Contents
Alcohol plays a major role in society today. It is constantly being .
…… in our minds through advertisements, whether its commercials or
billboards, holidays, or even just at the popular social scene. Alcohol is
consumed for many purposes, such as celebrations, to increase romance, out of
boredom, or a way to relax. Alcohol is a drug that is depended upon by the
majority of our society. Nonetheless, alcohol has very damaging effects, not
only does it cause self-inflicted diseases resembling alcoholism or cirrhosis
of the liver, but it harms unborn fetuses as well. Many women drink alcohol
when they do not even know that they are pregnant yet. Alcohol can cause
disorders such as Fetal Alcohol Syndrome and Fetal Alcohol Effects.
Fetal Alcohol Syndrome, FAS, is a congenital disorder which is
characterized by a variety of physical and behavioral traits that result from
maternal alcohol consumption during pregnancy. The term Fetal Alcohol Effects,
FAE, indicates that alcohol is being considered as one of the possible causes of
a patient’s birth defects. In other words, FAE is a less severe form of FAS.
Both FAS and FAE are the results of the use of teratogens, which are nongenetic
influences that can potentially complicate fetal development.(Harris, p.85)
FAS is due to the mother’s consumption of alcohol during pregnancy.
Alcohol in the woman’s bloodstream circulates to the fetus via the placenta.
There, the alcohol intrudes with the ability of the fetus to receive a
sufficient amount of oxygen and nourishment for normal development in the brain
and other body organs. The critical time for alcohol teratogenicity is around
the time of conception.
Effects of FAS/FAE
Although alcohol is the only cause of FAS, there are unfortunately
numerous effects. Infants with FAS may have a weak sucking response and an
irregular sucking pattern early in life. Some doctors describe them as
distracted and fatigued when sucking. Withdrawal symptoms such as prolonged
twitching, jitteriness, sweating, and hyperactivity have also been reported in
infants exhibited to alcohol before birth. (Timberlake and Birch, p.1)
Prenatal alcohol exposure is one of the leading known causes of mental
retardation in the United States. Mental retardation is usually mild to
moderate, but occasionally it is severe. Central nervous system handicaps are
also present in children with FAS. A small brain, learning disabilities, short
attention span, hyperactivity in childhood, and poor body, hand, and finger
coordination are examples of CNS handicaps.(NIAAA, p.1) Mental handicaps and
hyperactivity are probably the most debilitating aspects of FAS.(Streissguth,
p.1)
Children with FAS also suffer from facial abnormalities. These
abnormalities include: small eye openings, drooping eyelids, short upturned nose,
thin upper lip, and low set or poorly formed ears. (NIAAA, p.1) These facial
patterns distinguish children with FAS/FAE from normal children, however they
are not harshly malformed.
A more serious and life threatening symptom of FAS is organ deformities.
This includes heart defects, heart murmurs, genital malformities, as well as
urinary and kidney defects. Abnormal thyroid functioning and a decrease in the
effectiveness of the immune system are also present in infants exposed to
alcohol.
What about paternal alcohol consumption? Alcohol may affect fetal
development through a direct effect on the father’s sperm or gonads. Studies
have shown that children with alcoholic fathers often experience cognitive
abilities and have a greater chance of being hyperactive. These findings were
found in adoption cases, where the biological father was an alcoholic and the
child was raised by nonalcoholic parents.(Cicero,p.3)
FAE is a broad term covering a wide range of success levels, from mild
learning disabilities to a less severe form of FAS. FAE is much harder to
detect than FAS and extremely difficult to diagnose at birth. This is because
FAE conditions begin to occur during school years. These conditions include
behavioral problems, short attention span, language difficulties, and
hyperactivity. (Timberlake and Birch, p.1)
Occurrence
The number of new cases each year of FAS and FAE are significantly
underreported, therefore it is difficult to obtain accurate findings. The
incidence of FAS is estimated at 1-2 per 1,000 live births whereas FAE is
estimated to occur in 3-5 per 1,000 live births.(Timberlake and Birch, p.2)
According to the Centers for Disease Control’s(CDC), Birth Defects Monitoring
Program (BDMP), FAS is difficult to recognize in newborns for three reasons:
1)Facial stigmata of FAS are often subtle; 2)Some types of CNS deficits in
infants are difficult to detect; 3)The birth weight of some affected infants is
normal.(Abel and Sokol, p.1) Symptoms become more noticeable with age.
According to statistics, 44% of chronic alcoholics have affected children: 50%
of these children will be mentally retarded and 30% will have physical
malformations. (Harris, p.98) If a pregnant woman drinks 1-2 ounces of alcohol
a day for the first three months of pregnancy, FAE will be present in 11% of the
births.
