Pregnancy is a wonderful time. Mothers have varying experiences with those nine months, but all are focused on the child they carry. During that time many things can go wrong. One of the easiest to prevent is Fetal Alcohol Syndrome and its related spectrum of disorders. Specifically, if a mother does not drink or expose herself to alcohol, then her unborn child will likewise remain alcohol free, and thus develop in an optimum environment, as nature intends.
Nonetheless, Fetal Alcohol Syndrome Disorders remain a significant problem in our society. This page details the problem, diagnostic criteria, treatments, and prognostic information.
What is Fetal Alcohol Syndrome (FAS)?
Fetal Alcohol Syndrome Disorder is a broad term that encompasses a range of symptoms and problems that stem from a fetus' exposure to alcohol during pregnancy. There are four types of FASD: Fetal Alcohol Syndrome (FAS), Alcohol-Related Neurodevelopmental Disorder (ARND), Alcohol-Related Birth Defects (ARBD), and Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE).
The symptoms for the various sorts of FASDs can be physical, cognitive, and behavioral. Doctors look for things like low birth weight, an underdeveloped cranium, and a smooth ridge between the nose and upper lip when they are attempting to diagnose. As FASD children grow up, they are prone to display symptoms that include, but are not limited to:
- Poor coordination
- Difficulty with school
- Cognitive and neurological disabilities
- Vision/hearing problems
- ADHD
The most extreme version of them all is FAS. Sufferers often live a life of disability. Many require constant medication, therapies for behavioral problems, and strong family and community support.
How Common is FAS?
Fetal Alcohol Syndrome is not a rampant problem, but since it is wholly avoidable, any incidence at all is far too many. While the CDC does not have firm numbers for the rates of FAS, they estimate that between .2 and 1.5 births per 1,000 are in the FASD spectrum. They also show that nearly 10% of pregnant women engage in drinking during pregnancy and 30% of those report binge drinking. While FASD may not manifest as a result of one drink, or even one extreme binge, the risks for lifetime damage are far too high. Pregnant women are encouraged to maintain absolute abstinence during pregnancy.
What are the Symptoms of Fetal Alcohol Syndrome?
- Alcohol-Related Birth Defects (ARBD): People suffering ARBD have problems with any or all of the following: heart, kidney, bones, and hearing. It's not uncommon for sufferers to display multiple symptoms.
- Alcohol-Related Neurodevelopment Disorder (ARND): Sufferers of ARND display cognitive and intellectual problems. The frequently struggle in school, particularly in math class. They may also have issues with memory, attention span, and impulse control, among other problems.
- Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): The symptoms of this disorder are similar to ARND and include behavioral and cognitive problems. Sufferers may exhibit temper tantrums, irritability, and will struggle with mundane daily tasks such as dressing, meal preparation, bathing, and peer interactions.
- Partial FAS (pFAS): Some children were exposed to alcohol during pregnancy and yet do not display symptoms extreme enough to be considered full FASD. They may have partial cognitive disabilities, slight facial abnormalities, or be below average for height or weight. They tend to require some community and extra family support.
Visible Symptoms
Fetal Alcohol Syndrome Disorders not only manifest in the organs or cognitively but there are tell-tale visible symptoms that are common among sufferers. These include a thin upper lip, an unusually small skull, a smooth (non-ridged) area between nose and mid-upper-lip, and below-average height/weight. FASD victims will also have abnormalities at the horizontal openings of the eyes, known as small palpebral fissures.
FASD sufferers may also display a low nasal bridge, a short nose, flat mid-face, and a small jaw. When these visible symptoms are combined with behavioral or cognitive disruptions doctors, psychologists, and social workers can easily make a diagnosis.
Physical System Symptoms
On top of FASD's visual symptoms, there are a number of physical problems that aren't as evident, but which cause lifelong problems. That is, many organs and systems in the sufferers body are impacted when their mother drinks during pregnancy. The nervous system is often impaired, resulting in cognitive disabilities that include behavior disorders, poor academic performance, and problems with mood.
FASD children also have lifelong problems with their heart, kidneys, and bones. FASD babies can be born with a temporary heart murmur that usually disappears by age one. Their skeletal problems don't always impact daily functioning, but FASD children typically have below-average height and weight. Their renal problems include aplastic, dysplastic, or hypoplastic kidneys.
Functioning Issues
One of the most heartbreaking aspects of the FASD spectrum is the fact that suffers must deal with their symptoms over their entire lifetime. That is, their daily functioning will always reflect the traumas their bodies incurred in their mother's womb. These functional issues include cognitive disorders, learning delays, and emotional disturbances.
Frequently, FASD patients have trouble in school. In particular, their compromised neurological system impairs their ability to learn mathematics. They can also display problems with attention, memory, judgment, and impulse control. These issues are often compounded by emotional problems and result in poor peer relationships.
FASD sufferers can also have problems with mood control, may erupt with rage, and they frequently feel irritated. These psychological and emotional problems can betray whatever social abilities they do have. In this way, FASD children may experience a downward spiral that can spin out of control.
What are the Causes of Fetal Alcohol Syndrome?
