Neural crest cells arise during neurulation, a process that occurs during the third week of embryogenesis. These diverse cells then divide into various subtypes including cranial neural crest cells and cardiac neural crest cells. Each of these subtypes gives rise to a wide range of features throughout the fetus. While these cells are extremely diverse, they are also incredibly sensitive to their surrounding environment. Many maternal conditions affect neural crest cell division and migration, but maternal alcohol consumption and hyperglycemia due to gestational diabetes will be discussed in detail, with special attention paid to tissues that derive from cranial neural crest cells. While the initial mechanisms of the pathology vary for both of these conditions, what is remarkable is that they ultimately cause effects in similar ways. Both mechanisms lead to the creation of reactive oxygen species, which in turn trigger apoptotic pathways. Neural crest cell death causes a variety of congenital anomalies in fetuses, including craniofacial defects and cardiac outflow tract defects. Treatment options that have been researched in both conditions also vary, but are based on similar principles. Antioxidant therapies reduce the production of reactive oxygen species, thus reducing the severity of the anomalies affecting the fetus during development. Both maternal alcohol consumption and gestational diabetes are important public health concerns, and their management is of utmost priority in society. By decreasing the rates of women who consume alcohol during pregnancy, and managing gestational diabetes in those at highest risk, the rates of fetal congenital defects could be decreased.

O objetivo deste estudo foi investigar os efeitos do tratamento musicoterapêutico aplicado ao desenvolvimento da memória não declarativa em crianças com Síndrome de Williams (SW) e com Síndrome do Álcool Fetal (SAF). Foram conduzidos dois experimentos de antes e depois. Um incluindo 10 indivíduos com SW e outro 10 indivíduos com SAF com idade entre 6 a 17 anos, que receberam 13 sessões de tratamento com periodicidade de uma vez por semana em formato individual e duração de 45min cada sessão. As avaliações foram feitas pelas escalas IMTAP (Individualized Music Therapy Assessment Profile) e WISC-III (Escala Wechsler de Inteligência para Crianças) que mensuraram respostas de QI e habilidades cognitivas antes e depois das intervenções com musicoterapia. Os resultados foram mensurados por um avaliador cego, antes e depois das intervenções, através da pontuação das escalas WISC-III e IMTAP. A média calculada nos diferentes tempos do estudo para as crianças com SAF pela escala WISC-III antes do tratamento foi de 70.9 e desvio padrão 2.67 (IC 95% 65.65 a 76.15 p= 0.001) e média do IMTAP de 73.90 e desvio padrão de 1.90 (IC 95% 70.17 a 77.63 p=0.001) e no período após a intervenção a média da escala WISC-III foi de 78.60 e desvio padrão de 2.41 (IC 95% 74.40 a 82.80 p=0.001) e do IMTAP 85.70 e desvio padrão de 2.52 (IC 95% 80.75 a 90.65 p=0.001). Com relação às crianças com síndrome de Williams a média calculada pela escala WISC-III antes do tratamento foi de 52.2 e desvio padrão de 1.26 (IC 95% 49.72 a 54.68 p= 0.001) e média do IMTAP de 70.2 e desvio padrão de 0.77 (IC 95% 68.69 a 71.71 p= 0.001) e no período após a intervenção a média da escala WISC-III foi de 59 e desvio padrão de 1.6 (IC 95%55.86 a 62.14 p=0.001) e IMTAP 83.3 e desvio padrão de 1.68 (IC 95% 80.01 a 86.59 p=0.001). Com este estudo conseguimos verificar que as intervenções com musicoterapia apresentaram um efeito positivo para estas populações, mesmo com pouco tempo de tratamento, com relação ao desenvolvimento de habilidades cognitivas. Os resultados observados na investigação dos efeitos da musicoterapia aplicada ao desenvolvimento da memória não declarativa de crianças com síndrome de Williams e síndrome Alcoólica Fetal são inconclusivos. Sugere-se para as próximas investigações uma amostra maior, grupo controle e mais tempo de tratamento. Estas modificações poderão aumentar a precisão para observar os efeitos do tratamento nestas populações. / This study aimed to investigate the effects of music therapy treatment applied to the non declarative memory development in the Williams Syndrome (WS) and the Fetal Alcohol Syndrome children (FAS). A