In-utero Toxic Exposure Flashcards
FASD structural brain anomalies
- Microcephaly
- Migrational anomalies
- Reductions in frontal, parietal, and temporal lobes volumes
- White matter hypoplasia > gray matter hypoplasia.
The following four criteria must be met for a medical FAS diagnosis…
Growth Deficiency - below average height and/or weight
Craniofacial Features:
- short palpebral fissures (eye width decreases with increased prenatal alcohol
exposure)
-flat midface
- a short upturned nose
- smooth or long philtrum
(the ridges running between the nose and the lip)
- thin vermilion (the upper lip thins with increased prenatal alcohol exposure)
Central Nervous System Dysfunction:
- Structural abnormalities
- Hard neurologic signs (e.g., seizures)
- Functional abnormalities (e.g., cognitive, EF/attention, memory)
Prenatal Alcohol Exposure - confirmed or unknown prenatal alcohol exposure
FAS prevalence
global prevalence - 10%
US <1%
Risk of FAS in each trimester
First trimester drinking increases the likelihood of FASD 12x; drinking during the first and second trimester increases the likelihood of FASD 61x, and drinking in all three trimesters increases the likelihood of FASD 65x.
FAS neuropsychological expectations
ID (25%) FAS and (10%) ARND
ADHD (60–95%)
Verbal learning and memory deficits
Behavior: impulsive, disruptive, aggressive, delinquent, poor social judgement (increased ODD, CD, and OCD)
In utero exposure to cocaine may lead to abnormalities in the…
frontocingulate cortex, including the anterior cingulate gyrus.
Cocaine exposure: neuro expectations
Lower IQ
Attention/processing speed/EF
Verbal > visuospatial
Behavior: impulsive and display poor emotional control.
Prenatal cannabis exposure (PCE) has been found to be associated with…
fetal growth restriction and lower birthweight.
Neuropathology of regular marijuana use
- reduced visual maturation and visual attentiveness
- heightened tremors
- exaggerated startle and visual responses
- poor habituation to novel stimuli,
common drug use during pregnancy
alcohol > tobacco > cannabis
Marijuana use: neuro expectation
- No IQ but academic underperformance
- Attention/EF deficits
- Verbal > visual
- Behavior: delinquency, mood, and behavior dysregulation
Mercury’s harmful effects to the fetus include …
brain damage, intellectual disability, poor motor coordination, blindness, seizures, and inability to speak.
Lead exposure neuro expectation
EF
visuospatial skills
Increased: ADHD, ODD
Nicotine/Tobacco exposure neuro expectation
Increased ADHD
Amphetamine neuro expectation
- Motor deficits during infancy
- Deficits in executive functions during childhood
- Poor emotional regulation
Opiates neuro expectation
Motor deficits during infancy with later deficits in executive functions and ADHD symptoms during childhood.
Antiepileptic meds (Valproic acid)
1st trimester - major anatomical birth defects
3rd trimester - cognitive and behavioral deficits
Exposure to Valproic acid has been linked to verbal deficits, as well as increased risk for ADHD and ASD.
In utero exposure to many toxic substances, namely lead and cocaine, appears to affect the developing CNS via its actions on what neurotransmitter?
Dopamine
Prenatal alcohol consumption affect on brain development in utero
during the first and second trimester interferes with neuronal migration and proliferation,
third trimester leads to structural damage to the cerebellum, hippocampus, and prefrontal cortex
In utero Exposures associated with visual/spatial deficits
Cocaine
Lead
Marijuana
Likely MRI finding from child with severe in-utero exposure to alcohol:
greater white matter than gray matter hypoplasia. Temporal lobes were more affected than temporal or occipital lobes.