Treatments
There are many needs that call for attention with FAS/FAE. Firstly,
FAS/FAE patients typically have complex medical needs associated with their
higher than average congenital anomalies. Infants with FAS are at risk for CNS
problems, therefore, they must be carefully watched.
Patients with FAS/FAE are placed in special education classes beginning
in elementary school. A child in a small class room may benefit highly if their
is a lot of individual attention. Even if it does not show an increase in the
child’s intellectual level, it may prevent further deterioration. Many patients
will reach an academic plateau in high school. However, it is important that
these patients still learn basic life skills, such as safety, money management,
and interpersonal relating. This is where the role of their family comes into
play. Patients with FAS/FAE are at a higher than average risk of sexual and
physical abuse, as well as neglect. They need loving, stable homes with open
lines of communication to develop to their fullest potential.(Roots and Wings,
p.2)
Most FAS/FAE patients will be unable to hold a regular job. Many will
also require sheltered living throughout their entire life. More functional
patients may be able to reside in half-way houses or group homes for
developmentally disabled adults, if their own family is unable to give them the
proper care and attention they need and deserve.
An important person(s) to remember when dealing with patients of
FAS/FAE is the guardian. This person assumes a responsibility much greater than
that of a normal child. The guardian must remember to keep a realistic view
point. They must have reasonable expectations of the child as well. Because
this job is so difficult, social services offer support to prevent the burnout
of the guardian.
Research Studies
The key questions in FAS research include How much is too much?, and
When is the fetus at the greatest risk?(Ernhart, p.2) A safe amount of
drinking during pregnancy has not yet been determined, and all major authorities
agree that women should not drink at all during pregnancy. (NIAAA, p.2) The
fetus seems to be at greatest risk during the first trimester. (Kids Health,
p.2) Much of the human research has been epidemiological and for obvious
ethical reasons. Human clinical studies investigating a dose response effect of
alcohol during pregnancy are not possible.(Timberlake and Birch, p.2)
The saddest part of this disease is that it is preventable. FAS and FAE
are the leading preventable causes of birth defects.
FAS accounts for about
4,000 new cases of preventable birth defects in the United States each year. It
has been estimated that the economic cost associated with FAS in the United
States is $321 million each year. A recent survey done by the National
Institute on Alcohol Abuse and Alcoholism(NIAAA), consisted of 23,000 men and
women ages 18-44 to determine their perception of FAS. Only 73% of the women
and 55% of the men were familiar with the subject. Even more discouraging,
most believed FAS patients were born addicted to alcohol, but had no birth
defects. (Timberlake and Birch, p.3)
According to the CDC, FAS and other alcohol-related birth defects can
be prevented if women do not drink alcohol during pregnancy or if they use
reliable birth control methods when they do not abstain from drinking.
Unfortunately women do not stop drinking until pregnancy is confirmed. By
then the embryo/fetus has gone through several weeks of critical development.
The alcohol may have already done damage to the embryo/fetus.(NIAAA, p.2)
Pregnant women who drink heavily run a 40-50% risk of causing serious problems
to the developing fetus. (Kids Health, p.2)
Work has been done to develop innovative strategies to identify the
women who are at a high risk of having a child with FAS or FAE. Two strategies
that are currently used, are to help educate these mothers about the threat
alcohol has on their fetus, and to help them change their behavior. Prenatal
clinics offer screening , counseling and support services to help achieve
abstinence, as well as case management and follow-ups. If these methods prove
to be effective, they may be inserted into current health care systems. (Centers
for Disease Control and Prevention, p. 2)
In order to reduce the amount children born with FAS/FAE, there must be
an increase in the number of women who abstain from alcohol during their
pregnancies. To reach that goal further research needs to continue. There must
be an improvement in public health surveillance methods, a refinement in
methods used for identifying children who have been affected by prenatal alcohol
exposure, a demonstration in the effectiveness of primary prevention programs,
and an investigation on the effectiveness of secondary intervention strategies,
such as foster-care placement and special education strategies.(Centers for
Disease Control and Prevention, p.4)
Not all women who drink during pregnancy will have an infant with FAS or
FAE, but if there is a 40-50% risk of harming the fetus, why chance it? Women
should be more careful when drinking, because drinking often leads to sex even
if it is not planned. The best prevention for FAS/FAE is to either abstain from
sexual intercourse while consuming alcohol, or abstain from alcohol while
planning a pregnancy. Therefore sexual partners should use birth control.
Fetal Alcohol Syndrome and Fetal Alcohol Effects are fully preventable and the
responsibility lies within the role of being parents
