Fetal Alcohol Syndrome (FAS)

What are Fetal Alcohol Spectrum Disorders?

The range of disorders that occur in the fetus due to maternal alcohol consumption during pregnancy are referred to as fetal alcohol spectrum disorders. They can range in severity and include:

• Alcohol Related Neurodevelopmental Disorder - Associated with intellectual and learning difficulties and behavioral problems.
• Alcohol Related Birth Defects - Involve the physical defects caused in the fetus as a result of maternal alcohol drinking during pregnancy.
• Fetal Alcohol Syndrome - Is the most severe form. It comprises both neurological as well as physical defects related to maternal alcohol consumption. The presence of only some signs and symptoms of fetal alcohol syndrome is classified as partial fetal alcohol syndrome.

What is Fetal Alcohol Syndrome?

Fetal alcohol syndrome (FAS) is the extreme form of fetal alcohol spectrum disorder. It refers to the presence of both physical and neurological signs and symptoms in the fetus, related to alcohol consumption by the mother during pregnancy. The severity of symptoms is highly variable.

In the United States, fetal alcohol syndrome is believed to be the commonest cause of preventable mental retardation. Estimates suggest that between 800 and 8000 children are born with this condition annually in the United States.

How Does Fetal Alcohol Syndrome Develop?

• When the pregnant woman consumes alcohol, it enters her bloodstream, and reaches the developing fetus by crossing the placenta
• Since the fetus is unable to metabolize alcohol quickly, it stays in the fetus's system and causes serious adverse effects.
• Alcohol affects the delivery of oxygen and nutrients to the developing baby's tissues including the brain, causing their damage.

What Are the Symptoms of Fetal Alcohol Syndrome?

Fetal alcohol syndrome (FAS) may show a few or all the physical manifestations that include the following

• Growth retardation
• Characteristic appearance of the face with eyes set wide apart with narrow openings, thin upper lip, short and upturned nose with flattening of the crease (philtrum) between the nose and upper lip
• Small head
• Hearing and visual defects
• Heart abnormalities
• Deformities in bones, joints and limbs
• Kidney problems

Neurological manifestations include

• Lack of coordination and balance
• Learning disabilities
• Hyperactivity
• Poor memory
• Poor attention span
• Moodiness
• Low reasoning and problem-solving capacity
• Lack of judgment

As a result, these children have difficulties at school, lack social skills and ability to get along with others, not to mention the challenges faced due to the physical disabilities. As adults, they are unable to live independently and hold a stable job. Many run into trouble with the law due to violent behavior, and indulging in illegal activities due to poor judgment and reasoning. Drug and alcohol abuse are other issues that may need treatment.

What is in Fetal Alcohol Syndrome (FAS)?

How Is Fetal Alcohol Syndrome Diagnosed?

There are no specific tests to diagnose FAS. Correct diagnosis rests on a proper history given by the caregiver, and a thorough clinical assessment by a specialist. As a result, FAS is very often under diagnosed. The following points need to be noted while making a diagnosis of fetal alcohol syndrome:

• History of drinking alcohol during the pregnancy
• The characteristic facial and other features in the baby
• Lack of physical development as the child grows
• Impaired intellectual and brain development
• Occurrence of social and behavioral problems
• Learning and cognitive problems in school-going children

Early diagnosis is critical, since the special care and educational needs for such children can begin early to enable maximum achievement of their potential.

If one child is diagnosed as having fetal alcohol syndrome, it is important to evaluate other siblings to rule out the presence of fetal alcohol spectrum disorder especially since the mother may have been drinking during the other pregnancies as well.

Features of fetal alcohol syndrome may also occur in normal children, or in other disorders. It is essential that the child be evaluated by a trained expert in fetal alcohol syndrome to ensure a correct diagnosis.

How Is Fetal Alcohol Syndrome Treated?

Fetal alcohol syndrome does not have a specific cure, and the symptoms typically last for a lifetime. Management involves supportive and rehabilitation therapy to address learning, social and behavioural issues. Supportive therapy involves

• Speech therapy, physical and occupational therapy and a special educator in the school to counsel and help with learning and behaviour problems.

• Counseling and psychotherapy to help caregivers and family members deal with social and behavioral issues that may be stressful to handle.
• Medications to deal with at least some of the symptoms
• Management of heart and kidney problems
• Addressing maternal alcoholism to prevent future siblings from being affected, and to help in better care for existing children.

How Can Fetal Alcohol Syndrome Be Prevented?

Fetal alcohol syndrome can be completely prevented if alcohol consumption is avoided during pregnancy. It is worth emphasizing that it is one of the commonest causes of preventable mental retardation, at least in the United States. It may be helpful to remember the following guidelines

• Avoid Drinking Alcohol While Planning or During a Pregnancy: It is best to stop taking alcohol even when one is planning to get pregnant. If one is already pregnant, it is time to stop drinking, and the sooner, the better for the baby.
• Try to Avoid Alcohol During the Reproductive Years: Since many pregnancies are not planned, or couples may be having unprotected sex, it may be worthwhile to consider giving up alcohol during the childbearing years.
• Get Help for Alcoholism: Seeking professional help if one is having an alcoholism issue is essential in general and specifically if the woman is planning to get pregnant.

• Awareness About Fetal Alcohol Syndrome and Related Disorders should be created at the community level. Pamphlets and brochures may be distributed to educate the public on the ill effects of alcohol during pregnancy.

Partners can be supportive of their wives or girlfriends and abstain from alcohol during the pregnancy to make it easier for the women to stay away from alcohol.

It is wise to remember that there is no prescribed limit of alcohol that is safe for the developing fetus, and it is better to avoid alcohol completely during pregnancy rather than regret later.

References:

1. Fetal alcohol syndrome - Tests And diagnosis - (http://www.mayoclinic.org/diseases-conditions/fetal-alcohol-syndrome/basics/tests-diagnosis/con-20021015)
2. About the Effect of Alcohol on the Fetus - (http://americanpregnancy.org/pregnancy-complications/fetal-alcohol-syndrome/)
3. Fetal Alcohol Spectrum Disorders - Frequently Asked Questions - (https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/Frequently-Asked-Questions.aspx)
4. Fetal Alcohol Spectrum Disorders: FAQs of Parents and Families - (https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Fetal-Alcohol-Spectrum-Disorders-FAQs-of-Parents-and-Families.aspx)