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Fetal Alcohol Syndrome

Fetal Alcohol Syndrome (FAS) refers to a group of physical and mental birth defects resulting from a women’s drinking alcohol heavily or at crucial stages during pregnancy. Fetal Alcohol Syndrome was first named and treated in the late 1960’s. This condition results from the toxic effect of alcohol and its chemical factors on the developing fetus. FAS is the leading cause of mental retardation occurring in 1 out of every 750 births. The frequency of FAS occurs about 1.9 times out of every 1000 births according to the latest figures, and minor effects can be seen in up to 20% of pregnancies per year. This number changes drastically for women who are clearly alcoholics. As high as 29 children out of every 1000 births will suffer from FAS if the mother is an alcoholic. The overwhelming consistency of this disease is that it is 100% preventable if a mother would drink no alcohol while pregnant.

There are three major effects or hallmarks of drinking while pregnant. First, alcohol will cause pre- and postnatal growth retardation for the baby. Second, alcohol can cause central nervous system dysfunction and neurodevelopmental defects for the child. The third consequence of drinking while pregnant causes facial disformaties. Studies comparing children of women who drank continually throughout their pregnancy with women who abstained from drinking that alcohol exposed offspring were smaller in weight, length, and head circumference. The greatest effect of FAS appears to be the overall size of an alcohol-exposed child. Children exposed prenatally to alcohol continue to be smaller than their non-exposed peers. A study has shown that there is a relationship between alcohol exposure during the second and third trimesters and growth at 8 months, 18 months, and 3years of age. Children exposed to an average of one drink per day or more during the second or third trimester were significantly smaller in weight, length, and head circumference when compared with children who had not been exposed to alcohol. Children that were exposed to less than one drink a day were smaller than the non-exposed children but larger than the more heavily exposed children.

The attempt to understand FAS has lead to new areas of research attempting to discover the mechanism that causes defects. As of now the exact mechanism is not known. One theory suggest that alcohol increases placental contractility and thereby decreases oxygen supply to the growing embryo. A lack of necessary oxygen to a growing brain is no doubt the result of alcohol’s work but exactly how it happens is still under investigation.

In the United States, epidemiological data suggest that the rates of FAS tend to higher in African American and Native Americans than whites of similar socioeconomic status. A survey complied by the centers for disease control and prevention reviewed more than 4.6 million births in approximately 1,200 hospitals and showed considerable differences in occurrence of FAS among racial groups. The reason for variance among these groups remains unclear. Among Native Americans, rates of FAS even varied between the different tribes. This may be attributed to nutrition, fertility, or metabolic differences in the genetic makeup of each tribe. Also Native American family culture can influence drinking patterns often leading to a higher rate of alcohol consumption.

Among factors to consider, alcohol consumption is frequently associated with drug abuse, smoking, and malnutrition. All of these factors can cause serious harm to the developing embryo of a child. It is difficult for researchers to decide which effects are caused by alcohol alone.

To clearly distinguish a child as having FAS poses a difficult thing for researchers. They soon began to realize that they were encountering children with some, but not all the classical signs of FAS. Because a diagnosis of FAS demands the presence of all three hallmarks, (growth deficiency, central nervous system dysfunction, and physical abnormalities) a term was developed to refer to children with what seemed to suspected fetal alcohol exposure. The name to these occurrences is Fetal Alcohol Effects (FAE). This is not intended to be a diagnosis but rather a bookmark suggesting that the abnormalities seen in children were comparable with FAS. To date, there is no universal accepted evidence that FAE is definable and it would be unwise to use it as a diagnosis, but it does help explain apparent effects of alcohol that are not included in the FAS diagnostic criteria.

To correctly identify FAS, a documented history of the mother’s ingestion of alcohol during pregnancy is necessary. This is difficult for most women to provide accurately because the recognition of pregnancy usually occurs several weeks to even months after conception. When women are asked to report drinking from the beginning of pregnancy, many women think back to the point of pregnancy recognition instead of the time of conception. For most women alcohol abuse decrease over the length of a pregnancy and changes with each different stage of the pregnancy. Therefore, the amount that a woman consumed at the time in the beginning is often underestimated.

