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Index
A
Aarskog syndrome, 79
Abstinence during pregnancy, 27, 103, 105
encouraged as means of FAS prevention, 9, 17, 27, 118
Academic performance, 69, 159, 163-164, 165; see also Adolescence and post-puberty development
Acetaldehyde adducts, 129-130
Active surveillance, 7, 91, 94-96, 97
Adaptive functioning, 73, 159, 163
Adolescence and post-puberty development, 6, 36, 80, 158
behavior patterns, 165-166, 168-169
Adoption, 13, 15, 67, 74, 171, 172, 181, 186
Affected individuals, see Behavioral patterns; Cognitive performance; Developmental stages and life span; Diagnostic criteria; Growth deficiency; Incidence and prevalence of FAS; Physical anomalies; Secondary disabilities; Treatment and intervention for FAS children
African Americans
FAS rates, 83
maternal drinking patterns, 103
Age
and drinking patterns, 106, 107, 108-109, 121
and subsequent pregnancies, 136
see also Developmental stages and life span
Aggression 163
Alanine aminotransferases (ALT), 128-129
Alcohol abuse, 117
among FAS adolescents, 158
biological markers, 9, 109, 126-131
diagnostic definition, 5n, 29-30, 68, 74, 77n
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see also Drinking among women; Drinking during pregnancy; Heavy drinking; Treatment and prevention of alcohol abuse
Alcoholics Anonymous (AA), 140
Alcohol-related birth defects (ARBD), 3, 5, 7, 77, 78-79, 80, 97
incidence and prevalence, 84, 97
Alcohol-related effects (diagnostic category), 4-5, 76-77, 78-79, 80. see also ''Fetal alcohol effects"
diagnostic criteria, 4-5, 67, 70, 76-77, 78
Alcohol-related neurodevelopmental disorder (ARND), 3, 5, 7, 77, 78-79, 80, 81, 97
incidence and prevalence, 97
Alkaline phosphatase (AP), 129
Aminotransferases, 128-129
Anger, 80
Animal models and studies intervention and prevention strategies, 11-12, 15, 45-47, 144, 147, 155, 186
paternal alcohol exposure, 121
teratogenic effects, 6, 20, 22, 28, 37-41, 81
Antisocial behavior, 80
Asian Americans, FAS rates, 83
Aspartate aminotransferases (AST), 128-129
Aspirin, 45-46
Attention, 15, 73, 159, 163, 164, 168, 186
Attention-deficit hyperactivity disorder (ADHD), 69, 161, 164, 177, 182
Autopsy studies, 72
B
Babies, see Newborn period and infancy
Bartenders, 122
Behavioral patterns, 4, 5, 17, 43-44, 73, 75, 76, 77, 81, 158-166
across developmental stages, 69, 159-166, 168-169
as diagnostic criteria, 3, 67, 69
of FAS adolescents, 165-166, 168-169
of newborns and infants, 160-161
research studies, 158-159
specificity to FAS, 13, 79, 167, 173
vignettes, 56-58
see also Alcohol-related neurodevelopmental disorder (ARND)
Behavioral Risk Factors Surveillance Surveys (BRFSS), 100, 104, 105, 106
Binge drinking, 44, 68, 106, 165, 166
Biological markers, 6, 72, 81, 115, 126-131, 135, 169
of alcohol abuse, 9, 109, 126-131
Birth, see Newborn period and infancy
Birth control, 11, 136, 146-147
Birth Defects Monitoring Program (BDMP), 22, 83, 91
Birth to Three Project, 142
Blood alcohol levels, 127
Bloom syndrome, 79
Brain damage, 4, 38, 39-40, 44, 68, 71, 72-73, 74, 75, 76, 81, 157, 169, 173
Brain stem auditory evoked response (BAER) test, 157
Breath analyzer, 127
Brief interventions, 10, 123-124, 131-135
C
Carbohydrate-deficient transferrin (CDT), 130-131
Caregiving environment, 13, 53, 163, 165, 169-173
Categories, see Alcohol-related birth defects (ARBD); Alcohol-related neurodevelopmental disorder
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(ARND); Diagnostic categories; FAS with confirmed maternal alcohol exposure; FAS without confirmed maternal alcohol exposure; Partial FAS
Caucasians/whites
FAS rates, 83
