Alcohol causes fetal alcohol spectrum disorders

Fetal alcohol syndrome and fetal alcohol effects (see Appendix 15) are the leading causes of mental retardation in the country. At least 762,000 children are born each year exposed to alcohol during pregnancy. Once ingested and absorbed into the maternal bloodstream, alcohol readily crosses the placenta and enters the fetal circulation.

It is found in the amniotic fluid, even after ingestion of a moderate dose. Alcohol is eliminated from the amniotic fluid at one-half the rate at which it is eliminated from the maternal blood; therefore, it remains in the fetal circulation after it is no longer in the mother's bloodstream. It is estimated that approximately one of every three to four mothers exposes her fetus to the potentially harmful effects of alcohol. Fetal alcohol syndrome is the leading preventable cause of mental retardation and neurobehavioral defects in North America (Pagliaro & Pagliaro, 2002).

The signs and symptoms of fetal alcohol syndrome have been established by the Fetal Alcohol Study Group of the Research Society on Alcoholism and incorporate the following criteria (Pagliaro & Pagliaro, 2002):

• Prenatal and/or postnatal growth retardation.
• Central nervous system involvement (including neurologic abnormality, developmental delay, behavioral dysfunction, intellectual impairment, and/or structural abnormalities such as microcephaly).
• A characteristic face described as including short palpebral fissures and elongated mid-face, a long and flattened philtrum, thin upper lip, and flattened maxilla.

Many patients have a less severe form of alcohol-induced brain damage called fetal alcohol effects. The behavioral and neurological problems associated with prenatal exposure to alcohol in the absence of the symptoms of full-blown fetal alcohol syndrome are termed alcohol-related neurodevelopmental disorder or fetal alcohol effects. Patients with fetal alcohol effects don't have the full syndrome, but they have neurological and behavior problems due to alcohol-related brain damage. Children with fetal alcohol problems often have short attention spans and are described as hyperactive or impulsive. Maladaptive behaviors are common and include poor judgment, failure to consider consequences of their actions, and difficulty perceiving social cues (Gordis, 2003; Streissguth, 1998).

The Fetal Alcohol Behavior Scale (see Appendix 15) is helpful in uncovering fetal alcohol syndrome and fetal alcohol effects in your patients. You must make sure that you have evidence of maternal drinking before you can diagnose this problem. Many of your patients will have a mild to moderate form of this brain damage and will need more structure in recovery.

Alcohol has poisoned their brain, and they will need an advocate in the community to buffer problems with society (Streissguth, Bookstein, Barr, Press, & Sampson, 1998).