Infant Toddler Disorders: Fetal Alcohol Syndrome
Abstract
The fetus, a tiny person growing inside her mother can be an unintentional victim. Some, by genetic design may develop physical disabilities, while others might develop disfigurations or become mentally challenged due to mothers ingestion of alcohol or illegal drugs. It would seem that the sensible person would not partake of substances while pregnant to avoid harming the baby. If only all other childhood disorders were so easily remedied, by change of habit and diet. Yet, the habits continue.
Fetal Alcohol Syndrome
The knowledge of alcohol consumption and dangers to the fetus dates back to Greek and Roman times. Using updated terms such as ethyl-sulfate and ethyl-glucuronide in first waste products of the newborn are used to measure the birth defects in at risk women. Distinctive disorders result from the use of alcohol, including craniofacial alterations, abnormal behavior, and stunted growth. Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Spectrum Disorders (FASD) underscore the adverse effects of alcohol use by the woman not only during the first trimester, but also throughout gestation. The focus of the research will reveal that FAS is the single most preventable birth defect.
The first scientific results were by Sullivan in 1899. Imprisoned women in England gave birth to distinctive pattern of defects. He indicated that a birth-defect preventative tool is alcohol abstinence and the women were alcoholics when initially incarcerated. In 1968, Lemoine published a conclusive study of over 100 children of mothers who drank during pregnancy, connecting the defects to alcohol use. Since 1973, several thousand articles on the human prenatal exposure and animal models have proven the direct connection to alcohol use and avoidable birth defects.
In-lab controlled use of alcohol in animal models, the recent tests have shown similarities to FASD in humans. A maternal history in consumption of alcohol prior to and during gestation produced physical composition with characteristic abnormalities, which are comparable to a humans medical history. The tests verified that FASD could be avoided if alcohol use is curtailed or abstained from during childbearing years.
As the report was written in Europe and contains many European facts relating to wine or other alcohol use, brief mention of studies in the United States and Canada were acknowledged but not detailed. The common consensus being alcohol consumption by women of childbearing age is a direct threat to the health of a fetus. Prompt medical attention and treatment after birth is vital, however, not all symptoms reveal until possibly years later. One such evident is failure to thrive, where poor growth would need hospitalization for evaluation. Other problems are mental or delayed mental retardation where hyperactivity is often the diagnosis. Neurological examinations reveal abnormalities including cerebellar and hydrocephaly and a host of other syndromes are a possibility.
In 2011, a pilot study in seven neonatal wards on the Italian peninsula had results of 7.9% newborns exposed to ethanol and Rome a total of 29.4%. The testing was performed using the first body excrement of newborns and measuring contents of ethyl glucuronide (EtG) which is not present in non-drinkers.
Multiple-choice questionnaires emailed to registered Italian neonatologists. The focus of the questionnaire was to evaluate the physicians awareness of maternal drinking patterns during pregnancy and the experience, knowledge and confidence on FASD diagnosis. The results were a very low response rate with a majority not aware the even sporadic use of alcohol during the gestation period might interfere with the normal fetal development. Half of the respondents asked for more information on FASD. The same questionnaire, given to physicians during a meeting of the Italian Society of Pediatrics, signaled the need for forming a task force to improve the knowledge realization of major issues on FASD. The tools to investigate alcohol use and screening, early diagnosis and counseling for women to promote alcohol-free pregnancies would be the foundation for the task group.
Discussion and Conclusion
The research article states several times that FAS is preventable, and this knowledge is available worldwide, yet professionals (to date) are not using the tools available. Research performed in neonatal clinics in body waste of newborn infants revealed the high use of alcohol by their mothers. At the time of this writing, a tool to predict the use early in the pregnancy was not yet available. In my opinion, medical science has advance so quickly that the dose of a pain pill are traced by blood sample, and depending on how long a patient has been ingesting the medication, the test can reveal months or years of use. This same ideology could be used in detecting alcohol and the GtD and GtS present. As I read the article, my mind wandered to current procedures in the lab that are so refined.
I was amazed to find that doctors were not aware of the FAS cause and symptoms, but not surprised at the lack of participation in surveys. At some point a mention of physicians not wanting to treat or diagnose FAS patients, but I did not have a place to insert that finding. It would be beneficial if a newer study was published in the United States revealing the willingness of professionals to participate in the care, diagnosis and prevention of FAS.
The most prominent information that caught my attention is the fact that Fetal Alcohol Syndrome is the most preventable birth defect. As I once worked in a setting in which a there was a young man perhaps 25 years old diagnosed with FASD. His mother had consumed alcohol before and during pregnancy, during the time she carried him. He displayed the facial disfigurations and small stature and mental retardation. He did not talk, but communicated in grunts and screams. At any given time, he would go into a rage, screaming and clawing at his face, kicking his legs. We would have to confine him to his special cubby area where his sleeping bag, mattress and pillow stayed for his comfort. After he had calmed, we would have to clean his face with disinfectant. He cried and was so ashamed after his outbursts. When I read this research, I thought of him, and wondered how any woman could purposely damage their baby. I wondered if more people were exposed to those that have suffered the results of alcohol abuse via womb, would it help in educating. The researchers suggest the professionals find a way to briefly-counsel the mother-to-be. Why should it be brief and not incorporated into school systems and community awareness to prevent rather than counsel, after the fact? The article is enlightening, and full of information. I believe it was a small effort to educate more than to just research.
Resource
de Sanctis, L., Memo, L., Pichini, S., Tarani, L., & Vagnarelli, F. (2011). Fetal alcohol syndrome: new perspectives for an ancient and underestimated problem. The Journal of Maternal-Fetal & Neonatal Medicine: The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 24 Suppl 134-37. doi:10.3109/14767058.2011.607576
