Fetal alcohol spectrum disorders (FASDs) are a group of features or conditions that develop in the baby whose mother drank alcohol during pregnancy. These manifestations are also seen later during adulthood. Fetal alcohol syndrome (FAS) is the most severe form of this condition.
It develops in a fetus when the mother has been drinking alcohol heavily during her pregnancy causing prenatal exposure to alcohol.
It involves certain birth defects in the fetus, which are irreversible. Alcohol is one of the leading teratogens – meaning one of the leading substances that can cause prenatal defects in a newborn.
FAS causes brain damage and growth defects that include physical, behavioral, and learning problems. It is the most common non-genetic cause of mental retardation.
You will typically see characteristic facial anomalies, growth retardation, and central nervous system damage leading to cognitive loss, learning disabilities, or atypical behavior.
The physical abnormalities are most prominent in the features of the face and the reduced size of the newborn.
The effects of FAS can equally be caused by all types of alcohol including all wines, beer, and hard drinks.
How much alcohol or how frequently alcohol is consumed to cause FAS is something that cannot be confirmed. Safe limits cannot be ascertained.
In the U.S., about 40,000 children are born with fetal alcohol syndrome.
It is the leading cause of mental retardation in the United States.
About 30% of women in the United States drink alcohol during pregnancy.
In the U.S. and Europe, one out of every 100 babies born, develops this disorder.
The lifetime cost of one individual with FAS is about $ 2 million.
Estimates say that the cost of FAS to the United States is about $ 4 billion annually.
Causes of fetal alcohol syndrome
The cause of fetal alcohol syndrome is drinking alcohol during pregnancy. It may not always cause FAS but certain parameters do increase the risks.
The risk of fetal alcohol syndrome increases with a higher quantity of alcohol consumed. Alcohol from the mother’s blood crosses into the fetus through the placenta and can produce adverse effects on the development of the fetus.
The woman must not drink alcohol when she is pregnant or even from when she plans to become pregnant because she may not know if she is pregnant even 4 to 6 weeks after conception.
When she drinks alcohol during pregnancy, alcohol rapidly crosses the placenta and reaches the fetus. Studies have indicated that within two hours of ingestion, alcohol concentrations are equal in both the maternal and fetal blood.
In addition, the amniotic fluid acts as a reservoir for alcohol, prolonging the exposure of the fetus to alcohol.
Drinking alcohol in the first trimester of pregnancy poses the maximum risk because this is when the brain of the fetus starts to develop. It can cause permanent brain damage.
Drinking in the second and third trimesters will adversely affect the further development of the brain. Binge drinking during the course of the pregnancy will also cause substantial damage.
In the womb, the fetus does not have a fully developed liver that can metabolize alcohol. Alcohol levels, therefore, stay high and will directly damage the fetal organs causing severe and permanent complications.
Clinical presentation: symptoms and signs
Fetal alcohol syndrome characteristics are typical. In children who are severely affected, FAS can be diagnosed at birth, though the characteristic physical features are most prominent between eight months and eight years of age.
The newborn, who has developed this syndrome has the following signs and symptoms some of which extend into adulthood.
1. Prenatal and postnatal growth symptoms
The growth rate is slow. Height and weight are below the required parameters as per age. This could be the result of poor sucking reflex.
Poor muscle tone and coordination
Postnatal growth deficiency
2. Heart defects
Prenatal exposure to alcohol can produce a variety of abnormalities in the developing heart which include:
Congenital heart defects such as atrial or ventricular septal defect
Atrial and ventricular abnormalities
Defects in the atrioventricular valves (tricuspid and mitral) that allow blood to flow backward into the atria
3. Skeletal abnormalities
Deformities in joints and in the bones of the limbs and fingers
Cervical spine fusion
Microencephaly is a birth defect where the baby’s head is smaller than usual when compared to babies of the same sex and age. Such babies often have smaller brains that might not develop properly.
