Fetal alcohol syndrome (FAS) is caused by the mother drinking alcohol during pregnancy. It is characterized by physical and mental damage, facial deformities and underdevelopment in children. There is no cure for FAS, but the right encouragement and support makes life easier for those affected.
ICD codes for this disease: Q86
• Symptoms: Typical FAS symptoms are deformities of the face, head and other parts of the body. Internal organs and tissues as well as mental and social skills are often affected by the disease.
• Causes and risk factors: Fetal alcohol syndrome occurs in babies if the mother drank alcohol during pregnancy. Other risk factors include poor nutrition and older mothers, stress and high alcohol consumption on the part of the father.
• Diagnostics: The doctor diagnoses FAS based on typical facial features, growth disorders and abnormalities in the central nervous system that occur in connection with alcohol consumption during pregnancy.
• Treatment: The treatment of fetal alcohol syndrome is about mitigating the consequences: correcting deformities, compensating for limitations and promoting and improving the physical and mental abilities of those affected.
• Course and prognosis: How well and self-determinedly those affected with FAS live depends in particular on the severity of the mental impairments.
• Prevention: Abstaining from alcohol during pregnancy is the only way to prevent fetal alcohol syndrome in the child.
What is Fetal Alcohol Syndrome (FAS)?
Fetal alcohol syndrome (FAS) is what doctors call prenatal damage to a child caused by alcohol consumption by the mother during pregnancy. Another term for FAS is alcohol embryopathy.
What are the symptoms of fetal alcohol syndrome?
Childhood deficiencies and malformations characterize fetal alcohol syndrome. Those affected show abnormalities in the face, head and body. In addition, the affected children’s mental and social skills and often their sensory functions are restricted. Babies and children with FAS often thrive and grow poorly.
How does fetal alcohol syndrome manifest itself on the face?
The symptoms of Fetal Alcohol Syndrome are particularly noticeable on the face and head. These body regions show various changes and abnormalities. These include:
- An abnormally small skull (microcephalus) with impaired brain development.
- Short, narrow and slightly sloping eyelid gaps.
- Drooping of one or both eyelids (ptosis).
- An additional crease above the inner corner of the eyelid (epicanthus).
- A wide eye relief.
- A short, flat nose.
- An absent or faint furrow between the nose and mouth (philtrum).
- A thin upper lip with narrow lip red.
- The underdevelopment (hypoplasia) of the lower jaw.
- Small teeth.
- Uncommon: cleft palate.
Fetal Alcohol Syndrome: what other characteristics are there?
In addition to abnormalities in the face, Fetal Alcohol Syndrome also affects other parts of the body, organs and tissues. Other possible FAS or FASD symptoms include:
- Short stature in the womb and after birth.
- Malformations of the joints and skeleton, such as a funnel chest.
- Decreased basic tension of the skeletal muscles (muscular hypotonia).
- Malformation of the internal organs (e.g. heart defects
- , kidney malformations).
- Deformity of the genitals.
- Psychomotor restlessness (many patients also suffer from ADHD = attention deficit/hyperactivity disorder).
- Physical and mental retardation (“retardation”).
Prenatal exposure to alcohol also has a variety of effects on a child’s mental abilities: the affected person’s processing of information and perceptions is impaired. The possible consequences are, for example, social withdrawal or fear of new situations. Those affected are often very active and can easily be influenced or exploited.
Other children who have Fetal Alcohol Syndrome tend to behave aggressively and have poor social skills. For example, they are exceptionally defiant at times. These so-called impulse control disorders also occur in many adult patients.
Fetal alcohol syndrome is also often associated with hearing and vision disorders and a hernia.
Degree of damage varies
The severity of alcohol embryopathy is not always the same. In mild cases, those affected “only” show a growth retardation, underweight and a brain skull that is too small (microcephalus). In more severe cases, there are additional injuries and malformations, such as facial anomalies, organ malformations and mental impairments. The latter sometimes extend to severe intellectual disability.
Fetal alcohol syndrome in adults
FASD in adulthood is often associated with other disorders. These include depression, anxiety disorders and impulse control disorders. Some of those affected also show an increased risk of addiction or conspicuous sexual behavior. It is not uncommon for people with FAS to have difficulty fitting in with other people and in society. In many cases, this massively impairs the adjustment to social norms and causes difficulties in everyday life (problems with finding a place to live and a job, in social relationships, etc.).
Fetal alcohol syndrome: causes and risk factors
In unborn children, the so-called placental barrier prevents various pollutants and pathogens from the mother’s bloodstream from entering the child’s blood. However, this protective filter does not work 100 percent.
Among other things, alcohol from the mother’s blood gets into the blood of the unborn child almost unfiltered. Studies have shown that 10 grams of alcohol a day is enough to cause fetal alcohol syndrome in a child. This amount is in a small beer or 100 milliliters of wine.
Alcohol is a poison for the human body at every stage of life. The fact that unborn children are particularly sensitive to this is because their immature liver is not yet able to break down alcohol well. This damages cells more than in adults and inhibits cell division – with a variety of consequences, especially for the sensitive brain. The damage and changes lead to Fetal Alcohol Spectrum Disorders (FASD) in the baby. In the worst case, fetal alcohol syndrome (FAS) develops.
That being said, alcohol consumption during pregnancy increases the risk of miscarriage.
Risk factors for fetal alcohol syndrome
Not all children whose mothers drink alcohol during pregnancy will develop alcohol embryopathy. According to recent research, the cell nucleus of some unborn babies has genetic protection against damage caused by alcohol.