Center for Substance Abuse Prevention (CSAP), 23
Center for Substance Abuse Treatment (CSAT), 23
Centers for Disease Control and Prevention (CDC)
risk factor surveys, 100, 104, 105
screening check lists, 72
surveillance and prevention programs, 22, 28, 83-84, 91, 97, 136, 144-145, 176, 195
Central nervous system (CNS) dysfunction, 4, 33, 38, 39, 71, 75, 76, 91
Child abuse, 53, 102, 142, 170, 173
Cigarettes, see Smoking
Clinical practice guidelines, 15, 186
Clinic-based studies, 8, 102, 103, 158
FAS incidence and prevalence estimates, 83, 84-87
Cocaine, 21, 23, 36, 105, 137; see also Crack cocaine
Cognitive-behavioral interventions, 140
Cognitive performance, 4, 5, 17, 19, 73, 75, 76, 77, 81, 158, 159, 161, 163-164
see also Alcohol-related neurodevelopmental disorder (ARND); Mental retardation
Community involvement, 114-115, 122, 185
Computed tomography (CT), 69, 72
Confidentiality, 92, 141, 176, 186
Congenital rubella syndrome (CRS), 20-21
Contraceptive services, 11, 136, 146-147
Coordination of services, 15-16, 176, 183-184, 194-196
Coordination problems, 73
Corpus callosum
Counseling
for abstinence during pregnancy, 11, 146
brief interventions, 10, 123-124, 131-135
contraceptive services, 11, 136, 146-147
Creatine phosphokinase (CPK), 127
Cross-sectional research, syndrome characteristics over life span, 80
Culture, see Ethnic groups; Social-environmental factors
Custody losses and retention, 11, 21, 142, 171-173; see also Foster care
D
Dental abnormalities, 156, 157
Developmental delay, 6, 19, 73, 81, 135, 154, 161, 184
Developmental stages and life span
behavioral patterns across, 69, 159-166, 168-169
diagnoses performed over, 6, 67, 70, 73-74, 80, 92
interventions over, 15, 166, 167-169, 174-175, 186
variability in outcomes, 13, 167-168
worsening of effects over, 168-169
see also Adolescence and post-puberty development; Adulthood; Newborn period and infancy; Preschool period; School age
Developmental toxicity, 33-37
Diagnoses and diagnostic labels
history of FAS definition, 17-19, 70-73
as marker for preventive interventions, 79-80
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and secondary disability prevention, 80, 182
at various developmental stages, 6, 67, 70, 73-74, 80, 92
see also Biological markers
Diagnostic and Statistical Manual (DSM), 29-30, 64
Diagnostic categories, 3, 4-5, 74-79
Diagnostic criteria, 2-6, 64-70, 182, 185
for alcohol abuse and dependence, 5n, 29-30, 68, 74, 77n
alcohol-related effects, 4-5, 67, 70, 76-77, 78
application across life span, 3, 6, 67, 70, 80
behavioral and cognitive features, 3, 67, 69
clinical applications, 64, 66, 67, 80
documented exposure to alcohol, 2, 3, 4, 6, 67-68, 74-75, 76, 80
reliability and validity, 64-65, 71-72
research applications, 64, 66, 67, 80
role of imaging technology, 3, 67, 69, 69-70, 72-73
Dietary and nutrition factors, 9, 102, 109 fat intake, 46
Diethylbestrol (DES), 41
Differential diagnosis, 64, 79
Diphenylhydantoin (DPH, phenytoin), 34, 35, 41
Dose-response relationships, 41-45, 103, 112
Drinking among women, 9, 22, 100, 102, 105, 108, 109-110
low and moderate intake, 105
stigmatizing effects, 112, 146
Drinking contexts, 107
Drinking during pregnancy, 8-9, 103, 100-107
bingeing, 44, 68, 106, 165, 166
documentation of, 2, 3, 4, 6, 67-68, 74-75, 76, 80, 132
factors influencing, 9, 100-102, 106-107, 109, 121, 147
fetal protection mechanisms, 9, 12, 109, 147
first trimester, 106-107
heavy drinking, 27, 89, 100-101, 106, 120, 121
low and moderate intake, 2, 26-27, 116, 117-118, 120
and multiple-substance use, 21, 109
as proxy indicator of FAS, 95-96, 143
reduction of intake, 105-106, 119-120, 133-134
