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14th Annual Fetal Alcohol Canadian Expertise (FACE) Research Roundtable

Saturday, September 7, 2013, St. John's, Newfoundland and Labrador

Keynote - What Has Research Accomplished and Where Do We Go From Here? James N. Reynolds, PhD, Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON

Synopsis: Over the past 40 years, a tremendous body of scientific knowledge has been accumulated from basic and clinical investigations that have documented the consequences of prenatal alcohol exposure on the developing embryo/fetus, and the resulting neurobehavioural deficits that occur in offspring. In this overview, we will look at some of these discoveries, and explore the challenges and opportunities for innovative new approaches for improving outcomes for individuals affected by FASD.

About the Speaker: James Reynolds, PhD is Professor of Pharmacology & Toxicology at Queen's University. For the past 20 years the major focus of Dr. Reynolds' research has been investigations into the effects of prenatal alcohol exposure on the developing brain and on behavior in offspring. Dr. Reynolds has been the Principal Investigator for numerous grants awarded by the Canadian Institutes of Health Research for both basic and clinical studies on FASD. Dr. Reynolds is the current President of the FASD Study Group, and is also the FASD Project Leader for NeuroDevNet, a Network of Centres of Excellence in developmental neuroscience

Meconium Fatty Acid Ethyl Esters as Biomarkers of Ethanol Exposure in Late Gestation and Indicators of Ethanol-Induced Multi-Organ in Fetal Sheep Irene Zelner, Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto; Department of Pharmacology and Toxicology, University of Toronto

Synopsis: Meconium concentrations of fatty acid ethyl esters (FAEE) have been shown to be specific and sensitive biomarkers of heavy fetal exposure to ethanol. To the best of our knowledge, the present study is the first report evaluating the utility of meconium concentrations in identifying fetuses with organ-system injury resulting from in-utero ethanol exposure. In an ovine model, we found that meconium FAEE concentration was a highly sensitive and specific biomarker of a relatively moderate-dose fetal ethanol exposure in late gestation, and could be used to identify fetuses with ethanol-induced toxic effects in numerous organs, including the kidney, lungs, heart, and brain. This demonstrates the potential for using meconium FAEE to identify neonates at risk for major organ dysfunction following in-utero ethanol exposure that does not result in overt malformations. These findings add to the existing body of literature on the sensitivity, specificity, and potential clinical utility of meconium testing for FAEE as a screen for identifying newborns at risk for fetal alcohol spectrum disorders.

About the Speaker: Irene Zelner, PhD candidate graduated with distinction in 2008 from the University of Western Ontario with a Bachelor's degree in Medical Sciences, Honours Specialization in Pharmacology and Toxicology. Irene then enrolled in a collaborative doctoral program in Pharmacology and Biomedical Toxicology at the University of Toronto, where she is now completing her thesis work under the supervision of Dr. Gideon Koren. Her research projects focus on further validating and exploring the clinical utility of biomarkers used for the detection of prenatal alcohol exposure.

Prevalence of Drug Use During Pregnancy in Miramichi, NB - Analysis of a Routine Urine Drug Screen in the Obstetric Unit Kaitlyn Delano, PhD Candidate, University of Toronto

Synopsis: Routine urine drug screens are performed at Miramichi Regional Hospital for all delivering mothers. The study aims to determine the prevalence of drug use during pregnancy in this population as well as assess trends of drug use over the nine year period since the introduction of the routine urine screen. This project is a collaboration between Motherisk and Miramichi Regional Hospital.

About the Speaker: Kaitlyn Delano is a PhD student at the University of Toronto. She is currently working on her thesis project under the supervision of Dr. Gideon Koren at The Hospital for Sick Children, focusing on rates and trends of substance use during pregnancy in Canada. She received her Bachelor of Forensic Science from the University of Windsor and Bachelor of Science from the University of Western Ontario.

Fetal Alcohol Spectrum Disorder: Examining Communication Pathways Between Multidisciplinary Support Systems and Diagnosed Youth Melody Morton Ninomiya, PhD Candidate, Faculty of Medicine, Memorial University

Synopsis: This research study examines a comprehensive network of supports and services for individuals and families with FASD diagnoses - to determine how information is communicated, what is working and what is not working. The goals of this study are to identify best practices; understand how institutional policy, procedures and programs affect individuals and families who live with an FASD diagnosis; and examine barriers and gaps in supports and services in two distinctly different communities. This research focuses on two communities: 1) a predominantly Aboriginal and rural community in Labrador; and 2) an urban community in Newfoundland.

About the Speaker: Melody Morton Ninomiya is a PhD candidate at Memorial University, Faculty of Medicine. Her doctoral research project entitled FASD: an institutional ethnography examining communication pathways between multidisciplinary support systems and diagnosed youth is funded by the CIHR & RDC. Melody is co-Chair of the provincial FASD network in Newfoundland & Labrador (NL), represents NL on an Atlantic FASD committee and is involved with FASD Prevention from a Woman's Health Determinants Perspective (CanFASD).

