Fetal alcohol syndrome
Abstract-
Alcohol exposure in prenatal period leads to long-lasting effects on women. One of the worse outcomes is fetal alcohol syndrome (FAS), in which patient is suffered from prenatal or postnatal growth deficiency, craniofacial anomalies, and evidence of central nervous system (CNS) dysfunction (Jones & Smith, 1973). Statistical data is projected that FAS have an effect on roughly 0.29 to 0.48 per 1,000 live births, with incidences increasing to 2.99 per 1,000 in certain socioeconomic and ethnic groups (Goodlett Charles R., John H. Hannigan, Linda P. Spear, 1999, pg: 1). In present scenario, it is a hot theme of discussion and need to generate awareness about FAS to grip the syndrome in social structure because FAS affected person have physical anomalies and cognitive and behavioral impairments with outcomes ranging in severity from prenatal death to subtle behavioral problems. Since last decade, the danger of fetal alcohol syndrome is highlighted in media and public is educated to stop consuming alcohol during pregnancy. It also prepared health care professionals to deal tackle the situation emerged from fetal alcohol syndrome (Beckman and Mays, 1985). Though, it becomes visible that increases in FAS familiarity have been negligible in populations most likely to abuse alcohol (Gloster Susan P., Robert J. Williams, 1999, pg: 833). The present paper explains the fetal alcohol syndrome and to provide statistical data of incidence of this syndrome in Canadian territory. The causes of fetal alcohol syndrome, symptoms, some treatment, prevention and health promotion activities are elaborated.
Brief description Fetal alcohol syndrome (FAS) is defined as a constellation of physical abnormalities, most obvious in the features of the face and in the reduced size of the newborn, and problems of behavior and cognition, in children born to mothers who drank heavily during their pregnancy. The harmful consequences of alcohol consumption in prenatal period can be traced in classical and biblical literature. The term fetal alcohol syndrome was first coined by Lemoine et al. in 1968 in the medical literature in France (Jones and Smith, 1973). Observing FAS as a serious problem in the country, the U.S. Congress mandated in Section 705 of Public Law 102-321, the ADAMHA Reorganization Act, that the Institute of Medicine of the National Academy of Sciences perform a study of FAS and allied birth defects. There are individual differences in the degree of aberration in any one measure and can alter with time in the same individual (Stratton Kathleen, Cynthia Howe, and Frederick C. Battaglia, 1996, pg: 1, 17). This syndrome was known in society during 1973 and the 1990s and it started to be mentioned in plea from death-row inmates. Physicians steadily lost the cultural influence to outline its public sense. The ailment of FAS was realized not as a cluster of specifically defined symptoms, but it is understood as a social malformation that articulated the moral worsening of mothers and marked their children as politically insignificant and potentially perilous (Golden Janet, 1999, pg: 269).
It is important to recognize that prenatal alcohol exposure is of substantial public health alarm because FAS can cause mental retardation, neurodevelopment abnormalities and FAS crosses all socioeconomic groups and affects all races and ethnicities. Several conditions may modify risk for FAS among women who consume sufficient quantity of alcohol during pregnancy. There are great chances for women older than 30 years or those with a long history of alcohol consumption to give birth to a child with FAS. It is recommended to diagnose FAS is at the time of birth.
Canadian or NorthWest Territory statistics Fetal Alcohol Syndrome in Canada is much more widespread and leads birth defects and developmental impediment in children which can be avoided (BBC.co.uk, 3rd February, 2003). Pace (1997) in his thesis anticipated that an incidence rate of FAS among ECS-grade 3 children on the Blood Reserve in southern Alberta to be 5 % (20/400). It is to be expected that 120 cases of FAS required further assessment. According to existing population health statistics, the degree of the problem of FAS is undervalued in Canada. The main grounds of incidence rates become visible low because people usually do not report the cases, lack of recording case history of maternal alcohol use, and deficient in knowledge among health care professionals (Loock, 1990). In Aboriginal Canadians and other socially disadvantaged groups, there are chances of high incidence rates of FAS. Various Studies advocated that the risk factor is involved in reoccurrence of FAS for families where one or more children are affected by FAS. Statistical data indicates in a study of aboriginal groups in the Yukon and northern British Columbia (Asante and Nelms-Matzke, 1985, 1997) that the frequency of FAS was 46 per 100 and 26 per 1000, correspondingly. In Aboriginal single mothers in a Vancouver inner city neighborhood, a prevalence rate of 50% of live births was not uncommon (Report of the Standing Committee of Health and Welfare, Social Affairs, Seniors and Status of Women, 1992). “The inner city neighborhoods with FAS incidence rates of 50% might therefore have nearly no children born without some degree of Fetal Alcohol Effect” (Massey, 1997 p. 34-35).
