Alcohol and human health
Alcohol and human health

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Alcohol and human health

1.5 Fetal alcohol syndrome

There are a range of disorders associated with maternal alcohol consumption during pregnancy which are collectively known as fetal alcohol spectrum disorders, FASDs. The best characterised is fetal alcohol syndrome, FAS. FAS is defined by four criteria, the first of which is excessive maternal alcohol intake during pregnancy, the other three being:

  1. a characteristic pattern of minor facial abnormalities and other malformations (in particular of the limbs and heart); the characteristic facial features are illustrated in Figures 7 and 8;

  2. growth retardation;

  3. central nervous system abnormalities in the fetus/infant.

Figure 7
Figure 7 Characteristic facial features in a child with fetal alcohol syndrome. Findings may include a smooth philtrum (the vertical groove between the base of the nose and the border of the upper lip), thin upper lip, upturned nose, flat nasal bridge, skin folds covering the inner corner of the eye, small openings between the eyelids and small head circumference (Source: American Academy of Family Physicians)
Figure 8
Figure 8 Characteristic facial features in children of different ethnicities with fetal alcohol spectrum disorders illustrating the facial features described in Figure 14. (a) Northern European descent. (b) Black. (c) Native American, (d) Biracial (white, black) (Photos: American Academy of Family Physicians)

FAS is considered to be the leading cause of mental retardation in the world and is linked to impaired learning, attention problems, slower reaction times and impaired problem solving, planning and ability to keep track of things (National Institute on Alcohol Abuse and Alcoholism, 2000). Studies from the 1970s and 1980s estimated the incidence rate of FAS in the USA as 1–2 cases per 1000 children born each year. In a population-based study in Seattle in 1997 the rate was nearly 1 per 100 live births. The highest rates to date report 4.6 per cent of 6-year-old children in one community within the Western Cape Province in South Africa (Strömland, 2004).

The mechanisms that result in FAS are complex. Ethanol and acetaldehyde present in the mother's circulation cross the placenta and circulate freely through the blood vessels of the developing fetus. Fetal development involves the division and migration of cells in a carefully orchestrated manner, a process that is disrupted by substances such as ethanol. The developing nervous system is particularly sensitive to disruption.

Not all children who are exposed to alcohol during fetal life are born with FASDs, and there may be several risk factors, involving genetic as well as environmental factors. There are also likely to be many other contributing factors such as nutrition, parental care, drug abuse and smoking which make research into FAS complicated. There are no treatments to reverse the damaging effects of alcohol on the developing brain, although the characteristic facial features lessen during adolescence. A safe threshold of alcohol consumption or critical period during pregnancy when alcohol must be avoided has not been identified. Women who are pregnant, or even those who are just likely to become pregnant, are advised to abstain from drinking alcohol. Whilst FAS is entirely preventable by avoiding alcohol during pregnancy, in reality a significant number of women of childbearing age in all western cultures are dependent on alcohol to a certain extent. Treating alcohol dependence in these women is therefore a health care priority for the protection of any future children, as well as for their own health.

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