These individuals have the same functional disabilities but "look" less like FAS. Using medical and other records, CDC studies have identified about 1 infant with FAS for every 1,000 live births in certain areas of the United States. The assertion that moderate drinking causes FAS is said to lack strong evidence and, in fact, the practice of equating a responsible level of drinking with potential harm to the fetus may have negative social, legal, and health impacts. [47][50], Despite intense research efforts, the exact mechanism for the development of FAS or FASD is unknown. People can still be affected by prenatal alcohol exposure and not have the facial feature differences. Concentrations of FAEE can be influence by medication use, diet, and individual genetic variations in FAEE metabolism however. FAEE may be present if chronic alcohol exposure occurs during the 2nd and 3rd trimester since this is when the meconium begins to form. [20] PFAE and ARBD have fallen out of favor because these anomalies are not necessarily specific to maternal alcohol consumption and are not criteria for diagnosis of FASD.[60]. Kenneth Lyons Jones and David Weyhe Smith of the University of Washington Medical School in Seattle, United States. The severity of the condition can vary with a range of complications. Fetal alcohol spectrum disorder (FASD) refers to a range of problems caused by exposure of a fetus to alcohol during pregnancy. In the absence of an adequate body of research on diagnosis and intervention, this expert consensus opinion is a welcome advance and should provide some guidance for clinicians managing . FAS is one of a group of conditions. A mother consuming alcohol will cause the fetus not to receive the necessary nutrients or oxygen while in the womb. "Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan", Backside of Lip-Philtrum Guides (2004) (PDF), "Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently 'safe' levels of alcohol during pregnancy? Over time, as subsequent research and clinical experience suggested that a range of effects (including physical, behavioral, and cognitive) could arise from prenatal alcohol exposure, the term Fetal Alcohol Spectrum Disorder (FASD) was developed to include FAS as well as other conditions resulting from prenatal alcohol exposure. National Institute on Alcohol Abuse and Alcoholism. [99], Dr. Paul Lemoine of Nantes, France had already published a study in a French medical journal in 1968 about children with distinctive features whose mothers were alcoholics,[100] and in the U.S., Christy Ulleland and colleagues at the University of Washington Medical School had conducted an 18-month study in 19681969 documenting the risk of maternal alcohol consumption among the offspring of 11 alcoholic mothers. However, prenatal alcohol exposure and central nervous system damage are the critical elements of the spectrum of FASD, and a positive finding in these two features is sufficient for an FASD diagnosis that is not "full-blown FAS". To make this diagnosis or determine any FASD condition, a multi-disciplinary evaluation is necessary to assess each of the four key features for assessment. [56], The proposed Ten Brain Domains include:[56], The Fetal Alcohol Diagnostic Program (FADP) uses unpublished Minnesota state criteria of performance at 1.5 or more standard deviations on standardized testing in three or more of the Ten Brain Domains to determine CNS damage. Correction: Fetal Alcohol -Syndrome- can be recognized by this feature. Mental and physical defects such as a small head, flat face, epicanth. [2][20][27][30], Neurological problems are expressed as either hard signs, or diagnosable disorders, such as epilepsy or other seizure disorders, or soft signs. [26], In terms of FASD, growth deficiency is defined as significantly below average height, weight or both due to prenatal alcohol exposure and can be assessed at any point in the lifespan. Over time, an unaffected child can negotiate the increasing demands of life by progressing through stages of development normally, but not so for a child with FAS. It operationalizes high risk exposure as a blood alcohol concentration (BAC) greater than 100mg/dL delivered at least weekly in early pregnancy. (2002). [14] Other risk factors include the mother's older age, smoking, and poor diet. [15][47][49], Among those women who are alcoholic, an estimated one-third of their children have FAS. Court documents reveal Kathryn Dennis' drug and alcohol abuse caused her son's Fetal Alcohol Syndrome diagnosis. While other FASD conditions may not yet be included as an ICD or DSM-IV-TR diagnosis, they nonetheless pose significant impairment in functional behavior because of underlying brain damage. Taylor was diagnosed with an FASD in 8th grade. lack of focus. Admonitions against prenatal alcohol use from ancient Greek, Roman, Talmudic, and possibly Biblical sources[90] indicate a historical awareness of links between