What is Fetal Alcohol Syndrome (Alcohol and Pregnancy)?
Fetal alcohol syndrome is part of a wider set of conditions known as fetal alcohol spectrum disorder (FASD). In total, there are five disorders in this category. These are fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND), a neurobehavioral disorder linked to alcohol use during pregnancy (ND-PAE), and alcohol-related birth defects (ARBD). Each of these falls under the umbrella of fetal alcohol spectrum disorders, and they’re used to categorize the broad range of physical and neurological damage that can occur to a fetus from alcohol exposure during pregnancy.
What Causes Fetal Alcohol Syndrome (Alcohol and Pregnancy)?
Fetal alcohol spectrum disorders all have a common cause: the baby’s exposure to alcohol before birth. Alcohol is extremely harmful to a developing baby and can cause a wide range of permanent damage. It’s important to understand that there is no safe level of alcohol that can be consumed during pregnancy. Even small amounts may lead to serious problems. There also isn’t a ‘safe’ time to drink — alcohol is harmful throughout the whole pregnancy. Therefore, any amount of alcohol consumed at any point during pregnancy can cause irreversible damage leading to fetal alcohol spectrum disorders.
There are certain risk factors that might make a baby more likely to develop these disorders. These include:
– Mothers over 30 with a long history of alcohol use are more likely to have a baby with fetal alcohol syndrome.
– Poor nutrition can also contribute to the risk.
– If a woman has already had one child with fetal alcohol syndrome, her future children are also at higher risk.
– Certain genetic factors can make some women process alcohol more slowly, which can increase the risk of their baby developing a disorder.
Risk Factors and Frequency for Fetal Alcohol Syndrome (Alcohol and Pregnancy)
Exposure to alcohol during pregnancy is the leading preventable cause of birth defects and developmental issues. The condition it causes, known as fetal alcohol spectrum disorders, can have a broad range of symptoms. This makes it difficult to accurately determine how many people are affected. In the 1980s and 1990s, it was estimated that fetal alcohol syndrome, one aspect of fetal alcohol spectrum disorders, impacted between 0.5 to 2 babies for every 1,000 live births. However, many believe these numbers were underestimated because other types of fetal alcohol spectrum disorders were not yet recognized.
When considering the full range of effects caused by alcohol exposure during pregnancy, more recent studies estimate that now, 6 to 9 out of every 1,000 babies are affected by fetal alcohol syndrome, and 24 to 48 out of every 1,000 babies are affected by fetal alcohol spectrum disorders. These higher numbers are commonly found in high-risk groups such as those with lower socioeconomic status and certain racial and ethnic minority populations. For example, American Indians have some of the highest rates in general. It’s also reported that the prevalence of fetal alcohol syndrome can be as high as 1.5% among children in the foster care system.
Interestingly, many cases of prenatal alcohol exposure happen unintentionally, before women realize they’re pregnant. Although most women stop drinking when they know they’re pregnant, about 7.6% continue to drink during their pregnancy.
Signs and Symptoms of Fetal Alcohol Syndrome (Alcohol and Pregnancy)
Fetal alcohol spectrum disorders (FASDs) refer to a range of conditions that can occur in a person whose mother drank alcohol during pregnancy. These can affect multiple systems in the body and result in various physical and behavioral issues. Typically, those diagnosed with FASDs have one or more of the following features:
- Unusual facial features
- Central nervous system problems
- Delayed growth
Distinct facial features such as short eye openings, a thin upper lip, and a smooth area between the nose and upper lip are common. Alongside these, growth problems and smaller head size, issues related to the jaw, eyes, and other physical features may also be observed. There could also be structural issues with the heart, kidneys, bones, eyes, and ears.
The impact of FASDs extends to the brain and nervous system, resulting in a range of conditions. This can start with fussiness and developmental delays in infancy. As the child grows, they may struggle with hyperactivity, attention problems, and learning disorders. These conditions could be mistakenly diagnosed as attention-deficit hyperactivity disorder (ADHD). In teenage years, this could manifest as poor coordination, abnormal reflexes, low academic performance, impaired problem-solving skills, and poor social skills. Moreover, teens might have trouble understanding the consequences of their actions, managing daily tasks, and controlling impulses which can lead to disruptions in school, consistent unemployment, and inappropriate sexual behavior.