variation among ethnic groups, 103, 108-109
vignettes, 53-62
see also Abstinence during pregnancy
Drugs, see Illicit drug use during pregnancy
"Drunk" baby, 19
Dubowitz syndrome, 79
Dysmorphism, see Physical anomalies
E
Early intervention programs, 175, 176, 177
Eating disorders, 107
Education, see Academic performance; Parenting education; Professional training and education; Public education campaigns
Educational interventions, 15, 186
for children with prenatal drug exposure, 15, 186
for secondary disabilities, 14, 155, 174-175, 177-179
Eligibility for services, 155, 156, 182-183
Embryonic period, 38-39
Emotional health, 15, 173, 186
Environment, see Caregiving environment; Social-environmental factors
Epicanthal folds, 72
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drinking among women, 9, 22, 100, 105, 108, 109-110
drinking during pregnancy, 8-9, 22, 100-109
FAS baseline data, 7, 89-90, 97
and FAS diagnostic problems, 64, 84, 90, 91-92
passive surveillance, 6-7, 83, 91-94
role in prevention programs assessment, 89-90, 97
use of multiple data sources, 84, 90-91
see also Clinic-based studies; Incidence and prevalence of FAS; Longitudinal studies; Population-based epidemiologic studies; Registry-based studies
Erythrocyte delta-aminolevulinic acid (ALA) dehydrase, 127-128
Ethnic groups
biomodal patterns of alcohol abuse, 88-89, 103
and maternal drinking, 103, 108-109, 121
variation in FAS prevalence estimates, 7, 90, 97
see also African Americans; Asian Americans, FAS rates; Caucasians/whites; Hispanics, FAS rates; Native Americans
Etiology, of behavioral patterns, 166-167, 169-173
Eyebrows, 72
F
Facial anomalies, 17, 38, 68, 70, 72, 73, 165
in diagnosis, 4, 73, 74, 75, 76
presence at birth, 71, 73, 160
Failure to thrive, 73, 157, 161
Families
alcohol abuse history in, 53, 102, 107
interventions and support, 11, 14, 14-15, 117, 142, 180-181, 185
involvement in mothers' alcohol reduction and cessation, 10, 11, 115, 122, 146, 147
see also Caregiving environment
FAS with confirmed maternal alcohol exposure (diagnostic category), 3, 4, 74, 76
FAS without confirmed maternal alcohol exposure (diagnostic category), 3, 4, 74-75, 76
Fathers, see Partners of women; Paternal alcohol exposure
"Fetal alcohol effects" (FAE), 3, 63, 67, 70, 78. see also Alcohol-related effects
Folic acid deficiency, 21
Follow-up in treatment, 15, 183, 186
Foster care, 11, 13, 74, 142, 171, 172, 181
Fragile-X syndrome, 69, 74, 79
G
Gamma glutamyl transferase (GGT), 128, 131
Gender differences
alcohol treatment effectiveness, 139
biological markers for alcohol abuse, 128, 130-131
growth, 73
prenatal dose-response effects, 44
Genetic susceptibility, 40-41, 90
D-Glucaric acid, 127
Growth deficiency, 40, 71, 73-74, 157, 160
in diagnosis, 4, 70, 75, 76, 92, 160
low birthweight, 4, 40, 41, 68, 69-70, 76, 92-93
H
Health care interventions, 12, 147, 176-177
brief interventions, 10, 123-124, 131-135
referrals, 10, 11, 15, 131-132, 135, 147, 184
screening for maternal alcohol use, 124-131
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secondary disabilities, 174, 176-177
training, 11, 15, 123, 132-133, 147, 184
universal, 118-119
Health Resources and Services Administration (HRSA), 23, 143, 195
Healthy People 2000 goals, 20, 89-90
Heavy drinking, 29, 30-31, 88, 105
definitions, 106
during pregnancy, 27, 89, 100-101, 106, 120, 121
identification, 11, 123, 124-126, 132-133, 147
Heroin, 35
Hispanics, FAS rates, 83
Hospital discharge data, 83, 84, 91
Hydronephrosis, 156
Hyperactivity, 159, 160, 161, 163, 164, 182
I
Ibuprofen, 46
Illicit drug use during pregnancy, 21, 103, 105, 109
educational interventions for children, 15, 186
