Module 2: Fetal Alcohol Spectrum Disorders
Module 2 of the Pregnancy & Alcohol Cessation Toolkit
Pregnancy & Alcohol Cessation Toolkit
By the end of this module you should:
- Understand why and how alcohol affects the fetus
- Be aware of the evidence about timing of exposure and risk
- Know the additional risk factors which should be identified and managed in pregnancy
- Know the key messages to tell pregnant women
- Understand the clinical spectrum of FASD
- Be aware of the added consequences that differ from classical features of FAS
2.1 How does Alcohol affect the Fetus and Child? (1-3)
- Alcohol is a teratogen − a substance that may affect the development of a fetus
- Alcohol passes freely through the placenta and reaches concentrations in the fetus that are as high as those in the mother
- Alcohol passes from maternal blood into the breast milk where the usual hepatic enzymes for metabolism and detoxification can’t reach it
- The fetus has only a limited ability to metabolise alcohol
- Research on the relationship between alcohol consumption during pregnancy and child outcomes is complicated by multiple prenatal and childhood factors, and the difﬁculty of obtaining accurate information on the level of exposure
- Miscarriage and stillbirth are among the possible consequences of alcohol exposure in pregnancy
- In the child, alcohol exposure in pregnancy can result in prematurity, brain damage, birth defects, growth restriction, developmental delay, and cognitive, social, emotional and behavioural deﬁcits
- As the child grows, the social and behavioural problems associated with alcohol exposure in pregnancy may become more apparent
- Intellectual and behavioural characteristics in individuals exposed to alcohol in pregnancy include low IQ, inattention, impulsivity, aggression and problems with social interaction.
- These problems can be misdiagnosed unless the fact of intra-uterine alcohol exposure is known and considered in the clinical evaluation
2.3 Evidence on Dose, Timing and Risk(1-3)
- The amount of alcohol that is safe for the fetus has not been definitively determined
- Not all children exposed to alcohol during pregnancy will be affected to the same degree, and a broad range of effects is possible
- Exposure to nicotine or other drugs in combination with alcohol during pregnancy may potentiate harmful effects associated with each of them
- The level of harm is generally related to the amount of alcohol consumed, the frequency of consumption and the timing of the exposure although genetic and maternal health factors play a part
- Structural damage to the viable fetus is more likely to occur with high amounts of alcohol and, in particular, a pattern of drinking where high amounts of alcohol are consumed on any one occasion in early pregnancy
- The impact of alcohol on the developing central nervous system can occur at any time during pregnancy
- Both human and animal studies have shown that there is a great deal of variation in the traits or features of FASD regardless of the timing and dose suggesting that genetics plays a significant part in the outcome
BEST ADVICE! NO DRINKING IS SAFE DURING PREGNANCY AND WHEN BREAST FEEDING
- All types of alcoholic beverages can be harmful during pregnancy
- The risk to the fetus is generally proportional to the amount of alcohol consumed
- Damage is most likely to occur with high blood alcohol levels, or high levels of metabolites, particularly in early gestation
- There is no safe time to drink alcohol during pregnancy
- Breast feeding should be encouraged - noting that feeding mothers should be aware that alcohol crosses into the breast milk. Advise to limit alcohol consumption or to feed before having a drink of alcohol (limit to less than 2 standard units).
2.4 The Fetal Alcohol Spectrum Disorder (1-3)
Fetal alcohol spectrum disorder (FASD) is a general term that was introduced in 2004 to describe the range of effects that can occur in an individual who was exposed to alcohol in utero.
The effects include physical, mental, behavioural and learning disabilities, with life-long implications.
Recent multi-site studies using active case-based ascertainments, estimate the prevalence of FASD in alcohol consuming countries to be in the vicinity of 2-5%.
FASD is not a diagnostic term.
Rather it refers to a range of deficits that are categorised in diagnostic terms as fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (p-FAS), alcohol-related birth defects (ARBD) and alcohol-related neurodevelopmental disorder (ARND).
The accurate diagnosis of these conditions is often complex.
For example, the characteristic facial features often associated with fetal alcohol syndrome may not be very evident at birth, tends to normalise in adolescence and may be difﬁcult to detect in some ethnic groups or resemble those associated with other syndromes.
Accurate differential diagnosis is best achieved by a multidisciplinary clinical team comprising of at least a medical professional and a clinical psychologist trained in FASD diagnostic protocols.
- The Centre for Disease Control FASD Homepage
- Public Health Agency of Canada FASD Homepage
- Motherisk Fetal Alcohol Research
- Alcohol Research & Health Special Edition on FASD
- Alcohol Healthwatch Report Toward Multidisciplinary FASD Diagnosis in New Zealand
- Fetal Alcohol Network NZ - www.fan.org.nz
- May, P., Gossage, P., Kalberg, W., et al. (2009). Prevalence and epidemiologic characteristics of FASD from various methods with an emphasis on recent in-school studies. Developmental Disabilities Research Review 15: 176−92
- May, P. & Gossage, J. (2011) Maternal Risk Factors for Fetal Alcohol Spectrum Disorders: Not As Simple As It Might Seem. . Alcohol Research and Health 34(1), 15-26.
- Jones, K. and Streissguth, S. (2010) Special Edition Introduction: Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders: A brief history. Journal of Psychiatry & Law 38(4), 373-382.
Credit: Fetal Alcohol Child - Yahoo Images
Conﬁrmed alcohol exposure in pregnancy is a feature of all FASD conditions.
- Fetal Alcohol Syndrome:
- Characteristic facial features (such as a ﬂat mid-face, low nasal bridge, short nose, thin upper lip)
- Growth restriction
- Central nervous system abnormalities
- And the subtype p-FAS:
- partial fetal alcohol syndrome
- Alcohol-related Birth Defects:
- Birth defects (including cardiac, skeletal, auditory, ocular, renal defects)
- Alcohol-related Neurodevelopmental Disorder:
- Central nervous system neurodevelopmental abnormalities
- Central nervous system neurodevelopmental abnormalities
2.6 Self-evaluation exercise