Almost a century ago, Sullivan (a physician for the Liverpool prison in England), reported one of the earliest observations on teratogenic effects of alcohol among incarcerated alcohol-abusing mothers. Through the years, it was assumed that the adverse effects of alcohol on the infant were due either to some form of genetic damage or to "poor mothering". It was not until 1973 that Jones and Smith reported in Lancet on a characteristic pattern of malformations observed in eight children of alcoholic mothers. Their article utilized the term "Fetal Alcohol Syndrome"(FAS), for the first time, characterized by a spectrum of physical, developmental and behavioral characteristics, resulting from maternal alcohol consumption during pregnancy.

From 1979-1992, the reported cases of FAS (Birth Defects Monitoring Program) increased fourfold among newborns in the United States. The overall rate of FAS was 2.2 per 10,000 births (1979-1992). However, in 1993, the incidence of FAS was reported as 6.7 per 10,000 births, generating a concern as to "Are we dealing with a true increase or an increase in awareness?"

The adverse sequelae of alcohol abuse during gestation has been fairly well documenteFetal Alcohol Syndrome(FAS) and (2) Fetal Alcohol Effects (FAE). This has engendered particular interests and concerns for specialists in the field of developmental and behavioral pediatrics.

Fetal Alcohol Syndrome is characterized by a triad of (a) fetal growth deficiency (b) facial dysmorphology; and (c) mental retardation, (as well as a spectrum of organ and behavioral abnormalities). Fetal Alcohol Effects, despite the absence of the 'typical' triad, is similarly associated with a broad spectrum of pathologies; ranging from intrauterine growth retardation, congenital anomalies, hyperactivity, speech-language disorders, learning disorders, and varying degrees of cognitive impairment. It is recognized that FAS and FAE represent major causes of mental retardation.

A more comprehensive analysis of the "FAS Triad" reveals:

• Fetal Growth Deficiency: Characteristically the infants are born small for gestational age (birthweight <10th percentile for gestational age or low birth weight <2500g. Evidence indicates that small stature is a permanent sequelae of FAS.
• Facial Dysmorphology:A spectrum of common facial features have been associated with FAS; including:
  • long and flat philtrum
  • low nasal bridge
  • short palpebral fissures
  • thin upper lip
  • flat mid-face
  • small mandible
• Central Nervous System (CNS) Pathologies: Involve a 'spectrum of casualties,' involving gross and microscopic anatomical structures of the CNS.  The resultant damage is reflected by:
  • microcephaly
  • developmental delays
  • hyperactivity/attention deficits
  • speech-language delays
  • seizures
  • delayed fine motor development

  CNS injuries and its devastating sequelae present a psychoeducational challenge in recognizing that society is addressing a preventable cause of mental retardation!

  Although there appears to be a 'cause and effect relationship' between alcohol use and a poor outcome of the pregnancy, many significant questions remain unanswered: "How much is too much?' ... "Does the type of alcoholic beverage have any specific role? .... "Does the period during the pregnancy, when alcohol is consumed, make a significant difference in outcome?" .... "Are associated factors, such as nutrition and other substance abuses, the precipitating factors in initiating pathology?" .... "Does alcohol abuse have a counterpart in defective spermatogenesis?" Many of these issues constitute research challenges in FAS and FAE.  As a general rule, it is assumed that alcohol during pregnancy, engenders a high risk for fetal outcome, and only a specific warning can be  offered. "There is no safe dose of alcohol and no safe period for consuming alcohol during pregnancy." The disastrous triad associated with FAS, [(1) prenatal and/or postnatal growth retardation in height, weight and/or head circumference; (2) altered morphology, especially of facial structures; and (3) central nervous system involvement, usually with mental retardation] rates a public campaign of "warning",mandating avoidance of alcohol consumption during the course of pregnancy. The "cluster" of abnormalities prognosticates an extremely high risk for the offending parents-to-be.

  The primary goal of management is the prevention of an alcohol-abused fetus. Parent education is the most critical and significant component of a meaningful management strategy. For the victims of fetal alcohol abuse, a wide range of management interventions are required to assist with the associated language, educational, intellectual, psychosocial and financial problems inherent with this disorder, (often with frustrating results).

  Fetal Alcohol Effects, as a consequence of alcohol abuse during pregnancy, represents a myriad of congenital, developmental, educational, and behavioral sequelae (in the absence of the recognizable characteristics triad of FAS). The potential impact on cognitive development contributes to anxieties regarding ultimate IQ of the affected fetus. FAS and FAE are educational responsibilities for primary care physicians. For physicians providing care for adolescents, this responsibility is even more acute; recognizing the 'new' lifestyle of adolescents and their frequency of sex exploration practices.

  At this time, we have no defined markers to delineate who is most at risk for the adverse consequences of alcohol use during pregnancy. It appears that realistic counseling must admit to a lack of knowledge, addressing issues of "how much is too much?".

  
  

  Related Childrens' topics:
  Television Viewing: Impact On Child/Adolescent Development
  Gifted Children: Blessed or Handicapped?
  Latchkey Children: "Something To Think About"
  Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE)
        (Development-Behavioral Considerations)
  The Child In Educational Jeopardy
        (A Pediatrician's Perspective)
  Head Trauma: After Acute Care, Then What?
        (The Developmental-Behavioral Pediatrician's Perspective)
  Chronic Otitis Media - Speech/Language Disorders
        Learning Disabilities: Is There A Link?

  
  

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