Fetal alcohol spectrum disorder

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Christine Rogan, Alcohol Healthwatch health promotion advisor and FASD project coordinator explains a common, preventable cause of disability in children.

What is fetal alcohol syndrome?

Fetal alcohol syndrome (FASD) is caused by alcohol consumed during pregnancy. FAS, however, is only part of the story. Science has recognised that alcohol causes a wide range of developmental disorders and most have no outward physical signs associated with the syndrome. FAS is part of a range of outcomes called Fetal alcohol spectrum disorder (FASD).

FASD is a leading preventable cause of intellectual disability in western societies. The consequences for the child include lifelong behavioural and learning difficulties that adversely impact on the child and their families. Children affected often have recognisable physical traits such as facial abnormalities and growth retardation. But how they look is secondary to how their brains function.

How does it manifest in children?

An unborn baby is not protected from the toxic effects of alcohol. Alcohol in sufficient doses can damage any organ or system that is developing during gestation. Structural damage to organs, bones and the brain can occur early in development, whereas the central nervous system, and brain cell growth and development are susceptible to the toxic effects of alcohol throughout pregnancy.

A child born affected by FASD can have problems with attention, language, adaptation, reasoning and memory. For example, poor reasoning and judgment affects the ability to see beyond the moment despite knowing the rules intellectually, and memory impairments mean they may not remember or recall as needed.

People with FASD may not fully understand consequences, instructions and rules, time, money, social messages, body language or their own and others feelings. They are at increased risk of developing mental health problems, being dependent on someone for their daily needs, having employment problems, being expelled from or dropping out of school and getting into trouble with the law.

Basically, people born with FASD are brain damaged and without the right kind of care and understanding, life can be very difficult for them.

How common is it?

Unfortunately, no studies have been done in New Zealand yet to measure FASD prevalence. Estimates, however, have been made and the picture doesn’t look good. The international prevalence for FASD in western countries is 1 in 100 live births. A recent prevalence study in three countries found prevalence rates of two to five per cent of the population. Based on these estimates up to 3000 babies every year in New Zealand could be born with FASD.

However, we know that many women in New Zealand do still consume alcohol when they are pregnant. This would indicate that the international picture could be an underestimate of what the picture is here due to our high drinking rates.

How does it happen?

Alcohol crosses the placenta freely, disrupting whatever is developing at that moment in the embryo or fetus. Basically, whatever alcohol the mother drinks, the baby drinks, too — and for a longer time.

A variety of factors can vary the outcome. For example, the amount of alcohol that is drunk, the way it is drunk, when it is drunk during pregnancy, the mother’s age, health and nutrition and the mother’s, father’s and baby’s genetics.

What do women need to know? When is the greatest risk? Is any amount of alcohol OK when I’m pregnant?

Despite some media reports to the contrary, there is no known safe amount or time to consume alcohol during pregnancy. The best case scenario is that if you are pregnant or planning on getting pregnant; do not drink any alcohol. Evidence is also emerging that alcohol consumed by fathers before conception may alter gene expression that predisposes their child to greater developmental risks. The greatest risk, however, remains the time during pregnancy, so dads have a role to play in supporting their partners to not drink.

If I’ve had alcohol before I knew I was pregnant, should I be worried? Is there anything I can do to lower the risk?

It is impossible to predict who is at risk or how much they may be affected. Not all children exposed the same way will have the same outcome. Every child and situation is unique. The sooner in pregnancy drinking stops, the higher the chance that problems are avoided. The best way is to reduce any binge or hazardous drinking overall and at the same time be alert to any risk of an unplanned pregnancy. If there is uncertainty, don’t drink alcohol until you are sure.

If a child is born with FASD, is there any treatment available?

The damage caused by alcohol before birth is permanent but that does not mean that nothing can be done to improve their quality of life and capacity to learn. Just as with all children, needs are unique, and influenced as much by their environment as by their genetic potential. Recognising signs and symptoms early in childhood and responding with appropriate support of their learning and behaviour can and does improve outcomes. If you are worried about your child, talk to your GP for a referral to a paediatrician.

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