevention of fetal alcohol spectrum disorders?

Maria B Ospina1,2, Liz Dennett1,3, Egon Jonsson1

1Institute of Health Economics, Edmonton, Canada;2University of Alberta School of Public Health,Edmonton, Canada; 3John W Scott Health SciencesLibrary, University of Alberta, Edmonton, Canada

Objectives: A number of systematic reviews have beenconducted in the area of prevention of fetal alcoholspectrum disorders (FASD); however, it is necessary tofurther evaluate their characteristics, methodology andresults to attain greater confidence in their conclusionsand contributions into prevention policy formulations.The objective of this overview was to identify thescientific evidence on best FASD prevention practicessynthesized in systematic reviews.Materials & Methods: Searches in biomedicalelectronic databases and the grey literature wereconducted up to February 2012 to identify systematicreviews (SRs) that evaluated the effectiveness of FASDprevention interventions. A SR was required to: have aclearly formulated research question; a search strategyfor identifying studies for inclusion; it should useexplicit, reproducible, and uniformly applied criteria

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for article selection and incorporate a critical appraisalcomponent.Results: From 207 references retrieved, six SRs metthe eligibility criteria and were included in theoverview. The scientific evidence analyzed in theoverview indicates that prenatal screening tools (i.e.,ACE-T and TWEAK) are likely to be effective inidentifying prenatal alcohol use. There is somescientific evidence that brief interventions in the formof clinical advice and counselling about the risks ofprenatal alcohol exposure can help to reduce the risk ofalcohol-exposed pregnancy among women ofchildbearing age. The scientific evidence regardingother prevention approaches, such as home visits,education and counselling remains uncertain from anoverview analysis. None of the SRs identified in theoverview conducted subgroup analyses to evaluate theimpact of prevention interventions in specialpopulation groups.Conclusion: The development, evaluation anddissemination of preventive evidence-basedinterventions for FASD and prenatal alcohol use havelagged significantly since the disorder was identified inthe 1970s. Encouragingly, some scientific evidence hasaccumulated regarding the effectiveness of prenatalalcohol screening tools and certain preventiveapproaches to FASD and prenatal alcohol use such asbrief and intensive interventions. It is important toincrease efforts to expand the scientific base that isneeded to inform policy and healthcare decisionsregarding prevention of alcohol consumption duringpregnancy and the development of FASD.

98What is happening in the Russian Federation interms of research on Fetal Alcohol SpectrumDisorder and prenatal alcohol exposure?

Aleksandra Yaltonskaya1,2, Vladimir Yaltonsky1,3

Yaroslav Kolpakov1,3, Ilya Abrosimov1,3, AnastasiaDerevnina1, Jürgen Rehm4,5,6, Kristina Pervakov4,Valeria Tanner4, Svetlana Popova4,5,7

1Department of Analysis and Implementation ofPrevention Programs, National Research Centre onAddiction, Moscow, Russian Federation; 2Departmentof Psychiatry, Addiction and Psychotherapy, MoscowState University of Medicine and Dentistry, Moscow,Russian Federation; 3Department of ClinicalPsychology, Moscow State University of Medicine andDentistry, Moscow, Russian Federation; 4Social andEpidemiological Research Department, Centre forAddiction and Mental Health, Toronto, Ontario,Canada; 5Dalla Lana School of Public Health,University of Toronto, Toronto, Ontario, Canada;6Epidemiological Research Unit, Klinische

Psychologie and Psychotherapie, TechnischeUniversität Dresden, Dresden, Germany; 7Factor-Inwentash Faculty of Social Work, University ofToronto, Toronto, Ontario Canada

Objectives: The Russian Federation has one of thehighest rates of alcohol consumption in the world;however, little is known about the existing pool ofresearch related to prenatal alcohol exposure, andparticularly Fetal Alcohol Spectrum Disorder (FASD)in this country. The objective of this study was to locateand review published and unpublished studiesconcerning any aspects related to FASD and prenatalalcohol exposure conducted in or using populationsfrom the Russian Federation.Materials & Methods: A systematic literature searchwas performed simultaneously in the RussianFederation and Canada. The search was conducted inmultiple (English and Russian) electronic bibliographicdatabases, using multiple combinations of the keywords in both Russian and English. In addition, thesearch was conducted in several major libraries inMoscow.Results: In total, only 60 studies were identified andincluded in the current review: 48 studies were inRussian and 12 were in English. The examined studiescan be categorized into the following four majorgroups: those that 1) assessed alcohol consumptionduring pregnancy; 2) examined Fetal AlcoholSyndrome (FAS) and FASD prevalence in the generalpopulation, and/or foster homes and orphanages; 3)clinically examined children and adults anddemonstrated the life-long polysystemic teratogeniceffect of alcohol on the fetus; and 4) experimentallystudied the teratogenic effect of alcohol on laboratoryanimals. The results of the studies are exceptionallyalarming. Alcohol consumption during pregnancyvaries from approximately 14% to 83% in variousregions of the Russian Federation. Binge drinking isreported to occur in up to 21% of pregnancies. Theprevalence of FAS in the general population wasestimated in only one study, which reported theprevalence to be as 18-19 per 1,000 live births. Thisfigure is approximately 20 times higher than thatreported for the general population of Canada. Theprevalence of FAS in orphanages for children withspecial needs was reported extremely high – rangingfrom about 427 to 680 per 1,000.Conclusion: Given the alarming prevalence rates ofprenatal alcohol exposure and FASD, very little is beingdone in terms of research in this area within the RussianFederation. An increase in attention by the researchcommunity is urgently needed in order to improve theoverall awareness of the negative consequences ofconsuming alcohol while pregnant, as well as theinitiation of preventive measures in this country.

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99Concurrent alcohol and drugs consumption inpregnancy

Daniela Fiorentino1, Maria Concetta MarcellaScamporrino1, Simona Solombrino1, Paola Ciolli2,Giovanna Coriale1, Mauro Ceccanti1,3

1Lazio Regional Reference Center for Alcohol, Rome,Italy; 2Department of Gynaecology-Obstetrics andUrological Science, University of Rome “Sapienza”,Italy; 3Department of Clinical Medicine, University ofRome “Sapienza”, Italy

Objectives: to describe prevalence and risk factors forsimultaneous use of alcohol and drugs in a populationof pregnant women attending a major hospital in Romefor antenatal visit.Materials & Methods: Women attending an antenatalclinic in Policlinico Umberto I in Rome volunteered tobe interviewed about alcohol and drugs consumptionduring pregnancy, through a semi-structured interview,while waiting for their visit. Data were gathered fromJune 2011 to May 2012.Results: Consent to be interviewed was given by allthe women approached (N = 991; mean age =32,3SD=5,7). Main results showed that 68,6% drank beforepregnancy and 5.4% used drugs, these behavioursbeing highly significantly related. Women using bothalcohol and drugs before pregnancy were 5.9%. Duringpregnancy the percentage of women consuming bothsubstances decreased to 2.2% in the first trimester andto 0,7% in the second one. None of the womeninterviewed consumed drugs during the third trimester.The majority (70,6%) of those consuming bothsubstances before pregnancy was under 30, whileduring pregnancy all consumers were under 30.Moreover, consumers during pregnancy could be eithermarried/cohabitant or single; 50% were manualworkers and 50% were a managers. Even if 26,8% ofwomen interviewed were foreigner, 100% of thoseperforming both consumptions were Italian.Conclusions: A minor but significant number ofchildren are exposed in utero to the adverse outcomesof concurrent use of alcohol and drugs. Thecontemporary use of alcohol and drugs increases therisk of giving birth to an affected child. Thereforefertile age women using both substances represent avery high risk category, that needs to be targeted byselective and indicated preventive interventions.

100The experience of the National Organization onFetal Alcohol Syndrome(NOFAS): twenty threeyears of FASD prevention, media, and policy in theUnited States


Washington, DC, USA


Objectives: Participants will learn about the twenty-three year history of the National Organization on FetalAlcohol Syndrome (NOFAS). Attendees will beprovided with an overview of historical timeline media,policy, prevention and treatment efforts in the UnitedStates.Materials & Methods: The speaker will use a PowerPoint presentation including personal photos whiledescribing her personal journey, 23 years of photos andcampaigns from NOFAS projects, television excerptsand historical timelines. Participants will receive freeFASD prevention materials from NOFAS and theCenters for Disease Control (Fact Sheets, brochures,FASD Diagnostic publications, posters, DVD’s –English and Spanish).Results: Conference participants will be able todescribe the history of NOFAS and how the U.S. hasadapted policy and programs to address FASD. Theaudience will be introduced to innovative approachesto FASD prevention designed to for specific targetgroups.Conclusion: The audience will be able to describe theevolution of understanding and preventing FASD in theU.S. They will gain information about the role andpurpose of NOFAS. Participants will understand theneed for a grassroots advocacy group in educatingpolicy makers and gaining government support ofFASD research, prevention and intervention. The takeaway message will be to consider what Margaret Meadreminded us all: “that a small group of committedindividuals can change the world.”

101Outcome of young adults exposed in utero withdifferent levels of alcohol

Pierre Auguet Mancini1, Laurent Urso Baiardo1,Damien Subtil2, Denis Therby3, Monique Kaminsky4,Nathalie Lelong4, Cécilia Blin1

1Addictology Ward, Roubaix Hospital, Roubaix,France; 2OB-GYN Ward, Lille University Hopsital ofJeanne de Flandres, Lille, France; 3OB-GYN Ward,Roubaix Hospital, Roubaix, France; 4INSERM U 953,Tenon Hospital, Paris, France

Objectives: The main goal of the study is to show therelation between different levels of mothers’ alcoholconsumption during the years 1985-1986 and the

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outcome of their children at the age of 25 and 26. Wewant to examine specifically the following aspects:educational, scholar or professional issues, addictionsor psychiatric diseases, loss of independence, positiveand negative life events, violent or criminal behaviour.A second objective is to determine a possible thresholdbeyond which these items are significantly altered. Atlast, we can find out if the problems detected at the ageof four when they completed a series of tests persist atadult age.Materials & Methods: The protocol was submittedand approved by the CNIL (Conmission NationaleInformatique et Liberté) and the CCTIRS (ComitéConsultatif sur le Traitement de l’Information enmatière de Recherche dans le domaine de la Santé).The sample is composed of 155 adults born in RoubaixMaternity Ward between 1985 and 1986. Theirmothers were asked at the time about their habitsduring pregnancy. Alcohol and tobacco consumptionwere part of the questions. They were divided into foursub groups depending on the alcohol’s assessment:from zero to six standard drinks a week, from seven tothirteen, from fourteen to twenty and above twenty-one. They all lived in Roubaix urban area in 1990, lasttime they were evaluated, but we had to update themailing address list. We used the available data baseswe had access to, such as the Social Security servicesand the Hospital administrative software. Then weinterviewed the subjects of the study over the phone.The questionnaire was made of sixty seven items abouthealth, education, professional life, life events andpersonal issues.Results: The participation rate was 49.7% (77/155)with no significant differences between the sub groups.The 21 years span with no intermediate study to updatepersonal information was an issue. Forty subjects wereloss to follow up due to incorrect addresses. Twelverefused to participate. One was reported deceased. Thecomplete results will be available for the BarcelonaCongress.Conclusion: The current study probably failed to showany significant difference in the health, psychosociallife of young adults related to their mother’s alcoholconsumption during pregnancy. The sample appearedto be too small. However, a slight difference innegative life events during the infancy tends to pointout the social vulnerability of heavy drinker families.

