Fetal alcohol syndrome

Definition

Fetal alcohol syndrome (FAS) is a condition that results from alcohol exposure during pregnancy. Problems that may be caused by fetal alcohol syndrome include physical deformities, mental retardation, learning disorders, vision difficulties and behavioral problems.

The problems caused by fetal alcohol syndrome vary from child to child, but defects caused by fetal alcohol syndrome are irreversible.

There is no amount of alcohol that's known to be safe to consume during pregnancy. If you drink during pregnancy, you place your baby at risk of fetal alcohol syndrome.

If you suspect your child has fetal alcohol syndrome, talk to your doctor as soon as possible. Early diagnosis may reduce the risk of problems, including learning difficulties and substance abuse.

Symptoms

Fetal alcohol syndrome isn't a single birth defect. It's a cluster of related problems and the most severe of a group of consequences of prenatal alcohol exposure. Collectively, the range of disorders is known as fetal alcohol spectrum disorders (FASDs).

Fetal alcohol syndrome is a common — yet preventable — cause of mental retardation. The severity of mental problems varies, with some children experiencing them to a far greater degree than others.

Signs of fetal alcohol syndrome may include:

• Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip
• Deformities of joints, limbs and fingers
• Slow physical growth before and after birth
• Vision difficulties or hearing problems
• Small head circumference and brain size (microcephaly)
• Poor coordination
• Mental retardation and delayed development
• Learning disorders
• Abnormal behavior, such as a short attention span, hyperactivity, poor impulse control, extreme nervousness and anxiety
• Heart defects

The facial features seen with fetal alcohol syndrome may also occur in normal, healthy children. Distinguishing normal facial features from those of fetal alcohol syndrome requires expertise.

Doctors may use other terms to describe some of the signs of fetal alcohol syndrome. An alcohol-related neurodevelopmental disorder is a mental or behavioral impairment that occurs as a result of fetal exposure to alcohol. Alcohol-related birth defects are physical defects that occur from fetal alcohol exposure.

When to see a doctor
If you're pregnant and can't stop drinking, ask your obstetrician or other health care provider for help.

Because early diagnosis may help reduce the risk of long-term problems for children with FAS, let your child's doctor know if you drank alcohol while you were pregnant. Don't wait for problems to arise before seeking help.

If you've adopted a child or are providing foster care, you may not know if your child's biological mother drank alcohol while pregnant — and it may not initially occur to you that your child may have fetal alcohol syndrome. However, if your child has learning and behavioral problems, talk with your child's doctor so that the underlying cause might be identified.

Causes

When you're pregnant and drink alcohol, it enters your bloodstream and reaches your developing fetus by crossing the placenta. Because a fetus metabolizes alcohol more slowly than an adult does, your developing baby's blood alcohol concentrations are higher than those in your body. Alcohol also interferes with the delivery of oxygen and optimal nutrition to your baby's developing tissues and organs, including the brain.

The more you drink while pregnant, the greater the risk to your unborn baby. The risk is present at any time during pregnancy. However, impairment of facial features, the heart and other organs, including the bones, and the central nervous system may occur as a result of drinking alcohol during the first trimester. That's when these parts of the fetus are in key stages of development. In the early weeks of the first trimester, many women may not be aware that they're pregnant.

Risk factors

Although doctors aren't sure how much alcohol you'd have to drink to place your baby at risk, they do know that the more you drink, the greater the chance of problems. Because there's no known safe amount of alcohol consumption during pregnancy, don't drink alcohol if you are or think you are pregnant or you're attempting to become pregnant. You could put your baby at risk even before you realize you're pregnant.

Preparing for your appointment

Call your child's doctor for an appointment if you see any symptoms that concern you. Your child's doctor will let you know if your child needs to see a specialist, such as a doctor specializing in heart problems (cardiologist) if your child has a heart issue.

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you've noticed in your child, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, vitamins or supplements that you took during pregnancy. Also, let your child's doctor know if you drank alcohol during your pregnancy, and if so, how much and how often.
• Consider asking a family member or friend to come with you. Sometimes it can be difficult to remember all of the information provided to you during an appointment, especially if you've been told that there may be something wrong with your child. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Preparing a list of questions can help you make the most of your time with your child's doctor. For fetal alcohol syndrome, some basic questions to ask your doctor include:

• What's the most likely cause of my child's symptoms?
• Are there other possible causes for these symptoms?
• What kinds of tests does he or she need? Do these tests require any special preparation?
• Will my child's condition improve over time? Will it get worse?
• What treatments are available, and which do you recommend?
• How can I prevent this from happening in future pregnancies?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• Are there medications that may help, and are there medications that should be avoided?

