• About AFA
  • About Us
  • Board
  • Staff
  • Sponsors
  • Contact
• Library
• Donate
• Online Community
  • Create an All Access Pass
  • Find Support
  • Ask the Experts
  • Blog
  • Blog Archives
  • Online Educational Module (OEM)
  • Calendar
  • Online Webinars
  • Get Our eNewsletter and Updates
• Press & News
  • AFA in the News
  • Press Releases
  • News Archive
  • AFA Position Statements
• Join
  • For Public
  • Create an All-Access Pass
  • For Professionals
  •     » The AFA Physician Network Form
  •     » The AFA Therapist Network Form
  •     » The AFA Professional Practices Network Form
  •     » The AFA LGBT Professional Network Form
• Resources
  • Find a Professional
  •     » The AFA Physician Network
  •     » The AFA Therapist Network
  •     » The AFA Professional Practices Network
  •     » The AFA LGBT Professional Network
  • Links
•  

by Dr. Michael Traister

While the toxic effects of consuming alcohol has been known for centuries, it was only in 1973 that the first real physical description of fetal alcohol syndrome (FAS) was published.

In 1980, the term fetal alcohol effect was introduced to include children who exhibited partial physical characteristics of the syndrome.

The nomenclature has evolved over the years. Fetal alcohol spectrum disorder, alcohol-related neuro-developmental disorder and alcohol-related birth defects have been proposed to define the complex physical and/or developmental issues that can occur in a child exposed to alcohol in utero. The feeling is that children can have the full physical characteristics of FAS but that many more may have only a few (or none)of the physical signs yet still have the developmental and behavior problems. Complicating the problem, there is no objective biochemical (blood or x-ray) test that defines alcohol-related problems in a child.

Drinking in women of child-bearing age is not uncommon, even in the United States. Drinking alcohol during pregnancy was very common decades ago, and recent studies in the US and Western Europe still show that about one-quarter of the pregnant women still consume some alcohol while pregnant.

If drinking during pregnancy is not that uncommon, even in the US, what causes FAS? How common is it? How much alcohol does a woman have to drink before there is a problem in the child? How can we recognize FAS in a child? What are developmental problems associated with fetal exposure to alcohol? Do the children outgrow the problems?

How common is the problem?

It is difficult to estimate the true incidence since only the physical findings can be objectified. Many studies are based upon retrospective estimates of alcohol use during pregnancy. There may also be confounding issues such as maternal drug use, malnutrition during pregnancy and being born premature. But estimates run from 10 cases per 1000 births in the US to 141 cases per 1000 births in Russia. Thus, alcohol-related problem in children is a major issue world-wide.

How much alcohol is safe to drink during pregnancy?

Since double-blind, prospective studies on drinking alcohol during pregnancy are obviously not ethically possible, the answer is impossible to determine. But research from animal studies and epidemiologic data from humans suggest that it may be the acute rise and then withdrawal of alcohol that may cause damage. It appears that there may be genetic differences in risk and there may be more vulnerable periods in fetal development.

The consensus, though, is that there is no safe amount of alcohol consumption. Other risk factors are advanced maternal age, low socio-economic status and binge drinking.

How to recognize fetal alcohol syndrome?

The physical characteristics of fetal alcohol falls into three categories: minor facial anomalies, growth problems and central nervous system problems.

Minor facial anomalies:
• The palpebral fissure (the width of the eye) is small (<10percentile of normal for age)
• A smooth or flattened philtrum (the depression in the skin between the nose and upper lip)
• Thin upper lip

Growth problems:
• Infants are born small for their gestational age and continue to grow slowly

Central nervous system problems:
• Microcephaly (a small head when compared to length and weight)

There are many other physical characteristics which are less commonly seen such as underdeveloped ear creases, minor joint and limb abnormalities, altered creases in the palm and cardiac defects.

There are a number of weighted scales available to aid in the diagnosis; assigning points to various minor anomalies and if the total exceeds a certain number, there is a high probability of fetal alcohol. Until an objective marker of fetal alcohol is found, the syndrome is still a clinical diagnosis.

What are the developmental problems associated with fetal alcohol?

The neuro-developmental problems associated with fetal alcohol include:
• Hyperactivity
• Attentional deficit disorder
• Lower IQ scores
• Verbal processing problems
• Learning/memory problems
• Social understanding difficulties

It has been reported that the severe long-term developmental problems can occur even without any physical characteristic of fetal alcohol. This makes estimating the risk of maternal drinking during pregnancy almost impossible.

Prognosis?

Long term studies following children growing up with the diagnosis of fetal alcohol into young adulthood reveal that the problems do persist. The smaller head, the thin lips and philtrum and small size usually remains. Developmental issues can lead to emotional and behavorial problems which can have major effects on employment opportunities and independent living.

The best treatment is, of course, prevention. This is not an option for parents exploring adoption options. Early identification of developmental problems with aggressive referral for therapies is crucial. Studies have shown that being diagnosed earlier (and therefore getting therapy earlier) and having a stable home environment is associated with a better outcome.