What is Fetal Alcohol Syndrome (FAS)?

1] [2] [3]

Fetal alcohol syndrome

Fetal alcohol syndrome (FAS), also known as fetal alcohol syndrome, is a mother's permanent birth defect caused by alcohol abuse to the fetus during pregnancy. The degree will be affected by the mother's amount, frequency and time of drinking. Alcohol can enter the placenta, hinder the growth and weight of the fetus, cause unique small patches on the face, damage neurons and brain structures, and cause physical, mental or behavioral problems.

Fetal Alcohol Syndrome

1] [2] [3]

The main effect of fetal alcohol syndrome is permanent damage to the central nervous system. Alcohol exposure during life can hinder the development of nerve cells and brain structures or cause deformities. It generally causes a series of primary cognitive and dysfunctions, including weakened memory, insufficient attention, impulsive behavior and weak understanding. It can also cause secondary obstacles, such as legal difficulties, mental illness and drug addiction. [3] [4] The risk of brain damage occurs every three months of pregnancy, because the fetal brain develops throughout the pregnancy. [5]

Alcohol exposure in the Western world during life is a major cause of mental retardation. [6] In the United States, the transmission rate of fetal alcohol syndrome is estimated to be 0.2-2.0 cases (that is, 0.02% to 0.2%) per 1,000 newborn babies, which is comparable to or higher than other developmental disorders, such as Down syndrome Spina bifida. [7] Lifetime medicines and social costs for each person with fetal alcohol syndrome are estimated to be as high as $ 800,000. [8] Although fetal alcohol syndrome may not be caused naturally by alcohol exposure during pregnancy, the U.S. Department of Health still recommends that pregnant women quit drinking to reduce risk

Fetal Alcohol Syndrome Historical Reference

Pregnant women were banned from drinking in the Bible, ancient Greece, and ancient Rome. This shows that historically, there is a recognition of alcohol abuse in pregnant women and the negative effects of fetuses. [10] This claim has been repeated in different literature and books, but there is an assessment that the original historical literature does not support this ancient wisdom. [11]

As early as 1899, a Liverpool prison doctor, William Sullivan, discovered that pregnant women's drinking had an impact on the fetus, and he found that every 120 female prisoners of alcoholism had a higher stillbirth rate than their relatives who did not drink. He believes that drinking is the cause of this situation. [12] This idea runs counter to the prevailing thought that intellectual disability, poverty, and criminal behavior were inherited. [3] Henry H. Goddard's research on the Kallikak family in the early 1900s represented this early idea, and [13] subsequent research shows that this family is almost certainly suffering from fetal alcohol syndrome. [14] Alcoholism research in the mid-1900s was based on this genetic argument. [15]

Fetal alcohol syndrome confirmed as syndrome

Fetal Alcohol Syndrome was named in 1973 by Kenneth Lyons Jones and Dr David W. Smith, two specialists in deformity at the University of Washington, Seattle, USA. They found that in the 8 children who had no relationship with each other and their mothers were alcohol-drinking, they found some patterns of cranial face, limbs, and cardiovascular defects, together with growth defects and retardation before birth. [16] The malformation pattern shows that the damage was caused before birth. This finding shocked some, but others were skeptical of the findings. [17]

Within four years of the discovery at the University of Washington in Seattle, a study involving non-human primates identified alcohol as a teratogenic substance. As of 1978, there were a total of 245 cases of fetal alcohol syndrome, and this syndrome has become the largest cause of mental retardation.

When many syndromes are named after the first discoverer, David W. Smith names the symptoms in common vocabulary. [19] He explained that he wanted to encourage prevention. He believed that as long as people knew that alcohol caused the syndrome, pregnant women could quit drinking through patient education and public awareness. [19] No one will pay attention to the birth defects or prevalence of all fetal alcohol syndromes [18], but the concept of drinking alcohol during pregnancy will make a deep impression on pregnant women, and complex diagnosis can cause this name Preventive effect.

