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The National Institutes of Health defines Fetal Alcohol Syndrome (FAS) as a debilitating collection of birth defects that include craniofacial dysmorphisms, neurological and motor insufficiencies, growth retardation, and behavioral and social discrepancies. Characteristic craniofacial abnormalities, which include smooth philtrum, thin vermillion border, short palpebral fissures, and microcephaly, are used as a diagnostic tool for FAS. There is agreement across the literature that the characteristic craniofacial dysmorphisms are induced as a result of prenatal alcohol exposure in very specific doses, and during very particular time periods during embryonic development. However, ambiguity still exists about the critical time and dose relationship of prenatal alcohol exposure in the production of FAS. In regards to the critical timing, researchers have concluded that prenatal alcohol exposure during the second half of the first trimester, defined as days 43-94 postconception, was found to cause an increased incidence of smooth philtrum, thin vermillion border, microcephaly and reduced birth weight. Conversely, other studies found that prenatal alcohol exposure on day 7 of gestation in mice, which corresponds to week 3 of human gestation, induced craniofacial abnormalities comparable to those seen in humans with FAS. In regards to the critical dose, there is a linear relationship between the dose of prenatal alcohol exposure and the incidence of FAS-related craniofacial abnormalities, with no safe threshold. It was also found that a binge pattern of drinking was more significantly associated with the craniofacial abnormalities seen in FAS than a continuous or less condensed pattern of drinking, even if the binge pattern involved a smaller absolute dose of alcohol. These results regarding both dose and pattern on prenatal alcohol exposure, suggest that binge-drinking patterns are most significantly associated with craniofacial abnormalities if consumed before pregnancy or during late pregnancy, whereas absolute high doses of alcohol in a non-binge pattern were most significantly associated with craniofacial abnormalities in the first trimester. Further research is required for clarification of the critical time and dose relationships involved in the production of the characteristic craniofacial dysmorphisms seen in FAS. A definite conclusion will aid in the public education and prevention programs for FAS if solid information can be provided about the harms of alcohol consumption during pregnancy in regards to timing and dose.

The teratogenic effects of prenatal alcohol exposure can significantly influence the development of a child, which may result in a range of structural, cognitive and behavioural abnormalities. The severity of these effects can vary and fall under the fetal alcohol spectrum disorder (FASD). South Africa hosts the highest prevalence rate (12%) of this disorder in the world. All conditions included in the FASD spectrum are completely preventable through maternal abstinence of alcohol during pregnancy. At present, very limited information is available regarding how much pregnant women in South Africa know about adverse effects caused by prenatal alcohol exposure. This study aimed to determine pregnant women’s awareness of alcohol’s potential teratogenic effects on pregnancy and their knowledge of the features and characteristics associated with fetal alcohol syndrome (FAS), the most severe of the FASD conditions. Additionally, the study compared the awareness and knowledge of pregnant women attending private antenatal centres, to those attending an antenatal clinic at Charlotte Maxeke Johannesburg Academic Hospital, a state hospital in the Johannesburg area. Participants (n=211) completed a self-administered questionnaire at their private antenatal class or state clinic. A total of 211 questionnaires were analysed; 107 questionnaires from the state antenatal clinic and 104 from the private antenatal centres. The awareness levels regarding alcohol use in pregnancy were found to be very similar amongst the private (52%) and state (55%) participants. However, results indicated that significantly more private participants (19%), compared to state participants (3%) could be classified as having knowledge of the condition FAS. Overall, this study found that pregnant women from various backgrounds have limited knowledge of the harms caused by alcohol use during pregnancy. Misconceptions about the acceptable levels of maternal alcohol consumption and the effects thereof were also evident. The results of this research highlights that prevention strategies and awareness campaigns regarding alcohol use during pregnancy should incorporate information on the severity and permanent nature of FAS, as well as highlighting the fact that all types of alcoholic beverages can result in this condition. Also, these campaigns should focus on informing women that no level of alcohol is acceptable during pregnancy, as any amount may have potentially teratogenic effects on the developing fetus.

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Thesis (MEdPsych)--University of Stellenbosch, 2007. / Bibliography. Also available via the Internet.

Thesis (Ph.D.)--Auburn University, 2007. / Abstract. Vita. Includes bibliographic references.

