Fetal Alcohol Spectrum Disorders Or FASD

Fetal Alcohol Spectrum Disorders (also commonly referred to as FASD) is a multitude of disturbing health issues that are usually reported in the babies born to alcoholic mothers. Research and clinical data indicates that consumption of alcohol in any form during pregnancy may lead to deleterious side-effects in the babies. These effects may range from physical anomalies to severe behavioral changes and mental retardation in the newborn.

According to a new study reported in the peer reviewed journal Pediatrics (1), investigators suggested that the prevalence of FASD among first-graders is 2.4% to 4.8% (or 24 to 48 per 1000 pupils).

Pathophysiology Of FASD

It has long known that some drugs have teratogenic potential if taken during the pregnancy and therefore the intake of such drugs should be strictly avoided. One such example is alcohol (or ethanol). Alcohol consumed by mothers during pregnancy can gain access into the fetal circulation via placental vessels; thereby leading to accumulation of alcoholic breakdown products in the fetal tissues. Unfortunately, since fetal metabolic and detoxification centers are underdeveloped, the risk of alcohol toxicity is even higher. In the absence of any management, deleterious complications in the fetus may occur even before the childbirth.

Classic Sign And Symptoms Of FASD

FASDs presents with various symptoms. The severity of symptoms and ensuing complications may vary from person to person, depending upon the dose, genetic factors, overall health of mother during pregnancy and exposure to other chemical or environmental toxins. Classic symptoms include:

Physical abnormalities:

Dysmorphic facial features like short nose, flat nasal bridge, smooth and indistinct philtrum (the groove between the nose and upper lip), small jaw, minor ear anomalies and ‘epicanthal skin folds’ covering the inner corner of eye
Small head circumference (Microcephaly)
Short stature and low birth weight
Auditory and visual deficits
Congenital cardiovascular defects including Ventricular or/and Atrial Septal Defects
Kidney and deformities of urinary system
Bone and joint anomalies

Neurodevelopmental & Behavioral problems:

Learning difficulties
Speech and hearing delays
Low intellectual abilities
Poor attention span
Impaired posture and fine motor skills
Disrupted higher mental functions including poor reasoning, judgment and cognition
Inefficient memory functions

What Are Some Clinical Varieties Of Fetal Alcohol Spectrum Disorder?

The clinical varieties of Fetal Alcohol Spectrum Disorder (FASD) are often hard to differentiate clinically on the basis of presentation alone. Study reported in the Alcoholism: Clinical and Experimental Research (3) journal suggested that the clinical accuracy of classification of FASD is approximately 71%. The prominent clinical varieties include:

1. Fetal Alcohol Syndrome:

It is the most frequently reported clinical variety of FASD. The infants exposed to alcohol prenatally due to maternal drinking habits can present with a multitude of symptoms including craniofacial abnormalities, cerebral retardation and organ dysfunction as well as problems with learning, language, memory and coordination. Anti-social and behavioral changes are also very common; such as, inability to deal with teachers and peers, and failure to learn new skills. At the extreme end of this disorder, death can also occur early in the infancy or childhood due to complications.

2. Alcohol Related Neurodevelopment Disorder (ARND):

People with this disorder may have problems with mental control, learning and cognitive reasoning. They may have difficulty in performing at school, especially at learning math or calculus. Memory formation, consolidation and recall may also be impaired and they may have hyperactive behavior leading to poor adjustment with coworkers.

3. Alcohol Related Birth Defects (ARBD):

Babies born with this disorder have congenital birth defects involving multi-organ, structural and functional impairment for major organ systems; for instance, cardiac defects, skeletal anomalies, renal problems or a combination of these.

How To Treat FASD?

Since the symptoms vary from person to person, a unique treatment approach is needed for each patient. Management should be directed to improve the quality of life as much as possible.

Steps in management of FASDs are as follows:

Early diagnosis and intervention i.e. from birth to 3 months of life should be sought so that maximum intellectual capacity can be salvaged.
Consult the pediatrician if you notice a new developmental or behavioral defects or deviation from normal
Involvement of a multidisciplinary team that is focused at giving optimal medical care to the child allow early detection of complications. Pediatricians, neurologists, child psychiatrists and physiotherapists must all join hands to provide good medical care. Drugs may be given to combat neuropsychiatric symptoms.

A collective effort on the part of parents and teachers in child’s behavior management, educational training, self-control strategies and provision of special skills is very much needed.
Offering special classes to the parents, supervised by specialized therapists also helps, in which they are taught how to manage their children
Making use of alternative approaches like visual imagery, hearing training, relaxation techniques and mental exercises helps a great deal in combating learning and behavioral difficulties.
Provision of a violence free and safe home environment, caring parental attitude and involvement of the child in social services is also needed.

How To Prevent FASD?

Any amount of alcohol can affect the well-being of mother and child during pregnancy. This occurs more often in unplanned pregnancies where women continue to consume alcohol oblivious to the fact that they have conceived. Several research studies suggests that consumption of alcohol prior to conception can also affect fertility and alter your chances of conceiving. Abstinence from drinking is the only way to protect the child from these disorders.

References

1. May, P. A., Baete, A., Russo, J., Elliott, A. J., Blankenship, J., Kalberg, W. O., … & Adam, M. P. (2014). Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics, 134(5), 855-866.

2. Paolozza, A., Rasmussen, C., Pei, J., Hanlon-Dearman, A., Nikkel, S. M., Andrew, G., … & Reynolds, J. N. (2014). Working memory and visuospatial deficits correlate with oculomotor control in children with fetal alcohol spectrum disorder. Behavioural brain research, 263, 70-79.

3. Mattson, S. N., Roesch, S. C., Glass, L., Deweese, B. N., Coles, C. D., Kable, J. A., … & Jones, K. L. (2013). Further development of a neurobehavioral profile of fetal alcohol spectrum disorders. Alcoholism: Clinical and Experimental Research, 37(3), 517-528.