Alcohol consumption during pregnancy can give rise to a spectrum of anomalies that can vary in severity and that affect the foetus and later the child, adolescent or adult affected on a physical, cognitive, emotional, behavioural and functional level. For this reason, the term Fetal Alcohol Spectrum Disorder (FASD) is preferred and the term Fetal Alcohol Syndrome is reserved for the most severe end of the spectrum.
The effect of alcohol on the foetus is the main cause of mental retardation and it is also a preventable cause, which is why we must be categorical on this issue: there is no minimum level of consumption above which the foetus is damaged, there is no safe trimester and there are no types of alcoholic drinks that are safer than others; the only way to ensure that we do not suffer from FASD is by completely avoiding alcohol intake. What is true, however, is that continued exposure over time increases the likelihood of effects on the foetus.
The incidence in Europe is estimated to be 1 in 1000 newborns, but the frequency varies widely from country to country.
Alcohol crosses the placenta without any difficulty and foetal blood levels are equivalent to maternal levels approximately 2 hours after ingestion, with two particularities, on the one hand the damage to the developing central nervous system is irreversible and on the other hand the foetus has more difficulty than the mother in eliminating it and therefore exposure is more prolonged, The fetus excretes most of the alcohol through the urinary tract and we must remember, if you did not know, that the foetus urinates in the amniotic fluid and also swallows it, so it is constantly being re-poisoned without being able to get rid of the alcohol.
In severe cases it can cause foetal death, in the first trimester there is a greater risk of spontaneous abortion and facial anomalies such as short palpebral fissures (reduction of the horizontal diameter of the eye), thin upper lip, absence or softening of the groove between the nose and lip and cerebral anomalies such as behavioural disorders, mental retardation and even microcephaly. It can also affect other organs such as the heart, kidney, bones, vision and hearing.
It usually causes foetal growth retardation, with low birth weight and growth in the low or pathological percentiles throughout childhood.
Symptoms can range from very mild to very severe, and central nervous system impairment may not be evident in early life and may take time to diagnose. Some mild cases present only behavioural problems, which are the most common, present in 70% of affected children. Within these behavioural problems we can find attention deficit hyperactivity disorder (ADHD), sleep or mood disorders, impulsivity, de-inhibition, impaired memory capacity, motor coordination difficulties and learning delays, and difficulties in abstract reasoning and in the use of pragmatic language. All these problems can result in school failure, legal problems, inappropriate sexual behaviour, substance abuse, alcohol and drugs, higher crime rates and difficulties in accessing the world of work.
Three criteria must be met for the diagnosis of Foetal Alcohol Syndrome:
1. Prenatal and/or postnatal growth retardation.
2. Presence of the 3 typical facial signs.
3. Presence of any of the associated neurological deficits.
Given these 3 criteria, a diagnosis of full Fetal Alcohol Syndrome can be made even if there is no maternal confirmation of alcohol intake.
Fetal alcohol spectrum disorders cannot be cured, but there are multiple support therapies to bring out the maximum potential of these children, which is why early diagnosis is important, as with training of both parents and children, behaviour modification techniques, educational interventions and support in schools and families, the prognosis of these children can be improved, and it is also very important the diagnosis so that it does not recur in subsequent pregnancies, identifying the problem and encouraging mothers to stop drinking alcohol.
This is a serious problem for those affected and their families, with a high cost and perfectly avoidable, so we must focus on education and general awareness to prevent women from consuming alcohol during pregnancy and the periconceptional period.