FASD is caused when women drink while pregnant. The alcohol enters the mother's blood stream and crosses the placenta. Where the developing fetus expects nutrition, instead the mother's blood delivers alcohol. Alcohol is a neurotoxin that negatively impacts every system of the adult body, and a developing fetus has little or no defense. Further, while an adult can often recover from the deleterious effects of alcohol, a fetus' development is more dramatically impacted. The damage from the alcohol has lasting, often permanent, implications.
Essentially, the baby's small body receives the same BAC, or blood alcohol content percentage, of alcohol as the mother. Since the baby is far smaller, the alcohol presents itself in far higher concentrations. As the fetus has not yet developed a liver, depending on the mother’s body to filter out toxins, the alcohol never leaves their system, building up over time. When the alcohol restricts oxygen and nutrients to a baby's developing systems, they are incapable of proper growth. If the alcohol's damage comes at the wrong time, the organ or anatomical system may not ever fully recover.
FASD is 100% avoidable, so long as mothers do not drink while pregnant.
Identification
FASD is difficult to diagnose at birth. Unless a woman volunteers that she was drinking during pregnancy, there's little hope that a medical team will be on the lookout for symptoms. However, as affected children grow and mature, certain visible symptoms become evident. Childcare workers should be on the lookout for the following symptoms:
- All three of the following facial abnormalities:
- Smooth area between the nose and upper lip - Normal children have a vertical groove from their septum to the middle of the upper lip
- Thin upper lip (thin vermillion border)
- Small fissures between the eyelid and eyeball (small palpebral fissures)
- Below-average growth rate
- Evidence of neurological dysfunction
On top of these symptoms it is vital to have a report of the mother's drinking habits, particularly during the pregnancy. It may be difficult to elicit such an admission from the mother, but if her child's future health is on the line, she may have a change of heart.
What Are the Treatments for Fetal Alcohol Syndrome?
FASD is not a curable problem. When a mother drinks and her baby's development is injured, that baby can never recover. However, those children can receive treatments and therapies to help offset the damage. Some may even develop coping skills that allow them to work with their disabilities.
Once a child is diagnosed with FASD then professional intervention can begin, and some developmental problems may be mitigated. Mothers are often given checklists so that they can recognize symptoms and tell-tale signs of FASD. When they report these, a professional psychologist, social worker, or medical professional can follow up with a proper diagnosis and interventions.
Interventions can include a range of medical treatments. If the child's heart, kidneys, or bones are impacted then these can be treated with drugs and possibly surgery. Other therapies can include work with social workers or psychologists to address emotional problems. Schools can respond with Special Education classes and families can do their part by ensuring a stable, loving household.
How Can FAS Be Prevented?
Fetal Alcohol Syndrome Disorders are most easily prevented when mothers abstain from all alcohol during pregnancy. This includes all purposeful drinking, as in a night of binge drinking, a glass of wine on the weekend, or even a sip during church services. It can also include being careful around seemingly benign household products such as cologne, rubbing alcohol, and hand sanitizers. All forms of alcohol can harm a developing fetus and there is no reason to take any chance.
While colognes and hand sanitizers may seem benign because one does not drink them, they are nonetheless absorbed into the body. When sprayed in the air, cologne can be absorbed through the mouth or skin. Consider that the alcohol in cologne can indeed result in intoxication, as can rubbing alcohol. Also, hand sanitizer contains the exact same sort of alcohol that you find in vodka.
Keep all of this in mind when seeking to prevent even the slightest chance of FASD. For nine months anyone can substitute essential oils for cologne, soap for a sanitizer, and vinegar or other natural antiseptic for rubbing alcohol.
Outlook for the Disorder
Though there is no cure for any ailment in the FASD spectrum, help is available. When a child is identified as early as possible, the medical and social services communities can respond and help mitigate the symptoms. The cognitive and neurological difficulties can be addressed, and the children can learn to work with their problems and overcome the most difficult parts of their disorder.
FASD impacts development in utero, but the child is still developing. If the subsequent developmental stages are met with appropriate therapies and care, many of the FASD outcomes can be mitigated, if not avoided. Though many need continued community and family support through adulthood, many children born with a FASD spectrum disorder have gone on to lead happy, successful lives.
Legal Issues
Though alcohol is perhaps the number one threat to public health, it remains legal. The legal status of the substance complicates the ability of law enforcement to prosecute the mother of a FASD child. Unlike illicit drugs that remain in a mother's system for a few days after use, alcohol generally leaves the body after an evening of drinking.
Nevertheless, certain states endeavor to prosecute mothers whose drinking endangers their unborn children. Those states allow law enforcement interventions in the case of mothers who seem incapable of stopping their drinking. However, there are surely many others who maintain a quiet drinking habit. Even those who have a glass each evening can be doing incredible, lifelong damage to their unborn children. However, such so-called moderate drinking is unlikely to be detected by law enforcement.
Though criminalizing maternal drinking is difficult, if not impossible, public education can go a long way towards prevention. OB/GYN doctors and nurses need to emphasize the importance of absolute abstinence during pregnancy and public school sex ed or biology courses should include a section FASD prevention. It’s believed that many of the cases of FASD spectrum disorders that happen are because of a lack of knowledge among the general public. We need to make sure education is provided, so that mothers-to-be know exactly what their drinking is doing to their unborn child.