What is fetal alcohol syndrome?

Causes and Symptoms

Fetal alcohol
syndrome was first described in 1973 after recognition of a specific pattern of craniofacial, limb, and cardiac defects in unrelated infants born to alcoholic mothers.

Alcohol is a potent teratogen. Ethanol toxicity was initially suspected and has since been proven as the etiology of this syndrome. Fetal alcohol syndrome is not genetically inherited but rather is an acquired syndrome.

Alcohol induces abnormalities in neurogenesis and synaptogenesis and is the leading cause of preventable developmental disabilities in the United States. These processes result in central nervous system structural anomalies and microcephaly (small head size). Attention deficit, hyperactivity, and behavioral and learning difficulties; planning difficulties; memory problems; receptive language skill deficits; and math and verbal processing difficulties are common with fetal alcohol syndrome. Alcohol also has lifelong negative effects on fine motor coordination and balance. Prenatal and postnatal growth is below the 10th percentile for age and ethnicity.

Additionally, prenatal alcohol exposure results in numerous cardiovascular problems and facial and limb anomalies. Distinguishing features include short palpebral (eyelid) fissures, a thin vermilion (upper edge of the lip), and a long, smooth philtrum (vertical groove in the upper lip). Underdeveloped ears, clinodactyly (curvature of the little fingers), camptodactyly (bent fingers that cannot straighten), “hockey stick” palmar creases, and cardiac defects are common.

Treatment and Therapy

Primary prevention is the optimal treatment. Programs to educate health care providers and the general public regarding the adverse effects of alcohol usage during pregnancy may be effective in reducing the incidence of fetal alcohol syndrome. For individuals with this disorder, lifelong therapy directed toward educational planning, including improving cognitive, motor, behavioral, and psychosocial skills, is warranted. In addition, medical care is required for various associated anomalies such as cardiac defects.

Perspective and Prospects

Alcohol exposure—as a fetus, adolescent, or adult—leads to an increased probability of further alcohol ingestion at other developmental stages. An interruption of this cycle is imperative in order to reduce the incidence of fetal alcohol syndrome. Prevention of alcohol-affected pregnancies depends on developing and implementing evidence-based tools for fetal alcohol syndrome prevention, diagnosis, and treatment. There is no safe dose of alcohol during pregnancy, and current recommendations note that no alcohol should be ingested at conception and throughout gestation.

Bibliography:

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"Fetal Alcohol Spectrum Disorders." MedlinePlus, May 2, 2013.

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Hoyme, H. Eugene, et al. “A Practical Clinical Approach to Diagnosis of Fetal Alcohol Spectrum Disorders: Clarification of the 1996 Institute of Medicine Criteria.” Pediatrics 115, no. 1 (2005): 39–47.

"About FASD." National Organization on Fetal Alcohol Syndrome (NOFAS), 2012.

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Wood, Debra, and Rimas Lukas. "Fetal Alcohol Syndrome." Health Library, Sept. 10, 2012.