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Drinking during pregnancy has remained one of the challenging public health, despite the numerous efforts, which has been implemented by governments and stake holders in the recent past (Buxton, 2005). It is highly notable that, drinking during pregnancy results to notable defects during birth, including life-time effects both to the new born as well as the mother. When a pregnant woman consumes alcohol, the level of alcohol in the body of the baby rises as high as that of the mother. However, the ability of the baby’s liver to metabolize alcohol is significantly lower, a factor which exposes them to higher amounts of alcohol for a prolonged period as compared to the mother (Buxton, 2005). According to Streissguth (1997), alcohol ingested during the pregnancy period may have various deleterious consequences to the developing fetus. One of the extremely severe conditions caused by prenatal alcohol is the fetal alcohol syndrome (FAS). These defects can further be divided into alcohol-related birth defects (ARBD) as well as alcohol-related neuro-developmental disorder (ARND) (U.S. Department of Health and Human Services, 2000). Based on the above arguments, this paper will carefully examine the causes, prevention and treatment of fetal alcohol syndrome.
Background at Fetal Alcohol Syndrome
Fetal alcohol syndrome can be termed as a pattern of physical and mental defects, which develops in a fetus as a result of high consumption of alcohol by the mother during pregnancy. Fetal Alcohol Syndrome was discovered by two scientists, Drs. Kenneth Lyons Jones and David Weyhe Smith in 1973. They found a pattern in eight children, according to which, craniofacial and cardiovascular defects were a result of prenatal developmental impediment and growth failure. All those examined were unrelated and born to mothers of three ethnic groups that abused alcohol. As recommended by British Department of Health and Surgeon General from the U.S., FAS there is the need of pregnant mothers not to consume any alcohol as a preventive measure. U.S. Department of Health and Human Services (2000) indicates that, when alcohol is consumed, it crosses the barrier created by the placenta, thus stunting the weight and growth of the fetus. The main effect of FAS is the permanent damage to the central nervous system, mostly in the brain section. According to Buxton (2005) more than 30% of babies, who are born to alcoholic women sustains adequate damage arising from utero exposure, which calls for full diagnozation with FAS. For one to be diagnosis of FAS, there must be growth retardation either post-natally or uterus and CNS damage. CNS damage includes irreversible brain damage, poor coordination, language and speech delay among others. Other symptoms include abnormalities in the head and face.
These abnormalities may include smooth and wide philtrum, thin upper lip small head circumference, underdeveloped jaw, flat mid-face, short and upturned nose, abnormally small and widely spaced eyes and epicanthal folds (Buxton, 2005). It is notable that, developing brain structures and cells can easily be malformed or their development prematurely interrupted due to alcoholic exposure during pregnancy. Consequently, this can result to an array of primary functional and cognitive disabilities, which includes impulsive behavior, poor memory, reduced cause-effect reasoning, attention deficits among others (Buxton, 2005). Secondary disabilities include drug addiction, predisposition to once mental health among others. As indicated by Ethen, Ramadhani , Scheuerle, E.et al (2008), exposure to alcohol during pregnancy presents an enormous risk of damage to the brain as its growth is continuous during pregnancy. As argued by U.S. Department of Health and Human Services (2000), in the Western world, FAS is the single biggest cause of mental retardation, especially in the U.S., European region among others. For instance, in these regions, the prevalence of FAS is approximated to range between 0.2-2.0 in every 1000 live births. However, it is significant to note that, there exists a considerable difference between FASD (Fetal Alcoholic Spectrum Disorders) and FAS. This is because FASD is a condition describing a continuum of birth defects, which are permanent, which include even FAS among other disorders. In the U.S., FASD affects approximately 1% of live births (Buxton, 2005). The cost to families and society dealing with this kind of disorder is staggering. For instance, in the U.S. among other developed nations, it is estimated that, the lifetime social and medical cost incurred per child born with this disorder is approximately $ 800,000 (Malbin, 2002). The figure below compares the incidences of FAE and FAS in the U.S. in comparison to other disorders.
