Fetal alcohol syndrome

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

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Fetal alcohol syndrome (FAS) is caused by the mother's alcohol consumption during pregnancy. It is characterized by physical and mental damage, malformations and development of deficiencies. FAS is incurable, but with the right encouragement and support, life can be made easier for those affected. Read more about fetal alcohol syndrome (FAS): symptoms, causes, diagnosis, therapy and prognosis!

Fetal alcohol syndrome: description

Fetal alcohol syndrome (FAS) is the term used by doctors to describe the prenatal damage caused to a child by the mother's alcohol consumption. Another term for FAS is alcohol embryopathy.

Fetal alcohol syndrome: frequency

Experts estimate that around 10,000 babies with alcohol-related damage (Fetal Alcohol Spectrum Disorders, FASD) are born in Germany every year. Probably more than 2,000 of them have the highest degree of damage - a fetal alcohol syndrome. This makes the FAS one of the most common congenital disabilities in Germany.

There are no exact numbers on the frequency because the damage is often not recognized or not correctly diagnosed. On the one hand, this is due to the difficult proof (see below). On the other hand, employees in the health system are often reluctant to express suspicions to their parents. Or they don't know enough about Fetal Alcohol Spectrum Disorders and Fetal Alcohol Syndrome themselves.

Fetal alcohol syndrome: symptoms

Childhood deficiencies and malformations characterize a fetal alcohol syndrome. For example, the face and head show various changes and anomalies. These include:

• an unusually small skull (microcephalus) with impaired brain development
• short, narrow and slightly upward sloping eyelids
• drooping of one or both eyelids (ptosis)
• an additional fold over the inner corner of the eyelid (epicanthus)
• a wide eye relief
• a short, flat nose
• a missing or weak furrow between the nose and mouth (philtrum)
• a thin upper lip with a narrow red lip
• the underdevelopment (hypoplasia) of the lower jaw
• small teeth

Sometimes a cleft palate also appears. Other signs of fetal alcohol syndrome can include:

• Short stature in the womb and after birth
• Malformations of the joints and skeleton such as the funnel chest
• decreased basic tension of the skeletal muscles (muscular hypotension)
• Malformation of the internal organs (such as heart defects, malformations of the kidneys)
• Deformity of the genitals
• psychomotor restlessness (many patients also suffer from ADHD = attention deficit / hyperactivity disorder)
• physical and mental retardation ("lagging behind")

The influence of prenatal alcohol also has a wide range of effects on the mental abilities of a child: The affected person's processing of information and perceptions is impaired. The possible consequences are, for example, social withdrawal, fear of new situations, activity, easy influenceability and exploitation.

Other children who have fetal alcohol syndrome tend to behave aggressively and exhibit disrupted social behavior (such as rebellion). Such impulse control disorders also occur in many adult patients (see below).

Fetal alcohol syndrome can also be associated with hearing and visual impairment and a hernia.

The extent of the damage varies

The severity of alcohol embryopathy can vary. In mild cases, those affected show “only” growth retardation, underweight and a brain skull that is too small (microcephalus). In more severe cases, additional damage and malformations occur, such as facial anomalies, organ malformations and mental impairments. The latter can range up to severe intellectual disability.

FAS syndrome in adults

Fetal alcohol syndrome in adulthood is often associated with other disorders. These include depression, anxiety disorders, and impulse control disorders. Some of those affected also show an increased risk of addictions, abnormalities in sexual behavior and antisocial developments. This can massively impair the adaptation to social norms and cause difficulties in everyday life (problems with looking for a flat and job, in social relationships, etc.).

Fetal alcohol syndrome: causes and risk factors

In unborn children, the so-called placental barrier prevents various pollutants and pathogens from entering the child's blood from the maternal bloodstream. However, this protective filter does not work 100 percent.

For example, alcohol from the mother's blood can pass almost unfiltered into the blood of the unborn child. Studies have shown that as little as 10 grams of alcohol a day can cause fetal alcohol syndrome in children. This amount can be found in a small beer or 100 milliliters of wine.

Alcohol is a poison for the human body in every phase of life. The fact that unborn children are particularly sensitive to this is because their immature livers are not yet able to break down alcohol so well. This can damage cells more than in adults and inhibit cell division - with a wide range of consequences, especially for the sensitive brain. The damage and changes lead to Fetal Alcohol Spectrum Disorders (FASD). In the worst case scenario, Fetal Alcohol Syndrome (FAS) will develop.

That being said, alcohol consumption during pregnancy increases the risk of miscarriage.

Risk factors for fetal alcohol syndrome

Not all children whose mothers consume alcohol during pregnancy develop alcohol embryopathy. According to recent research, the nucleus of some of the unborn babies is genetically protected from damage caused by alcohol.