After subsequent research and clinical experience, alcohol exposure during life will cause a series of physiological, behavioral and cognitive effects. Fetal Alcohol Spectrum Disorder (FASD) is a new term that includes fetal alcohol syndrome And other conditions caused by alcohol exposure during life. [19] Fetal Alcohol Syndrome is the only definition of prenatal alcohol exposure in the statistical classification of international diseases and related health problems, and has been incorporated into the diagnosis of ICD-9 and ICD-10. [16] [20] [21]

Fetal alcohol syndrome diagnosis

Several diagnostic systems have been discovered in North America:

The National Academy of Sciences guidelines are the first system to unify the diagnosis of alcohol exposure during life. [twenty one]

The "Four Diagnostic Codes" of the University of Washington in Seattle ranked the four main characteristics of fetal alcohol spectrum disorders according to Likert scales, resulting in 256 codes and divided into 22 different clinical categories (from fetal alcohol syndrome to no detection ). [twenty two]

U.S. Centers for Disease Control and Prevention guidelines document general consensus on fetal alcohol syndrome diagnosed in the United States, but delay the availability of fetal alcohol spectrum disorders. [7]

The following 4 criteria must be met to determine fetal alcohol syndrome: [22] [21] [7] [23]

Growth deficits-height or weight below 10 quantiles before or after birth [24]

Facial Features of Fetal Alcohol Syndrome-All 3 Features Exist [25]

Central nervous system disruption-clinically significant structural, neurological, or functional deficiency

Prenatal alcohol exposure-confirmed or unknown prenatal alcohol exposure

Differential diagnosis of fetal alcohol syndrome

The U.S. Centers for Disease Control and Prevention has evaluated the following nine syndromes, all of which have features that overlap with fetal alcohol syndrome, but none include facial features of all three fetal alcohol syndromes, and none are due to prenatal alcohol Caused by exposure: [7]

Alskovgues syndrome

Williams Syndrome

Luneng Syndrome

Dubowitz Syndrome

Dalenya Syndrome

Toluene syndrome

Fetal hydantoin syndrome

Fetal valproic acid syndrome

Impact of Maternal Phenylketonuria on Fetus

Fetal Alcohol Syndrome

Growth deficits are defined as below-average height, weight, or both caused by alcohol exposure before birth, and can be assessed at any time in life. Growth should be measured in terms of parent height, gestational age, and other postnatal issues (such as lack of nutrition). Ideally, height and weight at birth are measured. [22] Even when height or weight is below the 10th quantile of a parent-friendly standard growth chart, it is a regret. [twenty four]

Growth defects are graded on the four-digit diagnostic code: [22]

Severe-Height and weight are below 3 quantiles.

Moderate-height or weight below 3 quantiles.

Mild-Height or weight is between 3 and 10 quantiles.

No-height and weight are above 10 quantiles.

Facial features of fetal alcohol syndrome

Patients with fetal alcohol syndrome have several features of craniofacial abnormalities. [26] These facial features show brain damage and are believed to occur during the 10-20th week of pregnancy. [27]

Intermediate-Two traits were rated as severe and one trait was rated as intermediate (3 points on lips or humans; eyelid fissure lengths ranged from 1-2 standard deviations below average).

Minor-includes the following feature combinations:

Two features are severe and one feature is normal;

One characteristic is severe and two characteristics are intermediate; or

One is severe, one is intermediate, and one is normal.

No-all three are normal.

Fetal alcohol syndrome destroys the central nervous system

Damage to the central nervous system is a major feature of the diagnosis of fetal alcohol spectrum disorders. Alcohol exposure during life can damage the brain and cause a series of superficial to deep defects, depending on the dose, time and frequency of exposure, and the genetic predisposition of the fetus and mother. [21] [32] The central nervous system damage can be assessed from three aspects, namely structural, neurological and functional defects.

All of the diagnostic systems described above can assess damage to the central nervous system, but with different criteria. Medical institutions need structural and neurological deficits to diagnose fetal alcohol syndrome. [21] The four-digit diagnostic code and US Centers for Disease Control and Prevention guidelines measure abnormalities in 3 or more functional areas to a standard deviation of 2 or worse. [22] [7] The four-digit diagnostic code further illustrates the extent of damage to the central nervous system:

Definite-structural or neurological deficits in fetal alcohol syndrome or resting brain lesions.

