Fetal Alcohol Spectrum Disorders

A teratogenic agent is any chemical substance, physical agent, infectious agent or deficiency state with the potential to produce a morphological or functional alteration in the fetus or child after birth. In this sense, it should be noted that not all teratogens affect the same, they do not do it to the same extent in all stages of pregnancy.

However, alcohol can affect the development of the central nervous system during the nine months of pregnancy. There is no time during pregnancy when it is safe to drink, as the placenta is not able to filter alcohol. Alcohol consumption during pregnancy can lead to the development of fetal alcohol spectrum disorders, with fetal alcohol syndrome being the most serious of the continuum.

Fetal alcohol spectrum disorders

Fetal alcohol spectrum disorders are a continuum of changes, from mild to severe, produced by the exposure of a fetus to alcohol. These include fetal alcohol syndrome, FAS (most serious condition), partial fetal alcohol syndrome (FAS), alcohol-related neurodevelopmental disorder, neurobehavioral disorder related to prenatal alcohol exposure, and other birth defects. related to alcohol.

As we will see later, children with fetal alcohol syndrome often present with developmental and mental retardation, hyperactivity, clumsiness, attention deficit, and learning disabilities and epileptic disorders. In addition to some characteristic facial alterations.

The type of alterations that occur will depend on the time and frequency of consumption, the amount of alcohol consumed and the age of the mother. Consumption can have very varied consequences and the probability of developing fetal alcohol syndrome is between 1 and 7%.

Morphological alterations at the facial and brain level

• Facial changes: smooth nasolabial fold, thinner upper lip than normal, small palpebral fissure, micrognathia (small lower jaw), low nasal bridge and flattened nose, small eye openings.
• Microcephaly.
• Decrease in the total size of the brain, especially in the telencephalon and cerebellum.
• Smaller size of the basal ganglia, especially the caudate nucleus and less metabolic activity in it.
• Agenesis of the corpus callosum (total or partial absence of it).
• Inverted hippocampal asymmetry. Smaller size of the left hippocampus than the right, compared to healthy children.

• Decreased volume of the frontal lobes, especially in the left hemisphere.

The alterations present in partial SAF are very similar to those present in SAF, but milder, and their sequelae are less severe. In the case of alcohol-related neurological disorder, there are no physical alterations, but they do have brain alterations, intellectual disability, and learning and behavior disorders.

The neurobehavioral disorder related to prenatal alcohol exposure produces alteration in three areas: in the capacity for self-regulation, in the cognitive functions and in the adaptive mechanisms. Alcohol-related birth defects include changes in the heart, kidneys and bones, hearing and vision.

Neuropsychological disorders derived from fetal alcohol spectrum disorders

Deficits in executive function and attention are central alterations in children with fetal alcohol syndrome. They present visual attention problems, difficulty in cognitive flexibility, response inhibition and planning skills. They also present alterations in the resolution of abstract problems and in working memory. There is a high incidence of cognitive retardation and ADHD in children with fetal alcohol syndrome.

Academic performance is also impaired in children with SAF. About 40% of children will need support services and special education at some point in school. Mathematics appears to be the most affected area, with reading and spelling being the least affected areas.

Language skills are not particularly affected, but it has been found that children with FAS may have difficulties in understanding language. They frequently present motor clumsiness: alterations in balance, visomotor integration, and fine and gross motor skills.

At the psychosocial level, they may have problems with social skills and difficulty in adopting the point of view of others, so they can act on their own impulses. This disinhibition may be the cause that they also present disruptive behaviors or drug problems in the future.

Diagnosis and treatment of fetal alcohol spectrum disorders

The diagnosis of these disorders is complicated, since there is no specific test for it. Confirmation of having consumed alcohol during pregnancy, along with characteristic facial alterations and other symptoms such as growth retardation, cognitive delay, etc. they can help guide the diagnosis.

The treatments are varied depending on the level of deterioration of the children. Early intervention can greatly improve your development. In the case of comorbidity with ADHD, drug therapy with stimulants may be necessary. They also often need special education services to help them reach their full potential.

There are several effective behavioral therapy programs for treating children with fetal alcohol spectrum disorders:

• Good friends ( Good Buddies ). It is a group therapy for learning social skills.
• Families are moving ( Families Moving Forward). It is an intervention program for families of children with fetal alcohol syndrome who also have severe behavioral disturbances.
• Interactive experience for learning mathematics ( Math Interactive Learning Experience). It is a support program for learning mathematics, which is the most affected academic ability in these children.
• Parents and children together ( Parents and Children Together). It is a neurocognitive habilitation program to improve self-regulation and executive function. Through the metaphor “how does my engine work?” It is intended to promote awareness of their emotional state and behavior.

Of course, training with parents is vitally important for them to act as co-therapists. In this sense, it helps a lot to promote a family stability that produces positive experiences.

An appeal to future mothers

The consequences of alcohol consumption during pregnancy have been known since 1973, when it was discovered that drinking alcohol during pregnancy produced specific alterations. Nevertheless, the author of the book “Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong-And What You Really Need to Know” (better to wait: Why traditional beliefs about pregnancy are wrong and what you really need know) questioned the dangerousness of this behavior. She considered it safe to drink one glass of wine a day from the second month of pregnancy.

The consequences of drinking during pregnancy are irreversible and will accompany the child for the rest of his life. Of course, not all children of mothers who have drunk while pregnant will develop a spectrum disorder. And not all children who suffer from one will do so with the same severity. However, if it is in our power to avoid it, why not do it?

If you are trying to get pregnant, don’t drink alcohol. If you think you can be pregnant, don’t do it either. Of course, if you already know that you are pregnant, avoid drinking. You will already celebrate with a glass of wine after the birth of your baby. If you have an alcohol problem and want to get pregnant, this would be a great time to seek help to stop drinking.

We cannot completely control the health with which our babies are born, but we can make small gestures that decrease the chances that they have a disorder. It costs nothing, but it’s worth a lot.