102The National Organization on Fetal AlcoholSyndrome (NOFAS): twenty three years of FASDprevention, media, and policy in the United States


Washington, DC, USA


Objectives: Participants will learn about the twenty-three year history of the National Organization on FetalAlcohol Syndrome (NOFAS). Attendees will beprovided with an overview of historical timeline media,policy, prevention and treatment efforts in the UnitedStates.Materials & Methods: The speaker will use a PowerPoint presentation including personal photos whiledescribing her personal journey, 23 years of photos andcampaigns from NOFAS projects, television excerptsand historical timelines. Participants will receive freeFASD prevention materials from NOFAS and theCenters for Disease Control (Fact Sheets, brochures,FASD Diagnostic publications, posters, DVD’s –English and Spanish).Results: Conference participants will be able todescribe the history of NOFAS and how the U.S. hasadapted policy and programs to address FASD. Theaudience will be introduced to innovative approachesto FASD prevention designed to for specific targetgroups.Conclusion: The audience will be able to describe theevolution of understanding and preventing FASD in theU.S. They will gain information about the role andpurpose of NOFAS. Participants will understand theneed for a grassroots advocacy group in educatingpolicy makers and gaining government support ofFASD research, prevention and intervention. The takeaway message will be to consider what Margaret Meadreminded us all: “that a small group of committedindividuals can change the world.”

103Preventing FASD in school age populations: twenty-three years of lessons learned


Washington, DC, USA


Objectives: This workshop will provide informationon NOFAS (U.S.) FASD prevention targeted for schoolage populations. The presenter will review the stepstaken to develop a highly successful peer youth projectand the NOFAS K-12 FASD Prevention Curriculum.The peer program, known as REACH (ReducingFASD through Empowerment, Advocacy, Communityaction and Health education) was a community baseddemonstration initiative that included four sites inWashington, D.C. Participants will also receive anoverview of the development process anddissemination of the K-12 curriculum. Other notable



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youth efforts will be reviewed including the NOFASFASD Teen Town meetings, FASD regional andnational poster contests and a program designed toreach American Indian students.Materials & Methods: Powerpoint, excerpt fromDVD, FASD Brain model, K-12 curricula lesson plans,and posters designed by youth.Results: Participants will learn about several programsdesigned to educate students about FASD and to getyouth involved with FASD prevention.Conclusions: Attendees will be introduced to a varietyof youth focused programs that have successfullyeducated young people about the dangers of usingalcohol while pregnant. different projects

104Neurodevelopmental characteristics of newbornsexposed to maternal alcohol as proved by meconiumscreening

G Coriale1, L Tarani2, S Pichini3, R Pacifici3, DFiorentino1, M Fiore4, F Di Lauro1, R Marchitelli1, GParlapiano2, B Scalese1, M Ceccanti1

1Centro Riferimento Alcologico Regione Lazio(CRARL), Dipartimento di Medicina Clinica,Università degli Studi “La Sapienza”, Roma, Italia;2Dipartimento di Pediatria, Università degli Studi “LaSapienza”, Roma, Italia; 3Istituto Superiore di Sanità,Roma, Italia, 4EBRI-CRN, Roma, Italia.

Objectives: Alcohol is a known teratogen of the fetus.Early identification of an affected infant is importantand may prevent secondary disabilities. Since maternalself-report is not always a reliable diagnostic tool, thedevelopment of a biomarker for in utero alcoholexposure becomes a necessity. At moment, fatty acidethyl esters (FAEE) and Ethylglucuronide (EtG) aremeasured in neonatal meconium to demonstrate inutero exposure to maternal alcohol. What it has not yetknown if these two biomarkers can be used foridentifying children at risk for alcohol-relateddisabilities due to a relatively low incidence ofdiagnosis of Fetal alcohol spectrum disorders (FASD)among alcohol-exposed infants. As a matter of fact,alcohol-exposed infants may only manifest subtle fetal-alcohol effects at birth but show neuro-developmentalcharacteristics at a later time. We aimed to carry out aprospective, case control study of infants withmeconium positive to FAEEs and EtG vs infants withnegative test, prompting active follow-up of the infant'sdevelopment, and eventually identifying early neuro-developmental delays and adaptive inabilitiessuggestive of FASD.Materials & Methods: Eight children (mean age 16months; s.d. 2,3) positive for FAEEs and EtG in

meconium and eight children (mean age 17 months;s.d. 1,4) negative for the biomarkers in meconium wereenrolled in the study.Detailed evaluation was carried out on each child to getinformation about: 1) physical growth anddysmorphological data collected by pediatrician, 2)cognitive motor development and the adaptive abilitiesassessed using the Griffiths Mental DevelopmentScales and Vineland Adaptive Behaviour Scale. T-testswere performed to evaluate the differences between thetwo groups (positive to meconium test vs. negativemeconium test) concerning cognitive motordevelopment and the adaptive abilities.Results: None of the children (both positive andnegative to meconium test) showed anydysmorphological feature typical of FASD. Physicalgrowth measures always fell into a normal range.However, children positive to meconium testperformed significantly poorer on locomotor(P<0.003), and eye-hand coordination scales (P<0.049)from the Griffiths Mental Development Scales and hadsignificantly lower scores on the communication(P<0.05) and socialization (P<0.039) subscales ofVineland Adaptive Behaviour Scale.Conclusion: The obtained data clearly demonstrated inthe children positive to meconium test the presence ofneuro-cognitive and motor developmental delays andadaptive inabilities suggestive of FASD, even in theabsence of dysmorphological features.

105Early ethanol exposure affects NGF and BDNF butnot their receptors, TrkA and TrkB, in the agedmouse thyroid

Sara De Nicolo’1, Mauro Ceccanti2, RosannaMancinelli2, Marco Fiore1

1Istituto di Biologia Cellulare e Neurobiologia, CNR,Roma, Italy; 2Centro Riferimento Alcologico RegioneLazio, Universita’ di Roma ‘‘La Sapienza’’, Roma,Italy; 3Centro Nazionale Sostanze Chimiche, IstitutoSuperiore di Sanità. Roma, Italy

Objectives: Alcohol consumption during pregnancyand lactation has been shown to induce severe damageto the fetus both at neurobiological and endocrinelevels by inducing in children a variety of effectsleading to Fetal Alcohol Spectrum Disorder (FASD).FASD may include physical, mental, behavioral and/orlearning disabilities with possible lifelong implications.Some key features of FASD onset involve changes inthe endocrine system, including thyroid, anddisruptions at nerve growth factor (NGF) and brainderived neurotrophic factor (BDNF) levels also duringaging as shown in animal models.

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Materials & Methods: The aim of the present studywas to investigate in the thyroid of a FASD mousemodel the long lasting effects of ethanol exposureduring pregnancy and lactation on NGF and BDNF andtheir main receptors, TrkA and TrkB. For this purposewe used aged male mice exposed during fetal life andduring lactation to ethanol or red wine at same ethanolconcentration (11% vol).Results: We found elevated concentrations of bothNGF and BDNF in the mouse thyroid tissue exposed toethanol solution only but not in the red wine group.These findings were associated with no changes inTrkA and TrkB.Conclusion: The present findings may indicate thatearly administration of ethanol may induce long-lastingdamage in the thyroid at NGF and BDNF levelimplicating early endocrine programming.Furthermore, the differences in prenatal ethanol-induced toxicity when ethanol is administered alone orin red wine may be related to compounds with cellprotective properties present in the red wine.

106Smoke and alcohol consumption in an Italianunselected population of pregnant women

P Ciolli1, A Rasile1, M Nicotera1, F Ciccarone1, MScamporrino2, S Solombrino2, D Fiorentino2, MCeccanti3

1Department of Gynecology- Obstetrics and UrologicalScience, Sapienza University, Rome, Italy; 2SitacOnlus, Rome, Italy; 3Alcohol Unit Latium Region,Sapienza University, Rome, Italy

Objectives: High-risk behaviours are associated withan increased risk of adverse pregnancy outcomes. Theaim of this study is to describe risk behaviours in apopulation of Italian pregnant women. The main goal ismake recognition of the reality of alcohol and smokeconsumption in pregnant women.Materials & Methods: Between November 2009 andApril 2012 we collected data from 1000 unselectedpregnant women, referring to Department ofGynecology-Obstetrics and Urological Science,Sapienza University of Rome. Pregnant womenanswered semi-structured questionnaire whichinvestigated dietary habits, alcohol and smokeconsumption before and during pregnancy.Results: Of the 1000 women interviewed 68,6%consumed alcohol before pregnancy in a variableamount and 15,3% of these had more than one drinkper occasion. During pregnancy 36,3% of womencontinued to drink alcohol and 5,8 % of these had morethan one drink per occasion. Analizing how theychanged alcohol consumption since the beginning of

pregnancy, 44,4% of women suspended it, 29,6%decreased it, 25,4% did not change it and 0,6% evenstarted during pregnancy. As regards with smokinghabits, 32,8% of women used to smoke beforepregnancy, 59,2% continued to smoke during the firsttrimester, 45,9% during second trimester and 32,4 %during third trimester. Data also showed that there is astatistically significant association between those whodrank before pregnancy and those who smoked beforepregnancy (p <0,01).Conclusion: Smoke and alcohol consumption seems tobe related in pregnant women, especially beforepregnancy. Universal screening for alcoholconsumption should be done periodically for allpregnant women and women of child-bearing age. At-risk drinking could be identified before pregnancy,allowing for change. Health care providers shouldinform their patients about possible risks related tohigh-risk behaviours during preconception counseling.They also should create a safe environment for womento report alcohol and smoke consumption. The publicshould be informed that alcohol screening and supportfor women at risk is part of routine women’s healthcare. To women who continue to smoke and drinkalcohol during pregnancy, harm reduction/treatmentstrategies and psychological support should beencouraged.

