by Dr. Cheryl Schroeder Ed. D.
“The births of all things are weak and tender, and therefore, our eyes should be intent on beginnings.” – Michel Eyquem Montaigne
What is Fetal Alcohol Syndrome?
Fetal Alcohol Syndrome (FAS) is a pattern of malformations and disabilities resulting from a pregnant woman drinking heavily during her pregnancy. FAS will not occur if the father was drinking heavily or if the pregnant woman was drinking a very small amount of alcohol on rare occasions. Heavy drinking on a consistent basis or binge drinking on an occasional basis can produce FAS. Fetal Alcohol Syndrome is currently the leading cause of mental retardation in the United States.
What is Fetal Alcohol Effects?
Fetal Alcohol Effects (FAE) is a condition where children are born with lessdramatic physical defects but with many of the same behavioral and psychosocial characteristics as those with FAS. FAE is often thought of as lower on a continuum than FAS, but this is not correct. Many individuals with FAE, while looking quite normal, have significant deficits in their intellectual, behavioral, and social abilities which prevent them from leading normal lives.
Forty-four percent of women who drink heavily during pregnancy will have a child with Fetal Alcohol Syndrome.
Of the other 56%, some will have Fetal Alcohol Effects, be Fetal Alcohol exposed, to minor learning and behavioral difficulties.
A few will be apparently normal.
A combination of factors determines whether the exposed child will be afflicted with FAS or FAE. First of all is the genetic makeup of the mother and the fetus. It has been demonstrated that many members of certain populations have similar genetic compositions. Research has suggested, for example that some individuals of Native American descent do not make enough of an enzyme necessary in the breakdown of alcohol in the liver or some are lacking that enzyme all together. Therefore these individuals would be at genetic risk of passing this trait onto the fetus.
A mother’s nutritional status and physical well-being might also play roles of varying significance in determining whether an infant is affected, and to what degree, by the prenatal exposure to alcohol. A great deal more research is necessary to determine the reason that some developing fetuses are more vulnerable to prenatal exposure to alcohol than others. The knowledge base in this arena needs to be greatly expanded.
There is a continuum of effects that can result from maternal prenatal consumption of alcohol.
The most common effects seen is an increase in spontaneous abortions, commonly known as miscarriages. Babies can also be born at low birth weight, birth length, and with a small head circumference resulting from prenatal alcohol exposure. Some of the other effects caused by maternal drinking range from an increase in the number of stillbirths, decreased apgar scores at birth, an increase in the number of birth defects, increased developmental delays, decreased I.Q. scores, to Fetal Alcohol Syndrome and an increased death rate.
Birth defects are dependent on:
Agent (alcohol, crack, heroin)
Dosage (how much is used)
Timing of Exposure (when is it used?)
Individual Factors of mother and child
Genetic Factors
Nutritional Factors
Metabolic Factors
There are variables which help determine whether a teratogen will have an effect upon the fetus. Which teratogen is used – alcohol, crack, heroin, x-rays, etc. The dosage of the exposure is very important. The more minimal exposure, usually the better off the fetus will be. When the teratogenic exposure occurs is of vital importance. Is it one short exposure time or was the exposure on a daily or hourly basis?
The individual factors of the mother and child are also vitally important and the reason why professionals cannot tell a pregnant woman how much would be safe to drink. Since these individual factors cannot be determined, the only way to prevent FAS and FAE is for a pregnant woman to abstain from the use of alcoholic beverages during her entire pregnancy.
FAS is characterized by a triad of symptoms:
1. Central Nervous System Involvement: The central nervous system is composed of the brain and spinal cord. Damage to this area must be demonstrated; i.e., mental retardation, severe learning disabilities, etc.
2. Prenatal and Postnatal Growth Retardation: The baby is born weighing less than it should. The baby does not gain as much weight as it should once it is born.
3. Characteristic Facial Patterns: There are characteristic dysmorphic features which appear due to prenatal alcohol insult or exposure.
