Fetal Alcohol Effect (FAE) and Fetal Alcohol Syndrome (FAS)
The adverse and chronic effects of maternal alcohol abuse during pregnancy on her infant.
The effects of heavy maternal alcohol use during pregnancy were first described as fetal alcohol syndrome
(FAS) in the United States in 1973. An estimated one to three babies of every thousand births in the United States has FAS, making FAS the leading cause of mental retardation. It is also one of the few preventable causes of mental retardation and other birth defects. The U.S. Public Health Service estimates that between two and five of every thousand babies born in the United States exhibits one or more effects from fetal alcohol exposure. Although the precise amount of alcohol that must be consumed to cause damage is not known, it is believed that both heavy, consistent alcohol consumption and occasional binge drinking can produce FAS. In April 1997, the Centers for Disease Control and Prevention released the results of a study it had conducted in 1995. In a survey of 1,313 pregnant women, 3.5% said they "drank frequently" during pregnancy. (The agency defined "frequently" for the survey as having seven or more drinks per week, or binging on five or more drinks once within the previous month.)
Why some fetuses are affected and others are not is not completely understood. However, researchers believe that a combination of genetic and environmental factors work together to determine whether maternal alcohol consumption will affect the development of the fetus. Research has suggested that the genetic makeup of members of some racial and ethnic groups makes them less able to physically break down alcohol in the liver, and as a result, they are more susceptible to alcohol's adverse effects. When alcohol passes from the mother's bloodstream across the placenta to the developing fetus, the developing organs are unable to process it and thus are vulnerable to damage or arrested growth.
Women who drink heavily during pregnancy have a significantly higher risk of spontaneous abortion (known as miscarriage); their risk of miscarriage or stillbirth is at least twice that of nondrinkers. For the woman who carries the fetus to term (or near-term), researchers speculate that, in addition to genetic factors, her nutritional status and general health will affect her ability to tolerate alcohol. Due to these and other factors, an estimated 40% of women who drink heavily during pregnancy will give birth to an infant with FAS; all women who drink large amounts of alcohol during pregnancy risk giving birth to an infant with fetal alcohol effects (FAE). FAE describes the condition where the visible physical effects of alcohol are less pronounced than with FAS, but where the learning and psychosocial characteristics are still pronounced. Both FAS and FAE produce lifelong effects that can be managed and treated but not cured.
FAS encompasses a range of physical and mental birth defects:
There are two issues when dealing with the effects of maternal alcohol consumption on the newborn infant. First, a woman who drank heavily during pregnancy is likely to continue to drink after the baby is born. Second, the infant, born with low birth weight and length, may continue to display slow growth. Bonding with the mother is weaker than normal, and the baby may never establish regular feeding and sleeping patterns. Some FAS/FAE babies also display symptoms of failure to thrive. Babies with FAS/FAE may also be subjects of abuse or neglect, with inconsistent home and parenting environments.
When FAS/FAE is diagnosed during infancy, support services for parent and infant can be implemented.
These include treatment for alcohol abuse, stimulation for the infant, and counseling to improve parenting skills.
Toddlerhood
The FAS/FAE toddler may display signs of hyperactivity and distractibility. He or she may also show signs of developmental delay, such as delayed walking, poor coordination, delayed language development, and problems with toilet training. FAE/FAS toddlers may be prone to irritability and temper tantrums. Children with FAS/FAE will benefit from enrollment in Head Start or other preschool programs for children whose risk of failure in school is increased. FAS/FAE children may require more time to achieve developmental milestones that their normal peers.
School-age children
FAS/FAE children are at risk of experiencing failure early in their school career. Because their developmental problems are often undiagnosed, these students may not be provided with support and special education services that are available. By around fourth grade, when most school curriculums require higher cognitive processes, FAS/FAE children may begin refusing to go to school. They may have difficulty making and keeping friends, and may be viewed as intrusive "pests" by their peers. Appropriate social behavior is difficult for the FAS/FAE student to learn, further compounding problems of social isolation.
Early experimentation with drugs and alcohol is not uncommon. Other antisocial behaviors, such as arson, shoplifting, lying, defiance of authority, and destructiveness may develop in later elementary years and early adolescence.
Counseling and treatment for behavior and learning problems are best sought from professionals with experience in FAS/FAE. A coordinated program of family counseling and support of the child will bring the greatest likelihood of success.
Adolescence
Teachers and parents dealing with an FAS/FAE adolescent must adjust expectations to reflect the teen's actual abilities and maturation level. Researchers have found that FAS/FAE adolescents may not achieve the maturity of a normal 18-year-old until about age 25. Thus, the transition to adulthood will be slower and is best handled within a safe, controlled environment, with supportive adults to provide guidance and set limits.
FAS/FAE adolescents often become involved in inappropriate or unsafe sexual situations, brought about by physical maturity and emotional immaturity. FAS/FAE young adolescents, seeking approval, are easily victimized by sexual abusers; in addition, emotional immaturity may cause the FAS/FAE adolescent to abuse younger children sexually. Like many individuals who experience repeated failures in school, ostracism for behavior problems, and social isolation, sexual activity sometimes assumes a disproportionately significant role in the FAS/FAE adolescent's life.
Adolescents with FAS/FAE may benefit from involvement in vocational education and training programs, structured social situations (like clubs and organized recreational activities), and ongoing counseling about relationships, behavior management, and prevention of substance abuse.
FAS/FAE is a lifelong condition that, depending on its severity, will limit the individual's ability to function productively in the adult world. Early diagnosis and intervention with support and education services are the keys to success in social and vocational settings.
Books
Blume, Sheila B. What You Can Do to Prevent Fetal Alcohol Syndrome: A Professional's Guide. Minneapolis: Johnson Institute, 1992.
Davis, Diane. Reaching Out to Children with FAS/FAE: AHandbook for Teachers, Counselors, and Parents Who Work with Children Affected by Fetal Alcohol Syndrome and Fetal Alcohol Effects. West Nyack, NY: Prentice Hall, 1994.
Dorris, Michael. The Broken Cord. New York: Harper and Row, 1989.
Edelstein, Susan B. Children with Prenatal Alcohol and/or Other Drug Exposure: Weighing the Risks of Adoption. Washington, DC: CWLA Press, 1995.
McCuen, Gary E., ed. Born Hooked: Poisoned in the Womb. 2nd ed. Hudson, WI: G.E. McCuen Publications, 1994.
Stratton, Kathleen, Cynthia Howe, and Frederick Battaglia. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press, 1997.
Periodicals
"More Women Report Alcohol Use in Pregnancy." New YorkTimes, April 25, 1997, p. A13.
Steinmetz, George. "The Preventable Tragedy, Fetal Alcohol Syndrome." National Geographic Magazine, vol. 11, no 2, February 1992, pp. 36-39.
Audiovisual Recordings
Fetal Alcohol Syndrome (FAS) and Effects: What's the Difference? Evanston, IL: Altschul Group, 1989. (For information: 1-800-421-2363)