Background information can be telling as well. Alcohol use by the mother during pregnancy is a critical element. For older children, the key indicators stem from problems related to brain functioning and behavior. The history of emotional and behavioral issues is common. Signs might include previous involvement with the juvenile justice system, foster care, having a sibling with FASDs, recurrent unemployment, a history of substance misuse, or inappropriate sexual behaviors. These signs can indicate the existence of FASDs.
Testing for Fetal Alcohol Syndrome (Alcohol and Pregnancy)
When checking for fetal alcohol spectrum disorders, a series of specific tests are needed for each of the five conditions that fall under this term.
Fetal alcohol syndrome (FAS), one of these conditions, is identified by certain facial features, such as short eye slits, a thin upper lip, or a flat groove between the nose and upper lip. It can also involve slow growth before and after birth and issues with the central nervous system. Unlike other conditions, FAS can be diagnosed without explicit evidence of alcohol exposure during pregnancy.
Partial fetal alcohol syndrome (pFAS) also involves some of the physical facial features seen in FAS and its diagnosis can vary based on proof of alcohol exposure during pregnancy. Meanwhile, alcohol-related birth defects (ARBD) is the term used for physical issues caused by confirmed alcohol exposure during pregnancy, but without any impact on behavior or mental ability.
On the other hand, alcohol-related neurodevelopmental disorder (ARND) refers to issues with mental and behavioral capabilities caused by confirmed alcohol exposure during pregnancy, but with little to no physical effects. This can’t be diagnosed until the child is at least three years old. Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) is similar to ARND but may also involve some physical features.
Because the symptoms can vary widely and overlap with other conditions caused by drug use or genetics, general doctors can’t definitely diagnose fetal alcohol spectrum disorders. If a doctor suspects this condition, the patient should be referred to a team of specialists who can accurately diagnose the condition by ruling out other possible causes.
The team of specialists will depend on the age of the patient but usually includes a pediatrician or other doctor who specializes in this field, an occupational therapist, a speech-language pathologist, and a psychologist.
Treatment Options for Fetal Alcohol Syndrome (Alcohol and Pregnancy)
While it’s true that brain damage caused by alcohol exposure before birth is permanent and can’t be cured, there are treatments available to help manage the effects of fetal alcohol spectrum disorders. Because the impact of alcohol exposure before birth can vary greatly from person to person, treatments are usually customized for each individual.
One common treatment approach involves coordinating developmental and educational resources in a “medical home”. This recognizes that fetal alcohol spectrum disorders can disrupt normal growth of behaviors and brain functions, and these disruptions can differ significantly between individuals.
The goal of this treatment strategy is to develop and tailor specific therapies that can help to tackle any delays or deficiencies. This is done through additional education, practice, and reminders. However, it’s important to note that like many medical conditions, the best way to manage fetal alcohol spectrum disorders is to prevent them in the first place.
What else can Fetal Alcohol Syndrome (Alcohol and Pregnancy) be?
Dubowitz syndrome, fetal toluene embryopathy, and maternal phenylketonuria (PKU) are some conditions that may display similar features as other disorders. There are also instances where a person shows all the signs and symptoms of a particular condition, even though they don’t actually have that genetic disorder – this is known as Phenocopies. Additionally, in some cases, 22q11 deletion can also mimic the signs of other disorders.
What to expect with Fetal Alcohol Syndrome (Alcohol and Pregnancy)
Alcohol can increase the risk of various complications during pregnancy, not only affecting the fetus. These complications include spontaneous abortions, early delivery, separation of the placenta from the uterus (placental abruption), stillbirth, and inflammation of the amniotic sac (amnionitis).
Currently, the prognosis of these complications is uncertain; but the good news is, recent studies involving chick embryos hint at potential treatments to reverse the brain damage caused due to exposure to alcohol in the womb.
Possible Complications When Diagnosed with Fetal Alcohol Syndrome (Alcohol and Pregnancy)
As stated earlier, complications can vary greatly in nature and seriousness. This can result in problems with emotion regulation and thinking, as well as changes in physical appearance represented by distinctive abnormalities.
Preventing Fetal Alcohol Syndrome (Alcohol and Pregnancy)
The treatment for fetal alcohol syndrome focuses on prevention. This involves public health officials using health data to identify communities that are at risk. They provide education and support to these communities, encouraging them to stay away from harmful substances that can cause birth defects, such as alcohol. This is a critical part in preventing the syndrome.