Drawn by David P. Schroeder
Copyright © 1994-99 Creative Consultants, Inc.
The eyes appear to be widely spaced; the nose is often short and upturned; the philtrum (area between the bottom of the nose and upper lip) is elongated and flat; the upper lip is thin; and the ears might be low-set and rotated to the back of the head. In addition, the teeth of individuals with FAS are often misshapen and misplaced. It is common for orthodontia to be necessary.
Remember that a diagnosis of FAS or FAE should only be made by physician who is trained in the identification of these symptoms.
FAS is only the tip of the iceberg.
In addition to those with FAS are those individuals who appear normal but who have Fetal Alcohol Effects. Further from our sight are those individuals we suspect on a clinical basis have something wrong with them or are clinically abnormal but the reason why is hidden. The largest part of the iceberg, but where it most difficult for us to see, are those individuals that are apparently normal but unable to meet their potential. Some of these individuals are in the classrooms of today. They work hard and try, but it all doesn’t come together.
What mom drinks, baby drinks.
The alcohol that the pregnant woman drinks goes directly to the developing baby at the same level of concentration. If mom’s blood alcohol level is 0.2, so is the baby’s. However, mom is much, much larger. Her mature liver acts to detoxify the alcohol. On the other hand, the fetus is incredibly smaller. Its liver is not yet mature. Therefore, while mom might stay drunk for several hours, the developing fetus can stay drunk for three to four days.
It is because of this phenomena that binge drinking, consuming two or more drinks per hour, has been found to be more detrimental to the developing infant than low level, chronic drinking. The fetal blood alcohol level becomes very high and stays that way for a long period of time.
Incidence of FAS and FAE
World-wide incidence: 1.9 per 1,000 live births Southwest Plains Indians: 9.8 per 1,000 live births
-Abel, 1988, Abel & Sokol, 1986
What causes this large difference? Genetics is the answer. The results of the latest research indicate that many more members of some populations, in this case the Southwest Plains Indians, are lacking or have a reduced amount of an enzyme necessary in the breakdown of alcohol. The amount of enzyme produced by the body is genetically coded. Therefore some populations must be even more careful in this regards just as some other populations are at a much higher risk of developing high blood pressure or having an infant with spina bifida.
The knowledge that alcohol can cause problems has been around for a very long time.
In the Bible, Judges 13:7, pregnant women were admonished to “drink no wine nor strong drink, and eat no unclean food.” Women during that time were told to eat and drink only pure substances, those that would not harm the developing baby.
Aristotle said, “Foolish, drunken, and hare-brained women most often bring forth children like unto themselves, morose and languid.” It was seen even in Aristotle’s day that women who were alcoholic had children who appeared sullen, and not full of play and joy.
In England in the mid-1700’s, physicians were extremely concerned at the high number of infants being born who were mentally retarded and even stillborn. When Parliament imposed a hefty tax on gin, the number of people who could afford to drink it was dramatically reduced. Within a year or so, the number of children born mentally retarded and the number of infants who died before their first birthday fell dramatically.
Fetal alcohol exposure has lifelong consequences.
Fetal Alcohol Syndrome and Fetal Alcohol Effects do not go away. Once the brain is damaged, it is permanent. Most of the damage that occurs in the brain is a result of the brain tissue not moving and growing where it should, resulting in areas of the brain which are not developed at all or are underdeveloped. Neuronal connections that should have been made are simply are not there. Since brain tissue does not regenerate, this damage to the brain is permanent, especially if the tissue did not form initially. It doesn’t ever get better.
FAS is costly!
Anne Striessguth, Ph.D., a leading researcher in the area of FAS and FAE from the University of Washington, estimated in 1980 that the lifetime cost of each child born with FAS was over half a million dollars. In 1989 she adjusted that figure to 1.4 million dollars. Dr. Rizwan Shah, Director of the Family Ecology Center in Des Moines, Iowa, estimated that in 1994 the lifetime cost of each child born with FAS was 2.4 million dollars.