107Pilot study: Fetal Alcohol Spectrum Disordersrelated behavior problems in children in foster care

Sandra Knuiman1,3, Catharina Rijk2, RenéHoksbergen3, Anneloes van Baar1

1Utrecht Centre for Child and Adolescent Studies,Utrecht University, Utrecht, The Netherlands;2Department of Developmental and ClinicalPsychology, Tilburg University, Tilburg, TheNetherlands; 3Adoption Department, Faculty SocialSciences, Utrecht University, Utrecht, The Netherlands

Objectives: Early diagnosis of Fetal Alcohol SpectrumDisorders (FASD) is essential for the prevention ofsecondary problems. There are, however, strongindications that many children and adults with FASDgo unrecognized and are untreated. In addition, someindividuals with FASD are incorrectly diagnosed andreceive the wrong treatment. This pilot studyinvestigates to what degree FASD related behaviorproblems are present in children in foster care in TheNetherlands.Materials & Methods: Approximately 270 Dutchfoster parents will be approached to participate in ourstudy. Data will be collected for children, aged 6 to 16,who have been in their current foster family for over 6

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months. Foster parents will be asked to fill out a digitalquestionnaire including demographic and backgroundvariables and including two instruments that weredeveloped to detect children with FASD. The FetalAlcohol Syndrome Questionnaire (FASQ) developedby Feldmann (Scheffner, 2011) includes 38 itemspresenting social, behavioral and emotional problemsof children and adolescents indicative of FASD. TheNeurobehavioural Screening Tool (NST; Nash, Koren,& Rovet, 2009) is based on ten questions from theChild Behavior Checklist.Results: Data collection is in progress. Parents arecurrently being approached and asked to complete thequestionnaire. First results are expected in September2012.Conclusion: Based on the high risk background offoster children, we expect that children in foster careshow elevated levels of behavioral problems related toFASD, and that there is a significant relationshipbetween these problems and the consumption ofalcohol during pregnancy of the mother. An increasedrate of such behavior problems will be a strongindication for the need for diagnosticians and fostercare workers to focus more on FASD.

108The health communication campaign ‘MammaBeve, Bimbo Beve’. Efficacy of the communicationplan and future strategies to increase awareness onFASD in the area of the Local Health Authority ofTreviso (Italy)

Stefania Bazzo11, Patrizia Riscica2, GiuseppeBattistella3, Giuliana Moino2, Francesco Marini4,Gianluigi Scannapieco4, Giuseppe Dal Pozzo5, MeryBottarel5, Loredana Czerwinsky1

1Doctoral school in Sciences of Reproduction andDevelopment, University of Trieste, Italy; 2AddictionDepartment, Local Health Authority of Treviso,Veneto Region, Italy; 3Epidemiologic Unit, LocalHealth Authority of Treviso, Veneto Region, Italy;4Department of Innovation, Development andPlanning, Local Health Authority of Treviso, VenetoRegion, Italy; 5Obstetrics and Gynaecology Unit, LocalHealth Authority of Treviso, Veneto Region, Italy

Background: In 2010 the Italian Local HealthAuthority of Treviso (Venetian Region) launched thehealth communication campaign ‘Mamma Beve,Bimbo Beve’ (‘Mummy Drinks, Baby Drinks’). Thecampaign was targeted to local women of child-bearingage and their families living in the area of the LocalHealth Authority, and was aimed to raise awarenessabout the dangers of drinking alcoholic beveragesduring pregnancy and breastfeeding. The visual was

conceived by Fabrica, the communication researchcentre of Benetton Group, and consisted of theadvertising message ‘Mamma Beve, Bimbo Beve’accompanied by the symbolic image of a foetus insidea glass of a typical local alcoholic drink called ‘spritz’.Materials & Methods: The campaign used socialmarketing principles and involved differentstakeholders from the community. Different actionswere performed to spread the health message,including visual and print materials, street banners andbus banners, and a dedicated website.Results: In 2011-2012, two main actions wereperformed: - the evaluation of the level of awareness ofthe campaign in the target population. A survey wascarried out to assess the impact of the image used bythe campaign - the identification and implementation ofnew strategies to continue to spread the healthmessages at a community level. These strategiesinclude actions as a video-clip, that involved localcomedians, a Facebook profile, and viral marketingactions.

109Design and validation of a food frequencyquestionnaire for use in pregnant womenconsuming alcohol

Victoria Coathup1, Joanna Henry2, Jeremy Taylor2,Lesley Smith1, Simon Wheeler2

1Department of Social Work and Public Health, OxfordBrookes University, Oxford, United Kingdom;2Functional Food Centre, Department of Sport andHealth Sciences, Oxford Brookes University, Oxford,United Kingdom.

Objectives: Recent evidence has suggested that theteratogenic effects of alcohol are exacerbated in thepresence of sub-optimal maternal nutrition. Lowdietary intakes of folate, choline, and antioxidants havebeen suggested as potential mechanisms for FASD.Therefore we aim to design and validate a semi-quantitative food frequency questionnaire (FFQ) tomeasure the intake of folate, choline, vitamin C andcarotenoids in women of reproductive age. Oncevalidated, the FFQ will be used in a sample of pregnantwomen consuming alcohol, as part of an on-going PhDstudy. The objectives of the study are to determine theconcurrent validity between nutrient intake as assessedby the FFQ, 24-hour dietary recalls, and concentrationsof nutritional biomarkers in blood.Materials & Methods: The FFQ was based on avalidated instrument designed to determine folateintake in adult males and females*. Commonly eatenfood groups for folate, choline, vitamin C andcarotenoids were identified using data from the

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National Diet & Nutrition Survey and the Low IncomeDiet & Nutrition Survey. Food sources rich in folate,choline, vitamin C, and carotenoids were thenidentified using The Composition of Foods integrateddataset and the USDA Database for the CholineContent of Common Foods. A food portion sizebooklet to accompany the FFQ was designed using APhotographic Atlas of Food Portion Sizes. Aconvenience sample of approximately 60 femaleparticipants of reproductive age (18 – 40years) will berecruited and required to complete a short screeningquestionnaire. Participants will then complete the self-administered FFQ and participate in a multiple-pass24-hour dietary recall interview. Two further 24-hourdietary recall interviews will be completed over thenext three-week period by telephone.Red cell folate,plasma choline, serum ascorbate and plasma carotenoidcontent will be measured from capillary blood samples.Blood samples will be centrifuged within one hour ofcollection using a hematospin 1400 for 15 minutes toseparate the plasma from whole blood. Plasma will bestored at -70C until assayed. Red cell folate and plasmacholine will be quantified using chemiluminescencemethods. Plasma ascorbate and carotenoids will bequantified using HPLC methods.Results: Data collection will begin on June 6th 2012.Data will be presented on the correlation between thesedifferent dietary assessment methods and bloodbiomarkers.Conclusion: Conclusions will be drawn once datacollection and analysis are complete.Acknowledgements: *We would like to acknowledgeDr Maria Pufulete and King’s College London forallowing us to use and modify their folate FFQ for ourown research purposes.

110A systematic review of the current literatureinvestigating attachment and fetal alcohol spectrumdisorders

Elizabeth Wray1, Swapnil Palod1, Emilios Lemoniatis2

Raja A S Mukherjee1

1Fetal Alcohol Spectrum Disorder Specialist BehaviourClinic; Surrey and Border’s NHS Foundation Trust,2Fostering, Adoption and Kinship Care Team,Tavistock and Portman NHS Trust

Objective: The aim of this systematic report was toreview the literature regarding the attachment styles ofindividuals with fetal alcohol spectrum disorders(FASD).Materials & Methods: AMED, BNI, CINAHL,Embase, MEDLINE, ProQuest, PsycINFO, PubmedCentral, and Science Direct were systematically

searched using various FASD (FASD, PAE , FAS,FAE) terminologies alongside the keyword ofattachment. Papers were also checked manually againstrecords.Results: The systematic searches yielded a mere eightarticles and two dissertation abstracts dated from 1987to 2009. Only two articles were found that addressed aspecific FASD condition; which reported no effectsupon the child’s attachment. Five studies argued for anassociation between prenatal alcohol exposure andinsecurity of attachment in offspring, one reportedinfrequent effects of alcohol on attachment, whereasthe remaining two found no significant relationship;with one article contesting that any differences inattachment may be explained by low-quality careinstead. All of the articles suffered frommethodological issues including sample size, choice ofmeasures and control of confounding variables;however the specific variable of intellectualfunctioning, which is commonly damaged withinsuffers of FASD, was not appropriately considered.Studies into attachment within children diagnosed withdisorders that are frequently co-morbid with FASD,such as ADHD and ASD, may help to shed the light onthe effects of FASD.Conclusions: With many children born to alcoholaddicted mothers being taken into care or experiencingneglect the lack of research and high prevalence withinthis group of neurodevelopmental disorders, furtherresearch is required to understand attachment styles inchildren with FASD

111FASD Mothers-FASD Children: early follow-up bythe team of the CAMSP* (Early Medico SocialAction Center) Reunion Island France

Elsie Numan1, Joelle Balanche2, Valérie Noel3,Catherine Soares4, Thèrése Lamblin5, Denis Lamblin6

1CAMSP Fondation Pere Favron, Reunion Island,France; 2Fondation Pere Favron, Reunion Island,France; 3Fondation Pere Favron, Reunion Island,France; 4Fondation Pere Favron, Reunion Island,France; 5Conseil General, Reunion, France; 6FondationPere Favron, Reunion Island, France

Background: Here in Reunion Island we areconfronted with mothers carrying FASD like theirchildren and the specific problems that we encounterfor their follow-up.Materials & Methods: The clinical observations ofthese families by our multi-disciplinary team, has shedlight on a certain number of particularities in themother-child interactions.

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Competencies and disabilities of these mothers inresponding to the affective and educative needs of theirchildren and dealing with the daily organization offamily life.The goals are:1) To describe the specificities of the interactionsbetween FASD mothers and their children.2) To list the keys to observe those families. How tocreate a therapeutical alliance? How to change ourvision and comprehension? How to positivelyencourage these mothers to allow the settlements ofspecific supports in the fields where they encounter themost difficulties?Conclusion: A better understanding of thoseparticularities will help all the professionals servingthose populations to adjust and fine-tune their care.Acknowledgements: *CAMSP (Centre d’actionsmedico-social précoce) = Medico Social Center fordiagnosis, rehabilitation and support for disabledchildren from 0 to 6 years old and their parents.

