Fetal alcohol syndrome
The 1990s is witnessing the significant impact alcohol-related birth defects are having on our society. These birth defects are caused by maternal use of alcohol during pregnancy which are irreversible, yet preventable. The most severe outcome, fetal alcohol syndrome (FAS), to the less easily diagnosed fetal alcohol effects (FAE). The incidence of FAS is estimated at .33 per 1,000 live births. The estimated incidence of FAE is three times that of FAS. With an annual cost of $76.4 million in the United States which only includes FAS, not FAE. The bulk of these costs are associated with mental retardation. It impacts the family, education system, health system and social services in general, as well as individual losses. FAS is considered the most common known cause of mental retardation in the Western World. For a positive diagnosis of FAS, in addition to a history of maternal alcohol use during pregnancy, each of the following three categories must be present:
1. slow growth before and after birth including weight, height and/or head circumference,
2. facial dysmorphology such as thin upper lip, flattened philtrum, and/or short openings between eyelids, and
3. damage to the central nervous system.
Diagnosis can be difficult because many of the critical diagnostic features change with age. It is most difficult to diagnose in newborns and adults. Reaching an FAE diagnosis is even more difficult because only some of the symptoms are present, and possibly not as visible. This disorder cannot be detected by genetic testing because the damage is done after the baby is born.
It is not known how much a pregnant woman can safely drink without damaging the fetus, although heavier drinking increases the likelihood of damage. Also, there does not seem to be any time during pregnancy when it is safe to drink. As a result, it is generally recommended that pregnant women abstain from drinking. Children born later to alcoholic mothers were at greater risk than older siblings. Another variable is the fact that drinking alcohol may not be the only risk-taking behavior of the mother. Poor nutrition, poor health, smoking, and other drug use may also contribute to poorer neonatal outcome.
There is still a lot to be learned about how alcohol causes damage to the fetus, as well as the timing of exposure. Alcohol affects many organ systems, including the brain, which develops throughout all trimesters of pregnancy. As a result, stopping use any time during pregnancy will have a beneficial outcome, especially on growth and behavior. Alcohol may cause harm by directly damaging and killing fetal cells, affecting placental function or by indirectly affecting biochemical steps involved in fetal development.
The permanent damage that is done usually shows itself through behavioral, intellectual and physical problems. These characteristics include: mental retardation, hyperactivity, poor judgement, short attention span and memory difficulties. As damage is permanent, people affected by alcohol related disorders do not outgrow these symptoms. The consequences of these characteristics, together with a frequent disruptive living environment, may put these people at a serious risk for problems such as substance abuse, victimization, early pregnancy, suicide, homelessness and frequent encounters with the law. There is no cure for FAS. Beginning at birth, steps can be taken to ensure the newborn is diagnosed, treated for withdrawal symptoms and placed in the hands of a planning team. Children with FAS or FAE have such a variety of both physical and social needs. Hopefully people will become more educated about the consequences of consuming alcohol during a pregnancy, and no more children will have to suffer because of their mother’s ignorance.