The risk of fetal alcohol syndrome in children is particularly high and/or chronic alcohol consumption by the mother during pregnancy. However, there is also a risk of FAS if the mother-to-be drinks alcohol from time to time over the entire nine months – even if it is only moderate amounts. And even sporadic or one-time consumption of alcohol damages the embryo in some cases.
The consumption of beer, wine and other alcoholic beverages in the first and second trimester of pregnancy is particularly dangerous. The risk of FAS is also increased if the mother uses amphetamines or other drugs.
Other risk factors for Fetal Alcohol Syndrome include:
- Maternal age > 30 years.
- Maternal malnutrition or lack of trace elements or vitamins.
- Siblings with FASD.
- Genetic background.
Is fetal alcohol syndrome also caused by the father?
The cause of FAS is the mother’s alcohol consumption during pregnancy. However, high alcohol consumption by the father is also considered a risk factor for FAS.
Investigations and diagnosis
Ideally, Fetal Alcohol Spectrum Disorders (FASD) or Fetal Alcohol Syndrome (FAS) should be detected as early as possible. The affected children then quickly receive adequate and individual encouragement and support.
Problems with diagnosis
Fetal alcohol spectrum disorders and fetal alcohol syndrome are not always easy to diagnose. This is due, for example, to the fact that maternal alcohol consumption during pregnancy is difficult to record – for example because the mother provides incorrect information.
In addition, many children in World who show symptoms of fetal alcohol syndrome live in adoptive and foster families. It is then difficult to determine the alcohol consumption of the biological mother.
Another problem is that many abnormalities of fetal alcohol syndrome change with age. For example, facial abnormalities and impaired growth are clearly evident in childhood but less noticeable in adolescence and adulthood.
In contrast, attention and behavioral disorders, for example, often become more apparent as a person grows older.
Exclusion of other causes
For a reliable diagnosis of alcohol embryopathy, other causes are first ruled out (differential diagnosis). For example, short stature is often caused by familial short stature, prenatal deficiencies, hormonal disorders, genetic syndromes, chronic diseases or neglect.
Experts have developed diagnostic criteria for fetal alcohol syndrome. According to this, an FAS is present if a person fulfills the following four points:
- At least one growth abnormality: for example, unusually low birth or body weight, reduced birth or body length, or a low body mass index (BMI).
- Three abnormalities of FASD on the face, namely narrow upper lip, missing or little pronounced furrow between nose and mouth and short eyelid fissures.
- At least one abnormality of the central nervous system, such as intellectual disability, impairment of language or fine motor skills, attention deficit disorder or microcephalus.
- Alcohol consumption by the mother during pregnancy.
If the first three points are met, but maternal alcohol consumption during pregnancy remains unconfirmed, the treating physician will still diagnose Fetal Alcohol Syndrome.
Other FAS forms
In addition to the full clinical picture of fetal alcohol syndrome, there are other forms that the doctor distinguishes during FAS diagnostics:
Partial fetal alcohol syndrome (pFAS) differs from fetal alcohol syndrome in that there are no growth disorders in pFAS. Characteristics of partial fetal alcohol syndrome are:
- The facial features typical of the FAS.
- Central nervous system abnormalities.
- The association with confirmed or suspected maternal alcohol consumption during pregnancy.
Another form, alcohol-related neurodevelopmental disorder (ARND), occurs when the affected children only show the abnormalities of the central nervous system described for fetal alcohol syndrome and this is associated with proven or suspected alcohol consumption by the mother during pregnancy.
Fetal alcohol syndrome: treatment
The damage alcohol does to a child in the womb is irreversible. It is possible to operate on some of the physical deformities, such as a heart defect or a cleft palate. Visual and hearing disorders can also be corrected with aids such as glasses or a hearing aid.
However, most of the consequences of a fetal alcohol spectrum disorder or fetal alcohol syndrome cannot be eliminated. These include, for example, mental impairments, behavioral problems, short stature and facial anomalies.
Instead, the treatment of FASD and FAS is about helping those affected to deal with the alcohol-related disorders and abnormalities as well as possible. For example, children with developmental delays benefit from physiotherapy, speech therapy and/or occupational therapy. Under favorable conditions, some development deficits can be compensated for in part.
In the case of traumatic experiences in early childhood (e.g. with an alcoholic mother), additional psychotherapeutic help is usually useful. If FAS sufferers also suffer from ADHD, behave very aggressively or show severely disturbed social behavior, concomitant treatment with medication may be advisable.
The doctor decides individually which support and supporting measures are appropriate in each individual case.
Course of the disease and prognosis
A fetal alcohol spectrum disorder or a fetal alcohol syndrome is not curable. The mental and physical changes that occur, developmental disorders and behavioral problems usually remain permanent. The prognosis depends primarily on the extent of the cognitive impairment. Severely affected children are usually unable to live independently and are dependent on outside help for the rest of their lives.
Fetal alcohol syndrome often requires hospitalization in the first two years of life because of the frequent occurrence of infections, failure to thrive, and possible surgeries.
Because of the social problems, many affected children do not stay with their birth parents, but are placed in foster families or homes instead.
Fetal alcohol syndrome: prevention
Alcohol consumption during pregnancy is one of the few completely preventable causes of severe developmental disabilities in children. Experts recommend that pregnant women avoid alcohol altogether. Because even moderate alcohol consumption sometimes causes a fetal alcohol spectrum disorder or even a fetal alcohol syndrome in the unborn child.