In-utero Toxic Exposure

Question 1

FASD structural brain anomalies

Answer 1

• Microcephaly
• Migrational anomalies
• Reductions in frontal, parietal, and temporal lobes volumes
• White matter hypoplasia > gray matter hypoplasia.

Question 2

The following four criteria must be met for a medical FAS diagnosis…

Answer 2

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

Question 3

FAS prevalence

Answer 3

global prevalence - 10%
US <1%

Question 4

Risk of FAS in each trimester

Answer 4

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.

Question 5

FAS neuropsychological expectations

Answer 5

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)

Question 6

In utero exposure to cocaine may lead to abnormalities in the…

Answer 6

frontocingulate cortex, including the anterior cingulate gyrus.

Question 7

Cocaine exposure: neuro expectations

Answer 7

Lower IQ
Attention/processing speed/EF
Verbal > visuospatial
Behavior: impulsive and display poor emotional control.

Question 8

Prenatal cannabis exposure (PCE) has been found to be associated with…

Answer 8

fetal growth restriction and lower birthweight.

Question 9

Neuropathology of regular marijuana use

Answer 9

• reduced visual maturation and visual attentiveness
• heightened tremors
• exaggerated startle and visual responses
• poor habituation to novel stimuli,

Question 10

common drug use during pregnancy

Answer 10

alcohol > tobacco > cannabis

Question 11

Marijuana use: neuro expectation

Answer 11

• No IQ but academic underperformance
• Attention/EF deficits
• Verbal > visual
• Behavior: delinquency, mood, and behavior dysregulation

Question 12

Mercury’s harmful effects to the fetus include …

Answer 12

brain damage, intellectual disability, poor motor coordination, blindness, seizures, and inability to speak.

Question 13

Lead exposure neuro expectation

Answer 13

EF
visuospatial skills
Increased: ADHD, ODD

Question 14

Nicotine/Tobacco exposure neuro expectation

Answer 14

Increased ADHD

Question 15

Amphetamine neuro expectation

Answer 15

• Motor deficits during infancy
• Deficits in executive functions during childhood
• Poor emotional regulation

Question 16

Opiates neuro expectation

Answer 16

Motor deficits during infancy with later deficits in executive functions and ADHD symptoms during childhood.

Question 17

Antiepileptic meds (Valproic acid)

Answer 17

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.

Question 18

In utero exposure to many toxic substances, namely lead and cocaine, appears to affect the developing CNS via its actions on what neurotransmitter?

Answer 18

Dopamine

Question 19

Prenatal alcohol consumption affect on brain development in utero

Answer 19

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

Question 20

In utero Exposures associated with visual/spatial deficits

Answer 20

Cocaine
Lead
Marijuana

Question 21

Likely MRI finding from child with severe in-utero exposure to alcohol:

Answer 21

greater white matter than gray matter hypoplasia. Temporal lobes were more affected than temporal or occipital lobes.