Learn about fetal alcohol syndrome (FAS), a condition caused by prenatal alcohol exposure, its impact on development, and prevention strategies on Meri Sehat.

Fetal Alcohol Syndrome

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Iqra Mazhar

Overview

Fetal alcohol syndrome is a condition characterized by physical and mental defects in children born to mothers that consumed alcohol during pregnancy. 
&nbsp;

Fetal alcohol syndrome (FAS) is the most severe end of fetal alcohol spectrum disorder (FASD). FASD is a group of conditions that describes the range of effects that can occur in an individual who was exposed to alcohol while in the womb.

Alcohol is a teratogen, which means that it can cause birth defects and developmental abnormalities in the fetus. There is no safe level of alcohol consumption during pregnancy, as even small amounts of alcohol can increase the risk of FAS. Moreover, binge drinking and heavy alcohol consumption are particularly dangerous and can increase the risk of FAS and other alcohol-related birth defects. In women, binge drinking is defined as consuming four or more drinks on a single occasion, while heavy drinking is defined as consuming eight or more drinks per week<a href="#accordion">[6]</a>. As per research, 1 in every 13 pregnant women who consumed alcohol during pregnancy had a child with fetal alcohol spectrum disorder<a href="#accordion">[3]</a>. 
&nbsp;

FAS is the most severe form of alcohol-related birth defect, and it can cause a range of physical, behavioral, and cognitive problems in affected children.

According to a systematic review and meta-analysis, the global prevalence of fetal alcohol spectrum disorder (FASD), including FAS, is 7.7 per 1000 population<a href="#accordion">[3]</a>. However, the prevalence of FAS specifically varies widely across different countries and populations, with some estimates as high as 53.3 per 1,000 people<a href="#accordion">[3]</a>. Furthermore, South Africa seems to have the highest prevalence of FASD (111.1 per 1000 population)<a href="#accordion">[3]</a>.

In the United States, the estimated lifetime cost of caring for an individual with FAS is approximately $2 million<a href="#accordion">[1]</a>.

Note: If you are pregnant and have difficulty stopping drinking, contact a healthcare professional immediately. 
&nbsp;

Alcohol exposure during fetal development can lead to various birth defects, ranging from mild to severe. These signs and symptoms are grouped under fetal alcohol spectrum disorder (FASD). Fetal alcohol syndrome is the most severe FASD. The FASD umbrella also includes other conditions. 
&nbsp;

<ul>
	<li>Partial Fetal Alcohol Syndrome (pFAS): Individuals with pFAS exhibit some FAS-related traits (such as alterations to their facial features), but not all of its symptoms. 
	&nbsp;</li>
	<li>Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND experience impulsivity, inattentiveness, difficulties with judgment, and difficulties with academic achievement.. 
	&nbsp;</li>
	<li>Alcohol-Related Birth Defects (ARBD): This is characterized by physical birth abnormalities that can affect the heart, ears, eyes, skeletal system, and kidneys. 
	&nbsp;</li>
	<li>Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure (ND-PAE): Individuals with this condition have a history of more than a small amount of alcohol exposure as a fetus. They may exhibit significant behavioral problems like violent tantrums. Moreover, they have trouble with basic daily tasks like bathing and may find it difficult to fit in with others in social situations. Memory and thinking-related problems are also common.&nbsp; 
	&nbsp;</li>
</ul>

Signs and Symptoms

The severity of symptoms associated with fetal alcohol syndrome can vary significantly, with some children experiencing more severe symptoms than others. These symptoms can include a combination of physical abnormalities, cognitive or intellectual disabilities, and difficulties coping with daily life. 
&nbsp;

<h5>Physical Abnormalities</h5>

<ul>
	<li>Abnormal facial features, like a thin upper lip, small eyes, upturned nose, and a ridge between the nose and upper lip (philtrum)</li>
	<li>Small head size</li>
	<li>Hearing and vision problems</li>
	<li>Shorter-than-average height</li>
	<li>Low body weight</li>
	<li>Deformities of the fingers, limbs, and joints</li>
	<li>Heart, kidney, and bone defects 
	&nbsp;</li>
</ul>

<h5>Neurological Problems</h5>

<ul>
	<li>Balance and coordination problems</li>
	<li>Intellectual disability or low IQ</li>
	<li>Learning problems</li>
	<li>Delays in speech and language</li>
	<li>Hyperactivity</li>
	<li>Difficulty with problem-solving and reasoning</li>
	<li>Difficulty differentiating between reality and fantasy</li>
	<li>Memory issues</li>
	<li>Sudden mood changes 
	&nbsp;</li>
</ul>