112The Hope is in the interventions

Susan Doctor

The Center for the Application of Substance AbuseTechnology (CASAT), University of Nevada, RenoNevada, United States of America

Objectives: Participants will understand: interveningfor those with an FASD within the context of DynamicCase Managements (DCM); an innovative interventiontheory that will potentially produce positive outcomesfor the individual with an FASD; the possible ethicalissues that can arise in relationship to the use of theintervention theory processes.Materials & Methods: Apple laptop computer,PowerPoint presentation (on computer and flashdrive),LCD projector, laser remote, handouts of thepresentation slides. Instructor will lecture and, if timepermits, instruct participants through experientialactivities that will deepen their understanding of theconcepts taught.Results: Participants will gain a deeper understandingof the many “layers” involved with the provision ofinterventions for those with an FASD. Regardless oftheir role (i.e., care givers or service providers)participants will have tools that will aide the provisionof appropriate interventions/accommodations for thosewith an FASD resulting in outcomes that positivelysupport the life style.Conclusion: As an FASD specialist, I gain a great dealof satisfaction from being able to pass on what I havelearned about interventions and those with an FASD.Sharing the information at the conference provides the

opportunity to “pay it forward” to others involved inthe provision of services or caring for those with anFASD.

113Associated factors prenatal abuse: preliminaryresults of a population register

A Colet, M Jané, MJ Vidal, B Prats, MJ Morcillo, CCabezas

Mother and Child Health Unit, Catalan Public HealthAgency


Background: The child abuse is a public healthproblem and a global health priority of the CatalanPublic Health Agency. The prenatal violence such as:inadequate intake of drugs, tobacco or alcoholconsumption, personal body care neglect, andvoluntary or involuntary pregnancy control areconsidered a public health problem. In 2009, theCatalan Public Health Agency in collaboration with theDGAIA (General Direction of infant and teenagerAttention) implemented a population register, theUnified Register of Child Abuse (RUMI) in 40pediatric hospitals of Catalonia. The RUMI is a toolthat is used for early child abuse detection andprotection, allowing us to know the status of thisproblem in our social environment and to evaluate it.Objectives:1) To describe the pattern of child abuse in Cataloniasince the RUMI’s implementation to the first quarter of20122) To know the risk factors associated with prenatalviolence of babies reported in the RUMIMaterials & Methods: A cross sectional study. Thesample is based on notifications of child violence casesin RUMI register from 2009 to the first quarter of2012. The variables collected were as follows: sex,abuse gravity, suspected case of certainty, alcoholconsumption, tobacco consumption, drug consumption,body careless during pregnancy, violence of genre,ingestion of psychotropic substances. Statisticalanalysis was performed using the SPSS program.Results: 813 cases were reported in the RUMI, 9,7%related to prenatal abuse, 45,8% physical abuse, 37,5%sexual abuse, 18% neglect, 12,4% psychological abuse(80% accompanied by other types of abuse). Thepregnancy risk factors with notification of prenatalabuse were: 22% drinking alcohol, 65% smoking, 71,4 %consumption drugs and 22% psychotropic (mainlyamphetamines), others minor risk factors: 65% didn’thave followed pregnancy clinical guidelines and 6,5%reported having had gender violence. Related to drug


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abuse: 29% cannabis, 21% cocaine, 19% opiates, 12%cocaine and opiates, 7% cocaine, opiates and cannabis,9,5% cocaine and cannabis and 2,5% cannabis andopiates. Pregnant women who consume alcohol 100%smoking, 78,6% drugs consumption, 71.4% didn’t havefollowed pregnancy clinical guidelines (p <0.005) and28.6% psychotropic consumption (p> 0.005).Conclusions: The prenatal abuse covers a tenth of allchild abuse reported in the RUMI.A quarter ofpregnant women with this abuse, voluntarily or not,were detected with alcohol consumption. Theconsumption of tobacco and drugs and lack of care ofyour body are high risk factors related to alcoholconsumption. The most consumed drug in pregnantwomen with child abuse is cannabis and cocaine. TheRUMI is an important prevention and protection childabuse tool in Public Health field and it is alsoimportant for the multisectoral professionals involved.

114Using technology to create knowledge translationopportunities for FASD interventions

Jacqueline Pei1, Lauren Baugh1, Norman Mendoza2,Jason Suriano2

1Faculty of Educational Psychology, University ofAlberta, Edmonton, Canada, 2Rocketfuel Games,Edmonton, Canada


Objectives: Researchers and clinicians need to developnovel mechanisms for translating knowledge torelevant stakeholders to inform change in healthcarepractice and delivery. There is also a need within thegeneral public for access to reliable and valid researchfindings. The research knowledge that is available isoften not presented to the public in a relatable andeasily accessible way. Fetal Alcohol SpectrumDisorder (FASD) is a good example of how knowledgeneeds to be disseminated more effectively as thediverse needs of this population require a multifacetedinterventon approach. This presentation reflects theCanada FASD Research Network’s innovative uses oftechnology and web-based tools to provide empiricallyevaluated information in a context-specific way toimprove knowledge translation related to FASDintervention.Materials & Methods: Peer reviewed researchfindings are paired with user friendly informationsharing platforms to create a “one-stop shopping”network of FASD intervention information. Inparticular, three key modes of communicating researchto the community will be presented: an electronicnewsletter, a blog site, and an interactive website

created through a unique partnership between aresearch group and a corporate group. The process ofestablishing these communication platforms as well asevaluative strategies to assess impact of theseapproaches will be presented.Results: Each of these communication strategies hasshown increases in number and diversity of viewers.Number of blog viewers has been increasing by anaverage of 26% each month with viewers from 41countries. Search terms leading viewers to the blog siteillustrate the need for sharing of intervention researchinformation and working intervention strategies.Newsletter mail-out numbers have increased 145%since commencement. Viewer statistics for theinteractive website will be collected and presented.Conclusion: Increased use patterns indicate interestand need for reliable and easily accessible interventioninformation. Feedback and viewer statistics show thatuse of online technology is an effective means ofcommunity engagement and communication. Nextsteps will include creating a simulation of FASDintervention situations that enables users to seepotential outcomes from their intervention actions anddecisions. This can also be used as a training tool forfront line workers. The game will be based on a finiteset of scenarios structured into “choices” that the userwill make followed by the realistic outcomes thatwould result in a “choose your adventure” typescenario.

115Non-linear dose-dependent formation of ethanolexposure biomarkers

Clara Pérez-Mañá1,2,3, Antoni Pastor1,3,5, MitonaPujadas1,5, Esther Papaseit1,3, Silvia Frias1,4, Rafael dela Torre1,4,5, Magí Farré1,2,3

1Human Pharmacology and Clinical NeurosciencesResearch Group, Neurosciences Research Program,IMIM-Hospital del Mar Research Institute; 2UCICECIMIM-Hospital del Mar, CAIBER; 3UniversitatAutònoma de Barcelona-UAB 4Universitat PompeuFabra-UPF, Barcelona, Spain and 5CIBER Obesidad yNutrición (CIBERobn), Santiago de Compostela, Spain

Objectives: Subjects abusing alcohol can be identifiedthrough clinical history, examination or self-reportquestionnaires. Additionally a range of biomarkers isavailable for detecting alcohol misuse and in uteroexposure. Their analysis in both alternative (hair ormeconium) and conventional (blood/urine) biologicalmatrices is of relevance, due to limitations of thecurrent clinical approach, for the prevention of prenatalexposure to alcohol. Ethyl glucuronide (EtG) and fattyacid ethyl esters (FAEES) are non-oxidative


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metabolites of alcohol that can be detected inconventional and alternative biological matrices fromseveral hours to up to several months. Their rate offormation in humans particularly at doses of alcohollower than those producing intoxication are poorlyunderstood.Materials & Methods: The study design was double-blind, randomized, crossover, and controlled withplacebo. Participants were distributed in three differentcohorts: cohort 1 two doses of 18 and 30 g of ethanolwere administered to 12 subjects; cohort 2 two doses of6 and 12 g of ethanol were administered to 6 subjects;cohort 3 doses of 24 and 42 of ethanol wereadministered to 6 subjects. Thus each participantreceived two doses of ethanol, experimental sessionslasted 6 h. Ethanol and FAEEs (palmitic, stearic andoleic acid ethyl esters) in plasma were determined atpredose and at 15, 30, 45 minutes, and 1, 1.5, 2, 3, 4, 6and 24 hours after treatment administration. EtG wasdetermined in urine samples collected before (spotsample) and at different interval periods after treatmentadministration (0-2 h, 2-4h, 4-6h, 6-12h, 12-24 h).Results: EtG urinary recovery and plasma FAEEsconcentrations showed a dose-dependent relationshipwith ethanol administered doses. This relationshipfollowed an exponential trend.Conclusions: The formation rate of ethanol biomarkersdoes not follow a linear trend and this observationshould be taken into account when interpreting resultsin biological matrices.Supported by grant: ISCIII-FIS PI081913

116Alcohol disrupts the maternal seleniumtransference to liver fetus decreasing glutathioneperoxidase 1 (GPx1) activity

Domingo Montilla1, Karick Jotty1, Mª Luisa Ojeda1,Fátima Nogales1, Mª del Mar Guerrero1, Mª LuisaMurillo1, Olimpia Carreras1

1Alcohol and folic acid Research Group, Department ofPhysiology, Faculty of Pharmacy, University ofSevilla, Seville-Spain

Objectives: Maternal alcohol consumption affectsnutrients transport across placenta and enhancesoxidative stress. Both process inducing abnormalintrauterine fetus development. Recent studies havedemonstrated body selenium (Se) homeostasisdisruption in mother and offspring exposed to ethanol.The main goal of this study is to determine the effectsof alcohol’s ingestion on the maternal seleniumtransference to developing fetus, focusing on thehepatic Se concentration, its metabolic translation into

in the GPx1 hepatic selenoprotein, and its antioxidantactivity in fetus liver.Materials & Methods: Ethanol treatment (20% v/v)was administered in top water to dms for 10 weeksduring induction, reproduction and gestation. Fetus andlivers were extracted and weighed in 19 day ofgestation. The Se levels in liver were measured bygraphite-furnace atomic absorption spectrometry. Theantioxidant activity of glutathione peroxidase 1(GPx1), glutathione reductasa (GR) lipids peroxidation(TBARS) and protein carbonyl (PC) were determinedby spectrophotometric method. Liver GPx1 expressionwas detected by Western blotting technique.Results: Alcohol in dams reduces the solid caloricingest and the Se dietary intake, it also decreases infetus body and liver weights, and liver Seconcentration. The GPx1 expression and its antioxidanthepatic activity were also decreased in fetus exposed toethanol, showing a high imbalanced GPx/GR ratio,GPx1expression/GPx activity ratio, joint to an increasein lipids peroxidation.Conclusion: The dietary Se restriction induced byalcohol exposition, affects the maternal transference tofetus. Therefore, alcohol disrupts antioxidant seleniumrole via GPx1 in hepatic fetal tissue. Apparently, thisredox imbalance follows a selective reaction duringlater ontogenesis hepatic maturation that induces lipidsperoxidation.

