Fetal Alcohol Syndrome (FAS) is a term used to refer to a permanent birth defect syndrome that comes about as a result of maternal consumption of alcohol during pregnancy. The condition was first described in the 1970s and ever since then, very little changes in its definition have taken place (Adubato and Cohen, 2012). FAS is broadly characterized by prenatal/postnatal growth deficiency, unique but minor facial anomalies as well as abnormalities in the central nervous system. In the western countries, FAS has been identified as the number one cause of preventable intellectual disabilities. In the general population, the prevalence of FAS is estimated to be 1 to 3 per 1000 live births. However, the prevalence is reported to be as high as 10 to 15 per 1000 live births in some populations categorized as high risk such as children in the foster care system (Adubato and Cohen, 2010). FAS falls under a range of disorders that are collectively referred to as Fetal Alcohol Syndrome Disorders (FASD). This is an umbrella term that describes a range of effects that come about as a result maternal consumption of alcohol during pregnancy (May et al., 2014). Other than FAS, FASD also include Alcohol-related birth defects (ARBD), Alcohol-related neurodevelopment disorder (ARND) and Fetal alcohol effects (FAE). Under all the Fetal Alcohol Syndrome Disorders, FAS stands out as the most identifiable most serious (May et al., 2014). The current paper seeks to examine the causes of the disorder, its diagnosis as well as prevention and treatment.
Causes of FAS
The main cause of FAS is the maternal consumption of alcohol during pregnancy. When a woman takes alcohol while pregnant, a sizeable quantity of the alcohol passes across the placenta to the fetus. The manner in which the fetus processes alcohol is quite different from the way the body of an adult does. For the fetus, the little alcohol that passes across the placenta happens to be quite concentrated and often prevents enough oxygen and nutrition from reaching the fetus’ vital organs (Adubato and Cohen, 2012). Damage to the fetus might occur in the first few weeks of pregnancy when a woman is yet to find out that she is pregnant. As such, the risk of damage occurring increases in cases where the mother is a heavy drinker. Many studies show that the use of alcohol by a pregnant woman is most harmful during the initial three months of pregnancy (rxlist, 2018). However, consuming alcohol at any given point during pregnancy is equally harmful. The damage to the fetus as a result of alcohol consumption usually varies from one case to another depending on a variety of factors such as the volume of alcohol ingested, the period during pregnancy that the alcohol is consumed, environmental factors, genetic factors as well as peek blood alcohol levels (Adubato and Cohen, 2012). However, alcohol is always harmful to developing fetus at all concentrations and a safe level of alcohol consumption during pregnancy is yet to be established.
Delegate your assignment to our experts and they will do the rest.
Once consumed, alcohol is rapidly carried through the placental blood flow to the fetus from the mother. The fetal alcohol blood levels reach the same levels as the maternal levels within two hours of the mother ingesting alcohol. Ingestion of alcohol during the first trimester pregnancy has been found to be strongly associated with the characteristic facial abnormalities that are unique to FAS (rxlist, 2018). Additionally, reduced intrauterine growth rate has been found to be common with consumption of alcohol during the first trimester pregnancy (rxlist, 2018). Consumption of alcohol during the second trimester, on the other hand, has been found to contribute to growth retardation in birth weight and height, lower IQ, and cognitive defects in spelling, reading as well as Mathematics. Ingestion of alcohol in the third trimester results in amplification of retardation in birth length as well as the final adult height (rxlist, 2018).
Abel (2012) points out that researchers are still puzzled by the fact that despite equal amounts of alcohol consumption, some women give birth to children with Fetal Alcohol Syndrome and others do not. Abel (2012) quotes at study conducted by Sokol et al in Cleveland where 204 alcoholic women were identified and out of this, only 5 incidents of FAS were recorded. According to Abel (2012), it can be argued that mothers of children born with FAS differ from other alcoholic women in one or more ways. However, there is no single trait that has so far been identified and which puts one alcoholic woman at a greater risk of their child having FAS than another. As such, it can be argued that there are a couple of risk factors that contribute to a greater risk for FAS in some women. The frequently cited risk factors include maternal risk factors, ethnicity, patterns of alcohol consumption and paternal factors.
Research has shown that it is very much possible to prevent FAS and all it takes is for pregnant women to avoid consuming alcohol. However, this is not always an easy task due to the fact that alcohol is a socially accepted drug. Statistics from the National Survey on Drug Use and Health show that alcohol consumption among females has been going up in the recent past. Regular alcohol consumption, especially among teenage girls and younger women has been gone up by an alarming margin (rxlist, 2018). According to the National Survey on Drug Use and Health data for the years 2011 and 2012, 55.5 percent of women aged between 15 and 44 years who were not pregnant consumed alcohol (rxlist, 2018). It is also report that for the same age bracket, 8.5 percent of women who were pregnant consumed alcohol. Most alcohol ingestion took place in the first trimester but declined in the following two trimesters (rxlist, 2018). Studies have established that certain groups of women are more likely to take alcohol compared to others. These includes unmarried women, women who have a college education, women who are employed or are students, those with an annual household income of more than $ 10000 as well as smokers.
