Fetal alcohol syndrome and fetal alcohol effects
Fetal alcohol syndrome and fetal alcohol effectsPrenatal alcohol exposure is a preventable cause of birth defects, including mental retardation and neurodevelopmental deficits. Since the initial recognition in 1968 of the multiple effects that alcohol can have on the developing fetus [1] and the subsequent delineation in 1973 of fetal alcohol syndrome (FAS), [2] it has become clear that prenatal alcohol exposure can be associated with a wide range of abnormalities. [3]
More than 80% of children with FAS demonstrate prenatal and postnatal growth deficiency, mild to moderate mental retardation, microcephaly, infantile irritability, and characteristic facial features. Fifty percent of affected individuals also have poor coordination, hypotonia, attention deficit disorders with hyperactivity, decreased adipose tissue, and other identifiable facial features. Additionally, 20% to 50% of affected children demonstrate a variety of other birth defects, including cardiac anomalies, hemangiomas, and eye and ear anomalies. [2,4,15,16]
Even in the absence of growth retardation or congenital abnormalities, children born to women
who drank alcohol excessively during pregnancy appear to be at increased risk for attention deficit
disorders with hyperactivity, fine-motor impairment, and clumsiness as well as more subtle delays in
motor performance and speech disorders. [4] These findings have been referred to as fetal alcohol
effects (FAE).
As recently described, FAS and FAE produce profound cognitive, behavioral, and psychosocial problems that persist to date of follow-up of those affected. In the most comprehensive and far-reaching study to date, Streissguth et al [5] traced the natural history into adulthood and demonstrated the profound, pervasive, and persistent nature of the biopsychosocial manifestations of these disorders. Cognitively those affected maintained subnormal intellectual functioning; demonstrated specific arithmetic deficiency; had extreme difficulty with abstractions such as time and space, cause and effect; and could not generalize from one situation to another. They also demonstrated inattention, poor concentration, memory deficit, impaired judgment, and impaired comprehensive and abstract reasoning.
Behavioral problems such as hyperactivity and impulsivity as well as conduct problems such as
lying, stealing, stubbornness, and oppositional behavior were manifest. These behavioral problems
were qualitatively and quantitatively different from those found in other forms of mental retardation.
[6]
None of those in the study [5] were age appropriate in terms of socialization or communication
skills. Maladaptive social function was evidenced by their failure to consider consequences for their
actions, lack of response to appropriate social cues, lack of reciprocal friendships, social withdrawal, sullenness, mood lability, teasing and bullying behavior, and periods of high anxiety and excessive unhappiness.
Fetal alcohol syndrome is one of the most common identifiable causes of mental retardation,
[3] with a worldwide incidence estimated to be 1.9 per 1000 livebirths. [7] However, when children
with less severe manifestations of the syndrome (FAE) are included, the...
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