<h5>Social And Behavioral Problems</h5>

<ul>
	<li>Impulsiveness</li>
	<li>Poor school performance</li>
	<li>Poor social skills</li>
	<li>Difficulty planning</li>
	<li>Poor time management</li>
	<li>Difficulty getting along with others 
	&nbsp;</li>
</ul>

Causes

FAS occurs when a pregnant woman drinks alcohol, which can cross the placenta and enter the fetal bloodstream. There is no safe amount of alcohol during pregnancy. Nor is there a safe time for alcohol consumption during pregnancy. Moreover, all types of alcohol are equally detrimental to fetal health, including beer, cider, and wine. 
&nbsp;

Alcohol is a toxin that can damage the developing cells and tissues of the fetus, particularly during the first trimester of pregnancy when the major organs are forming. The amount and timing of alcohol exposure can affect the severity of the FAS symptoms. These symptoms are brought on in the following ways: 
&nbsp;

<ul>
	<li>Abnormal physical development results from alcohol-killing cells in different parts of the fetus.</li>
	<li>Alcohol inhibits the development and functioning of nerve cells as they form various areas of the brain.</li>
	<li>Alcohol causes constriction of the blood vessels. Thus, blood flow to the placenta is disrupted, resulting in a reduced supply of oxygen and nutrients to the fetus.</li>
	<li>As the body processes alcohol, toxic byproducts are formed. These can accumulate in the baby&rsquo;s brain cells, causing damage. 
	&nbsp;</li>
</ul>

Note: Since most women may not know they&rsquo;re pregnant for the first 4 to 6 weeks, it is recommended to avoid alcohol if there is a suspicion of pregnancy. 
&nbsp;

There is no exclusive guideline to screen for fetal alcohol syndrome. However, reviewing the medical history of the mother may point the healthcare provider in the right direction.&nbsp; 
&nbsp;

Diagnosis

The diagnosis of fetal alcohol syndrome is based on the child&rsquo;s signs and symptoms. Doctors look for atypical facial traits, below-average height and weight, small heads, attention- and hyperactivity-related issues, and poor coordination. Also, to assess for prenatal alcohol exposure, the mother is questioned on her history of alcohol consumption during pregnancy. Although fetal alcohol syndrome symptoms cannot be reversed, early detection and intervention can help a child&#39;s outlook and development. According to research, kids perform better when they<a href="#accordion">[9]</a>: 
&nbsp;

<ul>
	<li>Are clinically identified before they reach the age of 6</li>
	<li>Are raised in a devoted, dependable, and caring home during their school years</li>
	<li>Are protected from violence</li>
	<li>Get social services and special education 
	&nbsp;</li>
</ul>

Treatment

Unfortunately, there is no known cure for FAS and it may affect the child for the rest of his or her life. However, early intervention can lessen the intensity of some symptoms and enhance the child&#39;s growth. Certain medications can help treat symptoms like anxiety, behavior problems, and problems with concentration. These include: 
&nbsp;

<ul>
	<li>Anti-anxiety medications.</li>
	<li>Antidepressants for mood disturbances, sleep problems, problems in schools, and aggressive behaviors.</li>
	<li>Stimulants for impulsiveness, hyperactivity, and trouble concentrating.</li>
	<li>Neuroleptics for treating anxiety and aggression. 
	&nbsp;</li>
</ul>

Behavior and academic counseling are recommended for emotional and academic issues. Moreover, it is important to counsel parents on how to take care of and support children with fetal alcohol syndrome. 
&nbsp;

Parental education is designed to help parents support their children while they face behavioral, academic, and social issues. Parents may pick up new habits and guidelines that can aid in their child&#39;s situational adaptation. Many times, having a steady and encouraging household can assist children with FAS to avoid growing up with mental and emotional issues<a href="#accordion">[11]</a>. 
&nbsp;

Alternative therapies, such as acupuncture, massage, and yoga have also been shown to benefit children with FAS. 
&nbsp;

Fetal alcohol syndrome can cause subsequent impairments, such as problematic behaviors that were not evident at birth. These are called secondary effects and are experienced into adulthood. These include:

<ul>
	<li><a href="https://merisehat.pk/disease/attention-deficit-hyperactivity-disorder-adhd">Attention-deficit hyperactivity disorder (ADHD)</a></li>
	<li>Aggression, improper social behavior, and breaching the law</li>
	<li>Alcohol or drug abuse</li>
	<li>Mental disorders, such as sadness, <a href="https://merisehat.pk/disease/anxiety">anxiety</a>, or eating problems</li>
	<li>Issues with attending or completing school</li>
	<li>Issues with employment and independent living</li>
	<li>Sexually inappropriate actions</li>
	<li>Early death from homicide, an accident, or suicide 
	&nbsp;</li>
</ul>

