WILLIAM TECUMSEH SHERMAAlcohol plays a major role in society
today. It is constantly being in our minds through advertisements,
whether its commercials or billboards, holidays, or even just at the
popular social scene. Alcohol is consumed for many purposes, such as
celebrations, to increase romance, out of boredom, or a way to relax.
Alcohol is a drug that is depended upon by the majority of our society.
Nonetheless, alcohol has very damaging effects, not only does it cause
self-inflicted diseases resembling alcoholism or cirrhosis of the liver, but it
harms unborn fetuses as well. Many women drink alcohol when they do
not even know that they are pregnant yet. Alcohol can cause disorders
such as Fetal Alcohol Syndrome and Fetal Alcohol Effects. Fetal Alcohol
Syndrome, FAS, is a congenital disorder which is characterized by a
variety of physical and behavioral traits that result from maternal alcohol
consumption during pregnancy. The term Fetal Alcohol Effects, FAE,
indicates that alcohol is being considered as one of the possible causes
of a patient's birth defects. In other words, FAE is a less severe form of
FAS. Both FAS and FAE are the results of the use of teratogens, which
are nongenetic influences that can potentially complicate fetal
development.(Harris, p.85) FAS is due to the mother's consumption of
alcohol during pregnancy. Alcohol in the woman's bloodstream circulates
to the fetus via the placenta. There, the alcohol intrudes with the ability of
the fetus to receive a sufficient amount of oxygen and nourishment for
normal development in the brain and other body organs. The critical time
for alcohol teratogenicity is around the time of conception.Effects of
FAS/FAE Although alcohol is the only cause of FAS, there are
unfortunately numerous effects. Infants with FAS may have a weak
sucking response and an irregular sucking pattern early in life. Some
doctors describe them as distracted and fatigued when sucking.
Withdrawal symptoms such as prolonged twitching, jitteriness, sweating,
and hyperactivity have also been reported in infants exhibited to alcohol
before birth. (Timberlake and Birch, p.1) Prenatal alcohol exposure
is one of the leading known causes of mental retardation in the United
States. Mental retardation is usually mild to moderate, but occasionally it
is severe. Central nervous system handicaps are also present in children
with FAS. A small brain, learning disabilities, short attention span,
hyperactivity in childhood, and poor body, hand, and finger coordination
are examples of CNS handicaps.(NIAAA, p.1) Mental handicaps and
hyperactivity are probably the most debilitating aspects of
FAS.(Streissguth, p.1) Children with FAS also suffer from facial
abnormalities. These abnormalities include: small eye openings,
drooping eyelids, short upturned nose, thin upper lip, and low set or
poorly formed ears. (NIAAA, p.1) These facial patterns distinguish
children with FAS/FAE from normal children, however they are not
harshly malformed. A more serious and life threatening symptom of FAS
is organ deformities. This includes heart defects, heart murmurs, genital
malformities, as well as urinary and kidney defects. Abnormal thyroid
functioning and a decrease in the effectiveness of the immune system
are also present in infants exposed to alcohol. What about paternal
alcohol consumption? Alcohol may affect fetal development through a
direct effect on the father's sperm or gonads. Studies have shown that
children with alcoholic fathers often experience cognitive abilities and
have a greater chance of being hyperactive. These findings were found
in adoption cases, where the biological father was an alcoholic and the
child was raised by nonalcoholic parents.(Cicero,p.3) FAE is a broad
term covering a wide range of success levels, from mild learning
disabilities to a less severe form of FAS. FAE is much harder to detect
than FAS and extremely difficult to diagnose at birth. This is because
FAE conditions begin to occur during school years. These conditions
include behavioral problems, short attention span, language difficulties,
and hyperactivity. (Timberlake and Birch, p.1) Occurrence The number
of new cases each year of FAS and FAE are significantly underreported,
therefore it is difficult to obtain accurate findings. "The incidence of FAS
is estimated at 1-2 per 1,000 live births whereas FAE is estimated to
occur in 3-5 per 1,000 live births."(Timberlake and Birch, p.2) According
to the Centers for Disease Control's(CDC), Birth Defects Monitoring
Program (BDMP), "FAS is difficult to recognize in newborns for three
reasons: 1)Facial stigmata of FAS are often subtle; 2)Some types of
CNS deficits in infants are difficult to detect; 3)The birth weight of some
affected infants is normal."(Abel and Sokol, p.1) Symptoms become
more noticeable with age. According to statistics, 44% of chronic
alcoholics have affected children: 50% of these children will be mentally
retarded and 30% will have physical malformations. (Harris, p.98) If a
pregnant woman drinks 1-2 ounces of alcohol a day for the first three
months of pregnancy, FAE will be present in 11% of the
births.Treatments There are many needs that call for attention with
FAS/FAE. Firstly, FAS/FAE patients typically have complex medical
needs associated with their higher than average congenital anomalies.
