WILLIAM TECUMSEH SHERMA
Alcohol plays a major role in society today. It is constantly being ....... in our minds through advertisements, whether its commercials or billboards, holidays, or even just at the popular social scene. Alcohol is consumed for many purposes, such as celebrations, to increase romance, out of boredom, or a way to relax. Alcohol is a drug that is depended upon by the majority of our society. Nonetheless, alcohol has very damaging effects, not only does it cause self-inflicted diseases resembling alcoholism or cirrhosis of the liver, but it harms unborn fetuses as well. Many women drink alcohol when they do not even know that they are pregnant yet. Alcohol can cause disorders such as Fetal Alcohol Syndrome and Fetal Alcohol Effects.
Fetal Alcohol Syndrome, FAS, is a congenital disorder which is characterized by a variety of physical and behavioral traits that result from maternal alcohol consumption during pregnancy. The term Fetal Alcohol Effects, FAE, indicates that alcohol is being considered as one of the possible causes of a patient's birth defects. In other words, FAE is a less severe form of FAS. Both FAS and FAE are the results of the use of teratogens, which are nongenetic influences that can potentially complicate fetal development.(Harris, p.85)
FAS is due to the mother's consumption of alcohol during pregnancy. Alcohol in the woman's bloodstream circulates to the fetus via the placenta. There, the alcohol intrudes with the ability of the fetus to receive a sufficient amount of oxygen and nourishment for normal development in the brain and other body organs. The critical time for alcohol teratogenicity is around the time of conception.
Effects of FAS/FAE
Although alcohol is the only cause of FAS, there are unfortunately numerous effects. Infants with FAS may have a weak sucking response and an irregular sucking pattern early in life. Some doctors describe them as distracted and fatigued when sucking. Withdrawal symptoms such as prolonged twitching, jitteriness, sweating, and hyperactivity have also been reported in infants exhibited to alcohol before birth. (Timberlake and Birch, p.1)
Prenatal alcohol exposure is one of the leading known causes of mental retardation in the United States. Mental retardation is usually mild to moderate, but occasionally it is severe. Central nervous system handicaps are also present in children with FAS. A small brain, learning disabilities, short attention span, hyperactivity in childhood, and poor body, hand, and finger coordination are examples of CNS handicaps.(NIAAA, p.1) Mental handicaps and hyperactivity are probably the most debilitating aspects of FAS.(Streissguth, p.1)
Children with FAS also suffer from facial abnormalities. These abnormalities include: small eye openings, drooping eyelids, short upturned nose, thin upper lip, and low set or poorly formed ears. (NIAAA, p.1) These facial patterns distinguish children with FAS/FAE from normal children, however they are not harshly malformed.
A more serious and life threatening symptom of FAS is organ deformities. This includes heart defects, heart murmurs, genital malformities, as well as urinary and kidney defects. Abnormal thyroid functioning and a decrease in the effectiveness of the immune system are also present in infants exposed to alcohol.
What about paternal alcohol consumption? Alcohol may affect fetal development through a direct effect on the father's sperm or gonads. Studies have shown that children with alcoholic fathers often experience cognitive abilities and have a greater chance of being hyperactive. These findings were found in adoption cases, where the biological father was an alcoholic and the child was raised by nonalcoholic parents.(Cicero,p.3)
FAE is a broad term covering a wide range of success levels, from mild learning disabilities to a less severe form of FAS. FAE is much harder to detect than FAS and extremely difficult to diagnose at birth. This is because FAE conditions begin to occur during school years. These conditions include behavioral problems, short attention span, language difficulties, and hyperactivity. (Timberlake and Birch, p.1)
Occurrence
The number of new cases each year of FAS and FAE are significantly underreported, therefore it is difficult to obtain accurate findings. "The incidence of FAS is estimated at 1-2 per 1,000 live births whereas FAE is estimated to occur in 3-5 per 1,000 live births."(Timberlake and Birch, p.2) According to the Centers for Disease Control's(CDC), Birth Defects Monitoring Program (BDMP), "FAS is difficult to recognize in newborns for three reasons: 1)Facial stigmata of FAS are often subtle; 2)Some types of CNS deficits in infants are difficult to detect; 3)The birth weight of some affected infants is normal."(Abel and Sokol, p.1) Symptoms become more noticeable with age. According to statistics, 44% of chronic alcoholics have affected children: 50% of these children will be mentally retarded and 30% will have physical malformations. (Harris, p.98) If a pregnant woman drinks 1-2 ounces of alcohol a day for the first three months of pregnancy, FAE will be present in 11% of the births.