117Validity of a maternal alcohol consumptionquestionnaire in detecting prenatal exposure

O García-Algar1, A Manich1, M Velasco1, X Joya1, NRGarcía-Lara2, S Pichini3, O Vall1

1URIE Group, Hospital del Mar Research Institute-IMIM-Parc de Salut Mar, Barcelona, Spain;2Neonatology Unit, Banco de Leche, Hospital 12 deOctubre, Madrid, Spain; 3Drug Research andEvaluation Department, Istituto Superiore di Sanità,Rome, Italy

Introduction: Ethanol consumption by pregnantwomen can produce severe effects in the foetus and thenewborn, mainly in neurological and weight-heightdevelopment, and are included in the term FASD (FetalAlcohol Spectrum Disorder). Questionnaires are themost used screening method to detect prenatalexposure, but a previous population study questionedits reliability. The objective of this study was tocompare alcohol prenatal exposure detection byquestionnaire compared with biomarkers in meconium.Materials & Methods: Sixty two meconium samplesfrom mothers who denied alcohol consumption during

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pregnancy by questionnaire were analysed. Theobjective analysis was made by determination ofFAEEs (fatty acid ethyl esters) as exposure biomarkersin meconium as biological matrix.Results: In the meconium from 10 of 62 newbornsfrom non-alcohol consuming mothers by questionnaire(16.12%) FAEE values were positive (≥ 2 nmol/g). Discussion: Questionnaires as a screening methodduring pregnancy are not a reliable tool. It is necessaryto identify prenatal exposure to alcohol as soon aspossible by biomarkers analysis in biological matricesfrom the newborn or the mother. The early detectionwill allow these patients to benefit from follow up andtreatment to reach the best possible neurologicaldevelopment.

118Maternal ethanol consumption during pregnancy:prenatal exposure diagnosis, neonatal screening andpostnatal follow up

O García-Algar1, M Jané2, L Segura2, J Colom2, SPichini3, O Vall1

1URIE Group, Hospital del Mar Research Institute-IMIM-Parc de Salut Mar, Barcelona, Spain; 2 ASPC,Departament de Salut, Generalitat de Catalunya,Barcelona, Spain; 3Drug Research and EvaluationDepartment, Istituto Superiore di Sanità, Rome, Italy

Background: Prevalence, under declaration, severeeffects on neurodevelopment (fetal alcohol syndrome),and associated expenditure of prenatal ethanolexposure are well known.Objectives: (1) To study the measurement of prenatalalcohol exposure: questionnaire and biochemicalscreening techniques. (2) To design and to implement aprenatal diagnosis and a neonatal screening protocolsof prenatal ethanol exposure. (3) To design and toimplement an intervention protocol and follow up ofexposed newborns.Materials & Methods: Prospective study includingmothers and newborns prenatally exposed to ethanol,in the hospital of the PI: 200 pregnant women for theprenatal diagnosis, 400 couples of mothers andnewborns for the neonatal screening (200 previous and200 controls), and 125 children prenatally exposed toethanol for the follow up during 1 year. Aquestionnaire about consumption and exposure totobacco, alcohol and drugs of abuse during pregnancy,will be administered, and in biological samples(maternal hair from the first trimester and afterchildbirth, meconium and cord blood) fatty acid ethilesters (FAEE), EtG/EtS and phosphatidylethanol(PEth) of ethanol and drugs of abuse, will be analyzed

liquid cromatography coupled with tandem massspectrometry and by immunoanalysis.Expected Results: 1) To design and to implement(translational) a clinical prenatal diagnosis andneonatal screening protocol and follow up of alcoholfetal exposure. 2) To prepare a patent or a result to becommercially exploited from the EtG immunoassay inmaternal hair.

119Application of an ex ovo chick agar culture model toexamine the morphological and molecular effects ofethanol on early-stage embryos

Deirdre Brennan, Seamus Giles

School of Medicine and Medical Science, UniversityCollege Dublin, Belfield, Dublin 4, Ireland

Objectives: The chick embryo is an excellent modelfor studying the direct effects of ethanol on embryonicdevelopment. However a major drawback using thissystem involves the reliable and uniform delivery oftest agents. To counteract this problem we havedeveloped a modified ex ovo chick agar culturetechnique1. In the present study we have applied thismodel to investigate the molecular and morphologicaleffects of ethanol on early-stage embryos.Materials & Methods: Hamburger-Hamilton stage 7-8chick embryos were dissected onto filter paper carriersand submerged in varying concentrations of ethanol inchick saline (0%, 1%, 5%, 10%, 20%) for 2 minutes.Embryos were then rinsed in saline and placed ventralside up on an agar-albumen substrate at 37°C in ahumidified chamber. Embryos were staged andmorphologically assessed at explanation and again at24hours post-incubation. Further parameters assessedafter treatment included ocular histology and theexpression of selected genes such as sonic hedgehog(Shh). In addition, the levels of embryonic ethanoluptake were assayed immediately post-treatment.Results: This treatment caused a dose-related growthretardation as evidenced by significantly reducedsomite number (n=20/group). Resin histology throughthe optic vesicle showed a dose dependent increase inapoptotic activity occurring within theneuroepithelium. Molecular analysis indicated thatwhile Shh transcription remained unchanged, theexpression of the active signalling Shh protein wasfound to be significantly reduced in ethanol-treatedembryos compared to control counterparts.Measurement of ethanol concentrations in theembryonic tissue resulted in a peak ethanol uptake at 5minutes post-treatment, which declined to baselinelevels after 60minutes.

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Conclusion: Ethanol treatment using this ex ovoculture method has produced a more consistent andreproducible set of ethanol-induced defects bycomparison to previously used in ovo regimes.2 Usingthis culture model to administer an acute or ‘binge’ethanol exposure has resulted in growth retardation,apoptosis and Shh disruption - key endpoints of ethanolperturbation previously validated in other modelsystems. Utilising this ex ovo technique further allowscontinuous visual access to monitor the embryothroughout the treatment period. In addition, reliableassessment of the timing of exposure andconcentrations of test substances administered can beeasily achieved. Overall, this simple modification ofthe standard agar culture technique provides a powerfulnew tool in the field of ethanol research. References: 1.Chapman SC et al. Developmental Dynamics. 2001;220(3):284-9. 2. Kennelly K et al. ReproductiveToxicology. 2011, 32(2):227-34.

120Challenges in managing growth problems inchildren with FASD- review of existing literature

Inyang Takon

Department of Paediatrics, Queen Elizabeth IIHospital, East and North Hertfordshire NHS Trust,Welwyn Garden City, Hertfordshire, United Kingdom


Objectives: Growth deficiency is a major feature inchildren with FASD and forms one of the keycategories assessed in making a diagnosis ofFAS/FASD. Children with weight problems andfailure to thrive who have FASD make very poorprogress on the regular dietary and caloricsupplementation usually used in managing childrenwith failure to thrive from other conditions. Familiesof children with FASD and growth problems maysometimes come under intense scrutiny by variousprofessionals due to the sometimes wrongly perceivedfeeling that the children are not adequately fed.Materials & Methods: A review of the databases(Medline, Psychinfo and CINAHL) was carried out onthe outcomes and interventions for growth deficiencyin children with FASD. There were four relevantpapers relating to growth problems in children withFASD.Results: Review of a 10 year follow up study on 60children and adolescents with FASD who were livingin Berlin and localities in Germany and a further 20year follow up study on 37 of the 60 subjects followedup showed that growth restriction was still present in asignificant number of the subjects although some of the

severely affected children showed some catch upgrowth as they grew older. Some of the subjectsshowed normalization of their BMI with differencesnoted in the growth outcome in males and females. Thesmall sample size and the need to consider otherconfounding factors that may affect growth outcomemakes it important for clinicians to carry out more longterm studies on outcome of growth deficiency inChildren with FASD. Few studies have shown that thelevel of growth hormone is raised in children withFASD although there was poor response at tissue levelwhich suggested some degree of peripheral tissueinsensitivity. There are no studies showing effectiveevidence based approaches in managing the growthproblems in children and young people with FASD.Conclusion: There is a need to carry out prospectivelong term follow up studies on the growth outcome inchildren with growth deficiency as a result of alcoholexposure in utero. There is a need to carry out furtherstudies on interventions that work in managing theweight problems in children with FASD. The author isin the process of carrying out a Pilot study through theHealth Care Professionals Forum for FASD to addressthese questions.

121Maternal risk factors for fetal alcohol spectrumdisorders in a province in Italy: combined analysesfrom two waves of study

Mauro Ceccanti1, Daniela Fiorentino1, Marina Romeo1,Jason Blankenship2, Wendy Kalberg2, Philip A May3

1The University of Rome “La Sapienza”, Rome, Italy;2The University of New Mexico Center on Alcoholism,Substance Abuse and Addictions, Albuquerque, NewMexico, USA; 3The University of North Carolina,Chapel Hill, North Carolina, USA

Objectives: As part of population-based prevalencestudy of FASD in the Lazio Province of Italy,researchers conducted in-depth maternal interviewswith mothers of all cohort subjects (n=976). Theobjective was to examine and better define thematernal risk factors of the mothers who producechildren with an FASD.Materials & Methods: Lazio contains the city ofRome and the study area is characterized by small andmedium sized towns and rural areas. The studyconsisted of two waves of dysmorphology screening,child testing, and interviews of mothers all withaffected children and controls from first grade classesand their mothers.Results: Analysis of the maternal demographic anddrinking characteristics of mothers of children withFASD, mothers of randomly-selected controls, and


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community mothers of other first grade childrenprovided many statistically significant results includingheight and body mass index (BMI) differences, withmothers of the FASD children being the shortest (F =5.95, p =.003), and having the highest BMI (F = 3.45, p= .032). Mothers of FASD children report the highestlifetime alcohol consumption (X2 = 7.85, p = .020), aswell as more drinks consumed per month (F = 10.72, p= .000), and in the past week (F = 8.27, p = .000) at thetime of interview. In addition, total drinks consumedper week three months before pregnancy issignificantly higher for mothers of children with FASD(F = 5.03, p = .007), as is the percentage of that groupwho report consuming three drinks or more peroccasion during pregnancy (e.g., binge drinking; X2 =5.70, p = .058). Correlations illustrate the importanceof maternal demographic (e.g., mother’s occupationand monthly income) and other drinking variables(e.g., variety of alcohol types consumed, total numberdrinks consumed per week three months beforepregnancy, binge drinking), as they correlatesignificantly with child physical traits that are key toFASD diagnoses, In addition, paternal and familyvariables are examined, including reported alcoholproblems in the child’s family and father’s legalproblems, both of which differ significantly by group(FASD, Control, and Community; X2 = 11.74, p =.003 and X2 = 8.03, p = .018, respectively), with thegreatest problems in the FASD group.Conclusion: Maternal risk factors for FASD in Italyhave been better defined by this study, and the resultsmay be relevant to other European countries.

