Foetal alcohol syndrome (FAS) describes a characteristic pattern of abnormalities associated with alcohol intake during pregnancy
The higher the alcohol intake, the more severe the abnormalities
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There are characteristic facial, limb and heart abnormalities
Foetal development is delayed and mental retardation is common
There is no known safe limit to alcohol in pregnancy so women are advised not to drink at all
What is foetal alcohol syndrome (FAS)?
Drinking alcohol during pregnancy can damage the embryo and foetus as it develops, leading to a characteristic pattern of malformation which is identified as FAS.
FAS is not an “all-or-none phenomenon”. There is a spectrum of severity from the full blown syndrome to no defects at all. The higher the amount of alcohol consumed, the greater the degree of malformation. The safe limit for alcohol intake during pregnancy is not known.
Poor nutritional intake and smoking during pregnancy are additional adverse factors which probably aggravate the ill-effects of alcohol on the infant.
The term “Alcohol related birth defect” (ARBD) is now applied to the child with some of the typical alcohol-related organ defects but not the full picture. The term “Alcohol-related neurodevelopmental defect” (ARND) is used for the child who is developmentally affected but does not show the structural anomalies of fully developed FAS.
Who gets FAS and who is at risk?
South Africa has one of the highest incidences of FAS in the world, with the greatest prevalence reported in the Western Cape. A recent study in the Boland around the town of Wellington showed that 48 out of 1000 children in their first year at school had FAS. This is 36 times higher than the figure for Western nations, which is 1,33 children per 1 000.
Infants born to heavy drinkers have twice the risk of abnormality compared to those born to moderate drinkers. Among heavy drinkers, 32% of infants were born with congenital abnormalities compared with 9% in those who did not drink at all, and 14% in those who drank moderately.
Rates are highest in poor rural communities with a culture of heavy drinking, which had its historical origin in the “dop system” (paying farm-workers in alcohol), and in the building of beer-halls.
What are the features of FAS?
The principal clinical features of FAS comprise three groups of signs:
Growth deficiency
Poor growth in length, head circumference and weight, which starts in the womb and continues after birth
Central nervous system involvement
Delayed development or mental handicap which ranges from borderline to severe.
Learning difficulties (with specific deficits in mathematics), poor school performance, deficits in receptive and expressive language, short concentration span, poor memory, hyperactive behaviour and poor judgment are some of the characteristic findings in children with FAS.
Facial features
In the fully developed syndrome the facial appearances are characteristic:
Small eyes with epicanthic folds (folds at the inner aspects of the eyes)
A flattened nasal bridge with upturned nostrils
A smooth thin upper lip
A small lower jaw
Other birth defects may be present, such as:
Heart defects, mainly in the walls which divide the chambers of the heart (the ventricles)
Minor joint and limb abnormalities, including some restriction in movement and altered creases in the palms of the hands
Kidney anomalies
And many others
The Western Cape study showed that affected school-entrants had poor language ability, problems with fine motor activities, poor eye-hand coordination and difficulties with practical reasoning.
How is FAS diagnosed?
The diagnosis is based on a combination of a history of drinking during pregnancy and the characteristic pattern of abnormalities. There are no biological markers or laboratory methods for diagnosing the disorder.
ARND and ARBD can only be diagnosed if there is a clear history of (usually heavy) drinking during that pregnancy.
How is FAS treated?
There is no specific treatment.
These children require special schooling and intervention to help them with coordination and problems with motor activities.
What is the outcome of FAS?
In severe cases the outlook is poor, with severe developmental delay and mental retardation. In mild cases, people can lead relatively normal lives provided the correct schooling and therapy is available. This is often not the case as these children tend to be born into very poor circumstances.
Can FAS be prevented?
Yes, by not drinking during pregnancy. Since a safe lower limit of alcohol during pregnancy is not known, it is best not to drink at all.
Community education on the dangers of alcohol abuse is an urgent requirement
Another is to improve maternal nutrition prior to and during pregnancy
Most important is the alleviation of poverty in rural areas
In the Western Cape prevention workshops, community upliftment programmes, campaigns against the “dop system”, life skills and educational programmes and new labour laws are being introduced.
Reviewed by Prof M. Kibel, Emeritus Professor of Child Health.
Further reading:
For a full description see D Viljoen; Fetal Alcohol Syndrome. In: Child Health for All – A manual for Southern Africa (eds. Kibel MA & Wagstaff LA) OUP (Cape Town) 2001.
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