Probablyobvious obstacles for 3 or more functional areas reach 2 or worse standard deviations.

Possiblymild to moderate disorders with 1-2 functional areas to 2 or worse standard deviations, or impaired central nervous system failure from clinical assessment.

Impossible-there is no evidence of damage to the central nervous system.

Structural destruction of fetal alcohol syndrome

In the first 3 months of pregnancy, alcohol affects the migration and organization of brain cells, causing structural deformities or defects in the brain. [33] In the 6th to 9th months, damage can extend to the hippocampus responsible for memory, learning, feelings, and coding of visual and auditory information, causing neurological and functional deficits. [34]

As of 2002, a total of 25 infant autopsy cases had fetal alcohol syndrome. The first case occurred in 1973, a baby who died shortly after birth. [10] Examination revealed extensive brain damage, including microcephaly, abnormal migration, corpus callosum hypoplasia, and a large amount of glial and pia mater in the left brain. [35]

In 1977, another baby died ten days after birth, and his mother was an alcoholic. Autopsy revealed severe cerebral edema, abnormal nerve migration, and small corpus callosum and cerebellum. [35] Fetal alcohol syndrome is associated with changes in the brainstem and cerebellum, dysplasia of the corpus callosum and anterior commissure, neurotransition errors, lack of olfactory bulbs, spinal cord and spinal membrane bulges, and hole brain deformities. [35]

Neurological destruction of fetal alcohol syndrome

Neurological damage can be assessed when structural damage is not visible to the enterprise. In the case of fetal alcohol syndrome, neurological damage is the damage to the central nervous system, peripheral nervous system, or autonomic nervous system caused by alcohol exposure before birth. Neurological problems must be determined by a doctor and not due to fever, concussion, or traumatic brain injury after birth.

All diagnostic systems have the same level of damage to the central nervous system at the neurological level. Neurological abnormalities caused by alcohol exposure before birth can diagnose fetal alcohol syndrome, as well as functional abnormalities. [21] [22] [7] [23]

Functional destruction of fetal alcohol syndrome

When structural or neurological damage is not visible, all diagnostic systems allow functional abnormalities to assess central nervous system damage due to prenatal alcohol exposure. [21] [22] [7] [23] Functional impairments include daily absences, problems, delays, or abnormalities that are visible or measurable due to alcohol exposure during life, and are generally referred to as developmental disorders. However, there is no consensus on a specific model [21], of which only the US Centers for Disease Control and Prevention guidelines indicate slow development [7], so the evaluation criteria are also different.

The following are the functional disruptions of fetal alcohol syndrome listed in four diagnostic systems:

There is evidence of complex behavioral or cognitive patterns in learning disabilities, academic achievement, impulsive control, social cognition, communication, abstraction, math skills, memory, attention, and judgment that are not consistent with developmental levels. [twenty one]

Achieved two or more standard deviations in three or more standardized tests of executive function, memory, cognition, adaptability, academic achievement, language, motor skills, attention, and motor level. [twenty two]

Three or more standardized tests on cognition, communication, academic achievement, memory, executive function, adaptive ability, social skills, and social interaction, reaching two or more standard deviations.

Fetal alcohol syndrome prenatal alcohol exposure

Prenatal alcohol exposure is assessed by interviewing a biological mother or other family member who knows the mother's drinking during pregnancy, prenatal health records, existing birth records, court records, drug addiction treatment records, or other reliable information.

Exposure levels were assessed based on confirmed exposure, unknown exposure, and confirmed no exposure. Among them, the confirmed exposure was classified as high risk and some risks in the four-digit diagnostic code:

High risk-Confirmed alcohol exposure to blood alcohol concentrations of at least 100 mg / dL per week during early pregnancy.

Some risksconfirmed alcohol exposure, but serving less than high risk or unclear intake patterns.

Unknown risk-Unknown alcohol intake.

No risk-Confirming that there is no pre-existing alcohol exposure can rule out the possibility of fetal alcohol syndrome.