The main difference between FSA and FSE is the fact that the first might occur when a pregnant woman suffers from chronic alcoholism. The second appears due to occasional or bring drinking. The fetus is less equipped to eliminate the alcohol as compared to the mother. It depends on the fact that, alcohol might easily pass the barriers of placenta. Therefore, fetus receives the most concentrated dose of alcohol that affects it much longer, than his/ hers mother’s systems (Ethen, Ramadhani , Scheuerle, E.et al, 2008). As argued by U.S. Department of Health and Human Services (2000), the number of drinking pregnant women increases yearly. Every year in the USA, 1 of 750 infants is born with mental, developmental or functional defects referred to Fetal Alcohol Syndrome and 40,000 per year are born with Fetal Alcohol Effects (Malbin, 2002). Despite of all these dangers, it saddening that, the number of women being involved in alcoholism during pregnancy is rapidly increasing. This raises some several questions on risk factors, which could be contributing to this trend.
There are several factors, which exposes one to engage in alcoholism during pregnancy.
As indicated above, FAS and FAE( Fetus Alcoholism Effects) are all fully preventable by the failure to consume alcohol during pregnancy. However, as argued by U.S. Department of Health and Human Services (2000), this is not possible. This is due to the fact that, in most societies alcohol is a socially accepted drug and in most cases, drinking patterns and sexual experimentations are formalized in teen years and this progress to college level. From a research conducted by Buxton (2005), normal consumption of alcohol has drastically raised, especially among teenage girls and younger women. In August 1988, the journal of obstetrics and gynecology carried out a research concerning drinking during pregnancy and it involved more than 100,000 women. From the study, it was clear that, there are various groups of women who are more likely to engage in drinking during pregnancy.
They include college educated, unmarried, and students and smokers among other groups whose household income exceeds $ 50,000 (Malbin, 2002). From the study it was also evident that pregnant women at higher risk for regular consumption of alcohol are most likely to be either smokers or unmarried. In fact, alcohol and smoking use together raises the potentiality for alcohol related damages in fetus by at least 35% (Clarren, 2005). Generally, health risk for women consuming alcohol is much greater as compared to that of men. This is due to their inability to metabolize alcohol as fast as compared to men (Clarren, 2005).
The other factor, which increases the rate of alcohol consumption among pregnant women is ethnicity. According to studies carried out by CDC catchment study, the incidences of FAS per 10,000 births for various ethnic groups are different. For instance, for the Asians the value is 0.3, Caucasians is 0.9, 0.8, 6.0 and 29.9 for Hispanics, African Americans and Native Americans respectively. With the Native Americans, the occurrence of FAS varies among various cultures (Malbin, 2002). In the case of Afro-Americans a risk of Fetal Alcohol Syndrome remains seven times more often than in Whites. Investigation discovered frequency of parents’ alcohol consuming, problems related to alcohol, and number of children born. This depends on genetic susceptibility. The table below indicates the prevalence of FAS by ethnicity/race-BDMP (Birth Defects Monitoring Program), between 1981 and 1991.
Alcohol Consumption Pattern
The pattern of alcohol consumption during pregnancy enormously affects the fetus. It is notable that, consumption of more than 5 drinks on daily basis during the first trimester is considered as the strongest predictor to neurobehavioral deficits such as distractibility, hyperactivity, speech and language problems among others. However, it is crucial noting that, since the system of a baby is not mature to metabolize alcohol, there is no any amount of alcohol safe to be consumed during the pregnancy period (U.S. Department of Health and Human Services, 2000).
There are several secondary factors, which can lead to FAS. Ethen, Ramadhani , Scheuerle, E.et al (2008)argues that, alcohol induced malnutrition is a crucial secondary factor, which may affect a developing fetus. Deficiency of nutrition mostly occurs with alcohol intake as a result of reduced appetite as well as interferences with digestion, nutrition utilization and increased urinary excretion of minerals and vitamins. For instance, alcohol induced depletion of zinc is a major cause of this (Loop, & Nettleman, 2002). According to U.S. Department of Health and Human Services (2000), there exists a correlation between fetal malformations and reduced birth weight to zinc depletion (Clarren, 2005). Further, spina bifida can be associated to deficiencies in folic acid. Therefore, there is an enormous need to improve nutrition among pregnant mothers, though this in itself cannot prevent the development of FAS/E (Clarren, 2005).