In addition to the questions that you've prepared to ask your child's doctor, don't hesitate to ask any additional questions that may occur to you during your appointment.

What to expect from your doctor
Your child's doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

• When did you first notice your child's symptoms?
• Have these symptoms been continuous or are they only occasional?
• Does anything seem to improve the symptoms?
• What, if anything, appears to worsen the symptoms?
• Did you have any problems during your pregnancy?
• Did you drink alcohol while you were pregnant? If yes, how much and how often?
• Did you use any illegal drugs during your pregnancy?

Tests and diagnosis

Although doctors can't diagnose fetal alcohol syndrome before a baby is born, they can assess the health of mother and baby during pregnancy. If you report the timing and amount of alcohol consumption, your obstetrician or other health care provider can help determine the risk of fetal alcohol syndrome.

If you let your child's doctor know that you drank alcoholic beverages during your pregnancy, he or she can watch for signs and symptoms of this syndrome in your child's initial weeks, months and years of life. To make a diagnosis, doctors will assess:

• Growth
• Facial features
• Heart health
• Hearing
• Vision
• Cognitive ability
• Language development
• Motor skills
• Behavior

Doctors may refer a child with possible fetal alcohol syndrome to a medical genetics specialist to rule out other disorders with similar signs and symptoms.

If one child in your family is diagnosed with fetal alcohol syndrome, it's important to evaluate his or her siblings to determine whether they also have fetal alcohol syndrome.

Treatments and drugs

There's no cure or specific treatment for fetal alcohol syndrome. The physical defects and mental deficiencies typically persist for a lifetime. Heart abnormalities may require surgery. Learning problems may be helped by special services in school. Parents often benefit from counseling to help the family with a child's behavioral problems.

Coping and support

The psychological and emotional problems associated with fetal alcohol syndrome can be difficult to manage. Families and children with fetal alcohol syndrome may benefit greatly from the support of professionals and other families who have experience with fetal alcohol syndrome. Ask your doctor or public health nurse for local sources of support for families and children with fetal alcohol syndrome. If you know or suspect you have a problem with alcohol or other substances, ask a professional, such as a doctor or a psychologist, for advice.

As a parent of a child with fetal alcohol syndrome, you may find the following suggestions helpful in dealing with behavioral problems associated with the syndrome:

• Implement daily routines to which your child can become accustomed.
• Create and enforce simple rules and limits.
• Point out and use rewards to reinforce acceptable behavior.
• Because many children with fetal alcohol syndrome are vulnerable, guard against their being taken advantage of by others.
• Teach your child skills for daily living.
• Carefully chose who you ask to care for your child when you can't be there, because some behaviors may be difficult to manage.

A stable, nurturing home is the single most important factor in protecting children with FAS from some of the problems they're at risk of later in life, including drug abuse, dropping out of school and encounters with the juvenile justice system.

If you've given birth to a child with fetal alcohol syndrome, you may benefit from substance abuse counseling and treatment programs that can help you overcome your misuse of alcohol.

Prevention

Doctors haven't identified a safe level of alcohol that a pregnant woman can consume. But experts do know that FAS is completely preventable if women don't drink alcohol during pregnancy.

These guidelines can help prevent fetal alcohol syndrome:

• Don't drink alcohol if you're trying to get pregnant, because your baby's brain, heart and blood vessels begin to develop in the early weeks of pregnancy, before you may know you're pregnant. If you haven't already stopped drinking, stop as soon as you know you're pregnant or if you even think you might be pregnant. It's never too late to stop drinking during your pregnancy, but the sooner you stop, the better it is for your baby.
• Continue to avoid alcohol throughout your pregnancy. Fetal alcohol syndrome is completely preventable in children whose mothers don't drink during pregnancy.
• Consider giving up alcohol during your childbearing years if you're sexually active and you're having unprotected sex. Many pregnancies are unplanned, and damage can occur in the earliest weeks of pregnancy.
• If you have an alcohol problem, get help before you get pregnant. Get professional help to determine your level of dependence on alcohol and to develop a treatment plan.