Fetal alcohol syndrome
What is fetal alcohol syndrome?
Fetal alcohol syndrome is part of a group of conditions, in which a baby develops long-term complications due to exposure to alcohol, from the mother drinking during pregnancy. These complications include intellectual, physical and behavioral issues.
Fetal alcohol syndrome is at the extreme end of a class of conditions known as fetal alcohol spectrum disorders. Globally, these disorders are a significant cause of intellectual impairment.
Causes
The time spent in the uterus is a unique period in human life. During these months, the unborn baby must build itself from a single cell to a fully developed baby. The body undergoes many growth and development processes that will never be repeated later in life. These processes rely on the accurate action of a small number of developmental genes and signal molecules, which have a major effect on the overall development of the unborn baby.
When a pregnant woman drinks alcohol, it passes via her bloodstream to the unborn baby. It then has a profound effect on the operation of genetic mechanisms that are crucial to the development of the brain and nervous system. This may lead to the baby being born with a range of disorders, from mild to severe.
The risk to an unborn baby of developing a fetal alcohol spectrum disorder is usually higher the earlier and the more frequently in a pregnancy its mother drinks alcohol. However, even with heavy maternal alcohol consumption, a baby may not develop an obvious fetal alcohol spectrum disorder. Researchers do not know why some babies exposed to seemingly similar levels of alcohol in the uterus develop a disorder while others do not.
A lower 'safe' level of consumption is unknown, so guidelines in many countries, including the US, recommend that a woman who is pregnant (or who believes she might be pregnant) stops consuming alcohol completely until the baby is born. This 'safe rather than sorry' approach is likely to continue until more definitive research and evidence is available. However, it is very difficult to give a good estimate of the overall influence of alcohol on fetal development. Signs of problems related to alcohol exposure are not always evident at birth and may not be suspected until years later. Even then, it often cannot be proven that a problem in a child's health or behavior was actually caused by alcohol exposure in the uterus years before. Self-reporting of current or past alcohol consumption is not always accurate by people while pregnant or otherwise, so research and evidence can be hard to gather and interpret.
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Genes
A unit of inheritance (heredity) of a living organism. A segment of genetic material, typically DNA, that specifies the structure of a protein or related molecules. Genes are passed on to offspring so that traits are inherited, making you who you are and what you look like.
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Nervous system
The extensive network of cells and structures that is responsible for activating and coordinating the body's functions, sensory input and cognition.
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Uterus
The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.
Risk factors
Alcohol consumption
The risks to an unborn baby from the mother's alcohol consumption are related to three main factors:
- Quantity - how much alcohol the mother drinks;
- Timing - at what point in the pregnancy she drinks, and;
- Frequency - how often she drinks.
The risk of alcohol-related damage to the baby increases the more, the earlier and the more frequently the mother drinks. Maternal binge drinking is particularly risky.
Additional risk factors
Other factors that can affect a baby's chances of developing fetal alcohol syndrome include:
- Maternal smoking and use of recreational drugs;
- Maternal stress and anxiety during pregnancy, or poor prenatal care;
- Low socio-economic status - this is linked to a higher incidence of fetal alcohol syndrome, and;
- Genetic susceptibility - some people and some populations have been found to be genetically more susceptible to fetal alcohol syndrome than others.
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Stress
The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.
Types
Fetal alcohol syndrome is the most extreme of the fetal alcohol spectrum disorders. The other disorders in this group include:
- Partial fetal alcohol syndrome - people showing only some of the diagnostic signs of fetal alcohol syndrome;
- Alcohol-related neurodevelopmental disorder (ARND) - problems in the central nervous system, and;
- Alcohol-related birth defects (ARBD) - physical problems in the heart, bones, kidneys, vision and hearing.
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Central nervous system
The part of the body's nervous system that includes the brain and the spinal cord.
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Nervous system
The extensive network of cells and structures that is responsible for activating and coordinating the body's functions, sensory input and cognition.
Signs and symptoms
At birth
A baby born with fetal alcohol syndrome may have some or all of the following symptoms:
- Small birth size and weight;
- Small head;
- Problems with muscle control and suckling;
- Heart defects, and;
- Kidney problems.
Facial features
Babies born with fetal alcohol syndrome share some distinctive facial features, including:
- Small head;
- Wide-set eyes, small eye openings;
- Small upper jaw;
- Thin upper lip;
- Area between nose and upper lip (philtrum) is flat and long;
- Flat mid-face;
- Short nose, and;
- A smooth ridge between nose and mouth.
Distinctive facial features of a child with fetal alcohol syndrome.