Characteristics of a Child having Symptoms for FAS/FAE
The following section will undertake a systematic approach and carefully evaluate the kind of damage, which occurs from in utero alcohol exposures (Ethen, Ramadhani , Scheuerle, E.et al, 2008).
The following type of facial features is linked with FAS.
- Droopy eyelids (epicanthal
- Widely spaced eyes
- Short eye slits (reduced
- palprebral fissures)
- Crossed eyes
- Low and/or wide bridge of
- the nose
- Short, upturned nose
- Thin upper lip
- Flat midface
- Flat or smooth area between the nose as well as lip
- (indistinct philtrum)
- micrognathia (Small, underdeveloped jaw )
- Other physical features, which are associated with FAS include:
- Failure to thrive
- Low birth weight
- Small size for age in length and weight
- microcephaly (Small head for age)
- Malformed or large ears
- Underdeveloped toenails or fingernails
- Short neck
- Joint and bone abnormalities
It is worth noting that, children suffering with FAS will posses some or in some cases, all of these types of physical features. Buxton (2005) argues that, children with FAE become more apparent in the schooling age as a result of performance and behavioral issues (U.S. Department of Health and Human Services, 2000). Some of the disorders, which are apparent include:
In most cases, children with FAS have hearing defects, although the severity levels vary significantly. Some can suffer from chronic/advanced infection of the ears, which may persist even into adulthood. There are three notable types of disorders in hearing, which are associated with FAS.
Delayed auditory function, which is associated with language and speech disorder.
Sensorineural hearing loss hearing loss, which takes place in the auditory pathways or inner part of the ear
Intermittent conductive hearing losses, where conduction of sound vibrations is interrupted
There are three notable visual disorders, which are closely related to FAS.
Strabismus, a type of muscle disorder, making eyes to point differently
Optic nerve hypoplasia, which is underdevelopment of optic nerve at the time of pregnancy. This defect is not curable, inherited or progressive.
Posterior haze of cornea. In this case the cornea is hazy instead of being clear, thus blurring vision
Children with these kinds of FAS ought to visit optometrists or ophthalmologist, in order to evaluate or get cure. Generally, there are primary as well as secondary disabilities, which take place as a result of exposure from alcohol in the uterus (Clarren, 2005).
- Primary Disabilities
- Developmental speech and language disorders
- Developmental coordination disorder
- Central auditory processing disorder
- Extreme loss of intellectual potential
- Reduced cranial size
- Structural brain abnormalities
- Mental retardation
- Problems in social perception
- Poor capacity for meta-cognition or abstraction
- Eye disorders
- Cleft palate
- Night terrors
- Extreme impulsiveness
- Immune system functioning
- Poor judgment
- Renal problems
- Musculoskeletal abnormalities
- Cerebral palsy
- Complex seizure disorder
- Developmental delay
- Height and weight deficiencies
- Sleep disorder
- Tourette’s traits
- Precocious puberty
- Sociopathic behavior
- Serious maxilofacial deformities (Kell et.al, 2009).