alcohol use and fetal development, although sources rarely if ever distinguish maternal alcohol consumption from paternal. [41], As of 2002, there were 25 reports of autopsies on infants known to have FAS. For example, the main detoxicating organ in adults is the. [84] In Western Australia, the rate of births resulting in FASD is 0.02 per 1,000 births for non-Indigenous Australians, however among indigenous births the rate is 2.76 per 1,000 births. [87] Because the alcohol was being given intravenously, the doctor could continue giving the treatment to the mother long after she had passed out, resulting in her being more intoxicated than would otherwise be possible. Lynette Rice is the former editor at large at Entertainment Weekly. The IOM and Canadian guidelines explore this further, acknowledging the importance of significant alcohol exposure from regular or heavy episodic alcohol consumption in determining, but offer no standard for diagnosis. Tony Gentile/Reuters/Corbis. [66] Because CNS damage, symptoms, secondary disabilities, and needs vary widely by individual, there is no one treatment type that works for everyone.[16]. Fetal Alcohol Syndrome or (FAS) is a condition in infants that is caused by alcohol consumption by the mother during time of pregnancy. Moderate: Either height or weight at or below the 3rd percentile, but not both. Up to 10 times more children have disabilities related to fetal alcohol exposure -- drinking during pregnancy -- than previously believed, finds a new study. A holiday encore is planned for Dec. 26 at 9 p.m. Olivia Munn and John Mulaney's Relationship Timeline. Generally, a trained physician will determine growth deficiency and FAS facial features. The autopsy showed severe hydrocephalus, abnormal neuronal migration, and a small corpus callosum (which connects the two brain hemispheres) and cerebellum. [18] Diagnosis is based on the signs and symptoms in the person. Low body weight. [22] FAS is believed to occur in between 0.2 and 9 per 1,000 live births in the United States. Most individuals with deficits resulting from prenatal alcohol exposure do not express all features of FAS and fall into other FASD conditions. [20] The Canadian guidelines recommend the assessment and descriptive approach of the "4-Digit Diagnostic Code" for each key feature of FASD and the terminology of the IOM in diagnostic categories, excepting ARBD. Life expectancy can range from 31 to 37. poor judgment. Often, primary disabilities are mistaken as behavior problems, but the underlying CNS damage is the originating source of a functional difficulty,[79] rather than a mental health condition, which is considered a secondary disability. The bystander was concerned that Kathryns father was not watching Saint properly because the 4-year-old was able to escape from the residence twice unnoticed. Business, Economics, and Finance. Psychoactive drugs are frequently tried on those with FASD as many FASD symptoms are mistaken for or overlap with other disorders, most notably ADHD. In 1725, British physicians petitioned the House of Commons on the effects of strong drink when consumed by pregnant women saying that such drinking is "too often the cause of weak, feeble, and distempered children, who must be, instead of an advantage and strength, a charge to their country". If you are familiar with the condition known as fetal alcohol syndrome (FAS), you might be surprised to know that some of your favorite friends and famous people in Hollywood and politics have various forms of FAS, even though no one knows about their diagnosis. Alcohol was a teratogen, a substance that kills or damages developing cells, the researchers said, and then for the first time used term fetal alcohol syndrome to describe the result. Did he ever leave on one of his trips. [85] In Victoria, there have been no registered FASD related births for indigenous Australians, but the rate for the general population in Victoria is 0.010.03 per 1000 births. The lip and philtrum are measured by a trained physician with the Lip-Philtrum Guide,[36] a five-point Likert scale with representative photographs of lip and philtrum combinations ranging from normal (ranked 1) to severe (ranked 5). Growth measurements must be adjusted for parental height, gestational age (for a premature infant), and other postnatal insults (e.g., poor nutrition), although birth height and weight are the preferred measurements. . Severe: All three facial features ranked independently as severe (lip ranked at 4 or 5, philtrum ranked at 4 or 5, and PFL two or more standard deviations below average). Born and formed in New Orleans, LA, Ashlee is an absolute music junkie and self-proclaimed foodie who loves all things music, entertainment, and culture. [102], Within nine years of the Washington discovery, animal studies, including non-human monkey studies carried out at the University of Washington Primate Center by Dr. Sterling Clarren, had confirmed