Treatments
There are many needs that call for attention with FAS/FAE. Firstly, FAS/FAE patients typically have complex medical needs associated with their higher than average congenital anomalies. Infants with FAS are at risk for CNS problems, therefore, they must be carefully watched.
Patients with FAS/FAE are placed in special education classes beginning in elementary school. A child in a small class room may benefit highly if their is a lot of individual attention. Even if it does not show an increase in the child's intellectual level, it may prevent further deterioration. Many patients will reach an academic plateau in high school. However, it is important that these patients still learn basic life skills, such as safety, money management, and interpersonal relating. This is where the role of their family comes into play. Patients with FAS/FAE are at a higher than average risk of sexual and physical abuse, as well as neglect. They need loving, stable homes with open lines of communication to develop to their fullest potential.(Roots and Wings, p.2)
Most FAS/FAE patients will be unable to hold a regular job. Many will also require sheltered living throughout their entire life. More functional patients may be able to reside in half-way houses or group homes for developmentally disabled adults, if their own family is unable to give them the proper care and attention they need and deserve.
An important person(s) to remember when dealing with patients of FAS/FAE is the guardian. This person assumes a responsibility much greater than that of a normal child. The guardian must remember to keep a realistic view point. They must have reasonable expectations of the child as well. Because this job is so difficult, social services offer support to prevent the burnout of the guardian.
Research Studies
The key questions in FAS research include "How much is too much?", and "When is the fetus at the greatest risk?"(Ernhart, p.2) A safe amount of drinking during pregnancy has not yet been determined, and all major authorities agree that women should not drink at all during pregnancy. (NIAAA, p.2) The fetus seems to be at greatest risk during the first trimester. (Kids Health, p.2) Much of the human research has been epidemiological and for obvious ethical reasons. Human clinical studies investigating a dose response effect of alcohol during pregnancy are not possible.(Timberlake and Birch, p.2)
The saddest part of this disease is that it is preventable. FAS and FAE are the leading preventable causes of birth defects. FAS accounts for about 4,000 new cases of preventable birth defects in the United States each year. It has been estimated that the economic cost associated with FAS in the United States is $321 million each year. A recent survey done by the National Institute on Alcohol Abuse and Alcoholism(NIAAA), consisted of 23,000 men and women ages 18-44 to determine their perception of FAS. Only 73% of the women and 55% of the men were familiar with the subject. Even more discouraging, most believed FAS patients were born addicted to alcohol, but had no birth defects. (Timberlake and Birch, p.3)
According to the CDC, "FAS and other alcohol-related birth defects can be prevented if women do not drink alcohol during pregnancy or if they use reliable birth control methods when they do not abstain from drinking." Unfortunately women do not stop drinking until pregnancy is confirmed. By then the embryo/fetus has gone through several weeks of critical development. The alcohol may have already done damage to the embryo/fetus.(NIAAA, p.2) Pregnant women who drink heavily run a 40-50% risk of causing serious problems to the developing fetus. (Kids Health, p.2)
Work has been done to develop innovative strategies to identify the women who are at a high risk of having a child with FAS or FAE. Two strategies that are currently used, are to help educate these mothers about the threat alcohol has on their fetus, and to help them change their behavior. Prenatal clinics offer screening , counseling and support services to help achieve abstinence, as well as case management and follow-ups. If these methods prove to be effective, they may be inserted into current health care systems. (Centers for Disease Control and Prevention, p. 2)
In order to reduce the amount children born with FAS/FAE, there must be an increase in the number of women who abstain from alcohol during their pregnancies. To reach that goal further research needs to continue. There must be an improvement in public health surveillance methods, a refinement in methods used for identifying children who have been affected by prenatal alcohol exposure, a demonstration in the effectiveness of primary prevention programs, and an investigation on the effectiveness of secondary intervention strategies, such as foster-care placement and special education strategies.(Centers for Disease Control and Prevention, p.4)
Not all women who drink during pregnancy will have an infant with FAS or FAE, but if there is a 40-50% risk of harming the fetus, why chance it? Women should be more careful when drinking, because drinking often leads to sex even if it is not planned. The best prevention for FAS/FAE is to either abstain from sexual intercourse while consuming alcohol, or abstain from alcohol while planning a pregnancy. Therefore sexual partners should use birth control. Fetal Alcohol Syndrome and Fetal Alcohol Effects are fully preventable and the responsibility lies within the role of being parents.