forced treatment and incarceration, 21, 137
Imaging techniques, 45, 69, 71
role in establishing diagnostic criteria, 3, 67, 69-70, 72-73
Impulse control, 164
Incarceration, of substance-abusing mothers, 21, 137
Incidence and prevalence of FAS
alternative estimates, 1, 6, 19, 27, 82-91
among ethnic minorities, 7, 83, 97
Income and socioeconomic status, 89, 103, 106, 107, 108-109, 116-117, 121, 155
Indian Health Service, 23, 144, 195
Indicated prevention interventions, 10, 11-12, 115, 135-141, 145-147
alcohol abuse treatment as, 9, 10, 11, 107-108, 115, 135, 138-141, 141, 145, 154
for mothers of FAS children, 79, 135, 136-137
reproductive counseling and contraceptive services, 11, 136, 146-147
research needs, 11-12, 146-147
Indomethacin, 46
Infants, see Newborn period and infancy
Integration and coordination of services, 15-16, 176, 183-184, 194-196
Intellect, see Cognitive performance
Interagency cooperation, 15-16, 195-196
national survey, 7, 16, 97, 196
Intervention, see Educational interventions; Health care interventions; Prevention interventions and measures; Treatment and intervention for FAS children; Treatment and prevention of alcohol abuse
Iron deficiency anemia, 131
Isolation, 80
Isotreinoin, 42
J
K
Kidney anomalies, 156
L
Labeling, see Diagnoses and diagnostic labels; Warning labels
Language development and deficits, 15, 73, 159, 161-163, 186
Learning disabilities, 73
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Liver damage, 127
Longitudinal studies, 19, 80, 86-87, 167
Low and moderate drinking, 105
during pregnancy, 2, 26-27, 116, 117-118, 120
Low birthweight, 4, 40, 41, 68, 69-70, 76, 92-93
M
Magnetic resonance imaging (MRI), 45, 69, 71
Maintenance and aftercare, 114, 142
Males, see Gender differences; Partners of women
Mandatory drug testing, 21
March of Dimes, 133
Maternal and Child Health Bureau (MCHB), 23, 143
Maternal Health Practices and Child Development (MHPCD) Project, 93, 102
Maternal mortality, 171
Maternal PKU, 79
Math ability, 73, 159, 163-164, 166, 168
Mean corpuscular volume (MCV), 129
Medical interventions, see Health care interventions
Medical records, 84, 90, 92, 94
Memory, 163
Mental retardation, 19, 159, 169, 173
FAS as leading nongenetic cause, 7, 97
Methadone, 35
Methylphenidate, 177
Metropolitan Atlanta Congenital Defects Program (MACDP), 83-84
Michigan Alcoholism Screening Test (MAST), 126
Middle class populations, 89, 103, 155
Minorities, see Ethnic groups
Moderate drinking, see Low and moderate drinking
Motivational interviewing, 140
Multidisciplinary approaches to service, 15, 16, 194-196
Muscle tone, 73
N
National Fetal Mortality Survey, 104
National Health and Nutrition Examination Survey, 104
National Institute on Alcohol Abuse and Alcoholism (NIAAA), 16, 21-22, 28, 144, 195, 196
National Institute on Drug Abuse (NIDA), 21, 22
National Institutes of Health (NIH), 21-22
National Longitudinal Alcohol Epidemiologic Study, 104
National Longitudinal Survey of Youth (NLSY), 104, 105
National Maternal and Infant Health Interview Survey (NMIHS), 104, 105, 106
National Natality Survey, 104
National Organization on Fetal Alcohol Syndrome (NOFAS), 133
National Pregnancy and Health Survey, 22, 104, 105
National surveys, 7, 97, 108, 109
on drinking and pregnancy, 9, 102-103, 104, 108, 109
interagency cooperation in, 7, 16, 97, 196
Native Americans
incarceration of pregnant women, 137
maternal drinking patterns, 88-89, 103
substance abuse treatment programs, 23
Neglect, 53, 142, 157, 170, 171, 173
Neonatal withdrawal syndrome, 135, 160
Neural tube defects, 21
Neurobehavioral deficits, see Behavioral patterns