that alcohol was a teratogen. By 1978, 245 cases of FAS had been reported by medical researchers, and the syndrome began to be described as the most frequent known cause of intellectual disability. Daniel Radcliffe is a British actor primarily known for his role as Harry Potter. South Carolina court records, show that Thomas Ravenelclaimed Saint was formerly diagnosed with FAS due to Kathryns excessive drug and alcohol consumption while he was in utero. Thomas says that Saint took speech and occupational therapy for years to help combat his delays, but he is still falling behind at school., At Saints school, his teacher created Mom and Dadfolders filled with worksheets to be completed daily in an effort to catch Saint up to his peers. 2/7. "Neurobehavioral and Neuroanatomical Effects of Heavy Prenatal Exposure to Alcohol," in Streissguth and Kantor. [20] The "4-Digit Diagnostic Code" and CDC guidelines allow for a positive CNS finding in any of the three areas for any FASD diagnosis, but functional anomalies must measure at two standard deviations or worse in three or more functional domains for a diagnosis of FAS, PFAS, and ARND. [10] The negative effects of alcohol during pregnancy have been described since ancient times. [1] Alcohol crosses through the placenta to the unborn child and can interfere with normal development. (1998). Back in 2006, when she was pregnant with Moses, Gwynnie was spotted drinking a Guinness while out in NYC with husband Chris Martin. This BAC level is typically reached by a 55kg female drinking six to eight beers in one sitting. Morbidity and Mortality Weekly Report, 64(3), 54-57. They hope that before casting judgement, others will t. Celebrity. King, T. L., & Brucker, M. C. (2011). FAS causes brain damage and growth problems, along with other issues in intellectual abilities. Some of the risks associated with smoking and drinking while pregnant include miscarriage, Sudden Infant Death Syndrome, preterm birth, stillbirth, fetal alcohol syndrome, and many other birth defects. The study found . One study found that the people with FASD had a significantly shorter life expectancy. [76], Treating FAS at the public health and public policy level promotes FAS prevention and diversion of public resources to assist those with FAS. Abnormal appearance, short height, low body weight, Fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, static encephalopathy, alcohol-related birth defects, Avoiding drinking alcohol during pregnancy. Article about Celebrities with fetal alcohol syndrome He was very drunk as you can see. Behavioral problems. Initially, he waited until he was 19 to disclose that he struggles with side effects fully. There is evidence supporting the father before conception can cause FAS through long term epigenetic mutation of the father's sperm as well during conception. [47], Fetal Alcohol Syndrome occurs when a fetus is exposed to alcohol during conception. Before he was diagnosed, he struggled and had been misdiagnosed with attention-deficit . Connections between alcohol and incubating embryos are made multiple times in the novel. Dennis Crosby killed himself in 1991, and Phillip died of a heart attack in 1994. poor coordination. The Sessions are a blended family and 4 of their 6 children are diagnosed with fetal alcohol syndrome. Growth deficiency: Prenatal or postnatal height or weight (or both) at or below the 10th percentile, FAS facial features: All three FAS facial features present. People with pFAS have a confirmed history of prenatal alcohol exposure, but may lack growth deficiency or the complete facial stigmata. Partial fetal alcohol syndrome (pFAS). [103] At the time, nobody was aware of the full range of possible birth defects from FAS or its rate of prevalence. So to add insult to injury, you have this situation [with the twins] on the one hand and then she dies on the other. [57] Smith (1981) described FAE as an "extremely important concept" to highlight the debilitating effects of brain damage, regardless of the growth or facial features. A determination of a neurological problem must be made by a trained physician, and must not be due to a postnatal insult, such as meningitis, concussion, traumatic brain injury, etc. [citation needed]. In fact, many individuals with FAS require specialized care to cope with their condition. [24] It is unclear as of 2017[update] if identifying a FASD-related condition benefits the individual. Risk of damage is not solely dependent on how much alcohol is consumed during pregnancy; fetal genetics plays a vital role, a new study suggests. In a new custody battle, Thomas has revealed that his son suffered from Fetal Alcohol Syndrome. It is estimated that as many as three babies in 1,000 will have FAS. No Risk: Confirmed absence of prenatal alcohol exposure. [27][30], Evidence is insufficient for the use of chemical biomarkers to detect prenatal alcohol exposure. (2002). [102] Researchers in