In later life
As the baby grows, some or all of the following symptoms may appear:
- Thinking and learning disabilities;
- Cognitive defects, low intelligence;
- Behavioral problems, poor social skills, criminal or inappropriate behavior;
- Emotional disorders, rapid mood changes;
- Poor memory skills;
- Speech delays;
- Attention deficits, difficulty with processing information, reasoning, planning and problem solving;
- Hyperactivity;
- Sleep problems;
- Vision and hearing difficulties;
- Poor coordination;
- Tremors, and;
- Balance difficulties.
These problems can remain for a person's lifetime.
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Cognitive defects
A deficiency in intellectual functioning, or a specific cognitive impairment. Can be congenital, or caused later in life such as through brain injury.
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Kidney
A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.
Methods for diagnosis
There is no single test for fetal alcohol syndrome. A diagnosis of fetal alcohol syndrome will be made by the severity of symptoms, including:
- The distinctive facial features;
- Brain abnormality or mental problems, and;
- Growth deficits.
If the condition is diagnosed early on in the child's life, early intervention strategies can be used to better effect.
Brain imaging tests
In recent years, several kinds of brain imaging techniques such as magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scans are being used to identify and classify defects in the brains of people with fetal alcohol syndrome.
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Early intervention
A program of services designed to help babies and young children who have, or are at risk of having, developmental delays or disabilities.
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MRI
A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.
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PET
During positron emission tomography (PET) scan, an injection with a radioactive label is administered and then combined with a computerized tomography (CT) scan to produce functional images.
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Functional magnetic resonance imaging
A technique that enables measurement of the brain activity from magnetic resonance imaging of the changes in the blood flow.
Treatment and prognosis
There is no cure for fetal alcohol syndrome. By the time the baby is born, the effects of the syndrome are already in place and cannot be reversed. They are different for every person, but these effects can last a lifetime.
Professional treatment by healthcare professionals (occupational therapists, speech pathologists, psychologists) and a stable, nurturing social environment can help reduce and manage the effects of fetal alcohol syndrome to some degree.
Some medications can help manage behavioral and other problems caused by fetal alcohol syndrome. The specific course of medication varies from case to case.
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Occupational therapists
A healthcare professional trained to deliver occupational therapy, which involves teaching a person self care, work and play activities to promote independence and reduce disability.
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Speech pathologists
A health professional trained in the diagnosis, management and treatment of individuals with speech and language problems, or those who have difficulty with feeding and swallowing.
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Psychologists
A professional specializing in mental development, diagnoses and management of mental health conditions.
Prevention
On an individual level, fetal alcohol syndrome can be prevented by not consuming any alcohol during pregnancy. A 'safe' level of alcohol consumption in pregnancy is unknown.
On a wider level, prevention of fetal alcohol syndrome focuses on:
- Educating women about known and potential risks of alcohol consumption during pregnancy so they can make informed choices;
- Encouraging women to seek assistance preferably before they conceive if they have trouble with alcohol, and;
- Providing support for pregnant women who are at risk of drinking during pregnancy and may be facing difficult circumstances.
References
- Edenberg H.J. & Foroud T. (2013 August 1). Genetics and alcoholism. (Report). Nature Reviews Gastroenterology & Hepatology 10: 487(8).
- Fetal Alcohol Exposure - FASD.pdf. Accessed 30 July 2014 from link here
- Guerri C. Bazinet A. & Riley E.P. (2009). Foetal Alcohol Spectrum Disorders and Alterations in Brain and Behaviour. Alcohol and Alcoholism (Oxford Oxfordshire) 44: 108114.
- Kleiber M.L. Diehl E.J. Laufer B.I. et al. (2014). Long-term genomic and epigenomic dysregulation as a consequence of prenatal alcohol exposure: a model for fetal alcohol spectrum disorders. Frontiers in Genetics 5. Accessed from link here
- Mead E.A. & Sarkar D.K. (2014). Fetal alcohol spectrum disorders and their transmission through genetic and epigenetic mechanisms. Frontiers in Genetics 5. Accessed from link here
- Rasmussen C. Andrew G. Zwaigenbaum L. et al. (2008). Neurobehavioural outcomes of children with fetal alcohol spectrum disorders: A Canadian perspective. Paediatrics & Child Health 13: 185191.
- Reading R. (2013). Diagnosing fetal alcohol syndrome: new insights from newer genetic technologies. Child: Care Health & Development 39: 151151.
- Ungerer M. Knezovich J. & Ramsay M. (2013). In Utero Alcohol Exposure Epigenetic Changes and Their Consequences. Alcohol Research?: Current Reviews 35: 3746.
