Preventing Fetal Alcohol Syndrome Disorders

What are Fetal Alcohol Spectrum Disorders?

Fetal Alcohol Spectrum Disorders (FASD) is a general term that basically includes two specific disorders that affect a fetus because the mother drinks alcohol between the child’s conception and birth.  The specific disorders are:

(a) Fetal Alcohol Syndrome: Abnormal development of the fetus’s face and sometimes internal organs, hands, and other body parts can be identified visually at the child’s birth.  The child can also have abnormal brain development which cannot be recognized at birth, but will eventually be recognized as the underlying cause of the child’s failure to develop neurologically and behaviorally as expected. These children typically have stunted growth in utero, during infancy, and sometimes through childhood. If the newborn has only one or two of the five typical facial abnormalities, they will be identified as having “Partial Fetal Alcohol Syndrome” (PFAS). About 15% of all cases of FASD involve FAS.

(b) Alcohol-Related Neurodevelopmental Disorder (ARND):  Abnormal development of the fetus’s brain, which affects some parts of the brain more than others is present though probably undetected during infancy; there are no outward physical malformations of the face or body.  The damage to the brain caused by the mother drinking alcohol extends along a continuum, from mild to severe, and impacts the size and the function of the brain.  ARND results in learning disabilities, flawed cognitive processes, poor executive function, delayed motor function, discrepancy between the developmental level of verbal and nonverbal skills, attention and hyperactivity problems, and social dysfunction. These children often have stunted growth in utero, during infancy, and sometimes into childhood. It is important to note that IQ can vary from less than 40 to 140. About 85% of all cases of FASD involve some degree of ARND.

The functional deficits in children born with FAS, PFAS, or ARND, vary in degree based upon a number of factors, including the amount of alcohol consumed, the timing of the alcohol intake (in relation to the weeks of fetal development), and genetic factors that determine the specific fetus’s metabolic ability to deal with the alcohol, as well as the mother’s ability to metabolize alcohol.  It is important to note that the damage present at birth will continue throughout the person’s life, but intervention, as early as possible, can lessen the effects and help to prevent secondary mental health disorders.

Prevention

Public health is founded on prevention.  Through prevention we reduce disease, save lives, and save limited resources.  Prevention is about “moving upstream” to find the causes for disease and death and addressing them before they do damage.

Since FASDs are disorders that develop between conception and birth, we need to identify the prenatal factors that lead to FASD and address them pro-actively, maybe even prior to conception, to eliminate them.

Primary Prevention of FASD:

Primary prevention consists of initiatives that are used with the general population or a specific population and are usually the responsibility of a government such as a nation, state, or county.  For example, one primary prevention for FASD is educating all people age 12 and over about FASD.  Another example is ensuring that all primary health care providers recommend family planning to all female patients age 17 years and over, including short and long term planning.

Secondary Prevention of FASD:

Secondary prevention consists of initiatives that are used with women whose living habits, circumstances, and/or environment put them at moderate to high risk for becoming pregnant and exposing the fetus to alcohol. One example is screening and providing a brief intervention for all women in the moderate to high risk group for FASD, such as mothers who have an FASD themselves or women who admit to frequent or binge drinking. Another example is installing pregnancy test kits in the ladies’ restrooms in bars or college dorms.

Tertiary Prevention:

Tertiary prevention involves initiatives that might occur after the child is born with an FASD but could potentially reduce the impact of the damage done by alcohol prenatally.  Screening infants who were born to moderate to high risk mothers and screening infants who are placed in foster/adoptive care are two examples of tertiary prevention.  If the child screens positive, the child is then further evaluated and referred for interventions that can lead to improved function for the child.  For example, an infant or toddler suspected of having an FASD should immediately be referred to Early Intervention for appropriate services.

To win the battle against Prenatal Alcohol Effect (PAE), all of these prevention methods must be used consistently across the map, across time, and across all sectors of the population.

 

Written by Lyn Becker

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