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Behavioural and Psychological Issues in Fetal Hydantoin Syndrome
Published on: November 21, 2024
Behavioural and Psychological Issues in Fetal Hydantoin Syndrome
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Elahe Mohammadi Zadeh

I am a Medical Science graduate with a keen interest in pathophysiology and research focused on improving diagnostic techniques and treatments.

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Sungbeen Lee

BSc Neuroscience and Physiology, University of Toronto

Introduction

Fetal Hydantoin Syndrome (FHS) is a fetal condition that may be caused when the mother is on antiepileptic medications, particularly phenytoin (also known as Dilantin), during pregnancy.1

Fetal hydantoin syndrome

Fetal Hydantoin Syndrome (FHS) is a type of fetal anticonvulsant syndrome, which is a group of conditions caused by exposure to antiepileptic drugs during pregnancy.2 Phenytoin belongs to a class of drugs called hydantoins. When a fetus in the mother’s womb is exposed to phenytoin during critical periods of its development, it can lead to a range of physical and neurological abnormalities which negatively affect children's lives.3 

Symptoms vary in different affected fetuses:

  • Broad nasal bridge
  • ide-set eyes
  • Small nose
  • Slow growth before and after birth
  • Delayed motor skills and language development
  • Intellectual disabilities 
  • Behavioural and psychological issues 

Not all fetuses exposed to phenytoin will develop FHS, and the severity of symptoms can vary widely among the affected.4  Many factors can impact the severity of fetal hydantoin syndrome such as: 

  • Genetic
  • Dosage
  • Timing
  • Medication 

Behavioural issues in fetal hydantoin syndrome

 Many individuals with FHS also have symptoms similar to those seen in Attention Deficit Hyperactivity Disorder(ADHD), such as:

  • Difficulty focusing, 
  • Hyperactivity
  • Impulsivity5    

Also, autistic-like behaviour symptoms in some children with FHS have been seen:  

  • Repetitive movements, 
  • Difficulty with social interaction
  • Limited interests6

Moreover, aggression and irritability have been reported in some children with FHS.7 It is suggested that children with FHS suffer from anxiety due to a combination of neurological factors and the challenges associated with living with a chronic condition.10 Unfortunately depression, also have been observed in some individuals with FHS.11 The risk of depression may increase during adolescence and adulthood as affected children become more aware of their differences. However, it is possible to reduce the risk of depression by getting more involved in physical activities. There is promising research on how to reduce depression simply by doing more exercise 

Many children with FHS experience learning disabilities, which can affect their lives in school and work. This can develop into psychological distress.13

  • Difficulties with reading (dyslexia) 
  • Writing (dysgraphia) 
  • Mathematics (dyscalculia)

Skills such as planning, managing time organizing, and problem-solving, are often impacted in individuals with FHS.14

Severity

Several factors can influence the severity: 

  • The amount of phenytoin the fetus was exposed to during pregnancy
  •  Fetus age of exposure could impact the severity of behavioural and psychological issues15
  • Genetic variation also impacts how the fetus responds to phenytoin exposure16The presence of other medical at the time of the exposure or developmental conditions alongside FHS also can impact behavioural and psychological outcomes18

Symptoms management 

While there is no cure for FHS, various strategies can help to manage the symptoms

  1. Early intervention

Early identification and intervention are crucial for improving outcomes in children with FHS. This may include speech therapy, occupational therapy, and physical therapy to address developmental delays and promote skill acquisition.19

  • Behavioural therapy

Behavioural interventions, such as Applied Behavior Analysis (ABA) or Cognitive Behavioral Therapy (CBT), can help address specific behavioural challenges and teach coping skills.20

  • Pharmacological interventions

In some cases, medications may be prescribed to manage specific symptoms, such as ADHD-like behaviours or mood disorders. However, careful consideration must be given to potential side effects and drug interactions.21

  • Educational support

Individualized Education Programs (IEPs) and other educational accommodations can help children with FHS succeed academically and address specific learning challenges.22

  • Family support and education

Providing education and support to families of individuals with FHS is essential for promoting positive outcomes and managing behavioural and psychological challenges.23

  • Social skills training

Programs focused on developing social skills can help individuals with FHS navigate social situations more effectively and build meaningful relationships.24

Conclusion

While the effects of prenatal phenytoin exposure cannot be reversed, early intervention targeted therapies, and ongoing support can help individuals with FHS lead fulfilling lives and reach their full potential.

As research in this field continues to evolve, it is hopeful that new insights will lead to improved prevention strategies and more effective interventions for managing the behavioural and psychological aspects of Fetal Hydantoin Syndrome (FHS).

References

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Elahe Mohammadi Zadeh

I am a Medical Science graduate with a keen interest in pathophysiology and research focused on improving diagnostic techniques and treatments.

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