122Assessing the impact of the health communicationcampaign “Mamma Beve, Bimbo Beve”, to raiseawareness on the risks of alcohol use duringpregnancy in a local area of Italy

Stefania Bazzo1, Giuseppe Battistella2, PatriziaRiscica3, Giuliana Moino3, Francesco Marini4,Gianluigi Scannapieco4, Mariasole Geromel5, LoredanaCzerwinsky1

1Doctoral School in Sciences of Reproduction andDevelopment, University of Trieste, Italy;2Epidemiologic Unit, Local Health Authority ofTreviso, Veneto Region, Italy; 3Addiction Department,Local Health Authority of Treviso, Veneto Region,Italy; 4Department of Innovation, Development andPlanning, Local Health Authority of Treviso, VenetoRegion, Italy; 5University of Udine, Italy

Background: The health communication campaign“Mummy Drinks, Baby Drinks” (“Mamma Beve,Bimbo Beve”) was launched in 2010 to raise awareness

on the effects of drinking alcohol during pregnancy inthe childbearing-aged population of the Local HealthAuthority of Treviso (Italy).Objectives: To assess the impact of the advertisingimage used in the campaign. The image depicted afoetus inside a glass of a local alcoholic drink.Materials & Methods: A survey using a semi-structured self-reported questionnaire was carried out.The questionnaire was administered by nurses to aconsecutive series of 690 parents or caregivers whoaccompanied children aged 0–2 years in the localvaccination clinics during a 30-day period 1 year afterthe start of the campaign. The questionnaire measuredthe level of exposure to the image, emotional reactionsand awareness of the health messages conveyed by theimage.Results: Eighty-four percent of the sample said thatthey had seen the image. Ninety-three percent recalledthe warning message and 53% recalled the healthbehaviours suggested by the campaign. The imagegenerally seemed to arouse a high emotive impact:38% indicated distress and 40% liking as a generalopinion. We did not find unequivocal relationshipsbetween the level and kind of emotional reactions andthe recalling of the health behaviours.Conclusions: The image obtained a high level ofvisibility. We hypothesized that individuals approachedthe picture like an open task, that is, the image can leadto emotional elaboration and interpretation beforebeing placed in their cognitive patterns. This may bedue to the complexity of the tasks evoked.

123Combining challenging restless day-time behaviourswith challenging restless night-time behaviours

Osman Ipsiroglu1, Yi-Hsuan Amy Hung1, SamaraMayer1, Jean-Paul Collet2, Bruce Carelton3

1FASD & SLEEP Research Group at BC Children’sHospital/Sunny Hill Health Centre for Children,University of British Columbia, Vancouver, Canada;2Centre for Evaluation, BC Children’s Hospital,University of British Columbia, Vancouver, Canada;3Pharmacogenomics & Active Surveillance Program,Child Family Research Institute, University of BritishColumbia, Vancouver, Canada

Objectives: In Canada FASD incidence is 9/1000 livebirths (3000 babies per year). A significant percentageof children and adolescents with an FASD areprescribed stimulants for challenging day-timebehaviours, such as ADHD and/or selective serotoninreuptake inhibitors (SSRIs) and/or psychotropicmedications for other behavioural and mooddisturbances. ADHD related restless daytime

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behaviours occur in up to 95%, sleep problems (SP) inup to 85% of children with an FASD. However, SP arenot routinely assessed in clinical encounters. Firstpublications on SP in children with aneurodevelopmental disorder/disability, such as anFASD, show that day- and night-time behaviours areinterconnected and should be examined together.Materials & Methods: We analyzed commonly usedADHD questionnaires that are used for clinicalassessments and therapeutic interventions, in regards totheir ability to elicit SP.Results: Five standardized questionnaires wereinvestigated: BASC-2 Behavior Assessment System(160 items), Vanderbilt ADHD Diagnostic RatingScale (82 items), SNAP-IV Teacher and Parent RatingScale (90 items), ADHD Rating Scale IV (18 items),and Conners’ Rating Scale Revised (80 items). None ofthem screen systematically for sleep problems.Questions associated with behavioral sleep problems(BSP), excessive daytime sleepiness (EDS), WillisEkbom Disorder (WED), Sleep Disordered Breathing(SDB) were identified. The number of itemsdescribing possible ESD varies between 0 and 10, BSP0-1, WED 1-4, and SDB 0-3.Conclusion: Currently used ADHD questionnaires areinadequate to capture the connections between day-and night-time behaviours. The definition of‘challenging day-time behaviours’, ‘therapeuticinterventions’ and ‘treatment success’ depends on howspecifically or broadly outcome measures are rated bythe individual physicians and care teams. In addition,there are currently no mechanisms for monitoring theeffects of stimulants and psychotropic medication,inclusive adverse drug reactions that present asbehavioural deterioration. Given the methodologicalchallenges, clinical results are difficult to compare. Wesuggest widening the Active Surveillance Programs formonitoring the effects of psychotropic medication,inclusive of the adverse drug reactions that present asbehavioural deterioration using individualized ‘GoalAttainment Scaling’.Source of Funding: Victoria Foundation FASD-Action-Fund, British Columbia, Canada

124"They silently live in terror" why sleep problemsand night-time-related-quality-of-life are missed inchildren with FASD

Osman Ipsiroglu1, William McKellin2, Norma Carey1,Christine Loock1

1FASD & SLEEP Research Group at BC Children’sHospital/Sunny Hill Health Centre for Children,University of British Columbia, Vancouver, Canada;

2Department of Anthropology, University of BritishColumbia, Vancouver, Canada

Objectives: Children and adolescents with FetalAlcohol Spectrum Disorder (FASD) are at high-risk fordeveloping sleep problems (SP) that can triggerdaytime behavioural co-morbidities such as inattention,hyperactivity, and cognitive/emotional impairments.While daytime morbidities are easily recognized andtreated with psychotropic medications, clinicalexperience has shown that the underlying SP, mainlyInsomnia and restless sleep, may remain masked andappropriate treatment missed.Materials & Methods: To understand the reasons forthe lack of recognition of SP in children with FASD,we conducted qualitative interviews with parents andhealth care professionals (HCP), performedcomprehensive sleep assessments for patients referredto our clinic for unresolved SP, and analyzed patients'medical records using the concepts of narrative schemaand ‘therapeutic emplotment’.Results: In the qualitative interviews, parents and HCPexhibited awareness of the significance of SP, itseffects on the child’s daily function, and the associatedsuffering of the parents due to current practices, whichmay lead to a breakdown in care. This systemicinattention to the sequelae of SP and the affectedfamily's wellbeing can be due to insufficientunderstanding of factors that contribute to SP and theirsequelae. In our comprehensive sleep assessments, wefound that the exclusive focus on prominent daytimesequelae led to ignorance of chronic SP in children andadolescents. Daytime behavioural and emotionalproblems were targets of pharmacological treatmentrather than the underlying SP. Consequently, SP werealso targeted with medication, without an investigationof underlying causation.Conclusion: Our study highlights deficits 1) in thediagnostic recognition of chronic SP in patients with alife-long chronic neurodevelopmentaldisorder/disability, 2) which leads to uncontrolledpharmaceutical treatment and 3) we propose a clinicalpractice strategy that acknowledges the contributionfrom parents and community-based HCP inrecognizing SP and related sequelae.Source of Funding: Victoria Foundation FASD-Action-Fund, British Columbia, Canada

125Let us talk “night-time-related-quality-of-life” forchildren and adolescents with FASD

Osman Ipsiroglu1, William McKellin2, Norma Carey1,Christine Loock1

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1FASD & SLEEP Research Group at BC Children’sHospital/Sunny Hill Health Centre for Children,University of British Columbia, Vancouver, Canada2Department of Anthropology, University of BritishColumbia, Vancouver, Canada

Objectives: Insomnia is a major sleep problem (SP)for children and adolescents with neurodevelopmentaldisabilities/disorders (NDD/D), like Fetal AlcoholSpectrum Disorder (FASD). Children and adolescentswith FASD and SP are often sleep deprived and havesignificant challenges staying awake during normalactivities. Their daytime sleepiness, inattention, orparadoxical hyperactive behaviour are often seen aspart of an FASD and are medicated.Materials & Methods: Focusing on children withFASD, we employed a narrative approach based on theconcept of ‘therapeutic emplotment’ and analyzed howdecisions are made in the clinical setting and thefactors that encourage or impede working towardsoptimized patient outcomes. We conducted qualitativeinterviews with parents/caregivers and health careprofessionals to understand the lack of recognition andineffectual treatment of paediatric SP. In addition, weinvestigated 27 patients with FASD and SP (mean: 6.3years; median: 5.25 years; range 2-14).Results: All patients had SP and several co-morbiditydiagnoses: 19/27 affected daytime wellbeing andchallenging behaviour; 5/27 anxiety disorder. 22/27patients were medicated with melatonin, 14/27 forADHD and 11/27 with antipsychotics/-depressants.22/27 patients had symptoms suggestive of WillisEkbom Disease and associated Periodic LimbMovements in wakefulness which had not beendiagnosed before. Qualitative interview data revealedthat caregivers who report SP are not given appropriateattention by health care professionals. The interviewsalso verified that symptoms were identified, but notconnected to possible SP. Clinical investigationsrevealed that the provision of a categorical diagnosis ofFASD obscured the need for full functional assessmentand intervention.Conclusion: Our study highlights the deficits incurrent clinical practice and education regardingdiagnostics and treatment of SP in vulnerablepopulations. To assess children and adolescents withNDD/D, such as FASD, we propose the use of adifferent clinical strategy that acknowledges andformalizes the input from the patient and caregivers.Source of Funding: Victoria Foundation FASD-Action-Fund, British Columbia, Canada

126Is challenging behaviour aggravated by sleepproblems? Home based sleep assessment videos forinsomnia diagnostics

