Foetal alcohol spectrum disorder (FASD)

• What is Foetal Alcohol Syndrome
• Statistics on Foetal Alcohol Syndrome
• Risk Factors for Foetal Alcohol Syndrome
• Progression of Foetal Alcohol Syndrome
• Symptoms of Foetal Alcohol Syndrome
• Clinical Examination of Foetal Alcohol Syndrome
• Prognosis of Foetal Alcohol Syndrome
• How is Foetal Alcohol Syndrome Treated?
• Foetal Alcohol Syndrome References

What is Foetal Alcohol Syndrome

Foetal alcohol syndrome (FAS) is a pattern of abnormalities with a child caused by exposure of alcohol to a foetus (an unborn baby, still in the womb). Alcohol is known to be what is called a ‘teratogen’. A teratogen is something from outside the body that can cause problems with the unborn baby. When drunk, the alcohol gets into the mother’s blood and crosses via the placenta (the connection between mother and baby) into the baby’s blood. Here it can cause problems with the normal growth pattern of the baby. It is often associated with the problem of alcoholism in a mother.
There are several things which define FAS:

1. Changes in appearance such as small eyes and flat lips.
2. Problems with growth resulting in a smaller baby.
3. Brain involvement resulting in poor learning ability, incoordination and even aggressiveness.

It is not known how much alcohol is needed to cause problems with the baby, and so it is generally recommended that no alcohol be drunk during pregnancy, or at least that the amount of alcohol be very low. Having drunk a lot of alcohol during pregnancy does not mean that a baby will be born with FAS. Every woman is different and the effect that alcohol has on the baby can not be worked out easily before birth.

Statistics on Foetal Alcohol Syndrome

FAS is quite a common problem, and is the number one cause of intellectual disability that is not caused by genetic problems. It is also hard to know the exact number of children with FAS. In Western Australia, there is unfortunately a very large difference between Aboriginal and non-Aboriginal children, but this is thought to be due to social situation rather than race. The rates are:

• Non-Aboriginal Children: 0.02/1000
• Aboriginal Children: 2.76/1000

Across the world, the number of children reported to be born with FAS is between 0.5-5/1000 births depending on the country. It is also very different in different parts of each country and can be hard to accurately get the numbers on.

Risk Factors for Foetal Alcohol Syndrome

The only thing that predisposes a child to having FAS is alcohol consumption during pregnancy. Unfortunately, the time when the child is most at risk is early in the pregnancy, even before the woman’s first period is missed. This can mean that damage is being done without the mother even knowing it. The level of damage done to the unborn child depends on the amount of alcohol drunk. The more alcohol that is drunk during pregnancy the more severe the effects. It also is not known what the lower limit of safe alcohol consumption is, or whether there is a cut off level where it is okay.

Progression of Foetal Alcohol Syndrome

A child born with FAS may:

• Be born small.
• Have problems eating and sleeping.
• Have problems seeing and hearing.
• Have trouble following directions and learning how to do simple things.
• Have trouble paying attention and learning in school.
• Have trouble getting along with others and controlling their behavior.
• Need medical care all their lives.
• Need special teachers and schools.

A child with FAS can struggle in many areas of life without adequate help. Other than their difference in appearance, there are other less obvious problems, mostly affecting the brain. Children with FAS usually have slightly lower IQs than other children, with a greater reduction in those whose parents drank more. They have problems with learning and attention and this can lead to antisocial behaviour and aggressiveness. As little as one drink a day can lead to an increase in aggressiveness in children aged six to seven. FAS can even lead to Attention Deficit Disorder when the children reach their teens.

Prognosis of Foetal Alcohol Syndrome

Unfortunately there is no treatment for FAS that can cause a total cure. While some of the physical problems, such as heart defects, can be treated surgically, the only way that a child can cope with the effects on the brain are through good support from both their family and health professionals. The outcome is generally worse for those children that are more severely affected. The more support and care that they receive, the better the outcomes will be, and plenty of support is available if needed and can be accessed through your local doctor.