Infants with FAS are at risk for CNS problems, therefore, they must be
carefully watched. Patients with FAS/FAE are placed in special
education classes beginning in elementary school. A child in a small
class room may benefit highly if their is a lot of individual attention. Even
if it does not show an increase in the child's intellectual level, it may
prevent further deterioration. Many patients will reach an academic
plateau in high school. However, it is important that these patients still
learn basic life skills, such as safety, money management, and
interpersonal relating. This is where the role of their family comes into
play. Patients with FAS/FAE are at a higher than average risk of sexual
and physical abuse, as well as neglect. They need loving, stable homes
with open lines of communication to develop to their fullest
potential.(Roots and Wings, p.2) Most FAS/FAE patients will be unable
to hold a regular job. Many will also require sheltered living throughout
their entire life. More functional patients may be able to reside in half-way
houses or group homes for developmentally disabled adults, if their own
family is unable to give them the proper care and attention they need and
deserve. An important person(s) to remember when dealing with
patients of FAS/FAE is the guardian. This person assumes a
responsibility much greater than that of a normal child. The guardian
must remember to keep a realistic view point. They must have
reasonable expectations of the child as well. Because this job is so
difficult, social services offer support to prevent the burnout of the
guardian. Research Studies The key questions in FAS research
include "How much is too much?", and "When is the fetus at the greatest
risk?"(Ernhart, p.2) A safe amount of drinking during pregnancy has not
yet been determined, and all major authorities agree that women should
not drink at all during pregnancy. (NIAAA, p.2) The fetus seems to be at
greatest risk during the first trimester. (Kids Health, p.2) Much of the
human research has been epidemiological and for obvious ethical
reasons. Human clinical studies investigating a dose response effect of
alcohol during pregnancy are not possible.(Timberlake and Birch, p.2)
The saddest part of this disease is that it is preventable. FAS and
FAE are the leading preventable causes of birth defects. FAS accounts
for about 4,000 new cases of preventable birth defects in the United
States each year. It has been estimated that the economic cost
associated with FAS in the United States is $321 million each year. A
recent survey done by the National Institute on Alcohol Abuse and
Alcoholism(NIAAA), consisted of 23,000 men and women ages 18-44 to
determine their perception of FAS. Only 73% of the women and 55% of
the men were familiar with the subject. Even more discouraging, most
believed FAS patients were born addicted to alcohol, but had no birth
defects. (Timberlake and Birch, p.3) According to the CDC, "FAS and
other alcohol-related birth defects can be prevented if women do not
drink alcohol during pregnancy or if they use reliable birth control
methods when they do not abstain from drinking." Unfortunately women
do not stop drinking until pregnancy is confirmed. By then the
embryo/fetus has gone through several weeks of critical development.
The alcohol may have already done damage to the embryo/fetus.(NIAAA,
p.2) Pregnant women who drink heavily run a 40-50% risk of causing
serious problems to the developing fetus. (Kids Health, p.2) Work has
been done to develop innovative strategies to identify the women who are
at a high risk of having a child with FAS or FAE. Two strategies that are
currently used, are to help educate these mothers about the threat
alcohol has on their fetus, and to help them change their behavior.
Prenatal clinics offer screening , counseling and support services to help
achieve abstinence, as well as case management and follow-ups. If
these methods prove to be effective, they may be inserted into current
health care systems. (Centers for Disease Control and Prevention, p. 2)
In order to reduce the amount children born with FAS/FAE,
there must be an increase in the number of women who abstain from
alcohol during their pregnancies. To reach that goal further research
needs to continue. There must be an improvement in public health
surveillance methods, a refinement in methods used for identifying
children who have been affected by prenatal alcohol exposure, a
demonstration in the effectiveness of primary prevention programs, and
an investigation on the effectiveness of secondary intervention strategies,
such as foster-care placement and special education strategies.(Centers
for Disease Control and Prevention, p.4)Not all women who drink during
pregnancy will have an infant with FAS or FAE, but if there is a 40-50%
risk of harming the fetus, why chance it? Women should be more careful
when drinking, because drinking often leads to sex even if it is not
planned. The best prevention for FAS/FAE is to either abstain from
sexual intercourse while consuming alcohol, or abstain from alcohol while
planning a pregnancy. Therefore sexual partners should use birth
control. Fetal Alcohol Syndrome and Fetal Alcohol Effects are fully
preventable and the responsibility lies within the role of being parents.
. they do not even know that they are pregnant yet. Alcohol can cause disorders such as Fetal Alcohol Syndrome and Fetal Alcohol Effects. Fetal Alcohol Syndrome, FAS, is a congenital disorder which. to alcohol. What about paternal alcohol consumption? Alcohol may affect fetal development through a direct effect on the father's sperm or gonads. Studies have shown that children with alcoholic. with FAS in the United States is $32 1 million each year. A recent survey done by the National Institute on Alcohol Abuse and Alcoholism(NIAAA), consisted of 23, 000 men and women ages 18-44 to determine