Yi-Hsuan Amy Hung1, Adriano Barbosa2, EricVatikiotis-Bateson2, Osman Ipsiroglu1

1FASD & SLEEP Research Group at BC Children’sHospital/Sunny Hill Health Centre for Children,University of British Columbia, Vancouver, Canada2Cognitive Systems Program, Department ofLinguistics, University of British Columbia,Vancouver, Canada

Objectives: Up to 85% of children with FASD sufferfrom chronic insomnia. Many have globaldevelopmental delay and/or intellectual disability,often resulting in difficulty expressing verbaldiscomfort. Advanced video technology is available forsleep-laboratories and is used as a supporting tool toPSG or EEG. However, low-cost equipment that can beused independently, sent out for screening, andanalyzed quantitatively has not yet been identified andtested.Materials & Methods: Different combinations ofhardware/software were tested and used for clinicalpurposes. Prerequisites for in-vitro testing were: 1) lowcost/physical bulkiness/weight, durability for infrared-light camera and net-book; and 2) synchronizedaudio/video software with live time-stamp, constantframe-rates, automatic splitting of the recordings intomultiple smaller files.Results: We suggest an “ideal set ofhardware/software” that is reliable, affordable (~$500)and portable (=2.8kg) to conduct non-invasive home-based-overnight-video-sleep-studies. The equipmentconsists of a net-book, a camera with infra-red optics,and a video capture device. The recording software andvideo encoder provide consistent frame rate (>29 fps),are time-stamped for analysis, and allow standardizedqualitative and automatic quantitative analyses. Theequipment can be couriered to patient’s home. In orderto optimize results of clinical observations and tofacilitate equipment setup at their homes, patientsshould have internet connection for remote access fromthe research lab. Since September 2011, we have had45/46 successful recordings; problems occurred in onecase due to software programming.Conclusion: Home based sleep assessment videosallow us to observe the sleep patterns of patients intheir normal sleep environment. Using the videos as ascreening tool, we identified familial Willis EkbomDisease (WED) as one main cause of insomnia andchallenging behaviour. The strategy of using sleepvideos opens the floor for a new ‘observational sleepmedicine’ that has been useful in describingdiscomfort/urge-to-move/pain-related behaviouralmovement patterns in patients with FASD and WED.Source of Funding: Victoria Foundation FASD-Action-Fund, British Columbia, Canada

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127Prenatal exposure to alcohol and neurobehaviouraldevelopment at age seven

Janni Niclasen1,2, Anne Marie Nybo-Andersen2,Thomas William Teasdale1, Katrine Strandberg-Larsen2

1Institute of Psychology, University of Copenhagen,Denmark; 2Department of Social Medicine, Institute ofPublic Health, University of Copenhagen, Denmark

Objectives: the purpose of the present study was toinvestigate the effects of prenatal cumulated alcoholexposure and binge drinking on neurobehaviouraldevelopment at age seven.Materials & Methods: Sample: the Danish NationalBirth Cohort (DNBC), comprising information on100.000 pregnant women and their offspring.Exposure: separate information on average alcoholintake and binge drinking from three interviewsgathered at app. weeks 15 and 30 prenatally and 6months post-natally. The interviews cover the 1st, 2nd

and 3rd trimester respectively. Inclusion criteria wereinformation from these three interviews as well as fromthe seven year follow-up (N=37,152). Outcomemeasure: The four problem scales of the Strengths andDifficulties Questionnaire (SDQ) measuringhyperactivity/ inattention, conduct disorder, emotionaland peer problems. Confounders: register-basedinformation on maternal and paternal education andmaternal and paternal past history of psychiatricproblems, and self-reported information on maternaland paternal smoking and maternal well-being inpregnancy. Mediators: self-reported information onfamily/ home environment, maternal and paternalalcohol intake at age seven of the child, and childphysical activity and BMI at age seven. Analysisstrategies: multivariable linear regression measuringcontinuous externalising (combined hyperactivity/inattention and conduct problems) and internalising(combined emotional and peer problems) scores andmultivariable logistics regression measuring above cut-off hyperactivity/ inattention, conduct, emotional andpeer problem scores.Results: The multivariable linear regressions revealedthat binge drinking had a negative effect on boys’internalising problems. The multivariable logisticregressions showed that binge drinking was associatedwith >1 odd ratios (OR) on all four problem scales forboys (hyperactivity/ inattention, conduct, emotionaland peer problems) and >1 OR on hyperactivity/inattention and emotional problems for girls. No effectsof cumulated alcohol exposure were found in anyanalyses.Conclusion: Binge drinking is negatively associated

with emotional and behavioural scores for boys at ageseven, and to a smaller extent on girls. This finding issupported by the literature on animal models. No effectwas found on exposure to small to moderate amountsof cumulated alcohol exposure. It may be due toresidual confounding that was not possible to controlfor, or it may be that the 25 SDQ items are too broadand thus not sensitive enough to detect possible effectsof exposure to smaller amounts of alcohol. It may alsobe that possible negative effects are not present untillater in childhood.

128'As I see it...' Using social media to bring out thevoices of people with FASD, their families andcarers

Pip Williams, European Birth Mothers Network,London, UK; Maria Catterick, FASD Network,Stockton on Tees, UK; Eileen Calder, FASD Scotland,Hamilton, Scotland, UK

Email: Pip Williams ([email protected])

Background: Fetal alcohol spectrum disorders remainpoorly recognised across the UK despite the passage ofalmost 40 years since Fetal Alcohol Syndrome wasfirst named. Children and adults who are diagnosedwith an FASD often find themselves isolated withlimited professional support and care. Volunteer-developed support groups for FASD are a major sourceof advice and guidance for individuals and theirfamilies.Objectives: The objectives of the project were:1) to identify whether social media could be used to

ascertain perceptions and views of people withFASD, their families and carers about diagnosisand about living with an FASD

2) to develop and distribute an electronic survey tomembers of a closed social media site for FASD

3) to collate, analyse and interpret responses to thesurvey

4) to present the findings of the survey to nationaldecision makers to influence service development.

Materials & Methods: The start-up of a new closedFASD social media community provides anopportunity to collect the perceptions and views of themembership on the challenges and opportunities theyface. A semi-structured questionnaire is being sent tomembers of the group (number=100 at 4th September2012). Included in this survey are questions about themembers (age group and gender), role (person withFASD, parent, carer), whether or not they have adiagnosis of an FASD, and about the diagnosticprocess and post diagnosis support received. Questions


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are also included around the positive and negativeaspects of a diagnosis of FASD and the most importantaspects of prevention of fetal alcohol harm.Results: The results of the survey will be presented atthe conference together with the actions that have beenand are being progressed. It is intended that the UKand Scottish Governments will be presented with thesurvey report and requested to respond.

129Characteristic of women who drink – and do notdrink – alcohol in pregnancy: a large-scaledescriptive cohort study

Janni Niclasen

Institute of Psychology, University of Copenhagen,Denmark

Objectives: The majority of studies investigatingpossible long-term effects of a prenatal exposure toalcohol define alcohol exposure solely on the basis offirst trimester intake. The present study aimed 1. toinvestigate possible effects of using exposureinformation from three trimester interviews and pre-pregnancy intake rather than only using exposureinformation from early part of pregnancy; and 2. tocompare possible trends in background characteristicsbetween exposure groups with trends in estimates ofmultivariable linear and logistic regressions betweenalcohol exposure and behavioural scores on theStrengths and Difficulties Questionnaire (SDQ)controlling for a large number of confounders.Materials & Methods: Sample: The Danish NationalBirth Cohort (DNBC), comprising information on100.000 pregnant women and their offspring. Alcoholconsumption in first trimester: grouped 0, >0-2, >2-4,>4+ alcohol containing units/ week. Alcoholconsumption pre-pregnancy and during entirepregnancy: grouped 0, >0-5, >5-15, >15-45, >45-90,>90+ cumulated alcohol exposure. Outcome measures:1) Descriptive measures on background characteristicsincluding demographic and lifestyle factors derivingfrom either registries or self-reports. 2) SDQcontinuous scores for use in linear regression andabove cut-off SDQ scores for use in logisticregressions.Results (preliminary): 1). Abstainers defined on thebasis of full pregnancy information were more extreme(in either direction) compared to the abstainers definedfrom first trimester. Reversely, the high exposure groupdefined from first trimester scores more extreme on alarge number of parameters compared to the highintakers defined from full pregnancy information.2) No effects of alcohol were observed in themultivariable linear and logistic regressions with SDQ

outcomes. However, the trends in estimates from theregressions for the two groups resembled the trendsobserved for the key variables for the two groups in thebackground characteristics tables.Conclusion (preliminary): The study shows theimmense impact classification of alcohol groups haveon the observed results. Although studies may controlfor relevant confounders there seem to be immenseamounts of residual confounding that that is notpossible to control for. This may seriously affect theresults to such a degree that possible true effects ofprenatal exposure to small to moderate amounts ofalcohol on behavioural outcome is not detectable. Thefindings question whether this type of epidemiologicaldesign is at all appropriate to investigate theassociation between small exposures and outcomeslater in life. The finding may also explain the alcohol j-shape curve that has puzzled researchers for years.

130Treatment in institutions for pregnant women andtheir partners, voluntary and by force

Terje Knutheim, Hilde Evensen Holm, Egil Nordli

Drug and alcohol competence centre – region South,Borgestadklinikken, Skien, Norway

Objectives: Norway has an opportunity to givetreatment in institutions for pregnant women withsubstance abuse problems. There is the possibility ofcompulsory admission if "the woman’s abuse is of sucha nature that it is highly likely that the child will beborn with defects" (health and care Act § 10-3). Theaim of introducing this possibility was to protect thechild. But it also an intention that the woman should beoffered help for drug problem, and help to prepare formotherhood. It is possible that the partner also takespart in the treatment. The main focus of the treatment ismeeting the women with respect and establishing agood relationship between the hospitalized women andthe clinicians. The woman often changes from a stateof strong opposition to participate in the program, toactive engagement and preparations for motherhood.Many also gradually change lifestyle. Some of thefamilies stay voluntarily in the institution after birth totake part of an intensive family treatment program. Werecommend a stay for minimum one year.Materials & Methods: We want to present the contentin treatment by pictures and written information. Wewill emphasize the content of compulsory treatmentwhen we are aware of no other European country hasthe same chance of forced hospitalization of pregnantwomen. The voluntary offer for parents will also bepresented. Most patients have a mixed abuse, butwomen with a pure alcohol problem are also covered

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by the law. Dr. Egil Nordli will have a parallelpresentation where he will present results of his studyin the same treatment unit. This deals with thechildren's birth weight. This study will also bepresented at the poster.Conclusion: We want to show that the forcedhospitalization of pregnant women with substanceabuse problems can be a good measure for both parentand child.