France, Sweden, and the United States were struck by how similar these children looked, though they were not related, and how they behaved in the same unfocused and hyperactive manner. Fetal Alcohol Syndrome is one of the most common causes of mental retardation and is the only one that is 100% preventable. The effects of FAS include mental retardation, malformations of the skeletal system and major organ systems (specifically the heart and brain), inhibited growth, central . problems seeing or hearing. There is no cure for FASD and its effects last a lifetime. Mental health problems, alcoholism and drug abuse, antisocial behaviors, and repeated pregnancies (for the woman) were common problems. [59], Alcohol-related neurodevelopmental disorder (ARND) was initially suggested by the Institute of Medicine to replace the term FAE and focus on central nervous system damage, rather than growth deficiency or FAS facial features. As many as one in 10 children in some . Fetal alcohol syndrome among children aged 7-9 yearsArizona, Colorado, and New York, 2010. [43], When structural impairments are not observable or do not exist, neurological impairments are assessed. In A. Streissguth, & J. Kanter (Eds.). The standardized approach is referred to as the Ten Brain Domains and encompasses aspects of all four diagnostic systems' recommendations for assessing CNS damage due to prenatal alcohol exposure. [85], From the 1960s to the 1980s, alcohol was commonly used as a tocolytic, a method to stop preterm labor. [103] Currently, FAS[20][57][98] is the only expression of prenatal alcohol exposure defined by the International Statistical Classification of Diseases and Related Health Problems and assigned ICD-9 and diagnoses. [16][14] There is no known safe amount or time to drink alcohol during pregnancy. A summary of the criteria follows:[27][38], Central nervous system (CNS) damage is the primary feature of any FASD diagnosis. A group of conditions, known as fetal alcohol spectrum disorder (FASD), includes the following symptoms: Abnormal facial features. Signs and symptoms of fetal alcohol syndrome may include any mix of physical defects, intellectual or cognitive disabilities, and problems functioning and coping with daily life. The exact mechanisms for functional problems of primary disabilities are not always fully understood, but animal studies have begun to shed light on some correlates between functional problems and brain structures damaged by prenatal alcohol exposure. [43], In 1977, Dr. Clarren described a second infant whose mother was a binge drinker. The first was in 1973, on an infant who died shortly after birth. She was lovely, too, but she was a child of alcoholics and she had issues.". Lovato fought her substance use disorders, remaining sober for 6 years in March of 2018. 4. 2. (1996). [60] It is related to the advocacy model but promoted at a systems level (rather than with the individual or family), such as developing community education and supports, state or province level prevention efforts (e.g., screening for maternal alcohol use during OB/GYN or prenatal medical care visits), or national awareness programs. While many syndromes are eponymous, i.e. #2 Individuals with FAS may have problems with their hearing, memory, vision, attention span, and capabilities to communicate . Urban made several trips to rehab before getting sober. [61] Along with ordinary parenting styles, such strategies are frequently used by default for treating those with FAS, as the diagnoses oppositional defiance disorder (ODD), conduct disorder, reactive attachment disorder (RAD) often overlap with FAS (along with ADHD), and these are sometimes thought to benefit from behavioral interventions. It behooves both bride and bridegroom to be sober in order to ensure, as far as possible, in every case that the child that is begotten may be sprung from the loins of sober parents." She was very sick in a lot of ways. In 2018 he told the Hollywood Reporter, "My mom was addicted to pain medication. drug and alcohol abuse caused her sons Fetal Alcohol Syndrome diagnosis. In Aldous Huxley's 1932 novel Brave New World (where all fetuses are gestated in vitro in a factory), lower caste fetuses are created by receiving alcohol transfusions (Bokanovsky Process) to reduce intelligence and height, thus conditioning them for simple, menial tasks. Varies depending on the individual, the level of alcohol exposure, and quality of living and educational arrangements. Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. Armstrong, E. M. (2003). [22] FAS is believed to occur in between 0.2 and 9 per 1000 live births in the United States. Joaquin Phoenix. In such ancient sources, the warnings against alcohol consumption for fetal development are more frequently concerned with conception than pregnancy. Fetal alcohol syndrome, which can be physically, emotionally and intellectually disabling, is quite common, and most sufferers are not being diagnosed, according to new research. 