Foetal alcohol syndrome

Foetal alcohol syndrome (FAS) is the name given to a group of birth defects that is the direct result of a woman's drinking alcohol during pregnancy. It is the leading known cause of mental retardation. FAS manifests as a series of mental and physical birth defects that can include mental retardation, growth deficiencies, central nervous system dysfunction, craniofacial abnormalities and behavioral maladjustments. Foetal alcohol effect (FAE) is a less severe set of the same symptoms. FAS/FAE produces irreversible physical, mental and emotional effects. Behavioural and mental problems of FAE children can be just as severe as those of FAS children. Many children with FAS/FAE are not able to understand cause and effect relationships and long-term consequences.

When a person ingests more alcohol than her liver can process, the excess is released into the bloodstream to circulate until it can be detoxified. Once the placenta of a pregnant woman is formed, any raw ethanol present in her body envelops the foetus, where it is distributed in the liver, pancreas, kidney, thymus, heart and brain, concentrating in the grey matter of the developing child. It may interfere with zinc metabolism, with hormonal balance, or with the ability of the placenta to carry oxygen, thus creating anoxia and subsequent brain damage, especially during the first and third trimesters when brain development is most crucial.

Clinically alcohol is an insult to the foetus that can be manifested in a wide variety of symptoms comprising: prenatal and postnatal growth deficiency; a particular pattern of facial malformations, including small head circumference, flattened midface, sunken nasal bridge, and a smoothed and elongated philtrum (the groove between the nose and upper lip); central nervous system dysfunction; and varying degrees of organ system and physical malformation, such as teeth problems, cleft palate and clubfoot. Mental deficiency, in varying degrees, is the most debilitating aspect of FAS in those children who survive. The mean IQ for such individuals is between 65 and 80 or, in the terminology of psychological testing, from "mildly retarded" through "borderline" to dull normal". FAS children at all ages and stages of growth lag behind their peers in everything from rate of language acquisition to arithmetic skills, quite independently of the nurturing environment. They have little sense of personal space, have excessive curiosity and can be intrusively "touchy" and affectionate to strangers. They are easily influenced by others, and have difficulty comprehending social situations and showing appropriate behaviour.

The notion that alcohol is bad for a baby's health is not new. The Old Testament of the Hebrew Bible contains a very specific proscription to the wife of Zorah to "beware, and drink no wine or strong drink, and eat nothing unclean, for lo, you shall conceive and bear a son" (Judges : 13). As early as 322 BC, Aristotle noted that "foolish, drunken, or hare-brained women for the most part bring forth children like unto themselves, difficult and listless" (Problemata).

In the USA, at least 5,000 infants are born each year with FAS, or approximately one out of every 750 live births. Thirty to forty percent of babies whose mothers drink heavily throughout pregnancy have the syndrome. FAS/FAE is a problem found in all races and socio-economic groups. FAS and FAE are widely under diagnosed. Some experts believe between one third and two-thirds of all children in special education have been affected by alcohol in some way. The institutional and medical costs for one child with FAS are $1.4 million over a lifetime. Of a study group of 61 FAS and FAE adults, 86% had experience neglect, 52% abuse, 80% has "attention deficits", that is they could not concentrate on a single task for an extended period of time; 73% had memory problems, 72% had been classified as hyperactive. 95% could not handle money on their own and none were financially self-supporting. Ordinary duties like taking care of their own health, their own clothes, saving money, and making purchase independently were accomplished only four. Only half were able to care for their hygienic needs.

There are an estimated 70,000 foetal alcohol-impaired children born each year in the USA. Of these approximately 7,500 are clinically FAS, with mean birth weight around 5 lbs and 34% premature. Alaska has the highest incidence and certain portions of the state record the highest FAS rate among any population in the world. In 1985, the USA National Institute on Alcohol Abuse and Alcoholism spent $2.9 million on FAS research. This is less than 1% of the conservative estimate of the social costs of FAS.