Confirmed exposure to fetal alcohol syndrome

The amount, frequency, and duration of prenatal alcohol exposure have significant effects on the other three main characteristics of fetal alcohol syndrome. Although alcohol is considered to be teratogenic, there is no clear consensus on the level of exposure to toxicity. [21] The US Centers for Disease Control and Prevention guidelines do not mention this element at all in diagnostics. Medical institutions and Canadian guidelines recognize the importance of excessive alcohol exposure, but there are no diagnostic criteria. The Canadian guidelines discuss clarity and point out that excessive alcohol exposure is defined as "drink more than 5 glasses for 5 or more days in a 30-day period" as defined by the National Institute on Alcohol Abuse and Alcoholism. [36]

Unknown exposure to fetal alcohol syndrome

For many adoptive or adult patients and foster children, records or other reliable sources of information have been lost. Reports of drinking during pregnancy can also alert pregnant women, especially those who are drinking. [7] In these cases, all diagnostic systems indicate unknown prenatal alcohol exposure. Without this information, fetal alcohol syndrome can be diagnosed as long as the main features of other fetal alcohol spectrum disorders are clinically present.

Fetal alcohol syndrome related symptoms

Fetal alcohol syndrome also has other conditions, which are caused by alcohol exposure before birth. However, these conditions are considered to be alcohol-related birth defects [21] and not the diagnostic criteria for fetal alcohol syndrome:

Heart-Heart murmur, but usually disappear after 1 year of age; the most common is the ventricular septal defect, followed by the atrial septal defect.

Bone-joint abnormalities, including abnormal positions and functions, altered palm prints, small distal phalanges, and small tail fingernails.

Kidney-horseshoe kidney, hypoplasia.

Eyes strabismus, optic nerve dysplasia [37] (may cause light sensitivity, vision loss, or involuntary eye movements).

Occasional abnormalities-drooping eyelids, malformations of the small eye, cleft lip with or without jaw cleft, webbed neck, short neck, tetralogy of Fallot, aortic narrowing, spina bifida, and cerebral edema.

Fetal Alcohol Syndrome Prognosis Primary Disorder

Adaptation behavior-failure to control impulses, blurred personal scope, weak anger management, stubbornness, compulsive behavior, excessive affection for strangers, lack of daily life skills, and slow development.

Attentionhyperactivity, distraction.

Cognition-mental retardation, confusion when stressed, difficulty in abstraction, difficulty in distinguishing between reality and fantasy, and slow cognitive processes.

Executive function-low judgment, data processing obstacles, difficulty in perception mode, low reasoning ability, inconsistent association between words and actions, low generalization ability.

Language-language expression barriers or language reception barriers, can only grasp some ideas, lack of ability to understand metaphors, idiomatic expressions or sarcasm.

Memory-poor short-term memory, inconsistent knowledge and memory.

Motor skills-poor writing, weak motor skills or physical motor skills, slow development of motor skills.

Sensory integration and minor neurological problems-sensory integration disorders, sensory defenses, and insensitivity to stimuli.

Social Interactions-Chattering, inability to read non-verbal or social cues, and raping for no reason.

Fetal alcohol syndrome secondary disorder

Work problems-80% of cases require continuous work guidance, inability to maintain work or unemployment.

Fetal alcohol syndrome protection factor

8-12 years old living in a good quality family (meeting 10 or more qualities)

Services for developmental disabilities

Get a Fetal Alcohol Syndrome

13% of life meets basic needs

Another study showed that music, musical instrument performance, composition, singing, art, spelling, reading, computer, mechanics, carpentry, skilled occupations (such as welding, electrician, etc.), writing and poetry, etc. can help people with fetuses People with alcohol spectrum disorders appear prominent, and these should also be used in treatment plans. [42]

Fetal Alcohol Syndrome Treatment

Fetal alcohol syndrome is incurable because damage to the central nervous system is permanent, but treatment is still possible. Because the central nervous system is damaged, symptoms, secondary disorders, and needs vary from person to person, there is no single cure. Instead, a comprehensive and patient-based multi-model approach is effective. Several treatment models are now being used, and many studies suggest that multiple treatments can improve negative effects.