Neurobiological indicators, see Biological markers
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Newborn period and infancy
associated health conditions, 156
behavior patterns, 160-161
blood alcohol levels, 19
diagnosis during, 19, 70, 75, 91, 93-94, 168
environment enrichment, 46
low birthweight, 4, 40, 41, 68, 69-70, 76, 92-93
Non-steroidal anti-inflammatory (NSAI) agents, 46
Noonan's syndrome, 79
O
Obstetrician gynecologists, 118-119, 124, 133, 194
Occupational therapy, 176, 177
Ocular problems, see Eye defects
Opitz syndrome, 79
Organogenesis, 38
Outcomes research, alcohol treatment for women, 138-141
P
Parenting education, 15, 180-181, 185
Partial FAS (diagnostic category), 3, 4, 75, 76, 78
Partners of women
drinking behavior, 102, 107, 108, 121
stability of relations with, 53, 107, 122
targeted for interventions, 10, 11, 117, 121-122, 142, 146
Passive surveillance, 6-7, 83, 91-94, see also Registry-based studies
direct measures, 92
indirect measures, 92-94
Paternal alcohol exposure, 121-122
Pattern recognition, 72
Pediatric specialties, 176, 194
Peers and friendships, 163
Perinatal 20 demonstration project, 22
Phenylketonuria, 79
Physical anomalies, 17-19, 156-157, 159
as diagnostic criteria, 2, 67, 68
prenatal development, 37-40
see also Alcohol-related birth defects (ARBD); Facial anomalies; Growth deficiency
Physician involvement, see Health care interventions
Polychlorinated biphenyls (PCBs), 34, 35
Population-based epidemiologic studies, 7, 87-89, 96
drinking during pregnancy, 83, 95, 102-103
Poverty areas and inner cities, 89, 103, 155
Prader-Willi syndrome, 74
Predifferentiation period, 37-38
Pregnancy, see Abstinence during pregnancy; Drinking during pregnancy
Pregnancy Risk Assessment Monitoring System (PRAMS), 106
Pregnant and Postpartum Women and Their Infants (PPWI) initiative, 23, 142-143
Prenatal care, 107, 124, 126-127, 133-135
Prenatal development, susceptibility over, 36, 37-40
Preschool period
behavior patterns, 161-163, 168
Prevalence, see Incidence and prevalence of FAS
Prevention interventions and measures, 9-12, 112-113
birth defects, 20-21
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evaluation of impacts, 11, 16, 113, 119-120, 142-144, 146, 147, 196
indicated, 10, 11-12, 115, 135-141, 145-147
models of, 113-114
research needs, 11-12, 113, 146-147
research programs, 22-23, 144-145
secondary disabilities, 13-15, 80, 154, 173-181, 182-183, 185-186, 196
selective, 9-10, 12, 115, 120-135, 145, 147
universal, 9, 12, 114-115, 116-120, 145, 147
Problem solving, 163
Professional training and education
diagnosis of FAS, 66, 91, 92, 94, 133, 182
identification of heavy drinking, 11, 123, 132-133, 147
in prevention of FAS, 15, 132-133, 136, 179-180, 185
referral for treatment, 11, 15, 147, 184
Prospective studies, 83, 84, 86-87, 158-159
on effects of maternal substance use, 7, 26-27, 93, 94
Prostaglandin (PG), 45-46
Protective factors
against fetal injury, 9, 12, 45-46, 109, 147
women's drinking reduction, 9, 109, 147
Proxy indicators
of prevention activities impacts, 119, 143-144
surveillance criteria, 7, 92-94, 95-96
validation, 96
Psychological factors, 9, 102, 107, 109, 147
Psychotherapeutic drugs, 105, 177
Ptosis, 72
Puberty, see also Adolescence and post-puberty development
Public education campaigns, 9, 20, 116
Public Health Service (USPHS), 19, 20, 21-23
R
Racial groups, see Ethnic groups
Referrals, 10, 11, 15, 131-132, 135, 147, 184
professional training in, 11, 15, 147, 184
Registry-based studies, 7, 83-84
Research needs
alcohol abuse, 9, 27-28, 102, 107-110, 138, 139, 141
biological markers, 6, 9, 81, 109
developmental stages, 6, 80, 167
