Fetal alcohol syndrome

Fetal alcohol syndrome: a growing concern for health care professionals

OBJECTIVE

To provide an integrated review of the literature on fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE), focusing on the definition of FAS/FAE, their incidence and related problems, gestational research findings, FAS symptoms, the effects of prenatal alcohol consumption on offspring over time, and FAS/FAE preventive measures.

DATA SOURCES

Computerized searches of MEDLINE and Web sites, as well as reference lists from published articles on FAS/FAE from 1973 to present.

STUDY SELECTION

Literature was chosen from refereed journals and from current publications of the National Organization of Fetal Alcohol Syndrome.

DATA EXTRACTION

Data were extracted using keywords relevant to FAS and FAS prevention.

DATA SYNTHESIS

The consumption of alcohol during pregnancy can harm the fetus irreparably. Preventive measures can be helpful in decreasing or stopping the use of alcohol during pregnancy.

CONCLUSIONS

Alcohol is a definite teratogen. The amount of alcohol, if any, that can be safely consumed during pregnancy, the exact physiological mechanisms that make alcohol unsafe for the fetus, and the most effective prevention measures have yet to be identified. FAS/FAE is still increasing in the United States.

Is there evidence to show that fetal alcohol syndrome can be prevented?

Fetal Alcohol Syndrome (FAS) is currently the major cause of mental retardation in the Western world. Since FAS is not a natural phenomenon and is created by mixing alcohol and pregnancy, the solution to decreasing the incidence of all alcohol-related birth defects is therefore entirely preventable. To date, little is known about the effectiveness of prevention programs in reducing the incidence of FAS. Therefore, it is the intention of this article to review the effectiveness of prevention programs in lowering the incidence of FAS. The present review revealed that prevention programs, to date, have been successful in raising awareness of FAS levels across the groups examined. However, this awareness has not been translated into behavioral changes in "high risk" drinkers as consumption levels in this group have decreased only marginally, indicating prevention programs have had minimal or no impact in lowering the incidence of FAS. Urgent steps must now be taken to fully test prevention programs, and find new strategies involving both sexes, to reduce and ultimately eliminate the incidence of FAS.

Fetal alcohol syndrome: maternal and neonatal characteristics

Alcohol is the most common identifiable teratogenic cause of mental retardation in North America. Fetal Alcohol Syndrome (FAS) is a major public health problem, which is frequently under diagnosed by physicians.

OBJECTIVE

To identify and quantify the maternal risk factors and neonatal characteristics of children with FAS.

DESIGN

A retrospective case-control study using birth certificate data of North Dakota children diagnosed with FAS. Five controls were selected for each patient. Controls were selected from the computerized birth registry and matched by gender, year and month of birth.

SUBJECTS AND SETTING

A list of all the children diagnosed with FAS from the North Dakota FAS Registry was sent to the State Health Department. We were able to locate the birth certificates for 132 (56%) of the 228 cases on the registry.

RESULTS

Of the 132 FAS cases, 106 (80.3%) were Native Americans and 24 (18.2%) were Caucasians. In this sample 51 (38.6%) of the cases were male and 81 (61.4%) were female. Statistically significant maternal characteristics at p < 0.01 were: older mother's age, lower education level, fewer months of prenatal care, fewer prenatal visits, lower gestational age at time of delivery and less prenatal weight gain. Significant neonatal differences at p < 0.01 were lower birth weight and Apgar scores and higher incidence of congenital malformations.

CONCLUSION

FAS is a completely preventable developmental disability. Consumption of alcohol during pregnancy can result in lifelong physical and mental impairments on the fetus. All pregnant women should be screened for alcohol use during prenatal visits. Women with positive screens or at high risk should be identified early by the primary care physician and referred for treatment and counseling.