before and after experiment was conducted which included 10 WS individuals and another 10 individuals with FAS aged between 6 to 17, each received 13 treatment sessions, with weekly intervals, individually and 45min sessions. The evaluations were executed by the WISC III and the IMTAP scales measuring the IQ responses and the cognitive abilities before and after the music therapy interventions. A random evaluator measured the before and after results of the interventions using the WISC-III and the IMTAP scales scores. Regarding the FAS children’s analysis different time sequence, the WISC-III scales calculated average before treatment was 70.9 and standard deviation 2.67 (CI 95% 65.65 a 76.15 p= 0.000) the IMTAP average was 73.90 and standard deviation 1.90 (CI 95% 70.17 a 77.63 p=0.000) the post period intervention average for the WISC-III scale was 78.60 and standard deviation 2.41 (CI 95% 74.40 a 82.80 p=0.000) and for the IMTAP was 85.70 and standard deviation 2.52 (CI 95% 80.75 a 90.65 p=0.000). In relation to the Williams Syndrome children the WISC-III calculated average before treatment was 52.2 and standard deviation 1.26 (CI 95% 49.72 a 54.68 p= 0.000) the IMTAP average was 70.2 and standard deviation 0.77 (CI 95% 68.69 a 71.71 p= 0.000) post period intervention average for the WISC-III scale was 59 and standard deviation 1.6 (CI 95% 55.86 a 62.14 p=0.000) the IMTAP scale was 83.3 and standard deviation 1.68 (CI 95% 80.01 a 86.59 p=0.000). This study verifies that intervention with music therapy presents positive effects for these populations, even in short term treatment with relation to the cognitive skills development. The results observed in the investigation of the music therapy effects applied to the non declarative memory development of children with Williams Syndrome and Fetal Alcohol Syndrome is inconclusive. Therefore, for future investigations larger samples, group control, and longer treatment time is recommended. This modification can improve observation accuracy of treatment effects in these populations.

abstract: In the fifteen years between the discovery of fetal alcohol syndrome (FAS) in 1973 and the passage of alcohol beverage warning labels in 1988, FAS transformed from a medical diagnosis between practitioner and pregnant women to a broader societal risk imbued with political and cultural meaning. I examine how scientific, social, moral, and political narratives dynamically interacted to construct the risk of drinking during pregnancy and the public health response of health warning labels on alcohol. To situate such phenomena I first observe the closest regulatory precedents, the public health responses to thalidomide and cigarettes, which established a federal response to fetal risk. I then examine the history of how the US defined and responded to the social problem of alcoholism, paying particular attention to the role of women in that process. Those chapters inform my discussion of how the US reengaged with alcohol control at the federal level in the last quarter of the twentieth century. In the 1970s, FAS allowed federal agencies to carve out disciplinary authority, but robust public health measures were tempered by uncertainty surrounding issues of bureaucratic authority over labeling, and the mechanism and extent of alcohol’s impact on development. A socially conservative presidency, dramatic budgetary cuts, and increased industry funding reshaped the public health approach to alcoholism in the 1980s. The passage of labeling in 1988 required several conditions: a groundswell of other labeling initiatives that normalized the practice; the classification of other high profile, socially unacceptable alcohol-related behaviors such as drunk driving and youth drinking; and the creation of a dual public health population that faced increased medical, social, and political scrutiny, the pregnant woman and her developing fetus. / Dissertation/Thesis / Doctoral Dissertation Biology 2016