How is Foetal Alcohol Syndrome Treated?

As there is no treatment other than supportive care for children with FAS, the major way of lessening the impact of FAS is to lower alcohol intake while pregnant. Some guidelines say that at most, pregnant women can drink no more than two standard drinks on any one occasion, and no more than 7 a week and should never become intoxicated, but generally the ideal situation would be for the mother to not drink at all while she is pregnant with her child. This is because each woman is different and we cannot tell how much the alcohol will effect the baby between different people.
If the mother is finding it hard to give up alcohol during her pregnancy, then there are lots of options about assisting her with this which can be discussed with your doctor. If a child is born while the mother is still under the influence of alcohol, the baby may need to adjust to not having alcohol in its system, and will need specialist medical care for at least 48 hours after birth.
It is also recommended that the father stop drinking if attempts are being made by the mother to stop drinking, if both partners are actively trying to have a child. This is because alcohol lowers levels of testosterone, reduces the activity of sperm, and can even damage the DNA within the sperm. DNA is what transmits all the information about the father to the baby and so the less damage the better.
If a child is born with FAS, there are many services available to help with any problems they may have. While there may not be a cure for FAS, the more help they receive the better.
 

More information

For more information on drinking alcohol, including drinking disorders and alcohol’s effect on the body, as well as some useful tools, see Alcohol.

For more information on the effects of alcohol on the foetus, see Pregnancy and Alcohol Consumption

 

Foetal Alcohol Syndrome References

1. Abel, E. L. and Sokol, R. J. Foetal alcohol syndrome is now leading cause of mental retardation. Lancet 1986; 2: 1222.
2. Australian Alcohol Guidelines: Health Risks and Benefits (2001). National Health and Medical Research Council: Commonwealth of Australia.
3. Bower, C., Silva, D., Henderson, T. R., Ryan, A. and Rudy, E. Ascertainment of birth defects: The effect on completeness of adding a new source of data, J. Paediatr. Child Health 2000, 36, 574-576.
4. Chudley et al. Foetal Alcohol Spectrum Disorder: Canadian Guidelines for Diagnosis. CMAJ March 2005; 172 (5 Suppl).
5. Colleen O’Leary. Foetal Alcohol Syndrom: a literature Review. Occasional Paper Australia: Commonwealth Department of Health and Ageing.
6. Foetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment (1996). Institute of Medicine, National Academy of Sciences.
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8. Little JF, Hepper PG, Dornan JC. Maternal Alcohol consumption During Pregnancy and Foetal Startle Behaviour. Physiology & Behaviour 2002; 76(4-5): 691-4.
9. Mattson, S. N., Riley, E. P., Gramling, L., Delis, D. C. and Jones, K. L. Heavy prenatal alcohol exposure with or without physical features of foetal alcohol syndrome leads to IQ deficits, J. Pediatrics 1997; 131: 718-721.
10. Olson HC, Streissguth A, et al. Association of prenatal alcohol exposure with behavioural and learning problems in early adolescence, AJ. Am. Acad. Child Adolesc. Psychiatry 1997; 36: 1187-1194.
11. Robinson MJ, Robertson DM. Practical Paediatrics. Churchill Livingstone, Victoria, 2003.
12. Schuckit MA. Alcohol and Alcoholism. Harrison’s Internal Medicine [on-line], Access Medicine. Available at URL: http://www.accessmedicine.com/ (last accessed 3/07/06)
13. Sood, B., Delaney-Black, V et al. Prenatal Alcohol Exposure and Childhhod Behaviour at Age 6 to 7 Years: I. Dose-Response Effect, Pediatrics 2001; 108: 461.
14. Streissguth A, Barr H, Kogan J, Bookstein F. Understanding the occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome and Foetal Alcohol Effects. Final Report, 1996. Centres for Disease Control and Prevention.