Abnormal development of the thoracic cage
4. CNS and mental status
Mental growth and development of special senses are delayed.
There is mental retardation
Microcephaly
Cognitive impairment
Developmental delay
Irritability in infancy
Seizures
Inadequate myelination of neuronal processes and fibers
5. Special senses
Poor vision and hearing
Difficulty in interpreting communication coming into the brain from the senses– movement, balance, sound, touch, taste, smell, temperature.
6. Facial features
Narrow and small eyes
Smaller brain size
Smaller head
Thin upper lip
Flat philtrum. The philtrum is the groove between the nose and the upper lip.
7. Social issues
You will notice that the child with FAS faces difficulty in school and finds it difficult to get along with others.
Exhibits poor social skills
Does not have time sense
Cannot focus on the task at hand
Complications of fetal alcoholic syndrome
Complications of FAS manifest in the fetus and extend even into adulthood with life-long consequences. These effects can include physical abnormalities and concerns with behavior and learning. Frequently, a person with FAS has a combination of these problems.
Complications in fetus
Drinking effects trimester-wise include:
1st trimester: facial abnormalities and decreased intrauterine growth rate.
2nd trimester: lower IQ, growth retardation in height and birth weight, as well as cognitive deficits
3rd trimester: retardation in birth length and adult height
Complications in adults
The child with fetal alcohol syndrome grows into an adult and can develop complications that can make life difficult. He is at high risk and prone to develop wrong behavioral tendencies.
Mental health issues such as depression, anxiety, and eating disorders
Wrong sexual behavior
Cannot finish school
An aggressive attitude often gets mixed up with the law
Cannot stay alone
Does not last long on a job
Premature death by accident or suicide
Diagnostic criteria
Fetal alcohol syndrome can be diagnosed through three findings. These findings are characteristic facial anomalies, restricted intrauterine growth, and some CNS involvement. CNS involvement can include cognitive impairment, learning disabilities, or behavioral abnormalities.
Certain give-away points include:
History of alcohol consumption by the mother during pregnancy
Evidence of delayed physical development of the baby such as low birth weight, decelerating weight as time passes, and out-of-proportion low weight compared to the height of the baby
Presence of typical facial features such as short palpebral fissures, flat upper lip, flattened philtrum, and flat midface
Evidence of CNS abnormalities: reduced cranial size at birth, brain structure abnormalities such as microcephaly and cerebellar hypoplasia
Impaired neurological signs inappropriate with age such as poorly developed fine motor skills, hearing loss, poor eye-hand coordination, and poorly coordinated gait
Poor mental growth assessment a little later in life as the baby grows. Whether milestones such as uttering a word or taking to crawling or walking occur at normal ages.
Treatment of fetal alcohol syndrome
As mentioned above, defects caused by alcohol fetal syndrome are irreversible. There is no treatment or medication for the congenital defect. Only special care and special schools are advised. Parental counseling is also advocated.
Medications may be prescribed as per the indications.
Antidepressants to treat problems with low moods, irritability, and aggressive tendencies
Stimulants are prescribed to treat hyperactivity and to help with concentration
Neuroleptics are used to treat aggression and anxiety.
Complementary therapies such as massage, acupuncture, exercise, and yoga may prove useful.
Characteristics of adults with fetal alcohol syndrome
Fetal alcohol syndrome adulthood is characterized by unpredictable behavior, which can often get these people in trouble.
As mentioned above, the defects developed in fetal alcohol syndrome are irreversible and these adults have lingering defects due to which they cannot live independently. They have poor judgment and can hardly develop any skills.
These adults are impulsive in nature and their actions reflect accordingly. They tend to have the practice of having sex with many partners without any commitment (sexual promiscuity). They need to be put in residential group homes or farms.
Adults with FAS have criminal behavior and can get into problems with the police. They need help managing their money and many of them do get social security assistance.
Adults with fetal alcohol syndrome are at a greater risk of alcohol, tobacco, and drug dependence.