The health care costs for individuals with FAS and FAE can be staggering. If special facilities are needed, they are extremely costly. Special education costs are very high, especially if the individual needs to be placed in a special care facility.
The emotional burden on the family and child is monumental.
The child is very much aware that something is “different” about him or her. A great deal of the time they simply think they are dumb. The overwhelming majority of these parents do an outstanding job of working with and loving their affected child. Many of these children are in adoptive or long-term foster care settings.
Physical, cognitive, and social deficits associated with FAS:
Low birth weight
Failure to thrive (eat and grow well)
An exaggerated startle response
Poor wake and sleep patterns
Hyperactivity, distractibility and attention deficits
Impulsiveness
Temper tantrums
Lying and stealing are common behaviors
Poor social skills
Poor abstracting abilities
Many of these children are in adoptive or foster care.
As a result of their mothers’ high-risk lifestyles, many FAS children have been placed in adoptive or long-term foster care settings at an early age, usually before anyone knows that the child is affected. Many of these adoptive and foster parents have been chastised for harming their child when, in fact, they are only helping the child to the very best of their ability. We must be aware and not criticize nor judge. They are doing the best they can.
The good news is that FAS is 100% preventable.
Education and awareness by everyone at all levels is necessary. Individuals in their child-bearing years, both men and women, need to know the grave harm that can be caused to an unborn child by drinking during pregnancy. Our children world-wide need to know so they will not make these irreversible decisions.
Many health care providers need to learn more about FAS and FAE. Specific “selectives” dealing with this subject are currently offered in only three medical schools in the United States. Those schools are the University of New Mexico, Georgetown University, near Washington, D.C., and Northwestern University in Chicago, Illinois.
Physicians, especially those who deal with children,need to learn how to better diagnose this condition. We can all do something to help prevent this tragedy from occurring in the future.
The Surgeon General advises women who are pregnant or considering pregnancy not to drink alcoholic beverages and to be aware of the alcoholic content of foods and drugs. Even drinking on a social basis can have effects on the unborn child.
Social drinking (1 to 2 drinks per day) can produce an increase in miscarriages, stillbirths, low birth weight, and behavior abnormalities in the baby which can persist throughout adulthood.
The only way to prevent Fetal Alcohol Syndrome is for a pregnant woman to abstain from drinking alcohol during her entire pregnancy, even before she knows she is pregnant.
This will necessitate a change in lifestyle for those in their reproductive years unless they are consistently using a very safe method of birth control. Unfortunately much damage can be done to the developing embryo before the mother realizes she is pregnant. Therefore, it is recommended that a women should not drink alcohol beverages prior to and during her pregnancy.
It is never too late to stop drinking!
No matter when a pregnant women stops drinking,the child will be better off than if she continues to drink during the entire pregnancy.
Drinking during very early pregnancy, even before a woman knows she is pregnant, increases the chance of having a baby with growth deficiency or birth defects.
If someone is drinking 0 to 1 drinks per day during very early pregnancy they, like everyone else who has no additional risk factors, have a 2% chance of having a baby with growth deficiency or a birth defect. If, however, that pregnant woman is drinking two to three drinks per day, then the risk factor goes from 2% to 11% – more than one in ten. If a pregnant woman is drinking four or more drinks per day, even before she might know she is pregnant,then that chance of having a baby with growth retardation and/or a birth defect soars to 19% – almost one in five!
Please remember the good news: FAS and FAE are completely preventable!
People need to know what drinking during pregnancy can do to a developing fetus and the lifelong impact that it can have on a child. The longer we wait, the more children who will be born with significant disabilities If we all help spread this message, this leading and preventable form of mental retardation can be greatly reduced and even obliterated.
“Many things we need can wait, the child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being developed. To him we cannot say tomorrow, his name is today.”
copyright Creative Consultants Inc.