Within the womb, the fetal liver is not fully developed and cannot process alcohol. Thus, it causes damage to various organs. This leads to:

<ul>
	<li>Miscarriage - Women who drink alcohol during pregnancy have an increased risk of miscarriage compared to women who don&rsquo;t.</li>
	<li>Preterm Labor - Drinking alcohol during pregnancy can increase the risk of preterm labor and delivery, which can lead to complications such as respiratory distress syndrome and feeding difficulties in the newborn</li>
	<li>Stillbirth - This mostly occurs in the second trimester. 
	&nbsp;</li>
</ul>

Moreover, alcohol consumption during pregnancy can also affect maternal health. This results in:

<ul>
	<li>Maternal Alcohol-Related Health Problems: Women who drink alcohol during pregnancy are at increased risk of developing alcohol-related health problems such as liver disease, hypertension, and certain types of cancer.</li>
	<li>Mental Health Problems: Women who drink alcohol during pregnancy may also be at increased risk of developing mental health problems such as <a href="https://merisehat.pk/disease/depression">depression </a>and anxiety. 
	&nbsp;</li>
</ul>

It&#39;s important to note that the risk of these complications increases with the amount and frequency of alcohol consumed during pregnancy. Therefore, it&#39;s crucial for women to avoid alcohol consumption altogether during pregnancy to ensure the health and well-being of both themselves and their developing fetus. 
&nbsp;

Alcohol consumption is the only cause and risk factor for FAS. The greater the alcohol consumption, the greater the risk to the fetus. However, it is important to note that there is no safe amount of alcohol consumption during pregnancy.&nbsp; 
&nbsp;

Preventing FAS involves avoiding alcohol consumption during pregnancy. Women who are pregnant or planning to become pregnant should avoid all forms of alcohol, including beer, wine, and liquor. Women who are struggling with alcohol addiction or who are unable to stop drinking during pregnancy should seek medical and social support to help them quit. In addition to avoiding alcohol, pregnant women can take other steps to promote a healthy pregnancy, such as eating a balanced diet, getting regular exercise, and getting regular prenatal care. These steps can help to reduce the risk of other pregnancy complications as well. These guidelines can help prevent fetal alcohol syndrome: 
&nbsp;

<ul>
	<li>Avoid Drinking Alcohol If You Plan To Get Pregnant: If a woman hasn&#39;t already, she should quit drinking as soon as she finds out she&rsquo;s expecting or even just suspects it. Although it is never too late to stop drinking while pregnant, the sooner, the better for the fetus. 
	&nbsp;</li>
	<li>Complete Abstinence From Alcohol During Pregnancy: If a mother doesn&#39;t consume alcohol while she&#39;s pregnant, fetal alcohol syndrome can be fully avoided in her child. 
	&nbsp;</li>
	<li>Avoid Alcohol Completely If You Are Of Reproductive Age: Damage might happen in the first few weeks of pregnancy since many pregnancies are unplanned. Moreover, most women don&rsquo;t find out they&rsquo;re pregnant for up to 4 to 6 weeks. Therefore, it is best to quit alcohol consumption completely. 
	&nbsp;</li>
	<li>Professional Help: Professional assistance can help create a treatment strategy for women experiencing alcohol dependency. 
	&nbsp;</li>
</ul>
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A team of researchers from the University of Southern California (USC), Queen&#39;s University (Ontario), and Duke University have created a new tool that can quickly and cheaply screen children for fetal alcohol spectrum disorder (FASD). Thus, making it available to more children in far-flung areas around the world. The tool records patterns in children&#39;s eye movements as they watch repeated one-minute videos or glance at/away from a target using a camera and computer vision. It then compares those patterns to those of other children who watched identical videos or targets. In this way researchers identified children with abnormal eye movements as those who might be at risk for FASD and who require a more official diagnosis from medical professionals<a href="#accordion">[12]</a>. 
&nbsp;