Managing Mentally Disordered Offenders With FASD in the Community Mansfield Mela, MRCPsych, MSc. Psych, FRCPC, University of Saskatchewan

Synopsis: We are studying patients attending a forensic outpatient clinic to determine the incidence of FASD, as well as the cognitive, behavioral, and clinical characteristics of these individuals. Our goal is to standardize psychiatric diagnosis and improve FASD treatment programs. Findings to date illustrate that mentally disordered offenders with FASD have a characteristic pattern of maladaptive functioning, dependent living, multiple and significant psychiatric co-morbid diagnoses, especially ADHD, and multiple neurocognitive deficits. Effective treatment engages the patient on a long term basis, and accommodates for their deficits. Intensive case management is preferred over the usual approach of medication and short term involvement.

About the speaker: Mansfield Mela MRCPsych, MSc. Psych, FRCPC, is an academic forensic psychiatrist in the University of Saskatchewan and a Founder of the forensic subspecialty in Canada. He consults at the Regional Psychiatric Center and in the Saskatoon forensic psychiatric outpatient clinic. He is a member of the Saskatchewan Review Board. He is the head of the forensic interdisciplinary research team. His research focuses on the medico-legal implications of cognitive disorder specifically fetal alcohol spectrum disorder and ADHD.

Clinical Workshop - The Latest in FASD Screening & Diagnostic Technique

The Canadian FASD Screening Tool Kit Gideon Koren, MD, FRCPC, Director of the Motherisk Program, Professor of Paediatrics, Pharmacology, Pharmacy, and Medical Genetics, University of Toronto.

Synopsis: The Tool Kit was developed using a set of criteria to evaluate the identified tools in terms of sensitivity, specificity, positive and negative predictive values, and for their practical applicability in terms of ease of use; accessibility; cost; expertise required; cultural appropriateness; and interpretation of results. It includes items from the Child Behaviour Checklist (CBCL), which can screen for FASD behavioural phenotype, meconium testing, maternal drinking guide, medicine wheel, and the FASD screening and referral tool for youth probation officers.

About the Speaker: Gideon Koren, MD, FRCPC is the founder and director of the Motherisk Program and professor of Paediatrics, Pharmacology, Pharmacy, and Medical Genetics at the University of Toronto. He is also the Richard and Jean Ivey Chair in Molecular Toxicology in the Schulich School of Medicine, at The University of Western Ontario. Dr. Koren conducts research on drug safety, the molecular mechanisms and clinical effects of adverse drug and chemical reactions, with focus on pregnancy and children. He has received numerous national and international awards. In 2000 Dr. Koren established the FACE (Fetal Alcohol Canadian Expertise) Research Network and in 2002 he created the peer review medical journal, Fetal Alcohol Research.

Case Presentation Albert E. Chudley, MD, FRCP(C), FCCMG, Medical Director of the Genetics and Metabolism Program with the Winnipeg Regional Health Authority; Professor, Pediatrics and Child Health, Biochemistry and Medical Genetics, University of Manitoba.

Synopsis: Gideon Koren, MD, FRCPC is the founder and director of the Motherisk Program and professor of Paediatrics, Pharmacology, Pharmacy, and Medical Genetics at the University of Toronto. He is also the Richard and Jean Ivey Chair in Molecular Toxicology in the Schulich School of Medicine, at The University of Western Ontario. Dr. Koren conducts research on drug safety, the molecular mechanisms and clinical effects of adverse drug and chemical reactions, with focus on pregnancy and children. He has received numerous national and international awards. In 2000 Dr. Koren established the FACE (Fetal Alcohol Canadian Expertise) Research Network and in 2002 he created the peer review medical journal, Fetal Alcohol Research.

About the Speaker: This presentation provides an overview of the diagnostic assessment of FASD; the use of the 4-digit code; growth score; face score; brain domain score; alcohol exposure score; and the use of the lip-philtrum guide.

Assessment of the Neurobehavioural Domain Julianne Conry, PhD, R. Psych, Asante Centre, BC

Synposis: This presentation discusses the: purpose of the neurobehavioural assessment in the context of the multidisciplinary assessment for FASD; components of the neurobehavioural assessment; criteria for making an alcohol-related diagnosis; challenges in making an alcohol-related diagnosis.

About the Speaker: Julianne Conry, PhD, R. Psych., received her PhD in 1969 from the University of Wisconsin and retired from the University of British Columbia in 2001 after 33 years in the Department of Educational and Counselling Psychology and Special Education. She currently provides the psychological assessments as part of the multidisciplinary team evaluations for FASD at the Asante Centre in Maple Ridge, BC and for the CDBC teams in Smithers and Terrace, BC. Dr. Conry has been active in research and the clinical assessment of children, youth, and adults with FASD for over 30 years She collaborated on the first Canadian prevalence study of youth with FASD in the criminal justice system, co-authored Fetal Alcohol Syndrome and the Criminal Justice System (2000), and several articles on FASD and mental health disorders. With Dr. Chudley and others, she co-authored Fetal Alcohol Spectrum Disorder: Canadian Guidelines for Diagnosis (CMAJ, March 2005). Since 2008, she has been on the Scientific Review committee of the Canadian Foundation for Fetal Alcohol Research.

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