Fetal alcohol syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 18, 2016
StartDiseasesFetal alcohol syndrome

The consumption of alcohol is generally advised against during pregnancy, as a wide range of birth defects can result. The range and severity of these defects are often referred to as fetal alcohol spectrum disorder (FASD). Fetal alcohol syndrome (FAS) is the most severe point on the fetal alcohol spectrum of disorders and causes significant impairment and delays physically, mentally, and emotionally.

Contents

Definition & Facts

Particularly in the first three months of fetal development, when the mother ingests alcohol in even moderate amounts, some of it can transfer to the placenta. Because of the way that fetuses metabolize alcohol, alcohol ingested by the mother can greatly interfere with the reception of nutrients and oxygen, causing irreversible damage to the face and brain, as well as the function of the skeletal muscles.

The damage can affect movement, hearing, sight, and verbal communication, and although less severe forms can be mitigated or even worked around as the child grows, most impairments are permanent.

Symptoms & Complaints

FAS patients suffer a wide range of complaints, such as:

In addition to these problems, significant mood problems, hyperactivity, difficulty concentrating, and difficulty learning are all common, even in less severe cases. While the learning disabilities and behavioral problems can be altered and improved, the physical deformities, motor, and sensory issues are often permanent with little improvement. Heart damage, such as heart murmur and ventricle problems are common as well. People with FAS generally grow more slowly, another facet of the delays in development.

Causes

The only cause of fetal alcohol syndrome is drinking during pregnancy. While the concern is primarily the first three months of fetal development, any drinking can potentially cause problems during pregnancy. Women who drink heavily or abuse alcohol are at the greatest risk, as the accumulating alcohol will almost certainly cause some form of damage, and the longer that alcohol is consumed in the pregnancy, the more likely the child will be born severely impaired.

Children of alcoholics are at increased risk as are the children of younger drinkers. The less able the mother's body is to process liquor, the more likely for damage with the baby. As alcohol accumulates in the placenta, the developing fetus is starved of nutrition and is choked off from oxygen. The creates delays or halts in progression of development, which in turn makes the deformities and processing difficulties seen later on, after birth.

Diagnosis & Tests

Knowing that the mother drank during pregnancy is a key to correctly diagnosing FAS. Because the syndrome causes effects across multiple criteria, several factors must evaluated. The facial features of a potential FAS patient would have a smooth ridge between the upper lip and nose, a thin upper lip, and/or eyes that appear to be abnormally far apart. In addition, children with FAS have a range of growth problems, from very low percentile weight and height, to very low birth weight, though these problems can resolve as the child ages. In terms of neurological defects, there are three categories:

  • Structural - the child's head is often abnormally small
  • Neurological - in this case, symptoms such as muscle control problems and abnormal reactions
  • Functional - Significant impairment in the child's ability to learn, as well as learning delays, hyperactivity, mood swings, social interaction problems, and difficulty with sensory processing

Treatment & Therapy

Since there is no cure for fetal alcohol syndrome, the treatment relies on addressing the problems the syndrome causes. Early childhood intervention is key to helping a child with FAS develop as normally as possible. These include identifying that the child actually has FAS, and then working with teachers and healthcare providers to address critical needs for Fetal Alcohol Syndrome sufferers. This includes a stable, healthy home life, an environment free of violence as FAS children who are exposed to violence tend to develop more secondary problems like behavioral or social issues than those who are not exposed to violence.

Finally, access to protective social services and special education, as well as proper medical treatment for possible extraneous physical symptoms, are essential. While no medicine is approved to treat FAS, there are drugs that can treat the symptoms, such as stimulants for difficulty focusing, anti-anxiety and antidepressant drugs, and antipsychotics which are used to treat aggression and other behavioral problems. Behavioral training is extremely important and they can help address most of the problems that an FAS child might face.

  • Friendship training - helping with social skills can have a cascading effect, improving self-esteem and behavorial functioning
  • Special tutoring - again, cognitive deficits are prevalent and any extra help with learning is very important
  • Execute functioning training - this helps the patient learn to control their emotions and evaluate cause and effect when they react to situations

Training also can be essential for parents, helping them adapt to the needs of their child, and help them direct the child's frustration and anger into healthy expressions.

Prevention & Prophylaxis

The only prevention for FAS is to not drink alcohol if you're pregnant or you think you may become pregnant in the near future. Reduction in alcohol intake after unprotected sex in which impregnation may have occurred is advisable until pregnancy is ruled out. Proper usage of birth control methods for women who may become pregnant is also advisable.

For women who are pregnant that want to drink, beyond simply suggesting that they abstain until after giving birth, some experts suggest that a rare drink, after the second trimester, is not likely to hurt the child. There is no doubt that drinking, probably in any amount, during the first three months is completely dangerous, but if the mother has been drinking and then realizes she's pregnant, the best course of action is to completely stop consuming alcohol until after the birth. This will not reverse the damage already caused, but it will prevent further exacerbation of the condition.