8. [10] The lifetime cost per child with FAS in the United States was estimated at $2 million (for an overall cost across the country of over $4 billion) by the CDC in 2002. This means that while Kathryn was pregnant -- she allegedly drank so excessively that it causes delays in her son's development. [1] Symptoms can include an abnormal appearance, short height, low body weight, small head size, poor coordination, behavioral problems, learning difficulties, and problems with hearing and sight. Progress has been made most notably in research aimed at understanding the basic mechanisms involved in the neurobiological damage that occurs in alcohol-exposed fetuses . 1. she is intelligent linguistically 2. she was awkward and had few friends in high school and still is confused . There is no consensus on a specific pattern of functional impairments due to prenatal alcohol exposure[20] and only CDC guidelines label developmental delays as such,[30] so criteria (and FASD diagnoses) vary somewhat across diagnostic systems. [101] The Washington and Nantes findings were confirmed by a research group in Gothenburg, Sweden in 1979. [42] For example, Plato writes in his fourth-century B.C. Refinements in diagnostic criteria since 1975 have yielded three distinctive and diagnostically significant facial features known to result from prenatal alcohol exposure and distinguishes FAS from other disorders with partially overlapping characteristics. It's reported that 86% of the individuals with FASs have [] Symptoms. [27] Growth deficiency (at severe, moderate, or mild levels) contributes to diagnoses of FAS and pFAS, but not ARND or static encephalopathy. "Something had told me that it was fetal alcohol syndrome, so I took existing photos of the twins and showed it to a couple of specialists at USC. Because admission of alcohol use during pregnancy can stigmatize birth mothers, many are reluctant to admit to drinking or to provide an accurate report of the quantity they drank. The document also state, that Saintwas seen unattended (more than once) wandering the streets and had to be escorted back to his mothers home by bystanders. Canadian guidelines for FASD diagnoses, which established criteria for diagnosing FASD in Canada and harmonized most differences between the IOM and University of Washington's systems. The full picture of FAS usually occurs in babies born to alcoholic mothers, or to those who drink regularly or binge-drink. The secondary disabilities of FAS are those that arise later in life secondary to CNS damage. They also have difficulties in understanding concepts . Some of the risks associated with smoking and drinking while pregnant include miscarriage, Sudden Infant Death Syndrome, preterm birth, stillbirth, fetal alcohol syndrome, and many other birth defects. "[89] Vomiting put the mother at a high risk for aspiration and was "a brutal procedure for all involved". [20] The CDC guidelines are silent on these elements diagnostically. Central nervous system damage: Clinically significant structural neurological, Prenatal alcohol exposure: Confirmed or Unknown prenatal alcohol exposure, Growth deficiency: Growth or height may range from normal to deficient, FAS facial features: Two or three FAS facial features present. a unique cluster of minor facial anomalies (small eyes, smooth philtrum, thin upper lip). [14] 3.6% of pregnant American women met criteria for an alcohol use disorder in a 2001 epidemiological study. Jim Carrey. Its effects can include impaired growth, intellectual . A positive finding on all four features is required for a diagnosis of FAS. Daniel Radcliffe. [98] The pattern of malformations indicated that the damage was prenatal. [citation needed]. In Kathryn Dennis court response, she didnt address Thomas claims of Saint having FAS nor did she comment on not completing his worksheets. However, the Ten Brain Domains are easily incorporated into any of the four diagnostic systems' CNS damage criteria, as the framework only proposes the domains, rather than the cut-off criteria for FASD. Kim Kardashian Doja Cat Iggy Azalea Anya Taylor-Joy Jamie Lee Curtis Natalie Portman Henry Cavill Millie Bobby Brown Tom Hiddleston Keanu Reeves. The specialists looked at them and said 'Yeah, this is a like a textbook case of fetal alcohol syndrome.' Attention disorder. Kathryn, Bing's second wife, says in the film it was a terrible way to die. snorting cocaine in the presence of her kids, at her home. 9. [23] The term fetal alcohol syndrome was first used in 1973. [72], There is no current cure for FASD, but treatment is possible. [37], Ranking FAS facial features is complicated because the three separate facial features can be affected independently by prenatal alcohol. Notice social and behavior issues. [2], Thus, other FASD conditions are partial expressions of FAS. The document states. Sleep disruptions. [85] There have been no dedicated