The health risk posed by alcohol for women is quite high compared to men. One of the reason for the greater health risk for alcohol consumption among women is that they absorb alcohol quite faster compared to men due to the less amount of enzyme alcohol dehydrogenase they have in the stomachs compared to men. A lesser amount of alcohol dehydrogenase in the stomach means that women are not able to metabolize the amount of alcohol as men do. As such, most of the alcohol ends up in the bloodstream. Another reason why alcohol possess a greater health risk to women than men is that they often have lower body weight and tend to have less body water compared to men. This usually results in lower total volume of alcohol distribution which in turn leads to higher concentration of alcohol in the body.
The occurrence of FAS also differs from one ethnic group to another. The prevalence of FAS is highest among Native Americans followed by African Americans. Among Native Americans, FAS incidences vary from one culture to another. FAS prevalence among the Navajo and Pueblo tribes has been found to be relatively similar to that of the general US population while the Southwest Plains Indians have reported a significantly higher prevalence rate of FAS. Among African Americans, FAS incidences have been found to be approximately seven times higher than among the white population. FAS has also been found to be more prevalent in areas characterized by low socio-economic status.
Diagnosis of FAS
There is a certain criteria for which the diagnosis of FAS is based on. The criteria include small birth weight, facial features, a history of prenatal exposure to alcohol as well as dysfunction of the central nervous system. For infants who do not exhibit the identified physiological symptoms, a diagnosis of partial Fetal Alcohol Syndrome or Fetal Alcohol Effects might be given (Adubato and Cohen, 2012). The common facial characteristics that infants with FAS exhibit include small eye openings, thin upper lip and smooth, wide philtrum. However, it is worth noting that only babies that have been exposed to alcohol at a specific period of pregnancy will exhibit the facial features of FAS (Abel, 2012). It is possible for the identified facial features to occur in infants who are healthy as a result of inherited genetic features from the parents. The occurrence of these features together with prenatal alcohol exposure and the dysfunction of the central nervous system is what makes FAS to be considered a diagnosis. It is also important to note that the facial features are not evident immediately after birth and become more apparent when a child reaches the age of between 2 and 10 years (Adubato and Cohen, 2012).
Children who have FAS also exhibit a number of physiological anomalies such as low birth weight. Additionally, the circumference of their heads may be smaller than usually and some may have heart problems and showcase anomalies with the liver, eyes and ears. Most of the infants that have FAS also tend to be irritable and very much sensitive to sensory stimulation. They are also reported to possess a strong startle reflex. A huge number of children with FAS are usually diagnosed with Central Auditory Processing Disorder as well as Sensory Integration Disorder. Adubato and Cohen (2010) opine that FAS can present quite a hard challenge for diagnosis because people with prenatal alcohol exposure present a wide range of outcomes out of which a significant are not specific to the prenatal alcohol exposure. They add that to accurately assess and interpret the broad range of outcome that define the diagnosis, professionals from multiple disciplines are needed.
Prevention and Treatment
There is no known cure for Fetal Alcohol Syndrome. However, early intervention programs have been found to be effective in reducing the impact of motor, language as well as cognitive impairment. These programs are quite aggressive and utilize a variety of therapies including occupational therapy, physical therapy, educational therapy and education therapy (Adubato and Cohen, 2012). Prevention strategies for FAS fall into three main categories namely primary prevention, secondary prevention and tertiary prevention. The aim of having a comprehensive prevention strategy is to make available overlapping levels of reinforcement, that mostly include persuasion and education, as well as interventions and incentives aimed at preventing FAS. Primary intervention largely focusses on the eradication of the root cause of an issue through broad-based initiatives (Adubato and Cohen, 2012). For FAS, primary intervention usually focusses on preventing fetuses from being exposed to alcohol. Since there is no safe level of alcohol that pregnant women can drink, the focus is on ensuring pregnant ladies do not consume alcohol at any point of the pregnancy. Public education is the most common technique that is used for primary prevention.
Secondary prevention aims at reducing the severity as well as the duration of maternal drinking through identification of individuals who are at risk. Strategies that are usually utilized here include provision of services to pregnant women, screening as well as early intervention. The objective of tertiary intervention, on the other hand, is to lower the impairments, complications and disabilities that are brought about by FAS) ( Healthline, 2018). Upon a FAS diagnosis being made, aggressive measures are needed to ensure that injury to future children is reduced (Healthline, 2018). This is best achieved through aiding the mother to change their alcohol consumption behavior.