131Challenges in managing growth problems inChildren with FASD- review of existing literature

Inyang Takon

Department of Paediatrics, Queen Elizabeth IIHospital, Welwyn Garden City, Hertfordshire, UnitedKingdom

Objectives: Growth deficiency is a major feature inchildren with FASD and forms one of the keycategories assessed in making a diagnosis ofFAS/FASD. Weight problems in children with FASDalso poses significant challenges to the clinician.Children with FASD and failure to thrive generallymake very poor progress on the regular dietary andcaloric supplementation usually used in managingchildren with failure to thrive from other conditions.Families of children with FASD and growth problemsmay sometimes come under intense scrutiny by healthand social care professionals due to the sometimeswrongly perceived feeling that the children are notadequately fed. The teratogenic effect of alcohol on thedeveloping brain has been widely studied and thebehavioural and cognitive profile and outcome ofchildren exposed to alcohol in the prenatal period havebeen widely studied. Alcohol is known to alterneuronal migration in the nervous system and affectsdevelopment of effective neural networks. The effectof alcohol on the gastrointestinal system and feedingbehaviours of affected children with FASD is less wellstudied. It is known that Alcohol can affect thematuration of the myenteric plexus and thedevelopment of the gastrointestinal myocytes. There isvery little research being carried out on the feedingbehaviours and pattern of growth if infants withFAS/FASD and very little is known about the growthoutcome in infants with FAS/FASD.Materials & Methods- A review of the databases(Medline, EMBASE, Psychinfo and CINAHL) wascarried out to check for relevant literature on theoutcomes and interventions for growth deficiency inchildren with FASD. Journals search was also carriedout and references listed in selected journals were alsoreviewed.

Results: There were very few earlier studies whichdiscussed certain gastrointestinal pathologies that wereseen in Children with FAS/FASD. Vasiliauskas et al(1997) described a pattern of chronic intestinalpseudoobstruction which could be seen in children withFASD. The children could present with chronicconstipation. Van Dyke et al (1982) described a patternof severe feeding dysfunction in some children withFAS. Oral dysfunction was seen in some of theaffected children. This presented as minimal oralmovements, swallowing difficulties and fatigue duringfeeding. These feeding behaviours were noted tocontribute to the failure to thrive seen in some of thechildren. Sujay et al (2012) have described severegastroesophageal reflux in some of the affected infants.

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Author AbstractAbrosimov I 98

Ahola A 44

Aiton N 20

Albayrak O 77

Aliane P 65

Alvik A 50

Andrea Angelucci M 53

Andrew G 48

Arvidsson T 55

Atkinson E 88

Auguet Mancini 101

Autti-Rämö 15, 37, 75

Balachova T 9, 12, 25

Balanche J 111

Barbosa A 126

Bartu A 30

Battistella G 11, 108, 122

Baugh L 114

Bazzo S 11, 108, 122

Bedard A-M 26

Beekmann L 69

Bialystok L 26

Black D 34

Blankenship J 121

Blin C 101

Boix C 51

Bonner B 9

Borkowska M 40

Bottarel M 108

Bower C 30

Brennan D 119

Burd L 45

Burnside L 85, 92

Cabezas C 113

Calder E 128

Callejon- Poo L 51

Cameron K 78

Cánovas A 6

Carey N 124, 125

Carelton B 123

Carmichael-Olson H 48

Carreras O 116

Castiel Y 62

Catterick M 128

Caughey H 26

Ceccanti M 28, 99, 104,

105, 106, 121

Chaffin M 9

Chambers C 14

Chan E 88

Chen M 48

Chersich M 4

Chetty C 4

Chong S 44

Ciccarone F 106

Ciolli P 28, 99, 106

Clarren S 87

Coathup V 109

Colet A 113

Collet J-P 48, 123

Colom J 27, 118

Colome R 51

Cook J 87

Coriale G 99, 104

Corredera A 51

Curran L 56

Czerwinsky L 11, 108, 122

Dal Pozzo G 11, 108

D'Antoine H 30

Davies L-A 4

de la Torre R 115

De Nicolo S 105

De Oliveira E 54

de Vries H 57, 89

Dechief L 59

del Campo M 46

Delgado J 91

Dell C 26

Dennett L 96, 97

Derevnina A 98

Di Lauro F 104

Dikke G 3

Doctor S 112

Dor T 62

Dörrie N 77

Eklund H 41

Elicio M 90

Endziniené M 64

Esper L 65

Falcón M 6

Farré M 115

Feldmann R 32, 61, 93, 94

Fiore M 104, 105

Fiorentino D 28, 99, 104,

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106, 121

Fleisher S 13

Föcker M 77

Freunscht I 77

Frias S 115

Furtado E 53, 65, 84

Garcia-Algar O 42, 90, 117,118

Garcia-Lara N 117

Garden J 48

Geromel M 11, 122

Gil E 23

Giles S 119

Gomariz V 6

Gonzalez Rodríguez I 84

Gould L 88

Gourlay E 20

Greaves L 26

Guerrero M 116

Guerri C 43

Halliday J 30

Hanlon-Dearman A 48

Haralampopoulos R 83

Harstall C 96

Hautaniemi S 44

Hayes S 31

Hebebrand J 77

Heinen F 24

Henry J 109

Hertz P 62

Hoff-Emden H 72

Hoksbergen R 49, 107

Holm H 130

Holmila M 75

Houben R 48

Hoving C 57, 89

Hubberstey C 74

Hume S 74

Hung Y 123, 126

Hüseman D 71

Ibar A 27

Ipsiroglu O 48, 123, 124,125, 126

Isurina G 9

Jan J 48

Jané M 27, 113, 118

Janssen L 77

Jiménez-Roset J 6

Job J 33, 88

Jones K 14

Jonsson E 38, 96, 97

Jotty K 116

Joya X 42, 117

Kalberg W 121

Kaminen-Ahola N 44

Kaminsky M 101

Keivers K 48

Knuiman S 49, 107

Knutheim T 130

Kohl R 5, 66

Kolpakov Y 98

Kosyh E 12

Krijgsheld M 5

Krikorian J 3

Kroon D 17

Kuzmenkoviené E 64

Lamblin D 7, 54, 111

Lamblin T 111

Landgraf M 24

Lange S 45

Larsson L 19

Lelong N 101

Lemoniatis E 110

Leung W 88

Loock C 48, 124, 125

Lopez-Sala A 51

Luna A 6

Magnusson A 41

Mancinelli R 105

Manich A 117

Marchei E 90

Marchitelli R 104

Margold M 77

Marini F 11, 108, 122

Marjonen H 44

May P 121

Mayer S 123

McCallum K 88

McFarlane A 22, 80, 82, 92

McKellin W 124, 125

McNaughton D 48

Memo L 90

Mendoza N 114

Meneses C 23

Michalowski G 35

Mitchell K 8, 73, 100,

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102, 103

Mitten R 95

Moberg P 58

Moffatt J 38

Moga C 96

Moino G 11, 108, 122

Monk V 20

Montilla D 116

Morcillo M 113

Morini L 90

Mukherjee R 47, 110

Murillo M 116

Nagel M 71

Nathoo T 10, 79

Nelson M 80

Niclasen J 127, 129

Nicotera M 106

Noel V 111

Nogales F 116

Nogrix G 54

Nordlie E 60, 130

Numan E 111

Nybo-Andersen A 127

Nyman A 44

Obmascher K 83

Ojeda M 116

O'Leary C 30

Olivier L 4

O'Riordan T 33, 78

Ortega J 6

Ospina M 96, 97

Pacifici R 90, 104

Paditz E 63

Palchik A 29

Palod S 110

Papaseit E 115

Parlapiano G 104

Parpinelli P 65

Pastor A 115

Pei J 31, 33, 48, 88,114

Pérez-Mañá C 115

Pervakov K 98

Pichini S 2, 42, 90, 104,117, 118

Poole N 10, 26, 74, 79

Popova S 45, 98

Poth C 31, 33, 88

Prasauskiené A 64

Prats B 113

Prince R 83

Pujadas M 115

Quintero Rueda A 84

Raitasalo K 75

Rajani H 22, 78, 80, 81

Ramis J 90

Rapisardi G 90

Rasile A 106

Rehm J 45, 98

Reuter A 55

Rijk C 49, 107

Riley E 68

Riscica P 11, 108, 122

Rogojin V 44

Romeo M 121

Romo N 23

Rutman D 59, 74

Sánchez M 6

Sans A 51

Santos F 65

Sapir A 62

Sarman I 41

Scalese B 104

Scamporrino M 28, 99, 106

Scannapieco G 11, 108, 122

Segura L 27, 118

Senecky Y 36

Siedentopf J-P 71

Simon S 70

Skitnevskaya L 25

Smith L 109

Soares C 111

Sofronova G 29

Solombrino S 28, 99, 106

Spohr H-L 21

St. Arnault D 33, 88

Strandberg-Larsen K 127

Subtil D 101

Suriano J 114

Symes B 22, 81

Takon I 120, 131

Tanner V 98

Tarani L 90, 104

Taylor J 109

Taylor L 33

Teasdale T 127

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Tenenbaum A 62

Teófilo de Sá Roriz S 53

Therby D 101

Thiel V 81

Thomas G 26

Thorup K 20

Thursby A 76

Toutain S 54

Trivelli M 90

Tsvetkova L 9

Urban M 4

Urso Baiardo L 101

Vall O 117, 118

van Baar A 49, 107

Van Bibber M 74

Van Dalen W 57

van der Wulp 5, 57, 89

Van Stelle K 58

Varavikova E 3

Vardalas B 83

Vatikiotis-Bateson E 126

Veer D 48

Velasco M 117

Viader Vidal B 52

Vidal M 113

Viljoen D 4

Villar A 6

Virtanen M 1

Vitale-Cox L 48

Volkova E 9, 12, 25

Wagner J 21

Wargowski D 83

Warren K 67

Wason-Ellam L 95

Watts M 39

Weinberg J 48

Wertelecki W 14

Wexler I 62

Wheeler S 109

Whitelaw E 44

Williams P 16, 128

Wilson M 86

Wilton G 58, 83

Witmans M 48

Wölfle S 77

Wray E 110

Wybrecht, R 18

Yaltonskaya A 98

Yaltonsky V 98

Yevtushok L 14

Yo W 48

Zamboni 53

Zymak-Zakutnia N 14

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Conferencia Europea Saf 2012

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