Cause of disorder Many specialists accept as true that alcohol consumption is the foremost root of FAS which have an effect on mental retardation in the United States and may be accountable for up to 5% of all congenital abnormalities. Alcohol causes high levels of mortality, morbidity, and social problems. Its severity was noticeable from data that showed more than 60 causes of death have been credited to alcohol consumption. Poor maternal nutritional condition may also amplify the likelihood of having an alcohol-affected child (Dolly Baliunas, Jayadeep Patra, Svetlana Popova, Jurgen Rehm, Benjamin Taylor, 2007, pg: 36). According to American and European studies, another key aspect which is linked with FAS is low socioeconomic status rather than racial background. Abel (1995) reports indicate that the main causes of FAS are low socioeconomic status, heavy alcohol consumption, smoking, poor nutrition, poor health, increased stress and use of other drugs.
How it is transmitted
When a woman consumes excessive alcohol during prenatal period and she has no control over frequency of taking alcohol, she may give birth to infant gripped with FAS. Teratogen in alcohol can cause birth defects by disturbing the growth and proper formation of the fetus’s body and brain (Olson, 1992). Alcohol has potential to injure the fetus all through pregnancy, not just in the first trimester. When alcohol is consumed by a pregnant woman, it quickly crosses the barricade of the placenta, producing equal concentrations in fetal circulation. During prenatal alcohol exposure, the brain and central nervous system of the unborn child is highly sensitive (Streissguth, 1989; Olsen, 1992).
Body systems affected FAS were formerly estimated, as the most recurrent cause of mental retardation after Down’s syndrome and certain neural tube defects. It is estimated that FAS affects the body system of children to some degree of mental impairment, ranging from minimal brain dysfunction to severe mental retardation. It is observed that when one case of FAS was identified, there are a number of others who are affected by alcohol exposure but do not exhibit full set of characteristics of FAS. Due to prenatal exposure to alcohol, child is gripped in FAS characteristics which affect the body system such as reduced or delayed growth of the baby, single birth defects or developmental learning and behavioral disorders that are not noticed until months or years after the child’s birth. When unborn child is exposed to alcohol, it can lead to long-term developmental disabilities in the form of FAS. Children who are not diagnosed in infancy may be most likely recognized at 4-6 years of age, when behavioral and cognitive problems become noticeable. With natural maturation of the facial structures, some craniofacial features of FAS may not be as prominent in adolescents or adults as in children; however, the effects of alcohol on brain structure and function continue. Results of numerous studies have assessed particular areas of cognitive dysfunction in school-age children who are exposed to alcohol in prenatal period. “Researchers have validated short term memory deficits in verbal and visual material, inadequate processing of information, reflected sparse integration of information and poor quality of responses, inflexible approaches to problem solving and difficulties in mathematical computations” (Phelps, 1995 pg. 206).
signs and symptoms It is well understood that FAS affected patient exhibits signs of defining categories due to the result of their prenatal exposure (Coles et al, date n.k.). Though these children may not have growth retarded problem but demonstrate some dysmorphia and confirmation of mild neurological problems. The symptoms related with Fetal Alcohol Syndrome (FAS) are some of the facial abnormalities that are common to children with FAS such as microcephaly, small eye openings, broad nasal bridge, flattened mid-faces, thin upper lip, skin folds at the corners of the eyes, indistinct groove on the upper lip, Low birth weight, Small head, Flat face with a snub nose and unusually smooth area between nose and mouth, and an abnormal smallness of the lower jaw (Wekselman, Spiering, Hetteberg, Kenner, & Flandermeyer, 1995; Phelps, 1995). “The behavioral and cognitive impairments seen in individuals with FAS are most likely the expressions of underlying structural or functional changes in the brain. Some children with FAS are observed with clinically significant impulsivity, hyperactivity, oppositional behavior, and sometimes sleep disorders” (Goodlett Charles R., John H. Hannigan, Linda P. Spear, 1999, pg:1).
Preventative measures To control the FAS among individuals, the first step to guard against the effects of alcohol in pregnancy is prevention. The US Institute of Medicine is working seriously in this line and it has delineated a public health model of prevention. In this model there are three steps, these are universal, selective, and indicated. In universal prevention, women are educated about the risks of alcohol on the developing fetus and about the importance of avoiding alcohol consumption during pregnancy also to promote the health and well-being of all individuals in a culture or particular community. When individuals in the society are at high risk, selective prevention and intervention is carried out i.e., women of reproductive age who consume alcohol and who have the prospective to become pregnant. Through effectual screening for alcohol use and with brief involvements, preventive measure can be achieved. Indicated prevention and intervention is planned for the women who are drinking excessive quantities of alcohol having highest risk of producing FAS infant and for those who are likely to become expectant, e.g., women who have earlier delivered an affected child and they are still a heavy drunker. There is an upward consent that the best line of early intervention is with women before and during their childbearing years and also focused on family members, partners and the community (National Council on Welfare, 1997).