Key Points

<ul>
	<li>Fetal alcohol spectrum disorders (FASD) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy.</li>
	<li>FAS is the most severe form of alcohol-related birth defect, and it can cause a range of physical, behavioral, and cognitive problems in affected children.</li>
	<li>There is no safe level of alcohol consumption during pregnancy, as even small amounts of alcohol can increase the risk of FAS. However, binge drinking and heavy alcohol consumption are particularly dangerous and can increase the risk of FAS and other alcohol-related birth defects.</li>
	<li>&nbsp;According to a systematic review and meta-analysis, the global prevalence of FASD, which includes FAS, is estimated to be 14.6 per 1,000 people.</li>
	<li>Symptoms can include a combination of physical abnormalities, cognitive or intellectual disabilities, and difficulties coping with daily life.</li>
	<li>Physical abnormalities can include slow growth, vision or hearing problems, a small head circumference, and heart, kidney, and bone problems.</li>
	<li>Children with fetal alcohol syndrome may also struggle with hyperactivity, mood swings, and social and behavioral issues, including difficulty in school, and poor social skills.</li>
	<li>FAS occurs when a pregnant woman drinks alcohol, which can cross the placenta and enter the fetal bloodstream. Alcohol exposure during fetal development can lead to various birth defects, ranging from mild to severe.</li>
	<li>There is no exclusive guideline to screen for FAS. However, reviewing the medical history of the mother may point the healthcare provider in the right direction.</li>
	<li>Parental education is designed to help parents support their children while they face behavioral, academic, and social issues.</li>
	<li>Fetal alcohol syndrome can cause subsequent impairments, such as problematic behaviors which develop into adulthood. These include attention deficit hyperactivity disorder (ADHD), aggression, improper social behavior, and breaching the law.</li>
	<li>Common complications of FAS include miscarriage, preterm birth, and stillbirths.</li>
	<li>Women who drink alcohol during pregnancy may also be at increased risk of developing mental health problems, such as depression and anxiety.</li>
	<li>Alcohol consumption is the only cause and risk factor for FAS. The severity of FAS symptoms can vary widely, and affected children may have a range of different symptoms depending on the amount and timing of alcohol exposure.</li>
	<li>Preventing FAS involves avoiding alcohol consumption during pregnancy. Women who are pregnant or planning to become pregnant should avoid all forms of alcohol, including beer, wine, and liquor.</li>
	<li>In addition to avoiding alcohol, pregnant women can take other steps to promote a healthy pregnancy, such as eating a balanced diet, getting regular exercise, and getting regular prenatal care. 
	&nbsp;</li>
</ul>
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[1] May, P. A., Gossage, J. P., Kalberg, W. O., Robinson, L. K., Buckley, D., Manning, M., ... & Hoyme, H. E. (2009). Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in‐school studies. Developmental Disabilities Research Reviews, 15(3), 176-192.

[2] Centers for Disease Control and Prevention. (2022). Fetal alcohol spectrum disorders (FASDs).

[3] Lange, S., Probst, C., Gmel, G., Rehm, J., Burd, L., & Popova, S. (2017). Global prevalence of fetal alcohol spectrum disorder among children and youth: A systematic review and meta-analysis. JAMA Pediatrics, 171(10), 948-956.

[4] American Academy of Pediatrics. (2015). Fetal alcohol spectrum disorders. In R. Kliegman, B. Stanton, J. St. Geme, N. Schor, & R. Behrman (Eds.), Nelson textbook of pediatrics (20th ed., pp. 417-422). Saunders

[5] American College of Obstetricians and Gynecologists. (2013). Committee opinion no. 545: Nonobstetric surgery in pregnancy. Obstetrics and Gynecology, 121(4), 911-915.

[6] What is excessive alcohol use? Centers for Disease Control and Prevention.

[7] O'Leary, C. M., Nassar, N., Kurinczuk, J. J., Bower, C., & The Western Australian Fetal Alcohol Spectrum Disorders Project Population-Based Study Research Team. (2010). Prenatal alcohol exposure and risk of behavioral and emotional problems in adolescence: A birth cohort study. Pediatrics, 126(4), e914-e920.

[8] Sokol, R. J., Delaney-Black, V., & Nordstrom, B. (2003). Fetal alcohol spectrum disorder. JAMA, 290(22), 2996-2999.

[9] Fetal alcohol syndrome: Symptoms, causes, treatments (no date) WebMD. WebMD.

[10] Fetal alcohol syndrome (2018) Mayo Clinic. Mayo Foundation for Medical Education and Research

[11] Fetal alcohol syndrome (FAS): Symptoms, causes & treatment (no date) Cleveland Clinic.

[12] 26, A.B.| F. (2019) New method uses AI to screen for Fetal Alcohol Spectrum Disorder - USC viterbi: School of Engineering, USC Viterbi | School of Engineering