It is widely known now that alcohol should not be taken by a woman during pregnancy and no amount is safe to drink during pregnancy. Alcohol is a teratogenic substance that can cause birth defects to a baby.
Alcohol exposure in utero is associated with a broad spectrum of developmental problems, ranging from learning disabilities to severe intellectual disability.
Fetal alcohol spectrum disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual exposed to alcohol prenatally.
Fetal alcohol syndrome (FAS) refers to the full syndrome associated with prenatal alcohol exposure.
The diagnosis of FAS requires the presence of a characteristic pattern of facial abnormalities (short palpebral fissures, thin upper lip, and indistinct or smooth philtrum, for which there are standard measurements), growth deficiency, and evidence of central nervous system (CNS) damage and neurodevelopmental abnormalities.
This diagnosis can be made with or without confirmed maternal prenatal use of alcohol.
Alcohol-related neurodevelopmental disorder does not require the presence of dysmorphic facial features, but it does require the presence of neurodevelopmental abnormalities or evidence of a pattern of behavioral or cognitive abnormalities. These abnormalities may include learning disabilities, poor impulse control, and problems in memory, attention, and judgment. These characteristics must be inconsistent with the child's developmental level and cannot be explained by familial background or environment. This diagnosis requires confirmation of prenatal alcohol exposure.
The diagnosis of alcohol-related birth defects requires a history of prenatal alcohol exposure, at least two characteristic facial features, and the presence of one or more congenital anomalies, including malformations and dysplasias in cardiac, skeletal, renal, ocular, or auditory areas (i.e., sensorineural hearing loss) or two or more minor anomalies (i.e., hypoplastic nails, clinodactyly).
It is not known exactly how many people have an FASD. The CDC studies have shown that 0.2-1.5 cases of FAS occur for 1000 births. Ohter studies have estimated the rate of FAS at 0.5-2.0 per 1000 live births. The prevalence of alcohol-related neurodevelopmental disorder is unclear but not uncommon. Thus, the physician should always ask about alcohol (and other drug) intake during pregnancy. This is particularly true when evaluating a child presenting with developmental delays. The exact amount of alcohol consumption that leads to teratogenesis remains unclear. Thus, it is best to say that in order to avoid an FASD, abstention from all alcoholic drinks during pregnancy is essential.
Essential to the evaluation of a child with FASD, or one suspected of having FASD, is an assessment by a multidisciplinary team. The evaluation should include examination of growth, facial and other dysmorphic features, developmental or cognitive abilities, behaviorial function, and the documentation of prenatal alcohol exposure.
Individuals with FASD typically have significant difficulty with complex cognitive tasks. They process information slowly. They may do well with simple tasks but have difficulty with more complex tasks. They have difficulty with attention and short-term memory. They are also at risk for social difficulties and mood disorders. Functional classroom assessments can be a very helpful part of a complete evaluation. Structure is very important for individuals with FASD.
Hay, W. W., Deterding, R. R., Levin, M. J., & Abzug, M. J. (2016). Current diagnosis & treatment pediatrics. New York, NY: McGraw-Hill.
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