prevention interventions, 11-12, 113, 146-147
Research programs and studies, 21-23, 144-145
behavioral patterns, 158-159
coordination of, 15-16, 107, 194-196
prevention interventions, 22-23, 144-145
teratogenic effects, 19-20, 27, 37-45, 158
see also Animal models and studies; Clinic-based studies; Cross-sectional research; Epidemiology and surveillance; Longitudinal studies; National surveys; Population-based epidemiologic studies; Prospective studies; Research needs
Residential Treatment for Women and Their children, 23
Retrospective studies, 83, 84, 86, 158
Risk factors, see Dietary and nutrition factors; Social-environmental factors
Rubella, 20-21
S
Salicylate, 42
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School performance, see Academic performance
Screening tools, 11, 146; see also Biological markers
Secondary disabilities, 12, 13-14, 80, 154-155, 173-181
and caregiving environment, 155, 169-173
educational interventions, 14, 155, 174-175, 177-179
medical interventions, 174, 176-177
Selective prevention interventions, 9-10, 12, 115, 120-135, 145, 147
biological markers, 126-131
brief interventions, 123-124, 131-135
health care professionals' roles, 10, 123-133
and prenatal care, 133-135
professional training, 132-133
referrals, 131-132
screening instruments, 124-126
targeting of demographic subgroups, 12, 147
targeting of family, 115, 122, 147
targeting of women's partners, 121-122
Self-help groups, 140
Sensory integration, 15, 161, 163, 186
Sleep disturbances, 160
Smoking, 34, 36, 101, 105, 121
Social-environmental factors, 9, 90, 109, 147
in alcohol abuse, 88-89, 100-102, 108-109
role in modifying fetal alcohol exposure, 15, 46-47, 186
Socioeconomic status, see Income and socioeconomic status
Species susceptibility, 40
Stability of relationships, 53, 107, 121, 171-173
State government agencies, 195
Stigma
of alcohol abuse, 92, 94, 96, 112, 146
Substance Abuse and Mental Health Services Administration (SAMHSA), 23, 143, 195
Surgeon General's warning, 2, 22, 27, 118
Surveillance, see Epidemiology and surveillance
Sweden, FAS rate, 84
T
Targeting, see Indicated prevention interventions; Selective prevention interventions
Teratogenic effects, 33-36, 73, 101, 121, 159-160
dose-response effects, 41-45
low-level alcohol use, 27
multifactorial model, 47-48
research studies, 19-20, 27, 37-45, 158
Therapeutic intervention, 176-177
Tobacco, see Smoking
Training, see Professional training and education
Treatment and intervention for FAS children, 12-14, 27-28, 173-186
availability of services, 156, 175-176
barriers to services, 155-156, 175-176, 181-184
community outreach programs, 185
coordination of services, 15, 16, 195, 196
early identification, 14, 80, 155, 168, 182, 185
eligibility for services, 155, 156, 182-183
local and regional clusters, 14, 185
planning, 166-173
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Treatment and prevention of alcohol abuse
availability of services, 10-11, 137, 138, 141
in drug treatment programs, 21
evaluation of effectiveness, 138-141, 143-144
intensive, 10-11, 140-141, 146
as a preventive intervention for FAS, 9, 10, 107-108, 115, 135, 138, 145, 154
research needs and barriers, 27-28, 102, 138, 139, 141
Tremors, 73
Turner's syndrome, 79
U
Universal prevention interventions, 9, 12, 114-115, 116-120, 145, 147
health care professionals' roles, 118-119
Urinary dolichol, 127-128
V
Velocardiofacial syndrome, 79
Vigilance, 164
Violence against women, 102, 107, 108
Vitamin A, 42
W
Whites, see Caucasians/whites
Wiedemann-Beckwith syndrome, 74
Williams syndrome, 79
Women's drinking, see Drinking among women; Drinking during pregnancy