Foetal Alcohol Syndrome

Introduction

Foetal alcohol spectrum disorders (FASDs) are a group of preventable impairments ranging from physical, behavioural, and cognitive disorders occurring in a foetus due to maternal alcohol intake during pregnancy. These disorders can appear right after birth or at any period in adult life and often persist throughout life. There are five types of FASD which include:

• foetal alcohol syndrome (FAS)
• partial foetal alcohol syndrome (pFAS)
• alcohol-related neurodevelopmental disorder (ARBS, alcohol-related birth defects (ARBD)
• neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE)¹

Definition of foetal alcohol syndrome (FAS) 

Foetal alcohol syndrome is one of the five disorders that fall under the group of conditions known as foetal alcohol spectrum disorders (FASDs). It develops in a baby who has prenatal alcohol exposure and is by far the most dangerous form of foetal alcohol-associated disorder. Babies with FAS have growth problems, central nervous system problems, problems with learning and memory, diminished facial features and impaired hearing and vision.²

Causes and risk factors 

Prenatal alcohol exposure is the leading cause of FAS. Alcohol consumed by the mother is passed to the foetus through the umbilical cord which is then processed by the foetus. However, the foetus cannot metabolise the alcohol at a fast rate, resulting in long-term exposure.² 

There is no safe time and accepted quantity for the consumption of alcohol during pregnancy.² Having said that mothers should especially avoid alcohol during the first trimester of pregnancy (up to 13 weeks).³

Signs and symptoms

The babies born with foetal alcohol syndrome have:

Facial abnormalities 

Babies born with FAS develop one or more of the following facial abnormalities:² 

• Thin upper lip
• Smooth ridge between the nose and upper lip
• Narrow eyes
• Small head

Growth deficiencies

Drinking alcohol during pregnancy can lead to a deficiency of growth hormones in the foetus resulting in a lower weight and small height before and after birth. The child with FAS usually has short stature and small head size.² 

Central nervous system problems 

FAS can lead to serious central nervous issues in the child including life-long disabilities. Some of the central nervous system (CNS) problems include:^2,3

• Poor coordination
• Vision impairment
• Hearing impairment
• Abnormal reflexes
• Poor academic performances
• Poor memory
• Impaired problem-solving skills
• Seizure disorder
• Developmental delays

Behavioural issues 

The child born with FAS faces several behavioural issues such as:^2,4

• Lack of attention span
• Hyperactivity
• Anxiety disorder
• Substance abuse disorders
• Learning disabilities
• Language disabilities

Organ damage/defects

FAS can also cause damage or defects to organs including:⁴

• Structural brain abnormalities 
• Seizure disorder 
• Spinal cord abnormalities
• Renal hypoplasia, horseshoe kidneys, hydronephrosis
• Enteric neuropathy

Diagnosis 

The diagnosis of FAS is a rather difficult one. FAS could be easily mistaken for some other developmental disorders. This is often due to a lack of maternal and child health education among the general population. Another reason could be due to prevalent social stigma among families with FAS babies.²

According to the American Academy of Pediatrics, the best way to diagnose FAS in children is to conduct a compulsory prenatal alcohol exposure screening in collaboration with local government and healthcare centres. The diagnosis of FAS should be made based on the evidence of CNS impairments, developmental delays, facial abnormalities and a history of alcohol exposure.⁵

Prevention 

The alcohol taken during pregnancy is absorbed by the foetus where it acts as a toxin and impairs foetal brain development. The best way to prevent any alcohol-related health disorders in a child and mother is to practise alcohol abstinence.²

There are several ways the incidence of FAS can be mitigated in the general population. One way is to label the alcohol and its products for the harmful effects during pregnancy. Other methods such as prenatal alcohol screening programs, healthcare events for pregnant women, proper training for medical workers for counselling, and warning women about alcohol use during pregnancy are also seen to be effective.⁴ 

One of the complicated issues is for women with alcohol addiction. The mother might understand the harmful effects of alcohol and yet be unable to stop drinking alcohol. Substance use disorder (SUD) programs can be helpful in these kinds of situations. SUD programs usually include inpatient programs for severe addictions, and outpatient and medication-assisted treatment. Family support provided to the mother is pivotal, as it can serve as a significant motivator for her to abstain from alcohol consumption.⁶

Treatment and management 

There is no specific treatment for FAS as it is permanent damage. However, various approaches can relieve the symptoms of FAS and help the child to have a relatively normal life. The child born with FAS develops multiple impairments ranging from physical to mental to behavioural issues.