In addition to learning the exact stage at which alcohol exposure occurs, researchers must also learn the exact dose of exposure to be able to correctly identify FAS. Women usually have a normal pattern of drinking which reflects the amount they usually consume. This pattern will then begin to vary when a woman finds out she is pregnant. A study concluded that this pattern could only account for 73% of the total alcohol consumed. This means to correctly diagnosis FAS, researchers must accurately identify when, how often, dose of exposure, and variability in pattern. This makes for a difficult task.

There are specifics that doctors look for after a child is born that helps diagnose FAS. First of all the eyes are the most common and consistent sign of FAS, the eyelids especially. Children often appear to have widely spaced eyes but measurements reveal that they are spaced apart normally. This disparity in sight is caused by short fissures or eye openings. The distance between the inner and outer corners of each eye is shortened making the eyes appear smaller and farther apart than normal. The next common facial defect in children is slow growth in the center of the face. This produces an underdeveloped midface and the zone between the eye and the mouth may seem to be flattened or depressed. Also, the bridge of the nose is often very low. As a result of slow nose growth, the nose tends to point forward and downward in that same respect

FAS has crippling consequences throughout the life of a child affected with the disease. Adolescents and adults assigned a diagnosis of FAS during childhood often appear alert and verbal, but they can not live independently, hold down jobs, or succeed at school. FAS patents show poor concentration skills, social withdrawal, failure to consider consequences of their actions and related problems. During development, both physical and mental, FAS children have very fine and poor motor coordination skills and it becomes very apparent at the preschool age. They also are very affectionate but at the same time very hyperactive, which makes it a problem for the teachers who have them in class to deal with. This is why they are, during the first few years of school, given the diagnosis of having attention-deficit hyperactivity disorder (ADHD); this diagnosis is given because of their high activity level, short attention span, and poor short-term memory. Many of these children require special education help regardless of the fact that their IQ falls between the normal range. Their hyperactivity calls for them to receive special attention that normal teachers cannot and at most time will not give them. Severe mental retardation also persists among a majority of those with FAS. Researchers studied 38 males and 23 females ranging from 12 to 40. A total of 43 received a diagnosis of FAS before the age of 12. The other 18 had diagnosis’s of FAE. Study participants displayed little evidence of facial abnormalities, such as malformed lips and misaligned teeth, and low body weight typical of children with FAS. Many of the participants remained very short for their age with unusually small heads. One 29-year-old woman stood only 4 feet tall. IQ’s for the group ranged from 20 (severely retarded) to 105 (normal). Academic achievement fluctuated from second to fourth grade levels with deficits in math. Nearly the entire sample lived under some type of supervision, usually with parents, relatives, or foster parents. According to the caretaker reports, every participant exhibited significant behavioral problems such as consistently poor judgment and low concentration. Problems with lying cheating and stealing turned up frequently.

One of the most debilitating characteristics of FAS is the poor ability to adapt to the demands of their surroundings and live independently. To be independent, many FAS patients are required to learn to ride buses, prepare meals, and use money appropriately. Also, performing a job and obtaining the social skills necessary to keep the job are necessary. Educational goals for these students should go beyond classroom boundaries and target skills that will essentially make the patient independent, productive citizens.

There continues to be ongoing research on the nutritional, hormonal, and cellular events regulating fetal development to help guide early interventions in children with FAS. There will always exist a continual risk because of the lack of education in mothers-to-be. The one thing most importantly stressed is that mother who knows or even thinks that she is pregnant should not drink anything that is made of alcohol. The educating of these mothers to the harm that they can cause themselves and their unborn children is what needs to be done. They should know that with the imbalance of their meals and alcohol consumption that their children are suffering and cannot at times be given that chance to live and survive in society as normal children should. Because of the lack of education that they have they do not understand that what they do to themselves is also what they do to their children.

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