- Secondary Disabilities
- These are the disabilities, which develops if the above primary disabilities are not adequately dealt with (Ethen, Ramadhani , Scheuerle, E.et al, 2008). They include:
- Learning disabilities
- Early school drop-out
- Juvenile delinquency
- Chronic unemployment
- Sexual acting-out
- Social problems
- Behavioral problems
- Reactive outbursts
- Crimes against property
- Sexual assault
- Mental illness
- Early pregnancy
The Spectrum of FAS Preventive Approaches
As indicated by Kell et.al (2009), FAS can be fully prevented if women abstains from consuming alcohol during conception as well as throughout the pregnancy period. The Committee to Study Fetal Alcohol Syndrome (FAS) of the Institute of Medicine (MI) of the National Academy of Sciences in the U.S., has come up with three notable intervention spectrum for FAS, which include universal prevention of maternal abuse of alcohol, selective prevention of maternal abuse of alcohol and indicated prevention of FAS. Universal prevention of maternal abuse of alcohol is preventions, which aims to educate the general public on risks involved by taking alcohol during pregnancy. These kinds of universal efforts can be geared towards, women who are in the childbearing age or pregnant women and they include erecting billboards, public service announcements, media advertisements or pamphlets placed in physicians’ offices (Havens , Simmons, Shannon, Hansen, 2008). Warning labels, which are placed on alcohol beverage, is a good example of universal interventions that have been studied extensively in different parts of the world. Selective prevention of maternal abuse of alcohol are interventions targeting women at higher risk of having children with alcoholic related effects or FAS, that is, all women in the child bearing age consuming alcohol. For example, this can be done by screening all women who are pregnant as a result of alcohol use.
This is followed by extensive counseling of all the drinkers in regard to the risks posed to the fetus or, if warranted, referring them for specialized treatment (U.S. Department of Health and Human Services, 2000). On the other hand, indicated prevention of FAS refers to measures, which are directed to the high-risk women. This includes all those who consumes alcohol during pregnancy or during conception or even those who have previously delivered children suffering with FAS.Ethen, Ramadhani , Scheuerle, E.et al (2008) argues that, this level of prevention entails alcoholism treatment of all women, who consumes alcohol at any phase of pregnancy. The effectiveness of these three approaches is significantly increasing. For example, the impact of universal efforts is highly notable across various parts of the world. The media has helped to create awareness on the effects of drinking during pregnancy both to the health of the mother and the unborn child. Warning posters and alcohol beverage warning label have also helped to reduce the number of these cases by at least 30% in developed countries such as the U.S. and U.K. (Havens, Simmons, Shannon, Hansen, 2008).
Treatment of FAS
As noted by Kell et.al (2009), there is no any known cure for fetus alcoholic syndrome. This is due to the fact that, the CNS damage results into a permanent disabilities to most children (Mattson & Riley,2002). There are several interventions, which can be applied.
Traditional medical intervention, such as psychoactive drugs are mostly used on people suffering of FAS. This is due to the fact that, FAS disorders mostly overlaps with other types of disorders (Ethen, Ramadhani , Scheuerle, E.et al, 2008).
The traditional intervention behaviors are usually predicted on the learning theory, which forms the basis for many professional and parenting strategies as well as interventions (Clarren, 2005). Alongside the ordinary styles of parenting, these strategies are mostly employed by default to treat people suffering with FAS. These is due to the fact that, Reactive Attachment Disorder, Conduct Disorder as well as the diagnoses Oppositional Defiance Disorder (ODD) among others frequently overlaps with those of FAS, thus being able to significantly benefit from the behavioral interventions (Clarren, 2005).
This kind of approach pays attention to all neurologists’ underpinnings, which leads to cognitive and behavioral processes. This is a type of integrative approach encouraging as well as acknowledging multi-modal arrays of treatment interventions drawn from FAS approaches of treatment (Clarren, 2005). The neurobehavioral approach tries to shift the single perspective of treatment methods into new and coherent paradigm addressing complexities of all cognitions and problem solving behaviors, which emanates from damaged CNS of FAS (Guerri, 2002).
From the above discussion, it is clear that consumption of alcohol during pregnancy should not be advocated at all. The costs associated with the effects of FAS are staggering. For instance, in the U.S. among other developed nations, it is estimated that, the lifetime social and medical cost incurred per child born with this disorder is approximately $ 800,000. Aspects such as maternal factors, alcohol consumption patterns, ethnicity among others increases the level of alcohol consumption on pregnant women. Primary disabilities resulting from FAS includes developmental speech and language disorders, developmental coordination disorder and central auditory processing disorder among others. Treatment of FAS includes medical and behavioral interventions as well as neurobehavioral approach.
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