Thesis (M.A.)--York University, 2007. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 60-70). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR32020

The parietal lobe has been shown to be one of the regions most affected by prenatal alcohol exposure. Functional domains dependent on intact parietal functioning, including mathematical and visuospatial ability, have been consistently implicated in fetal alcohol spectrum disorders. This thesis examines, in children, using blood oxygenation level dependent (BOLD) functional Magnetic Resonance Imaging, the effect of prenatal alcohol exposure on brain activation during symbolic and nonsymbolic number processing, and place learning in a virtual environment. These functional domains were investigated using tasks of proximity judgment and exact addition to assess neural correlates of symbolic number processing in 65 children (mean age ± SD = 9.45 ± 0.42 years), nonsymbolic number comparison at varying difficulties in 34 children (11.55 ± 1.15 years), and place learning in a virtual reality computer generated (CG) arena in 57 children (9.44 ± 0.42 years; 29 boys). In the symbolic number processing tasks greater prenatal alcohol exposure was related to less activation in the right horizontal intraparietal sulcus known to mediate mental representation and manipulation of quantity. Children with fetal alcohol syndrome and partial fetal alcohol syndrome appeared to compensate for this deficit by increased activation of the left angular gyrus during the proximity judgment task. Syndromal children with fetal alcohol syndrome or partial fetal alcohol syndrome also demonstrated poor recruitment of the right horizontal intraparietal sulcus during nonsymbolic number comparison, indicating that mental representation and manipulation of quantity are impaired in children with heavy prenatal alcohol exposure, irrespective of the representation format used. This impairment was compensated for by the left angular gyrus, with only exposed children needing to recruit the left angular gyrus to a greater extent as number comparison task difficulty increased. Further, reduced activation of the right posterior superior parietal lobule in children with increasing prenatal alcohol exposure suggests that exposed children may be less able to employ the attentional systems associated with number processing. Notably, activation of nonsyndromal heavily exposed children was impaired in the right posterior superior parietal lobule, but spared in the right horizontal intraparietal sulcus. In boys only, prenatal alcohol exposure was associated with poorer place learning and reduced activation during place learning in the precuneus and posterior cingulate, as well as parahippocampal gyrus, frontal and temporal lobes, caudate, insula, claustrum, lentiform nucleus and thalamus. In girls, prenatal alcohol exposure was not associated with place learning performance or activation during place learning in any regions. These results confirm that boys and girls use different navigation strategies that rely on different brain regions and suggest that the regions used by boys are more susceptible to alcohol damage, while the regions used by girls are relatively spared. In conclusion, all the tasks investigated showed prenatal alcohol exposure related alterations in parietal function, with the impairments being widespread throughout the parietal lobe bilaterally. Notably, activation of the bilateral precuneus was affected by prenatal alcohol exposure in both the spatial navigation and nonsymbolic number comparison tasks. It is possible that this is a key region linking the deficits in number processing and visuospatial skills in children with prenatal alcohol exposure.

Alcohol is a major public health problem globally. According to the World Health Organization (WHO) report, alcohol accounts for 2.5 million deaths (4% of total) and 69.4 million (4.5% of total) of Disability-Adjusted Life Years (DALYs), (WHO, 2002, 2011). In South Africa, alcohol was found to be the third highest contributor to death and disability (Parry, 2007/8). Among the many far-reaching consequences of alcohol use in South Africa, Fetal Alcohol Syndrome (FAS) in certain regions in the country, rates among the highest in the world (May et al., 2007). Despite higher comparative levels of FAS in rural areas, almost one third of the population in urban sites (Gauteng) demonstrates that FAS is not exclusively a problem of South African rural areas. This study hypothesized that higher knowledge levels about the effects of alcohol on pregnancy may deter use among women. Employing secondary data analysis from a 2006 cross-sectional household survey, this study explored the prevalence of alcohol use among urban women (18-44 years) in the Tshwane Municipality, in general and in pregnancy. It also examined the relationship between knowledge of alcohol effects on pregnancy and alcohol use. A significant association was found between employment status, pregnancy outcome and general alcohol use among women. An almost significant association was found between knowledge of alcohol effects on pregnancy and past month alcohol use, knowledge levels and alcohol use during pregnancy. Findings partially support the hypothesis. However, knowledge of alcohol effects on pregnancy alone cannot deter women from using alcohol. Multiple influencing factors should be considered in planning prevention programmes for urban women’s alcohol use. Further research with larger sample sizes of pregnant women is suggested to explore the associations conclusively.

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