Wednesday, September 8, 2010

Foetal Alcohol Syndrome

What is Foetal Alcohol Syndrome?
Foetal Alcohol Syndrome refers to a group of abnormalities in growth and development that occur in children whose mothers consumed excessive amounts of alcohol whilst pregnant.

Incidence
• The World Health Organisation describes foetal alcohol syndrome as the most preventable cause of mental retardation worldwide.
• Previous studies have indicated that South Africa has one of the highest incidences of foetal alcohol syndrome in the world.
• The Western Cape had an incidence of foetal alcohol syndrome of around 7.5% in children in 2001. The Northern Cape had an incidence over 10% in children.
• Higher incidences of foetal alcohol syndrome are associated with higher levels of poverty and lower levels of education.
• High risk communities in South Africa have at least a 4 fold higher incidence of foetal alcohol syndrome than high risk communities in developed countries.

How Alcohol affects the Developing Foetus
• Alcohol exposure affects the development and function central nervous system and endocrine system of the foetus.
• Alcohol exposure can also cause abnormal gene expression in the foetus.
• The consumption of alcohol affects the blood flow to the uterus. As the blood flow is decreased, the oxygen nutrient delivery to the foetus is compromised. Without sufficient oxygen and nutrients, the growth and development of the baby is affected.
• The majority of the development happens during the 1st trimester. Alcohol consumption during the 1st trimester is therefore very dangerous and can result in a number of developmental disorders.
• The 2nd and 3rd trimester involves mostly growth for the foetus. Excessive alcohol consumption during the 2nd and 3rd trimester results in slowed growth of the foetus. This can result in a low birth weight and smaller stature as the child grows.
• Oxidative stress on the developing foetus as a result of the alcohol also plays a role in the abnormal growth and development of the foetus.

The Effects of Foetal Alcohol Syndrome
• It is very difficult to estimate the extent of the effects that alcohol consumption during pregnancy has on a foetus. One reason for the difficulty is the natural variations in intelligence and development of children as a result of genetics and environment.
• Whilst children with severe foetal alcohol syndrome are easily identified, milder cases may never be recognised. We will never know what the child’s potential may have been if the mother had not consumed alcohol during pregnancy.
• Foetal alcohol syndrome can have a far-reaching impact on the community. If these children are not correctly diagnosed and managed then they are less likely to progress in school and are at risk of repeated failure in academic and learning environments. If these children drop out of school they are more likely to turn to crime, drugs and violence, than other children. This has a long term impact on the health, safety and economy of the community.

Signs and Symptoms
• Children who are born with foetal alcohol syndrome have a number growth and developmental disorders ranging in severity. Milder cases of FAS may never be diagnosed.
• Children with severe foetal alcohol syndrome will be smaller than children of the same age.
• FAS children will also have a lower IQ than other children.
• These children will display abnormal behavioural characteristics. These include very short attention and concentration spans which are often associated with hyperactivity (as seen in Attention Deficit Disorder).
• FAS children also frequently display signs of aggression and can be very difficult for teachers and caregivers to handle.

Diagnosis
The diagnosis of FAS is based on the presence of the following abnormalities:

Size:
• Low weight
• Small height
• Small occipito-frontal circumference

Appearance:
• Small inner canthal distance
• Decreased length of the palpebral fissure
• “Railroad track” ears
• Strabismus
• Ptosis
• Flat nasal bridge
• Anteverted nares
• Thin border of upper lip
• Hirsutism
• Oral clefts

Behaviour:
• Attention-deficit disorder
• Hyperactivity

Coordination:
• Fine motor dysfunction

Cardiac:
• Cardiac abnormalities such as a cardiac murmur and cardiac malformations

Safe levels of Alcohol during Pregnancy
• There is still much debate as to what exactly the safe levels of alcohol consumption during pregnancy are.
• Therefore the best advice for women, is not to drink at all during pregnancy.
• Studies have indicated that 2 drinks a day, or 1 binge drinking session of 6 or more drinks, is sufficient to cause foetal alcohol syndrome

Treatment
• There is no way to reverse the effects of foetal alcohol syndrome.
• The child’s growth and development cannot be accelerated or improved.
• Developmental disorders can be managed with occupational and speech therapy, physiotherapy and other classes which teach language, motor, learning and social skills. Managing the difficult behaviour can be very trying for caregivers, teachers and parents.
• A skilled group of professionals is needed to improve the child’s behaviour, social skills, learning and development.
• Unfortunately most of these cases occur in poorer communities where access to the appropriate care for the child is limited.
• Furthermore, the parents of children with foetal alcohol syndrome are often alcoholics and often live in poverty. These parents are unable to care for their child properly and the child is unlikely to have access to the necessary therapies.

Prevention
• Alcohol related damage may be done to the foetus before the women realise that they are pregnant.
• Women of childbearing age should be counselled on the possible effects of alcohol consumption on a developing foetus.
• Women who are alcoholics or who partake in excessive alcohol consumption should be educated on the use of contraception in order to prevent accidental or unwanted pregnancies.
• Effective prevention involves preventing alcoholism, reducing poverty and preventing unplanned pregnancies. Achieving this is complex and difficult and involves designing and implementing effective protocols and strategies for awareness campaigns and community education. It also includes increasing the resources and staff to manage the prevention strategies.

Dr. Carrie Minnaar (M.Tech Hom.)

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