O objetivo deste estudo foi investigar os efeitos do tratamento musicoterapêutico aplicado ao desenvolvimento da memória não declarativa em crianças com Síndrome de Williams (SW) e com Síndrome do Álcool Fetal (SAF). Foram conduzidos dois experimentos de antes e depois. Um incluindo 10 indivíduos com SW e outro 10 indivíduos com SAF com idade entre 6 a 17 anos, que receberam 13 sessões de tratamento com periodicidade de uma vez por semana em formato individual e duração de 45min cada sessão. As avaliações foram feitas pelas escalas IMTAP (Individualized Music Therapy Assessment Profile) e WISC-III (Escala Wechsler de Inteligência para Crianças) que mensuraram respostas de QI e habilidades cognitivas antes e depois das intervenções com musicoterapia. Os resultados foram mensurados por um avaliador cego, antes e depois das intervenções, através da pontuação das escalas WISC-III e IMTAP. A média calculada nos diferentes tempos do estudo para as crianças com SAF pela escala WISC-III antes do tratamento foi de 70.9 e desvio padrão 2.67 (IC 95% 65.65 a 76.15 p= 0.001) e média do IMTAP de 73.90 e desvio padrão de 1.90 (IC 95% 70.17 a 77.63 p=0.001) e no período após a intervenção a média da escala WISC-III foi de 78.60 e desvio padrão de 2.41 (IC 95% 74.40 a 82.80 p=0.001) e do IMTAP 85.70 e desvio padrão de 2.52 (IC 95% 80.75 a 90.65 p=0.001). Com relação às crianças com síndrome de Williams a média calculada pela escala WISC-III antes do tratamento foi de 52.2 e desvio padrão de 1.26 (IC 95% 49.72 a 54.68 p= 0.001) e média do IMTAP de 70.2 e desvio padrão de 0.77 (IC 95% 68.69 a 71.71 p= 0.001) e no período após a intervenção a média da escala WISC-III foi de 59 e desvio padrão de 1.6 (IC 95%55.86 a 62.14 p=0.001) e IMTAP 83.3 e desvio padrão de 1.68 (IC 95% 80.01 a 86.59 p=0.001). Com este estudo conseguimos verificar que as intervenções com musicoterapia apresentaram um efeito positivo para estas populações, mesmo com pouco tempo de tratamento, com relação ao desenvolvimento de habilidades cognitivas. Os resultados observados na investigação dos efeitos da musicoterapia aplicada ao desenvolvimento da memória não declarativa de crianças com síndrome de Williams e síndrome Alcoólica Fetal são inconclusivos. Sugere-se para as próximas investigações uma amostra maior, grupo controle e mais tempo de tratamento. Estas modificações poderão aumentar a precisão para observar os efeitos do tratamento nestas populações. / This study aimed to investigate the effects of music therapy treatment applied to the non declarative memory development in the Williams Syndrome (WS) and the Fetal Alcohol Syndrome children (FAS). A before and after experiment was conducted which included 10 WS individuals and another 10 individuals with FAS aged between 6 to 17, each received 13 treatment sessions, with weekly intervals, individually and 45min sessions. The evaluations were executed by the WISC III and the IMTAP scales measuring the IQ responses and the cognitive abilities before and after the music therapy interventions. A random evaluator measured the before and after results of the interventions using the WISC-III and the IMTAP scales scores. Regarding the FAS children’s analysis different time sequence, the WISC-III scales calculated average before treatment was 70.9 and standard deviation 2.67 (CI 95% 65.65 a 76.15 p= 0.000) the IMTAP average was 73.90 and standard deviation 1.90 (CI 95% 70.17 a 77.63 p=0.000) the post period intervention average for the WISC-III scale was 78.60 and standard deviation 2.41 (CI 95% 74.40 a 82.80 p=0.000) and for the IMTAP was 85.70 and standard deviation 2.52 (CI 95% 80.75 a 90.65 p=0.000). In relation to the Williams Syndrome children the WISC-III calculated average before treatment was 52.2 and standard deviation 1.26 (CI 95% 49.72 a 54.68 p= 0.000) the IMTAP average was 70.2 and standard deviation 0.77 (CI 95% 68.69 a 71.71 p= 0.000) post period intervention average for the WISC-III scale was 59 and standard deviation 1.6 (CI 95% 55.86 a 62.14 p=0.000) the IMTAP scale was 83.3 and standard deviation 1.68 (CI 95% 80.01 a 86.59 p=0.000). This study verifies that intervention with music therapy presents positive effects for these populations, even in short term treatment with relation to the cognitive skills development. The results observed in the investigation of the music therapy effects applied to the non declarative memory development of children with Williams Syndrome and Fetal Alcohol Syndrome is inconclusive. Therefore, for future investigations larger samples, group control, and longer treatment time is recommended. This modification can improve observation accuracy of treatment effects in these populations.

