Fetal Alcohol Syndrome (FAS) – Alcohol and the Unborn Baby

What is Fetal Alcohol Syndrome?

Fetal alcohol syndrome (FAS) is not a single disease but a range of disorders which include numerous physical and mental problems, as well as various developmental defects, that may occur as a result of alcohol consumption by the mother while pregnant. No amount of alcohol is considered safe during pregnancy since alcohol passes easily through the placenta to reach the fetus, where it may also affect the fetal brain. Consuming even a small amount of alcohol carries the potential danger of irreversible birth defects in the baby. However, the risk may be lower with occasional drinking than with regular heavy drinking.

The whole spectrum of disorders associated with alcohol use and its effect on the unborn baby is known as fetal alcohol spectrum disorders (FASD), which may range from mild learning disorders to severe birth defects. Fetal alcohol syndrome is the extreme form of FASD and may include features such as facial abnormalities, small head (microcephaly), growth disorders, learning disabilities, and behavioral problems. FAS is the leading known cause of mental retardation.

Other Terms for Alcohol Related Symptoms in Babies

Other terms that may be used to describe related symptoms are :

• Fetal alcohol effects (FAE) – this is a milder version of FAS.
• Alcohol-related neurodevelopmental disorder (ARND) – the mental and behavioral problems that arise due to exposure of the fetus to alcohol.
• Alcohol-related birth defects (ARBD) – these are the physical defects that occur when the fetus is exposed to alcohol.

Patohophysiology of FES

How alcohol affects the unborn baby?

When a woman drinks alcohol during pregnancy, it passes easily and rapidly through the placenta to reach the fetus. The baby’s liver is not developed enough to detoxify all the alcohol in its system since the activity of the alcohol-degrading enzyme, alcohol dehydrogenase (ADH), in the fetal liver is only 10% of that in the adult liver. The baby is dependent on the mother’s liver for detoxification of the alcohol in its system. As a result, alcohol stays in the baby’s blood for a longer time and in higher concentration than in the mother’s blood. In addition, the amniotic fluid acts as a reservoir and prolongs fetal exposure to alcohol.

Ethanol and its breakdown product, acetaldehyde, have adverse effects on all organ systems of the developing fetus. By interfering with oxygen delivery it hampers tissue nutrition, thus affecting fetal growth and development, including the brain. The consequences are lifelong.

Signs and Symptoms of Fetal Alcohol Syndrome

Alcohol can cause damage not only in the first trimester (from conception to twelve weeks) but also in the later stages of pregnancy, when there is both physical and mental growth of the baby taking place. The amount of damage done to the baby depends on how much alcohol is consumed by the mother (quantity), in which stage of pregnancy, and how often (frequency). No amount of alcohol can be termed as safe for the child, but fetal alcohol syndrome is more likely to occur if the mother drank regularly during pregnancy. Occasional or binge drinking during pregnancy may give rise to milder symptoms of FAS, such as FAE or ARND.

Picture from Wikimedia Commons (commons.wikimedia.org)

The signs and symptoms that may be present include :

• Intrauterine growth retardation (IUGR)
• Low birth weight
• Failure to thrive after birth
• Microcephaly or small head
• Short palpebral fissure (the space between the margins of the upper and lower eyelids)
• Hypoplastic or thin upper lip
• Small upper jaw
• Absent philtrum (groove between the nose and upper lip in the midline)
• Small eyes
• Flat midface
• Flattening of cheek bones
• Short nose
• Sunken nasal bridge
• Cardiac malformations or defects in the heart, such as ventricular septal defect (VSD) and atrial septal defect (ASD)
• Other congenital anomalies (birth defects) such as cleft lip and/or cleft palate, spina bifida, and hydrocephalus
• Low IQ
• Developmental delay in relation to skills such as speech, thinking, and movement
• Decreased muscle tone and poor co-ordination
• Learning difficulties
• Behavioral problems
• Problems with vision and hearing
• Delayed mental development
• Hyperactivity, short attention span, irritability, and extreme anxiety states

Diagnosis of Fetal Alcohol Syndrome

There is no definitive test to diagnose fetal alcohol syndrome but by assessing the signs and symptoms in the child over a period of time ,such as mental and physical development or the typical facial features, a diagnosis may be reached. Children with FAS should be suspected in the following circumstances :

• If the mother had been consuming alcohol during pregnancy.
• An adopted child who displays learning difficulties, behavioral problems, or some of the physical features of FAS and in whom it is not possible to determine if the biological mother drank alcohol during pregnancy.

Prevention and Management of FAS

Keeping in mind that there is no definite treatment for FAS, and the physical and mental abnormalities that occur are irreversible, the aim should be to prevent the development of FAS in order to give birth to a healthy normal baby.

• Fetal alcohol syndrome is absolutely preventable by abstaining from alcohol during pregnancy.
• Pregnant mothers need to be aware that no amount of alcohol is safe for the baby, all types of alcohol are harmful during pregnancy, and drinking at any stage of pregnancy can be dangerous for the baby.
• It is recommended that women who are planning to get pregnant should stop drinking immediately since conception may occur at any time yet only be discovered a few weeks later.
• Women who are sexually active and regular drinkers should take effective contraceptive measures to avoid any unplanned pregnancy.
• Counseling may be necessary for a woman who has a previous child with FAS so as to prevent development of the same in the present pregnancy.
• Help from rehabilitation clinics, support groups and professionals should be sought by pregnant women who are unable to give up alcohol.
• After birth of the baby, supportive treatment in the form of counseling for the parents or help in dealing with learning or behavioral problems of the child may be needed.
• Although there is no cure for FAS, early diagnosis and intervention treatment can improve a child’s development.
• In addition, medication for certain symptoms such as anti-anxiety drugs for extreme anxiety states, and behavior and education therapy may be helpful.
• Stress management and utilizing techniques such as deep breathing, meditation and possibly even yoga should be considered.