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.
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