Thus, a multidisciplinary approach should be adopted for management. For example, individuals with CNS impairments might need physiotherapy and psychotherapy for behavioural problems. Children with ADHD could benefit from medicine-assisted treatment whereas learning disabilities require school for specially gifted students.

The child with FAS might require one or all of the following specialities:^2,3,4

• Paediatrician with experience in FAS
• An occupational health therapist or a physiotherapist
• A speech pathologist 
• A psychologist 

There have been instances where early diagnosis and interventions in children have been shown to yield greater results than those with late diagnosis and management. Some healthcare centres provide specialised therapies and interventions for FAS children. They include:^2,3,4

• Teaching strategies and games designed specifically for FAS at school
• Behavioural and cognitive interventions designed to improve social, mental and developmental skills
• Education and training for parents and caregivers
• Animal-assisted interventions such as the use of dogs, cats etc

Prognosis and long-term effects

In the case of early intervention, children with FAS can live a relatively normal life. However, as FAS is a permanent condition, there is no way to reverse the damage already done by alcohol.

The primary target, in the long run, is to improve the quality of life and help children adjust physically and socially as much as possible. Children born with FAS might find it difficult to do the things that come normally to other kids. They find it difficult to get involved in social events and to gain higher academic success. If there are CNS and facial impairments involved, children might need caregiver support for their whole life.^2,3,4 

Many FAS symptoms last up to adulthood, however, some symptoms might fade away with age. Some children tend to develop secondary symptoms in adolescents such as anxiety, depression, eating disorders, and ADHD. This can lead an adult to face a myriad of problems in adult life, including risk for:^2,3,4

• Unemployment, and problems in living independently
• Criminal activity and legal problems
• Substance use disorder
• Crimes related to sexual behaviours
• Higher risk of developing secondary diseases

Legal and ethical considerations 

Prevention is always a better approach than treatment. Many healthcare organisations believe in implementing legal penalties against the use of alcohol during pregnancy in hopes that this will discourage people from drinking alcohol during pregnancy.

However, most of the people who drink alcohol during pregnancy are not aware of its devastating consequences on babies or have no control over themselves due to addiction. A study of Danish and British women showed that many of the women felt that drinking was acceptable during pregnancy.^7,8

In addition to education, physicians should also consider using resources available to them for early detection, screening, and early intervention. If someone is addicted to alcohol, early screening before pregnancy might help prevent FAS. In any case, the coercive methods don’t seem to yield the desired results. Thus, early education is more beneficial in the long term.^7,8

Summary

Foetal alcohol syndrome is one of the five preventable disorders in a child that is caused by the ingestion of alcohol by the mother during pregnancy. Children born with FAS can have impairments ranging from facial abnormalities, growth disturbances, CNS disorders and mental health problems. FAS is permanent and therefore the best way to prevent it is to avoid alcohol consumption during pregnancy. The diagnosis is made by a licensed health professional, who will evaluate the child’s symptoms and maternal alcohol history. 

Children with FAS can face problems ranging from physical, and social awkwardness, anxiety, learning disabilities and emotional disability. The treatment for FAS focuses mainly on improving the lifestyle and preparing the child to live the best life possible. It usually includes physiotherapy, psychological counselling, and social development skill exercises. 

FAS has no permanent cure but can be easily prevented by avoiding alcohol intake during pregnancy. Avoiding alcohol not only reduces healthcare costs but, more importantly, ensures a better quality of life for children.