Fetal Alcohol Effects

What is Fetal Alcohol Syndrome?

Although the dangers of alcohol during pregnancy had long been suspected, fetal alcohol syndrome (FAS) was formally described in 1968 by P. Lemoine and colleagues from Nantes (France) in 127 children of alcoholic parents. Their report in a French paediatric journal drew little attention.

Focus on FAS only came after it was independently re-described in 1973 by K.L. Jones and colleagues from Seattle (U.S.) in eight children of mothers with chronic alcoholism. Their report in the British medical journal The Lancet triggered an avalanche of reports of FAS.

Alcohol is capable of causing birth defects. This capability classifies it medically as a teratogen – an agent that interrupts the normal development of a fetus resulting in evident birth defects. Alcohol is currently recognised as the leading teratogen to which the fetus is likely to be exposed. This applies only to societies in which alcoholic beverages are consumed. In these populations, prenatal alcohol exposure is thought to be the most common cause of mental retardation and limited growth.

What are the Signs?

Most of the features of FAS are variable and may or may not be present in a particular child. However, the most common and consistent features of FAS involve the growth, performance, intelligence, head and face, skeleton, and heart of the child.

–           Growth is diminished.

–           Birth weight is lessened.

–           The growth lag is permanent.

–           The face typically has short eye openings, sunken nasal bridge, short nose, flattening of the cheekbones and mid-face, smoothing and elongation of the ridged area between the nose and lips, and smooth, thin upper lip.

–           The skeleton shows characteristic changes such as abnormal position and function of joints, shortening of the metacarpal bones leading to the fourth and fifth fingers, and shortening of the last bone in the fingers.

–           There is also a small fifth fingernail and a single transverse crease across the palm.

The diagnosis of FAS must be based on solid evidence. This is because FAS is a diagnosis of great importance for the entire lifetime of the child, not to speak of its implications for the child’s mother and other family members. There is no laboratory test to aid the diagnosis it is almost always physical appearance and specific skeletal deformities.

Fetal alcohol effects (FAE) is a softer diagnosis than FAS. The diagnosis of possible FAE is considered when:

–           the person has some signs of FAS

–           the person does not meet all of the necessary criteria for FAS

–           there is a history of alcohol exposure before birth.

How Much Alcohol is Safe During Pregnancy?

Two approaches can be taken to this important question.

One is the rigorously scientific approach. It remains strictly within factual evidence.

–           Most children diagnosed with FAS have had overtly alcoholic mothers who drank at least eight to 10 drinks a day.

–           Children born to women who had four to six drinks a day have subtle signs of FAS/FAE.

–           Where mothers have had two drinks a day, the only indisputable effect noted has been subtly lower birth weight.

–           Where mothers have fewer than two drinks a day there is no concrete

evidence for an effect on the fetus. Therefore, from a strictly scientific viewpoint, one cannot say that one drink a day during pregnancy is dangerous to the baby.

The second and the more common favoured approach is ‘better-safe-than-sorry’. This position is promoted by public health experts. For example the warning label on all alcoholic beverages in the U.S. indicate that “According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.”

This conservative approach is also followed by most individuals and groups concerned with preventing FAS/FAE. For example, the National Organization on Fetal Alcohol Syndrome USA states, “No amount of alcohol has been proven safe to consume during pregnancy. FAS and FAE are 100% preventable when a pregnant woman abstains from alcohol.”

Alcohol and Pregnancy

The current UK guidelines state that women shouldn’t drink when trying to conceive or during the first three months of pregnancy. If you do choose to drink during pregnancy, you should limit yourself to only one or two units of alcohol, once or twice a week. Drinking heavily during pregnancy can result in premature labour and underweight babies – as well as FAS/FAE.

Most women, especially those who have never given birth, do not always fully understand that they are pregnant for the first couple of months of pregnancy or that this is a critical time in the development of their future child. This is when the danger lurks for the unborn child. I hear young women and not so young women state with an arrogance that I consider to be based on ignorance and lack of information that “I can drink like a fish and I don’t even suffer from a hangover.” Well goody! I hope their future children feel equally thrilled when they can’t remember things that they knew yesterday, or find that no one wants to play with them because they cannot understand the rules of social interaction.

Children with FAS or FAE struggle to make sense of facial expressions and often have no STOP button. They will continue to laugh hysterically over nothing at all or persist in teasing another child, adult or pet even when told in strong terms to stop.

My fear is that as more females consider that they are fully equal to men, even when it comes to drinking someone under the table, there will be more and more babies born after a drunken, oblivious weekend and more unwanted and unloved children desperate to find those special adults to love them and guide them to a successful future.

Caring for the Children

Raising a child who lives with the effects of alcoholic behaviours of their parents is not at all easy. It is difficult to convey the perpetual daily struggle to find the right key to open learning and interest. Every day is a huge challenge. Often every meal time becomes a battle ground where a very small yet determined child does not feel hungry, not because they have anorexia or any other eating disorder, but just because. Yet the parent knows they must eat as they have no reserves of body fat and no real resilience to the common infections and illnesses of childhood.

These children can cry and scream unaccountably for hours on end. They become exhausted by the sheer effort of it all. When the parent of such a child attempts to explain this to an outsider, the most usual response is “Well, most children go through those phases.” Or “Don’t you think you are just getting a bit paranoid about your child?”

In the UK, very little is known about FAS /FAE even by family doctors and health visitors. Until we are armed with more knowledge and begin an effective and, frankly, scare-led campaign in schools, there will be more children born to naïve parents who from the outset will not understand how this could have happened to them.

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