But prevention of FAS is not as simple as just to put the entire load on women to guarantee healthy result. In FAS, there are several interrelated variables that are alcohol, women, pregnancy, the woman’s partner and extended family, the community, and the health care profession that indicates the prevention of FAS and requires a wide-ranging program encircling an array of approaches (Stratton et al, 1996). There is a need to concentrate on the root causes of several comprehensive public health problems to make prevention program successful. Substance abuse, lack of comprehensive health education, unplanned pregnancy and inadequate pre and postnatal care must be corrected and organized (Seattle-King County Department of Public Health).
Cure or new treatments As far as the treatment is concerned, there is no therapy for fetal alcohol syndrome in the hands of health professionals. The physical defects and mental deficiencies caused due to FAS continue for lifetime. If there are heart abnormalities, it may require surgery. To learn about the FAS, its impact on body, one can avail special services in school. Sometimes counseling and guidance program benefit parents to assist the family with a child’s behavior problems (Mayo clinic staff, May 24, 2005). When the infant is born with fetal alcohol syndrome, he may need hospitalization in a neonatal intensive care unit instantly after birth. Numerous pathological tests have been done in laboratory to establish from what physical abnormalities the infant is suffering from. These tests provide basis to diagnose the ailment and specific line of treatment. For example, the child may need ant seizure medications if having seizures and hearing is tested in infancy (Dittmer, C., & Lentz-Kapua, S.L., 2005). Stratton advises that if the child with FAS is identified early, it can be used as an indicator that will lead to intervention with the mother for her own treatment and for the prevention of births of successive children with FAS. According to Stratton, “This is the best chance to prevent alcohol-related trauma and disease in the mother, increase the chance that she will be able to mother her child, decrease foster placement, and prevent the birth of more children with FAS” (Stratton et al, 1996, pg.79).
Health promotion activities and related health teaching. In Canada, a health promotion framework is a widespread approach to FAS prevention. There are many Health Promotion activities to generate awareness among individual for FAS. First of all there is a need to build healthy public plan such as warning labels on bottles and banning the advertising of alcoholic beverages. The important health related activity is to limit the accessibility of alcohol through price increases or by increasing the minimum age for drinking. There must be signs in public washrooms and restaurants to create wakefulness that can easily motivate against consuming alcohol. It is essential to provide caring atmosphere (Loney et al, 1994). Community action must be strengthened. Communities across the country must be keenly concerned and dedicated to tackle the needs of children and families who are affected by FAS. All efforts made in the direction of FAS health teaching should be family-centered and culturally sensitive. These must be addressed to the pregnant woman as well as her partner and family in the context of their community, to draw on all services suitable to the often multifaceted social, economic and emotional needs of these women. It is must to inform all health professionals regarding the risks of alcohol use during pregnancy to make possible early identification of at-risk drinking and early intervention.
Conclusion- It is observed by researchers and health practitioners that FAS issue is a national health concern which spreads its legs due to alcohol consumption by pregnant women. Health professionals across Canada are putting their best effort to identify and implement prevention strategies that will lessen the incidence of FAS. In medical science, there is no single, planned treatment that can be held liable for the development of a comprehensive approach to putting off fetal alcohol syndrome. When Families are affected by FAS, they need frequent help of services of specialists. Therefore, these anarchy lie within the purview of many groups but are clearly not the full liability of any one. Everybody has accepted the seriousness of FAS and have an interest in handling the problem, but no one lead and coordinate (Stratton Kathleen, Cynthia Howe, and Frederick C. Battaglia, 1996, pg: 194).
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Fetal alcohol syndrome
Outline
I) Abstract
A) Alcohol consumption leads to fetal alcohol syndrome
II) Brief description of FAS
A) physical abnormalities of new born baby
B) Alcohol consumption in prenatal period is harmful
III) Canadian or NorthWest Territory statistics
IV) Causes of disorder
A) Alcohol causes high levels of mortality
V) How it is transmitted?
A) Alcohol has potential to injure the fetus all through pregnancy
VI) Body systems affected
A) FAS affect the body system of children to some degree of mental impairment.
B) When unborn child is exposed to alcohol, it can lead to long-term developmental disabilities in the form of FAS
VII) Signs and symptoms
A) Facial abnormalities
B) Behavioral and cognitive impairments
VIII) Preventative measures
A) women must be educated about the risks of alcohol
IX) Cure or new treatments
A) No therapy
B) heart abnormalities may require surgery
X) Health promotion activities and related health teaching
A) Aim of health Promotion activities is to generate awareness among individual for FAS
XI) Conclusion
A) FAS issue is a national health concern