- Interagency coordinating committee on fetal alcohol spectrum disorders (ICCFASD). Recognizing alcohol-related neurodevelopmental disorder (ARND) in primary health care of children. Accessed from 30 March 2015 from link here
10 Most frequently asked questions (FAQs)
What is fetal alcohol syndrome? Fetal alcohol syndrome is part of a group of conditions in which a baby develops long-term complications due to exposure to alcohol, from the mother drinking during pregnancy. These complications include intellectual, physical and behavioral issues. What are the symptoms of fetal alcohol syndrome? People born with fetal alcohol syndrome show a range of symptoms at birth, in childhood and throughout life. Most of the major symptoms have to do with brain damage and can include growth deficits, cognitive and learning disorders, low intelligence and behavioral problems. In addition, exposure to alcohol before birth can cause defects in other body organs, such as the heart, the bones and the immune system. Babies born with fetal alcohol syndrome also have a distinct facial appearance. What causes fetal alcohol syndrome? Fetal alcohol syndrome is caused by consumption of alcohol by a woman during her pregnancy. The risk to an unborn baby of developing the syndrome is usually higher, the earlier and the more frequently an expectant mother drinks alcohol. However, even with heavy maternal alcohol consumption, a baby may not develop an obvious fetal alcohol disorder. Since a lower 'safe' level of alcohol consumption is unknown, it is generally recommended that women stop all alcohol consumption during a pregnancy. How is fetal alcohol syndrome diagnosed? There is no single test for fetal alcohol syndrome. A diagnosis of fetal alcohol syndrome will be made by the severity of symptoms, including: The distinctive facial features; Brain abnormality or mental problems, and; Growth deficits. If the condition is diagnosed early on in the child's life, early intervention strategies can be used to better effect. Brain imaging tests - recently several kinds of brain imaging techniques such as magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scans are being used to identify and classify defects in the brains of people with fetal alcohol syndrome. How is fetal alcohol syndrome treated? There is no cure for fetal alcohol syndrome. By the time the baby is born, the effects of the syndrome are already in place and cannot be reversed. They are different for every person, but these effects can last a lifetime. Treatment by healthcare professionals (occupational therapists, speech pathologists, psychologists) and a stable, nurturing social environment can help reduce and manage the effects of fetal alcohol syndrome to some degree. Some medications can help manage behavioral and other problems caused by fetal alcohol syndrome. The specific type of medication varies from case to case. Can fetal alcohol syndrome be prevented? On an individual level, fetal alcohol syndrome can be prevented by not consuming any alcohol during pregnancy. A 'safe' level of alcohol consumption in pregnancy is unknown. On a wider level, prevention of fetal alcohol syndrome focuses on: - Educating women about known and potential risks of alcohol consumption during pregnancy so they can make informed choices; - Encouraging women to seek assistance preferably before they conceive if they have trouble with alcohol, and; - Providing support for pregnant women who are at risk of drinking during pregnancy and may be facing difficult circumstances. Are there different types of fetal alcohol syndrome? There are different degrees of damage that alcohol can do to an unborn child. Fetal alcohol syndrome is at the extreme end of the scale, and there are also other diagnoses such as partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). What is the outlook for fetal alcohol syndrome? There is no cure for fetal alcohol syndrome. By the time the baby is born, the effects of the syndrome are already in place and cannot be reversed. They are different for every person, but these effects can last a lifetime. Treatment by healthcare professionals (occupational therapists, speech pathologists, psychologists) and a stable, nurturing social environment can help reduce and manage the effects of fetal alcohol syndrome to some degree. Some medications can help manage behavioral and other problems caused by fetal alcohol syndrome. The specific type of medication varies from case to case. What increases the chances of developing fetal alcohol syndrome? The risks to an unborn baby from the mother's alcohol consumption are related to three main factors: 1) Quantity - how much alcohol the mother drinks. 2) Timing - at what point in the pregnancy she drinks. 3) Frequency - how often she drinks. The risk of alcohol-related damage to the baby increases the more, the earlier and the more frequently the mother drinks. Maternal binge drinking is particularly risky. Other factors that can affect a baby's chances of developing fetal alcohol syndrome include: maternal smoking and use of recreational drugs; maternal stress and anxiety during pregnancy, or poor prenatal care; low socio-economic status, and; genetic susceptibility - some people and some populations have been found to be genetically more prone to fetal alcohol syndrome.
Related topics
Down syndrome is a genetic disorder that causes physical, developmental and intellectual impairment. Not all characteristics are present in all people with Down syndrome and levels of impairment can vary greatly. Progeria is a rare genetic disorder that causes a child to age rapidly, giving them an average life expectancy of 13 years. Symptoms begin to appear in the first two years of life. It’s also known as Hutchinson-Gilford progeria syndrome, or HGPS. Cerebral palsy (CP) is a group of conditions that affect how a person moves and controls their muscles. It is a result of damage that occurs to the brain before birth, or in the first few months after. Autism refers to a lifelong neurodevelopmental disorder that falls within a spectrum of similar disorders. People with autism spectrum disorder may have difficulties relating to their environment and interacting with people, have limited interests and may show repetitive behaviours and heightened sensitivities. Autism affects almost four times as many boys than girls.