Definition Foetal alcohol syndrome (FAS) is a collection of growth and brain development problems in newborns. Foetal alcohol syndrome is caused by heavy alcohol use by the mother during pregnancy.
What is going on in the body? The effects of FAS have been recognised for thousands of years. The condition was first reported in modern medical literature by a group of doctors at the University of Washington in Seattle. They saw a pattern of physical and developmental problems in infants born to women who were alcoholics. Other research conducted since then has helped to define this disorder.
There are no available figures in Austraila but, in the United States, 1 to 2 cases of FAS are reported for every 1,000 babies born. The actual rate is probably higher. This is because pregnancies with the most severely affected foetuses often end in miscarriage. In population groups where alcoholism is more common, the rate can climb as high as 1 in 100. FAS is the third most common cause of mental retardation.
The way in which alcohol affects the foetus is not well understood. Alcohol causes a broad range of defects. The severity of the disorder also can vary widely. Physical problems can range from many defects to none. Mental retardation can vary from severe disability to subtle learning problems. How the foetus is affected depends on when in the pregnancy alcohol use was heaviest. Use early in pregnancy is more likely to cause brain or body malformation. Use late in pregnancy is more likely to affect foetal nutrition and more subtle areas of brain function, such as personality and the ability to learn.
What are the signs and symptoms of the condition? Some of the classic effects of FAS seen in affected children include:
delayed physical and mental growth
abnormalities of the face, including a poorly developed jaw and upper lip, and a flattened bridge of the nose
heart defects, including holes in the walls of the heart, that may require surgery
mental retardation
minor malformations of the arms and legs, including some restriction of movement and poor muscle strength
behavioural problems, such as a short attention span and hyperactivity
What are the causes and risks of the condition? Not all women who abuse alcohol during pregnancy have children with FAS. However, the risks are clearly related to the amount of alcohol used daily during the pregnancy. FAS occurs in 30% to 50% of pregnancies in which the mother drinks heavily throughout the pregnancy. The impact of lesser amounts of alcohol on the foetus is not known.
What can be done to prevent the condition? Foetal alcohol syndrome is preventable. A woman should avoid alcohol during pregnancy. She should also avoid alcohol if she is trying to get pregnant. Because a woman often does not know she is pregnant until she misses a period, damage can be done before the pregnancy is recognised. The toxic effects of alcohol are most severe in the early months of pregnancy. However, the foetus's brain continues to develop throughout pregnancy. This development can be disrupted by alcohol at any stage.
How is the condition diagnosed? The diagnosis of FAS is based on defects in three different areas. These are growth, physical development, and mental development. To make the diagnosis, defects in all three areas have to be noted. A reliable history of the mother's use of alcohol during the pregnancy is required as well. Typical findings are as follows:
below normal height, weight and head circumference. This growth deficiency continues into childhood.
heart defects and abnormal facial features. Typical facial features smaller than normal eye openings and a wider space between the eyes. Other features include a short nose with a poorly developed nasal bridge and poorly developed philtrum, which is the groove between the nose and upper lip. Later in childhood, there may be poor growth of the bones in the face and crooked teeth.
mental retardation. This can range from mild to severe. The child may have learning disabilities or delayed language development. Behavioural problems such as hyperactivity, poor judgment, impulsiveness and an inability to learn from mistakes may also be present.
Some children have features of FAS in all three areas and are easily diagnosed. In most cases, however, children have a history of alcohol exposure before birth and exhibit typical behaviours of FAS, but lack the distinctive physical features of the condition. In others, the antenatal history may not be known. Sometimes the term "Foetal Alcohol Effect" is used. This describes a child has only some of the traits that are required to make the diagnosis.
A thorough diagnostic procedure is important. This is best conducted by a doctor familiar with the disorder. A genetics team at a children's hospital or a university department of paediatrics can help with the diagnosis.
What are the long-term effects of the condition? There are many long-term effects of FAS on the child and his or her family. The brain effects continue as the child grows. Mental and learning disabilities can affect schoolwork. The most severely affected children may never be able to function independently.
Many children with FAS are unable to plan ahead. They are unable to think about the consequences of their behaviour or learn from their mistakes. This defect has an impact on relationships with family and friends. Major behavioural difficulties are common. These problems are not easily fixed.
Other long-term effects include a tendency to get ear infections. This may lead to hearing loss. The movement of joints, particularly the elbows, is sometimes limited, as well.
Children with FAS often need long-term medical and educational help.
What are the risks to others? There are no risks to others, as this condition is not contagious. If the mother continues to drink, she may cause birth defects in future children.
What are the treatments for the condition?
The defects caused by FAS are not curable. The problems with behaviour and mental functioning may be only partially helped by medications and special education.
Heart defects or chronic middle ear infections may require surgery. Orthodontic surgery may be required, as well. There is no treatment for the growth deficiencies.
What are the side effects of the treatments? All surgery has a risk of bleeding, infection, and reactions to any pain medications used. Children with behaviour problems may need to be treated with drugs to control their behaviour. These drugs have possible side effects, such as allergic reactions, stomach upset, and stunting of the child's growth. Specific side effects depend on the drugs used.
What happens after treatment for the condition? Treatment is often needed for long periods of time in affected children. It may never end in those with severe mental retardation or behaviour problems. Others may not need further treatment, but may have trouble succeeding in school, at work, or in relationships, for the rest of their lives.
How is the condition monitored? Affected children need careful monitoring so that treatment can be started as soon as problems are detected. This will help to allow the highest level of functioning possible. Other monitoring depends on the specific problems a child has as a result of the mother's alcohol use.
Author: John Wegmann, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