Scenario
The fact the FAS is a very serious condition whose impact can be felt well into adulthood is evident in the story of Kathy Mitchell and her daughter Karli. While pregnant as a teenager, Kathy used to drink alcohol. Her behavior had a significant impact on the cognitive development of her daughter Karli who despite being 43 years old, is still in the developmental age of a first-grader (Fleming, 2016). Karli lives in the same house with her mother and stepfather where she spends most of her time collecting dolls and purses. As a result of FAS, she lacks most of the self-determination, awareness as well as independence that adults should have. She is unable to recognize social cues and is no position to tell dangerous. Given her limited cognitive development, she has limited understanding of sequence and can only follow a single rule at a time (Fleming, 2016). Despite Karli’s condition, Kathy still adores her as a daughter. She sees her daughter as an innocent soul and takes the full responsibility of her condition. She says “Not a day goes by that I don’t ask myself, ‘What if? What if alcohol hadn’t been a part of my life (Fleming, 2016)?” But Kathy has chosen not to sit all day and blame herself for Karli’s condition. She has dedicated her time to telling her story and that of her daughter so that other mothers do not make a similar mistake. She believes that by creating awareness, she will be able to prevent what happened to Karli from happening to other children.
Opinion on the topic
FAS is a preventable condition but there is very little awareness about the condition and how to prevent it especially among the at risk populations. I think that by placing more emphasis on public education, a lot of FAS cases will be prevented. Healthcare professionals also need to be better educated in this area. This way, they will be in a better position to detect the condition and even teach and counsel patients about FAS and the available prevention strategies.
Conclusion
Fetal Alcohol Syndrome (FAS) refers to a permanent birth defect syndrome that comes about as a result of maternal consumption of alcohol during pregnancy. FAS is broadly characterized by prenatal/postnatal growth deficiency, unique but minor facial anomalies as well as abnormalities in the central nervous system. In the western countries, FAS has been identified as the number one cause of preventable intellectual disabilities. The main cause of FAS is the maternal consumption of alcohol during pregnancy. When a woman takes alcohol while pregnant, a sizeable quantity of the alcohol passes across the placenta to the fetus. Damage to the fetus might occur in the first few weeks of pregnancy when a woman is yet to find out that she is pregnant. As such, the risk of damage occurring increases in cases where the mother is a heavy drinker. The damage to the fetus as a result of alcohol consumption usually varies from one case to another depending on a variety of factors such as the volume of alcohol ingested, the period during pregnancy that the alcohol is consumed, environmental factors, genetic factors as well as peek blood alcohol levels. The risk factors for FAS include maternal risk factors, ethnicity, patterns of alcohol consumption and paternal factors. There is no known cure for FAS and avoiding alcohol during pregnancy is the most effective way of preventing the disorder
References
Abel, E. L. (2012). Fetal alcohol syndrome and fetal alcohol effects . Springer Science & Business Media- https://books.google.co.ke/books?id=K9CpBgAAQBAJ&pg=PA165&dq=risk+factors+for+fetal+alcohol+syndrome&hl=en&sa=X&ved=0ahUKEwjeobrBqtPZAhVLVhQKHZv9AFQQ6AEIJzAA#v=onepage&q=risk%20factors%20for%20fetal%20alcohol%20syndrome&f=false
Adubato, S. A., & Cohen, D. E. (Eds.). (2012). Prenatal alcohol use and fetal alcohol spectrum disorders: diagnosis, assessment and new directions in research and multimodal treatment . Bentham Science Publishers- https://books.google.co.ke/books?id=5tXbAwAAQBAJ&pg=PA60&dq=Epidemiology+of+fetal+alcohol+syndrome&hl=en&sa=X&ved=0ahUKEwjIotSz1tLZAhVJVhQKHXvNC44Q6AEIMjAC#v=onepage&q=Epidemiology%20of%20fetal%20alcohol%20syndrome&f=false
Fleming A.R (2016). This mother drank while pregnant. Here’s what her daughter’s like at 43 . Retrieved from https://www.washingtonpost.com/national/health-science/this-mother-drank-while-pregnant-heres-what-her-daughters-like-at-43/2016/01/15/32ff5238-9a08-11e5-b499-76cbec161973_story.html?utm_term=.6bfc9e030cf1
Healthline (2018). Fetal alcohol syndrome . Retrieved from https://www.healthline.com/health/fetal-alcohol-syndrome#symptoms
May, P. A., Baete, A., Russo, J., Elliott, A. J., Blankenship, J., Kalberg, W. O., & Adam, M. P. (2014). Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics , 134 (5), 855-866- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210790/
Rxlist (2018). Fetal alcohol syndrome (FAS). Retrieved from https://www.rxlist.com/fetal_alcohol_syndrome_fas/article.htm#what_are_the_complications_and_long-term_effects_of_fetal_alcohol_syndrome