The risk of developing fetal alcohol syndrome in children is especially high if the mother consumes a lot of alcohol during pregnancy. However, there is also a risk of FAS if the mother-to-be drinks alcohol over and over again over the entire nine months - even if it is only moderate amounts. And even sporadic or one-time consumption of alcohol can damage the embryo.

The consumption of wine & Co. in the 1st and 2nd trimester of pregnancy is particularly dangerous. The risk of FAS increases if the mother also consumes amphetamines or various other drugs.

Other risk factors for fetal alcohol syndrome include:

• the age of the mother> 30 years
• maternal malnutrition or lack of trace elements or vitamins
• stress
• Siblings with FASD
• genetic background

Fetal alcohol syndrome: examinations and diagnosis

Ideally, fetal alcohol spectrum disorders (FASD) or fetal alcohol syndrome (FAS) should be detected as early as possible. The affected children can then quickly receive adequate and individual encouragement and support.

Problems with diagnosis

However, fetal alcohol spectrum disorders and fetal alcohol syndrome are often not so easy to diagnose. This is due, for example, to the fact that maternal alcohol consumption during pregnancy is difficult to record - for example because the mother gives false information about it. In addition, many children in Germany with fetal alcohol syndrome live in adoptive and foster families - the alcohol consumption of the biological mother is then difficult to determine.

Another problem is that many of the symptoms of fetal alcohol syndrome change with age. For example, facial anomalies and impaired growth are clearly recognizable in childhood, but less noticeable in adolescence and adulthood.

In contrast, attention and behavior disorders, for example, become more common with adolescence.

Exclusion of other causes

For a reliable diagnosis of alcohol embryopathy, other causes must be ruled out (differential diagnoses). For example, short stature can also be caused by short stature in the family, by prenatal deficiencies, hormonal disorders, genetic syndromes, chronic diseases or by neglect.

FAS diagnostics

Experts have developed diagnostic criteria for fetal alcohol syndrome. According to this, there is a FAS if someone fulfills the following four points:

1. at least one growth problem (unusually low birth or body weight, reduced birth or body length or low body mass index = BMI)
2. three abnormalities on the face, namely a narrow upper lip, missing or poorly pronounced furrow between nose and mouth and short eyelid slits
3. at least one abnormality of the central nervous system (such as intellectual disability, impaired speech or fine motor skills, attention disorders, microcephalus)
4. Alcohol consumption by the mother during pregnancy

If the first three points are met, but maternal alcohol consumption during pregnancy cannot be confirmed, the diagnosis “fetal alcohol syndrome” should still be made.

Fetal alcohol syndrome: treatment

The damage that alcohol caused to a child in the womb is irreversible. You can operate on some of the physical malformations such as a heart defect or a cleft palate. In addition, visual and hearing disorders can be corrected with aids (glasses, hearing aids).

However, most of the consequences of a fetal alcohol spectrum disorder or fetal alcohol syndrome cannot be remedied. These include, for example, mental impairments, behavioral problems, short stature and facial anomalies.

Instead, the treatment of FASD and FAS is about helping those affected deal with the alcohol-related disorders and abnormalities as well as possible. For example, children with developmental delays can benefit from physiotherapy, speech therapy and / or occupational therapy. Under favorable conditions, some development deficits can then be partially compensated.

In the case of traumatic experiences in early childhood (e.g. with an alcoholic mother), psychotherapeutic help can also be useful. If FAS sufferers also suffer from ADHD, behave very aggressively or show severely disturbed social behavior, concomitant treatment with medication may be indicated under certain circumstances.

Which funding and supporting measures are appropriate in each individual case is decided on an individual basis.

Fetal alcohol syndrome: disease course and prognosis

A fetal alcohol spectrum disorder or a fetal alcohol syndrome is incurable. The mental and physical changes, developmental disorders and behavioral problems that occur usually remain permanent. The prognosis depends primarily on the extent of the cognitive impairment. Severely affected children are usually unable to lead an independent life and are dependent on outside help for their entire life.

Fetal alcohol syndrome often requires inpatient treatment in the first two years of life - due to the frequent infections, failure to thrive and possibly required operations.

Because of the social problems, many affected children cannot stay with their birth parents, but have to be placed in foster families or homes.

Fetal alcohol syndrome: prevention

Alcohol consumption during pregnancy is one of the few completely preventable causes of severe developmental disorders in children. Experts recommend pregnant women to completely avoid alcohol. Even moderate alcohol consumption can cause a fetal alcohol spectrum disorder or even a fetal alcohol syndrome in the unborn child.

Tags:  drugs Baby Child alcohol