Abstract
Alcohol is used by millions of people on a daily basis. The consequences of chronic alcohol abuse on the individual are many such as, memory deficits, neuropathy, heart, and liver damage. However, even minute amounts when drank during pregnancy can have effects on the mother in the long term as well as more dire consequences on the developing fetus that can lead to a lifetime of deficits. Alcohol is a teratogen that crosses the placenta. Doctors cannot determine the exact reason why certain infants of mothers that drink develop dysmorphic and neurobehavioral changes but the fact is, is that fetal alcohol syndrome is a preventable condition when recognized early in the mother. In a child born with fetal alcohol syndrome early intervention may be their best bet in navigating a tough road ahead of them. Nurses are vital in helping recognize symptoms and in aiding patients receive help for their problems.
Etiology
Alcohol is a commonly abused substance and when used during pregnancy may have dire consequences. Alcohol is a substance that freely crosses from the mother to the fetus through the placenta, and is known to have teratogenic effects. Infants of mothers who consume alcohol during their pregnancy may develop any of the sequelae associated with fetal alcohol spectrum disorder, or they have no sequelae at all (Jansson, 2013).
Pathophysiology
There is no evidence to suggest that there exists a dose – dependent relationship between alcohol consumption and development of fetal alcohol syndrome, but maternal such as race, age, and genetics along with the consumption of alcohol do affect the outcome. It seems that women who are older, have had several pregnancies, and are of African American or Native American decent have an increased risk of having children with a higher risk; but the reason is unclear (CDC, 2002). Polymorphisms in the alcohol dehydrogenase enzyme, the enzyme responsible for breaking down alcohol in the liver, may explain the differences in the extent of damage seen in children of mothers that drink the same amount of alcohol during their pregnancy (Warren & Li, 2005). The allele, ADH1B*3 is associated with a quicker breakdown of alcohol, and is associated with a lesser extent of neonatal damage (Jansson, 2013).
The surgeon general recommends that women abstain from the use of alcohol from the time of conception onward, as the amount of alcohol that is considered safe to be consumed during pregnancy has not been determined at this present time.
Epidemiology
The CDC reports that the prevalence of alcohol use during pregnancy is approximately 7.6% (Chang, 2013). Fetal alcohol syndrome affects approximately 0.5-7 per 1,000 live births in the United States (May & Gossage, 2001). The risk is greatest in poor and disadvantaged groups such as African and Native Americans.
Signs/ Symptoms
Fetal alcohol spectrum disorder is a term that describes a broad group of sequelae that can result. This disorder is one of the most common causes of mental retardation (Jansson, 2013). It is defined as decreased prenatal and post natal growth; this means that the child’s height and/or weight are below the 10th percentile (Jansson, 2013). Another defining characteristic of fetal alcohol syndrome is central nervous system problems. Fetal alcohol syndrome results in a wide spectrum of neurobehavioral problems including, impairment in self – regulation, cognition and adaptive functioning. Areas of the brain, which have been assessed by imaging, that are associated with damage include, the frontal cortex, corpus callosum, hippocampus, cerebellum, and basal ganglia. This is not surprising considering these are the areas that are associated with impulse control, movement, memory and learning, and behavior.
An infant that suffers from fetal alcohol syndrome will manifest as irritable, jitteriness, autonomic instability, and problems with sleep and arousal. Therefore detecting fetal alcohol syndrome in these infants is difficult without knowing the mother’s history because this cluster of symptoms can mimic many toxic substances as well as other problems. In childhood these children are hyperactive, hyptonic, have learning disabilities, auditory and visual problems, seizure disorders, and may be mental retarded (Jansson, 2013). Adults manifest as having hyperactive/ inappropriate sexual behavior, legal problems, and may suffer from substance abuse themselves (Jansson, 2013). However the connection between alcohol exposure in the fetus and developing these sorts of symptoms in the adult is poorly understood.
Besides the neurobehavioral and mental defects that may result from fetal alcohol syndrome, dysmorphic features may be seen as well. These dysmorphic changes include, short palpebral fissure, smooth filtrum, and thin vermillion border (Jansson, 2013).
Diagnosis/ Treatment
The main goal of the Center for Disease Control is to prevent the development of fetal alcohol spectrum disorder. However, an even more important goal is the early identification of children that suffer from this condition, and place them as early as possible into intervention programs. Nurses are vital in assessing children with this problem. They may be able to work with the mother one on one to assess the child’s development on a daily basis. Not to mention that nurses can help in identifying mothers that are drinking throughout their pregnancy, and assist them in getting help early on as to avoid the potential disastrous consequences of drinking alcohol during pregnancy. Early intervention of affected children may help in preventing or lessen the language and learning deficits seen in these children. The patients that do the best receive early intervention in speech, physical, occupational, and educational therapies. The interventions and therapy must be individualized to each patient.
Fetal alcohol syndrome is ultimately a preventable syndrome. Early recognition of mothers that abuse alcohol is the best method in trying to prevent this condition from occurring. However, when this is seen in infants’, nurses can aid mothers in finding proper therapy and support groups for their children, and even ultimately for themselves. More research needs to be done to examine this problem, as there are many aspects of health that are affected by it.
Works Cited
Jansson, L. (2013) Infants of Mothers with Substance Abuse. UptoDate. Waltham, MA. Retrieved from: http://www.uptodate.com/contents/infants-of-mothers-with-substance-abuse?source=preview&anchor=H13&selectedTitle=1~105#H13
CDC. (2002) Fetal alcohol syndrome- Alaska, Arizona, Colorado, and New York, 1995-1997. MMWR Morb Wkly Rep. 51(20): 433-5. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed?term=12056499
Warren, K & Li, T. (2005) Genetic Polymorphisms: impact on the risk of fetal alcohol spectrum disorders. Birth Defects Res A Clin Mol Teratol. 73(4): 195-203. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed?term=15786496
May, P & Gossage, J (2001) Estimating the prevalence of fetal alcohol syndrome. A summary. Alcohol Res Health. 25(3):159-67. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed?term=11810953
Chang, G. (2013) Alcohol intake in pregnancy. UptoDate. Waltham, MA. Retrieved from: http://www.uptodate.com/contents/alcohol-intake-and-pregnancy?source=see_link&anchor=H2#H2