O objetivo deste estudo foi investigar os efeitos do tratamento musicoterapêutico aplicado ao desenvolvimento da memória não declarativa em crianças com Síndrome de Williams (SW) e com Síndrome do Álcool Fetal (SAF). Foram conduzidos dois experimentos de antes e depois. Um incluindo 10 indivíduos com SW e outro 10 indivíduos com SAF com idade entre 6 a 17 anos, que receberam 13 sessões de tratamento com periodicidade de uma vez por semana em formato individual e duração de 45min cada sessão. As avaliações foram feitas pelas escalas IMTAP (Individualized Music Therapy Assessment Profile) e WISC-III (Escala Wechsler de Inteligência para Crianças) que mensuraram respostas de QI e habilidades cognitivas antes e depois das intervenções com musicoterapia. Os resultados foram mensurados por um avaliador cego, antes e depois das intervenções, através da pontuação das escalas WISC-III e IMTAP. A média calculada nos diferentes tempos do estudo para as crianças com SAF pela escala WISC-III antes do tratamento foi de 70.9 e desvio padrão 2.67 (IC 95% 65.65 a 76.15 p= 0.001) e média do IMTAP de 73.90 e desvio padrão de 1.90 (IC 95% 70.17 a 77.63 p=0.001) e no período após a intervenção a média da escala WISC-III foi de 78.60 e desvio padrão de 2.41 (IC 95% 74.40 a 82.80 p=0.001) e do IMTAP 85.70 e desvio padrão de 2.52 (IC 95% 80.75 a 90.65 p=0.001). Com relação às crianças com síndrome de Williams a média calculada pela escala WISC-III antes do tratamento foi de 52.2 e desvio padrão de 1.26 (IC 95% 49.72 a 54.68 p= 0.001) e média do IMTAP de 70.2 e desvio padrão de 0.77 (IC 95% 68.69 a 71.71 p= 0.001) e no período após a intervenção a média da escala WISC-III foi de 59 e desvio padrão de 1.6 (IC 95%55.86 a 62.14 p=0.001) e IMTAP 83.3 e desvio padrão de 1.68 (IC 95% 80.01 a 86.59 p=0.001). Com este estudo conseguimos verificar que as intervenções com musicoterapia apresentaram um efeito positivo para estas populações, mesmo com pouco tempo de tratamento, com relação ao desenvolvimento de habilidades cognitivas. Os resultados observados na investigação dos efeitos da musicoterapia aplicada ao desenvolvimento da memória não declarativa de crianças com síndrome de Williams e síndrome Alcoólica Fetal são inconclusivos. Sugere-se para as próximas investigações uma amostra maior, grupo controle e mais tempo de tratamento. Estas modificações poderão aumentar a precisão para observar os efeitos do tratamento nestas populações. / This study aimed to investigate the effects of music therapy treatment applied to the non declarative memory development in the Williams Syndrome (WS) and the Fetal Alcohol Syndrome children (FAS). A before and after experiment was conducted which included 10 WS individuals and another 10 individuals with FAS aged between 6 to 17, each received 13 treatment sessions, with weekly intervals, individually and 45min sessions. The evaluations were executed by the WISC III and the IMTAP scales measuring the IQ responses and the cognitive abilities before and after the music therapy interventions. A random evaluator measured the before and after results of the interventions using the WISC-III and the IMTAP scales scores. Regarding the FAS children’s analysis different time sequence, the WISC-III scales calculated average before treatment was 70.9 and standard deviation 2.67 (CI 95% 65.65 a 76.15 p= 0.000) the IMTAP average was 73.90 and standard deviation 1.90 (CI 95% 70.17 a 77.63 p=0.000) the post period intervention average for the WISC-III scale was 78.60 and standard deviation 2.41 (CI 95% 74.40 a 82.80 p=0.000) and for the IMTAP was 85.70 and standard deviation 2.52 (CI 95% 80.75 a 90.65 p=0.000). In relation to the Williams Syndrome children the WISC-III calculated average before treatment was 52.2 and standard deviation 1.26 (CI 95% 49.72 a 54.68 p= 0.000) the IMTAP average was 70.2 and standard deviation 0.77 (CI 95% 68.69 a 71.71 p= 0.000) post period intervention average for the WISC-III scale was 59 and standard deviation 1.6 (CI 95% 55.86 a 62.14 p=0.000) the IMTAP scale was 83.3 and standard deviation 1.68 (CI 95% 80.01 a 86.59 p=0.000). This study verifies that intervention with music therapy presents positive effects for these populations, even in short term treatment with relation to the cognitive skills development. The results observed in the investigation of the music therapy effects applied to the non declarative memory development of children with Williams Syndrome and Fetal Alcohol Syndrome is inconclusive. Therefore, for future investigations larger samples, group control, and longer treatment time is recommended. This modification can improve observation accuracy of treatment effects in these populations.