FASD clinics within Western Australia, but there are also no nationally supported diagnostic criteria anywhere in Australia. Presently, four FASD diagnostic systems that diagnose FAS and other FASD conditions have been developed in North America: Each diagnostic system requires that a complete FASD evaluation includes an assessment of the four key features of FASD, described below. [84] The only states that have registered birth defects in Australian youth are Western Australia, New South Wales, Victoria and South Australia. We could have done a whole other film just about that.". [13], In 2013, the American Psychiatric Association introduced neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) into the DSM-V as a "condition for further study" and as a specified condition under, "other specified neurodevelopmental disorders" as a way to better study the behavioral aspects of all FASD disorders. Central nervous system damage: Clinically significant structural, neurological, Prenatal alcohol exposure: Confirmed prenatal alcohol exposure, Growth deficiency: Growth or height may range from normal to minimally deficient, FAS facial features: Minimal or no FAS facial features present, High Risk: Confirmed use of alcohol during pregnancy known to be at high. Fetal alcohol spectrum disorder (FASD) is a diagnostic term used to describe the permanent, severe neurodevelopmental impairments that may occur as a result of maternal drinking during pregnancy. [62] The IOM presents ARBD as a list of congenital anomalies that are linked to maternal alcohol use but have no key features of FASD. These deficiencies can cause several issues as the person develops into a child and adult. This can cause the alcohol levels to remain high and stay in the baby's body longer. [58] This term has fallen out of favor with clinicians because it was often regarded by the public as a less severe disability than FAS, when in fact its effects can be just as detrimental. Central nervous system damage is present at the same level as FAS. Disgraced former Southern Charm star Thomas Ravenel claimed that Kathryn Dennis gave their son fetal alcohol syndrome. It is also broadly categorized as fetal alcohol spectrum disorders (FASD) due to the fact that the fetus may not show all the features and the broad spectrum of effects on the . p. 10. [76], The US Centers for Disease Control estimates 3 million women in the United States are at risk of having a baby with FASD, and recommended that women of child-bearing age should be on birth control or abstain from drinking alcohol as the safest way to avoid this.[77]. Post 9/11, so much has changed in New York that it does not give you that homely feeling which it did before. . [13], These conditions believed to be related to prenatal alcohol exposure, such as spontaneous abortion and sudden infant death syndrome (SIDS), are also considered to be on the spectrum of related disorders. (2005). Celebrities with FAS include: model/actress Carrie Fisher; musician Bobby Brown; actor Ryan O'Neal; and baseball player Joe Mauer.Advertisement [] [32] The presence of FAS facial features indicates brain damage, although brain damage may also exist in their absence. "I had been hearing about it and then the twins, they didn't look quite right," Robert Trachtenberg, the documentary's director, tells PEOPLE. Claims that alcohol consumption caused idiocy were also part of the Teetotalism movement's message in the 19th century,[92] but such claims, despite some attempts to offer evidence, were ignored because no mechanism could be advanced. A working knowledge of the key features is helpful in understanding FASD diagnoses and conditions, and each is reviewed with attention to similarities and differences across the four diagnostic systems. Celebrity. Fetal Alcohol Syndrome (FAS) is the most severe collection of alcohol-related birth defects, and is defined by pre- and post-natal growth retardation . 1 2; Such heavy intoxication is highly likely to contribute to FASD.[87]. The face is formed at a specific timeframe during gestation and if alcohol is consumed around but not at that exact time, the child may have all the behavioural . An award-winning actress and producer working in Hollywood, Reese Witherspoon is also suffering from FAS due to her mother's addiction to alcohol at the time of her birth. [87][88] Doctors recommended a small amount of alcohol to calm the uterus during contractions in early pregnancy or Braxton Hicks contractions. Born and formed in New Orleans, LA, Ashlee is an absolute music junkie and self-proclaimed foodie who loves all things music, entertainment, and culture. Prenatal alcohol exposure, which is classified as a teratogen, can damage the brain across a continuum of gross to subtle impairments, depending on the amount, timing, and frequency of the exposure as well as genetic predispositions of the fetus and mother.
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