All about Foetal Alcohol Syndrome

Foetal alcohol syndrome is the most severe form of a spectrum of disorders caused by drinking alcohol during pregnancy
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Foetal alcohol syndrome is the most severe form of a spectrum of disorders caused by drinking alcohol during pregnancy. BYY expert, paediatrician Dr Maraschin, talks about the effects on children.

Foetal alcohol spectrum disorder (FASD) affects each individual to a greater or lesser extent. Imagine a spectrum as a rainbow, a band of light that reflects different colours. The colours go from red to orange, yellow, green, blue, indigo and violet in a continuum of light. Suppose we imagine that in a spectrum, each colour represents several symptoms, ranging in severity, but ultimately, the collective falls within a specific disorder.

If we understand a range of colours, then we understand a spectrum. Mild cases may struggle with a few behavioural issues while another may have stunted growth, cognitive problems, behavioural issues and lifelong mental health difficulties. The most severe end of the spectrum is known as Foetal Alcohol Syndrome. (FAS)

How does Foetal Alcohol Syndrome occur? 

Let’s take a hypothetical exampple: Jenny and her husband Bryan had been married for three years. They had been speaking about falling pregnant, so Jenny had just stopped her contraceptive medication. Jenny’s best friend, Cathy, was getting married. Jenny was the matron of honour and decided to spoil Cathy. Before the kitchen tea, Jenny booked for the two of them to have their nails done. While they chatted excitedly, they sipped on a glass or two of bubbles, just like the old days.

On Saturday, Jenny hosted a beautiful kitchen tea for Cathy. That evening, all the young ladies went out for a bachelorette. It was a classy event at a lovely venue. They enjoyed some wine and, as often happens, a couple of shooters – nothing unusual for a girl’s night out. The wedding took place a month later. Jenny and Bryan had a wonderful evening – a couple of glasses of wine and a champagne toast to their special friends.

Jenny had been feeling a bit off and very tired in the weeks leading up to the wedding. Still, she wouldn’t allow this to get in the way of celebrating her friend’s special day. A week or so later, Jenny thought it best to consult her doctor as her symptoms weren’t improving. She was also late with her period but hadn’t given pregnancy a thought until now. The doctor confirmed that Jenny was indeed nine weeks pregnant.

The couple were overjoyed, although surprised that it had all happened so quickly. There was a little scare around the 14-week period when Jenny was advised to get some bed rest. Other than that, her pregnancy went well. Seven months later, they welcomed a baby boy, Joshua, into their home. He was a little small for gestational age but other than that; he was healthy.

How does FAS affect a child?

The first couple of weeks were not easy. Joshua had difficulty sucking. Breastfeeding was a struggle, and Joshua didn’t gain weight as he should. Jenny eventually decided to bottle feed Joshua, as he managed to do it more easily. She was reassured by all around that many mothers struggle with breastfeeding. His sleep was also an issue, but many young parents complained about a lack of sleep.

By the age of 2 years, Joshua was not speaking. Jenny and Bryan were concerned about his tantrums and inability to sit still for any length of time. They even avoided going out with friends, as Joshua would make life difficult, while other babies were content with playing, chatting and entertaining themselves. 

The couple decided that it was time to take their child to a paediatrician, with all of their specific concerns written down so they didn’t forget anything. The paediatrician noted all their concerns. She then plotted Joshua’s growth, which was found to be below average in terms of his weight, height, and head circumference. The paediatrician examined the child and made a note of her findings. His lack of speech, disruptive behaviour and developmental delays were of concern. The paediatrician asked the parents make a follow-up appointment to discuss her findings with them and go through the various options for a plan to deal with Joshua going forward. 

When Jenny and Bryan returned the following week, the paediatrician presented them with her findings. Many of the findings and details given to her by Jenny and Bryan led her to believe that Joshua may have any of four syndromes. These included Autism spectrum (ASD), Williams Syndrome, a possibility of an attention deficit disorder or Foetal Alcohol Spectrum disorder. 

Given Joshua’s facial features, the paediatrician felt that the most likely diagnosis was that Joshua fell somewhere under the umbrella of a Foetal Alcohol Spectrum Disorder. (FASD)

Visit: Pregnancy Weight Gain Calculator

The parents asked questions and the doctor tried to answer:

  1. Bryan: When could this have happened?

Doctor: Some of the most severe problems occur when a woman drinks alcohol in the first trimester of her pregnancy.

Jenny: I didn’t know I was pregnant at the time of the nails, bachelorette party, or wedding.

  1. Jenny: I didn’t have that much to drink. How could this happen? 

Doctor: Unfortunately, we don’t have a measure of how much alcohol will cause damage. What we do know is that if you drink during pregnancy, your baby will be at risk. This is especially true during the first trimester.  

Jenny: I was in the first trimester when the celebrations were taking place.

  1. Jenny: But, I never had any hard liquor…

Doctor: Wine, beer, hard ciders and hard liquor can all harm a foetus.

  1. Bryan: What happened that our baby could have been so affected?

Doctor: Alcohol is passed through your bloodstream to your foetus via the umbilical cord. The umbilical cord is formed by week three. A foetus is unable to break down the alcohol, so alcohol consumed at any stage of pregnancy remains in the foetus for a longer period than it would an adult. During this time, it interferes with development.