Made available in DSpace on 2016-03-15T19:40:27Z (GMT). No. of bitstreams: 1 Stella Maria Coda Pinto Alves.pdf: 2917004 bytes, checksum: 4023390b83759490fdd7f6eb4340a61f (MD5) Previous issue date: 2007-09-13 / Alcohol consumption during pregnancy is associated with a wide range of effects on birth, from which fetal alcohol syndrome is considered to lead to the most severe phenotypes. The teratogenic effects of alcohol on the human growth represent a spectrum of features on facial anomalies, growth deficiency at intrauterine into postnatal period, attention deficits and poor academic achievements. The aim of the present investigation was to study cephalometry as a diagnostic tool concerning craniofacial disorders in children and adolescents with confirmed mothers' alcohol intake history during the pre natal period. The specific objective was to analyse McNamara and Björk-Jarabak craniofacial parameters of ten children and adolescents who were exposed to alcohol during their mothers' pregnancy. The age of the subjects ranged from 11 to 18 years old, 5 were female. It was measured linear and angular variables compared to previous standards as descrived by McNamara and Björk-Jarabak. For this purpose, five linear measures and four angular parameters were taken into account in order to better describe craniofacial growth changes: maxilla length, mandibular length, anterior facial height, anterior cranial base, posterior cranial base, saddle angle, articular angle, gonial angle, upper gonial angle. Posterior cranial base, anterior facial height, mandibular size and tegumentary profile parameters were analysed as a whole in order to undertake global craniofacial development. The study showed that ten children and adolescents who were exposed to alcohol during their mothers' pregnancy were associated with linear measurements changes relative to posterior cranial base (p=0.01), mandibular size (p= 0.0009), face height (p= 0.01) and upper gonial angle (p= 0.01). / A exposição ao álcool durante a gestação é responsável pelo amplo espectro de alterações ocasionadas ao feto, cuja manifestação mais grave é a síndrome fetal alcoólica. O efeito teratogênico do álcool no homem apresenta evidências clínicas caracterizadas por anomalias faciais, atraso no crescimento intrauterino ou após o nascimento, e deficiências relacionadas ao aprendizado e à atenção. O objetivo geral deste estudo foi testar a análise cefalométrica como auxílio diagnóstico dos efeitos fetais do álcool em sujeitos com história de exposição ao álcool durante a gestação. O objetivo específico foi estudar as análises cefalométricas de McNamara e Björk-Jarabak nestes indivíduos. Foram selecionados dez sujeitos com história de ingestão de bebidas alcoólicas pelas respectivas mães no período gestacional. As idades variam de 11 a 18 anos, sendo 5 de cada sexo. Foram mensuradas grandezas lineares e angulares, e comparadas com a norma destas medidas de acordo com padrões cefalométricos das análises de McNamara e Björk-Jarabak. Foram analisados os dados obtidos a partir de cinco medidas lineares (comprimento efetivo da maxila, comprimento efetivo da mandíbula, altura facial anterior e inferior, base anterior do crânio, base posterior do crânio) e quatro medidas angulares (ângulo da sela, ângulo articular, ângulo goníaco, plano superior do ângulo goníaco). As grandezas relacionadas à base do crânio, à altura facial, à mandíbula e ao perfil tegumentar foram avaliadas em conjunto para permitir análise global do crescimento craniofacial. Os dez sujeitos com história de exposição ao álcool no período gestacional mostraram as seguintes medidas com diferença estatística significante em relação à norma: grandezas lineares relacionadas à base posterior do crânio (p= 0,01), comprimento efetivo da mandíbula (p= 0,0009); altura facial antero inferior (p= 0,01) e a grandeza angular plano superior do ângulo-goníaco (p= 0,01).

