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DISCOVERY
The first reported association between maternal drinking and infant abnormalities was in 1971 at a meeting of the National Council on Alcoholism. A pediatrician from the University of Washington reported a common theme among six infants that were not growing or developing normally despite good medical care: all were born of alcoholic mothers. Research continued for the following two years, at which time the pattern of abnormalities was given a name: fetal alcohol syndrome (commonly referred to as FAS).
FACTS
The occurrence of FAS depends on a combination of factors, including quantity and timing of the mother's drinking and the genetic makeup of the infant. In 1974, 25% of infants born to alcoholics displayed signs of FAS. In 1983, rates ranging from 20-43% were reported. Currently, it is believed that about 30-40% of infants with mothers who drank alcohol during pregnancy have FAS, though the disorder is grossly under diagnosed and this figure is probably far less than the actual number affected. It is unknown as to why FAS is seen in only some children of alcoholics, though genetic makeup is strongly suspected as playing a large role. The importance of the genetic factor is demonstrated in two reported cases involving fraternal twins born to alcoholic mothers. In both instances each twin was subjected to the same alcohol effects in the womb, yet only one twin from each pair appeared to have been affected.
CHARACTERISTICS
There are three main symptoms that define fetal alcohol syndrome:
--Growth deficiencies (weight, length, head circumference)
--Dysfunction of the central nervous system (neurological abnormality, developmental delay, intellectual deficit)
--Facial abnormalities
Growth Deficiencies
Growth deficiency of the infant begins during development in the mother's uterus. After birth, there is no postnatal "catch-up" and the child will remain smaller than 90% of children the same age. Weight is often more affected than height. Researchers have reported that as children with FAS develop, their fatty tissue diminishes. As a result, they often appear very thin or malnourished.
It is estimated that alcohol consumption doubles the risk of having unusually small babies; however, the actual risk is usually much higher. Many studies have shown that mothers who are heavy drinkers also smoke cigarettes. Smoking has its own negative effects on the developing fetus, namely causing babies to be underweight and underdeveloped. Combining the risks of alcohol consumption with those of cigarette smoking increases the probability of giving birth to a growth-retarded baby by 400%.
Central Nervous System Dysfunction
Deficiencies and abnormalities of the central nervous system take several forms. Some are seen within a few days after birth. Others may not be detected for several years. The most common of these deficiencies include:
Exaggerated tremulousness: Tremors occur much more frequently and vigorously for longer periods than in healthy infants.
Frequent jitteriness and irritability: This behavior demonstrates that the nervous system is not functioning properly.
Disorganized sleep patterns: Children with FAS are more restless than normal infants and wake often while sleeping.
These symptoms are the same as those for alcoholics who stop drinking. At birth, the child is suddenly cut off from the source of alcohol, thereby causing the baby to display patterns of withdrawal similar to those of adults. The effects, however, are not temporary. Most symptoms continue long after infancy. Fine movements, such as finger control in picking up objects, become impaired. Muscles do not develop or perform correctly, and hand-eye coordination is less than optimal. Hyperactivity flourishes, attention spans suffer, and mental competence decreases. In fact, attention deficit hyperactivity disorder (ADHD) is a frequent secondary disorder among individuals with FAS.
Mental retardation is considered to be the most serious and unfortunate effect that alcohol has on the developing child. It occurs in approximately 85% of FAS children, making it the leading known cause of mental retardation in the United States. IQ tests, as well as academic achievement tests and monitored school performance support the evidence that children of alcoholic mothers display lowered intelligence. In fact, intelligence scores are related to the extent of the physical abnormalities that children may have developed as a result of FAS. Studies have shown that the more severe the physical abnormalities are, the lower the child's intelligence scores will be.
Many of the children tested in the above studies came from closely monitored foster homes that provided a favorable environment in which to be raised. The irreversibility of the mental impairment caused by FAS is demonstrated by the fact that these children, though removed from homes of heavy drinkers, continue to display lowered intelligence scores comparable to the children who were not placed in foster care. If the child's home environment were truly a critical factor in determining mental handicaps, it would be expected that the children placed in foster homes would have higher scores than children remaining in homes of alcoholic parents. Because the scores showed no difference, it can be concluded that the intellectual handicaps sustained from FAS are permanent and cannot be reversed or controlled by a favorable home environment.
Facial Abnormalities
The facial abnormalities that develop from FAS are not dramatic, but those who know exactly what to look for can recognize them. Some features include:
¸ Small head circumference (an indicator of retarded growth)
¸ Unusually small eye openings (causing the eyes look widely spaced)
¸ Drooping eyelids
¸ Short, upturned nose
¸ Ear abnormalities
¸ Absent ridges between the nose and mouth
¸ Thin upper lip
¸ Small chin
¸ Underdeveloped, flat midface region
In addition to these traits, heart defects occur in approximately 30% of FAS babies. Complications with the kidneys, joints and genitals are not uncommon.
TIMING
A mother must be a heavy drinker throughout her pregnancy in order for her baby to be diagnosed with FAS. Drinking during the first trimester of pregnancy produces the facial abnormalities characteristic of FAS. Drinking during the second and third trimesters affects growth. Drinking during the third trimester results in dysfunction of the nervous system, mental retardation and learning/behavior deficiencies.
THEORIES & RESEARCH
Some research points to how long the mother has been drinking, rather than how much she consumes. Alcoholics who stop drinking prior to conception display lower birth weights than non-alcoholics, though their children are far less affected than mothers who continue to drink during pregnancy. It is not known why the children of these abstinent mothers display lower birth weights. It has been speculated that the livers of former alcoholic mothers have been damaged to the point that they no longer function at their full capacity, thus causing malnutrition to affect fetus development.
Additional research indicates that children born into lower socioeconomic classes are at a higher risk of developing FAS. In this case other factors, such as the use of other drugs and poor nutrition, may be responsible for adding risk to the mother's pregnancy.
Further studies are being conducted to determine if heavy drinking by the father plays a role in infant development.
PREVENTION
At least 5000 infants born each year have FAS. This means approximately one out of every 750 live births is affected by the disorder. Women need to be better informed of the effects of alcohol on pregnancy. The physical, mental, and emotional effects caused by FAS are tragically irreversible. At the same time whether or not a woman's child develops FAS is entirely within her control. Fetal alcohol syndrome is an entirely preventable birth defect. If women are properly educated about the serious consequences alcohol can have on their unborn infants, the chances of their babies developing serious, incurable birth defects can be significantly reduced.
RESOURCES
There are many resources available to individuals interested in learning more about FAS. The following links provide additional information and preventative education, as well as support for affected individuals:
Fetal Alcohol Syndrome Family Resource Institute
National Organization on Fetal Alcohol Syndrome
Fetal Alcohol Syndrome: A Pregnant Pause
REFERENCES
Fried, P.A. Pregnancy and Life-Style Habits. New York: Beaufort Books, 1983.
Streissguth, A. and Kanter, J. The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities. University of Washington Press: Seattle, 1997.
Weiner, S. M. March of Dimes Birth Defects Foundation/Series 4: Nursing Issues for the 21st Century. Perinatal Impact of Substance Abuse (Module 3). Education and Health Promotion Department: March of Dimes Birth Defects Foundation, 1992.