Remember that the heart cells of a foetus cluster by 5 to 6 weeks and begin to pulse. Little buds form that will become the arms and legs. By the eighth week, most of the organs and systems will have taken shape. Alcohol affects the foetus in the following ways:

  • Alcohol kills cells in different parts of the foetus and may result in abnormal physical development. 
  • The major damage is done to the brain and nervous system. The baby’s brain begins to develop during the first trimester, making it very sensitive to any interference. When we drink alcohol as adults, by products are formed. These are, in fact, toxins. Our mature livers are usually able to process the toxins. Unfortunately, these toxins build up in the foetus’s brain and interfere with how nerve cells develop and function. 
  • Alcohol causes the blood vessels to constrict. This means that the blood flow from the mother to the placenta slows down. When this happens, oxygen and critical nutrients are unable to reach the foetus as they should. A lack of oxygen or food will negatively impact the development of a foetus.
  • During the pregnancy, this would increase the risk of miscarriage, prematurity or a low-birth-weight baby. After birth, a child that was exposed to alcohol during pregnancy may suffer from some form of damage, which places them on the spectrum of foetal alcohol syndrome.
  1. Bryan: Many of our friends have conceived while on holiday or over the festive season when they are partying up a storm. Why doesn’t this happen to their children?

Doctor: In truth, there are very few statistics on Foetal Alcohol Syndrome. Since it is a spectrum, some children have very mild symptoms and may go throughout their lives, never knowing that they fall on this spectrum at all. They may just be an individual with a slight learning difficulty.

Another may have sight or hearing problems, and another may have attention issues. Generally, mothers aren’t comfortable talking about alcohol consumption when they are pregnant, but we know that roughly 1 out of 9 pregnant women do consume alcohol at some point during their pregnancy. Like you say, many couples conceived during the festive season. Given the available data, scientists estimate that there are less than 2 cases of Foetal Alcohol Syndrome babies in every 1000 births in America. Foetal Alcohol Syndrome (FAS) is at the far end of the spectrum.

But let’s take all cases, beginning with the mild cases and moving across to the severe cases. We are likely to find that 1 to 5 out of every 100 children in America and Europe fall somewhere under the umbrella of this disorder. Given these statistics, we believe that our South African statistics are pretty similar.  

Read: 21 early signs of pregnancy

  1. Jenny: Why did we have to wait until now to be given this information? 

Doctor: Severe cases of Foetal Alcohol Syndrome can be diagnosed at birth, but many of the typical physical features tend to become evident between the ages of eight months and eight years. Very early on, the signs may be slow growth in the womb or weight issues after birth.

In the early years (0 to 5 years), these children may suffer from poor sleep cycles, attention deficits, and impulsivity and do not often cope well with change. If we take these features on their own, one can see that many children may, in fact, display these characteristics.

In our initial consultation, I was concerned about the presence of these characteristics, along with your concern about his language delay and behavioural issues. Joshua’s facial features added to the picture. No one facial feature can be used to diagnose this disorder, but if we put everything together, Joshua’s little eyes, his thin upper lip, the absence of the ridge between his nose and upper lip and the shape of his nasal bridge all lead us to this diagnosis.

Check out: What is an Ectopic Pregnancy?

Doctor: Let me show you a picture of the classic features:

Foetal Alcohol Syndrome classic features in children

  1. Bryan: Can’t you just do a test and tell us for sure if our boy has this syndrome?

Doctor: Bryan, I know that this has come as a terrible shock. You are loving parents who want the best for your child. Unfortunately, there isn’t a test that I can do which would either confirm or refute this diagnosis. We have to base our diagnosis on Joshua’s physical signs and symptoms.

What we know already is that there was alcohol exposure in the first trimester. He has abnormal facial features. He was small at birth, and the measurements we took at our last consultation indicate that he is below average now. His speech is impaired and he is already showing signs of emotional and behavioural issues.

I am sorry to bear difficult news, but you are courageous parents who initiated the process when you sought my help. You knew Joshua was different to the other children in your friendship group.

  1. Jenny and Bryan: But what now? 

Doctor: You have already ticked the first two boxes. Making a diagnosis before the age of 6 years is critical. Providing Joshua with a loving and supportive home during the school years is extremely important.

I can see that you are strong and positive as a couple, but support groups will be available to you at any time you need them. You will have bad days, and when that happens, don’t be afraid to ask for help. At a later stage, Joshua may require medication to help him with his attention issues. Joshua is likely to need therapy to address his educational and behavioural issues. Many capable and compassionate therapists can assist you. These interventions can begin immediately. I can refer you to a number of centres, and somewhere in there, you will find your tribe.

There are many parents, like yourselves, coming to terms with complicated diagnoses. The silver lining on the rainbow is that you have not been afraid to address the issue. You are here and willing to seek support. The days ahead will not all be sunny, but you have taken the first steps to provide Joshua with the best possible outcome. 

The parents were struck by the enormity of the task ahead of them. Joshua was going to need a lot of support to get through life. The thought of having another child was terrifying, but unlike other disorders, Foetal Alcohol Syndrome can be avoided.

Later, Jenny and Bryan set up an organisation to provide education to couples about the dangers of alcohol. Their slogan, No alcohol can be considered safe when thinking about getting pregnant or any time during those precious nine months.” 

My scenario was intended to bring you the facts about this disorder. It is a spectrum. That means that it may affect children in a very subtle way but may also have devastating effects. Later in life, these children are more likely to suffer from mental illnesses like depression, anxiety and eating disorders. School is a real struggle, so the tendency to hide in the shadows and associate with the wrong crowd becomes a reality. This leads to alcohol and drug abuse as well as inappropriate sexual behaviours.

Due to their behavioural problems like aggression and rule-breaking, these children often find themselves in trouble, and many fail to complete school. Unfortunately, there is no cure. There is management. This is critical to a positive outcome. The message that needs to be put out there is that this disorder can be prevented. No amount of alcohol is safe. If you are thinking of getting pregnant, then alcohol has to be eliminated 100% before and during the pregnancy. The long-term damage of a short-lived pleasure is not worth it. 

Also read: SA’s Teen pregnancy problem


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