Maternal consumption of ethanol during pregnancy contributes to a set of pathologies, grouped together as the fetal alcohol spectrum disorders, affecting as many as 5% of live births in the United States annually. Ethanol acts widely in the developing embryo, affecting many tissues, but causing deficits in neuronal and neural crest populations particularly. These deleterious effects cause archetypical craniofacial expression and neurological deficits, including microcephaly and neuronal dysfunction. Severity of symptoms is linked to frequency of maternal alcohol consumption as well as the maximum blood alcohol concentration reached by the mother. The teratology of ethanol has been widely researched over the last four decades, with the link between the neural crest pathology and the fetal alcohol spectrum phenotype becoming clearer. Animal model studies have managed to replicate many of the symptoms seen in humans afflicted with fetal alcohol spectrum disorders, and have allowed us to elucidate the biochemical mechanisms behind the disease. There is no singular pathway responsible for the fetal alcohol spectrum disorders: over half a dozen models of dysfunction have been identified, and ethanol’s ability to react with a series of targets means that more pathways are likely to be discovered. Current theories regarding the effects of ethanol on the neural crest have implicated apoptosis of the cephalic neural crest, mediated by G-protein coupled receptors, activation of a phospholipase C pathway, and subsequent release of intracellular calcium; perturbations of the actin cytoskeleton leading to migration dysfunction of neural crest cells in the developing neural tube; lack of functional trophic molecules, specifically Shh, likely due to dysfunction of the cholesterol biosynthetic pathway; lack of retinoic acid production; oxidative stress, production of reactive oxygen species, and iron dysregulation; and genetics, which seems to confer greater susceptibility and resistance to ethanol in certain individuals. Ultimately, a global model for ethanol’s actions on the developing fetus eludes researchers, as do any potential treatments, and more research is required to further elucidate ethanol’s teratogenic mechanism.

The anterograde horseradish peroxidase method was used to determine if prenatal exposure to ethanol affected the development of the characteristic afferent lamination pattern of the commissural projection to the dentate gyrus. Mean ethanol consumption for the ethanol-consuming dams was 12.7 g/kg ± 0.3 g per day. Adult offspring of rats that consumed a liquid diet containing 35% ethanol-derived calories during days 1-21 of gestation, and both pair-fed and normal controls were examined. Brain weights and volumes of the ethanol and pair-fed control rats did not differ significantly from normal controls. However, body weights of ethanol-exposed rats were significantly reduced compared to normal controls. Computer-assisted image analysis of the HRP-labeling revealed that in spite of the heavy ethanol exposure there was no evidence of alterations in the spatial distribution of the commissural terminal field.

Alcohol consumption during pregnancy remains a common occurrence and is associated with a multitude of adverse birth and long-term outcomes. Binge drinking in particular is shown to be particularly harmful to the developing fetus. Effects include full fetal alcohol syndrome, with characteristic facial dysmorphology, growth restriction, and developmental to delays. Exposed children may also have partial fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neurodevelopmental disorders. These effects are preventable, and efforts must begin with accurate identification of women who consume alcohol during pregnancy. Several screening tools have been developed and validated for use in prenatal care settings, and the most recently proposed brief and easy to use T-ACER3 has demonstrated high sensitivity and specificity in both identifying risk drinking during pregnancy and predicting long-term neurobehavioral outcomes in exposed children. Once identified, effective interventions are available for use with pregnant women consuming alcohol. Brief interventions, which can be delivered by a health professional and involve motivational interviewing, have been demonstrated to significantly reduce alcohol consumption during pregnancy. These approaches, recommended by American College of Obstetricians and Gynecologist (ACOG), help move patients toward increased readiness to positively change their drinking behavior. Ultimately, all prenatal care providers should routinely screen all patients for alcohol use using validated tools, and where appropriate, should offer intervention.

Alcohol consumption during pregnancy remains a common occurrence and is associated with a multitude of adverse birth and long-term outcomes. Binge drinking in particular is shown to be particularly harmful to the developing fetus. Effects include full fetal alcohol syndrome, with characteristic facial dysmorphology, growth restriction, and developmental to delays. Exposed children may also have partial fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neurodevelopmental disorders. These effects are preventable, and efforts must begin with accurate identification of women who consume alcohol during pregnancy. Several screening tools have been developed and validated for use in prenatal care settings, and the most recently proposed brief and easy to use T-ACER3 has demonstrated high sensitivity and specificity in both identifying risk drinking during pregnancy and predicting long-term neurobehavioral outcomes in exposed children. Once identified, effective interventions are available for use with pregnant women consuming alcohol. Brief interventions, which can be delivered by a health professional and involve motivational interviewing, have been demonstrated to significantly reduce alcohol consumption during pregnancy. These approaches, recommended by American College of Obstetricians and Gynecologist (ACOG), help move patients toward increased readiness to positively change their drinking behavior. Ultimately, all prenatal care providers should routinely screen all patients for alcohol use using validated tools, and where appropriate, should offer intervention.