Fetal alcohol syndrome medical treatment

Traditional medical treatments (ie, psychotropic drugs) are often used because many of the symptoms of fetal alcohol syndrome are misunderstood or overlapped with other symptoms, most notably attention deficit hyperactivity disorder. [44] For example, a patient who is inattentive, has not completed homework, and is unable to maintain a sitting position can be easily diagnosed as ADHD, especially when the patient has not been diagnosed with fetal alcohol syndrome. The general approach is to refer to a pediatrician, who may recommend trying altruism.

Medications are important in treating fetal alcohol syndrome, but they must be used in conjunction with other treatments to cope with multiple disorders.

Fetal alcohol syndrome behavior therapy

Because the learning system of patients with fetal alcohol syndrome is impaired, behavioral therapy is not often effective or effective for a long time, especially due to overlapping disorders caused or worsened by fetal alcohol syndrome. [42] Alfie Kohn pointed out that rewards and punishments may have short-term effects in general, but are not successful in the long-term. This is because this method does not consider satisfaction (that is, worth learning), community (that is, Safe and cooperative learning environment) and choices (ie making choices or following instructions). [45] Although these elements have some therapeutic uses, they do not improve performance by themselves. [42] And Ain's challenge to behavioral therapy shows that there are some important factors beyond learning theories, which support more models of treatment, such as in propensity models and neurobehavioral methods.

Fetal Alcohol Syndrome Development Framework

Many books and lecture notes on fetal alcohol syndrome suggest developmental methods based on developmental psychology, but many of these methods are not explained in detail or provide only minor supporting theories. The best human development can be divided into several stages, such as the cognitive development theory of Jean Piaget, the psychosocial development stage of Erik Erikson, and John Bobby ( John Bowlby) and other stages of development. Fetal alcohol syndrome affects normal development [43] and can lead to delayed, skipped or immature development. Over time, normal children should be able to overcome rising demands in life, but patients cannot. [43]

Knowing the child's stage of development, you can design treatments for fetal alcohol syndrome to help patients reach the stage of development. [43] If the patient is adapting to a behavioral delay, treatment can be targeted to the specific delay through additional education and training, reminders, and recommendations to support the desired level of function. This approach goes further than behavioral therapy because it takes into account the patient's developmental needs.

Fetal Alcohol Syndrome Tendency Model

The point of view of the propensity model is that someone needs to take the initiative to reconcile between the patient and the environment. [3] Tendency activities are carried out by an advocate (usually a family member, friend, or case manager) and are divided into three basic categories: [3]

Advocates are required to point out and explain the environment of the patient's fetal alcohol and its disorders.

Advocates cause change or adaptation on behalf of the patient.

Advocates assist patients in establishing and achieving achievable goals.

Tendency models are suggested treatments, especially when patients establish standard individualized education programs in schools. [44]

An understanding of the development architecture can help with the leaning model, and for patient internships, there needs to be intervention on the system, such as in schools, social workers, etc. Several fetal alcohol syndrome agencies also use propensity models in community practice. [46] [47]

Fetal alcohol syndrome neurobehavioral approach

Neurobehavioral methods focus on the neurology behind behavioral and cognitive processes. [42] It is a comprehensive approach to recognize and encourage multiple model treatments. The neurobehavioral approach is the transformation of a single treatment into a coherent set of approaches to address the complexity of fetal alcohol syndrome.

The neurobehavioral approach is characterized by trying to treat from different directions based on the patient's central nervous system damage and special needs, rather than just unproductive behavioral therapy. [48] This approach encourages more interest-based and strength-based treatments that successfully encourage and develop positive outcomes for patients. [42]

Fetal Alcohol Syndrome Public Health and Policy

At the level of public health and public policy, the prevention of fetal alcohol syndrome and the use of public resources to assist patients can be encouraged. [3] It is related to the propensity model, but it is encouraged at a system level.

Fetal alcohol syndrome prevention

Alcohol is teratogenic, and the only sure way to prevent fetal alcohol syndrome is to avoid drinking during pregnancy. [3] Some studies have suggested that a small amount of alcohol does not pose a risk to the fetus, and of course, absolute inhalation is absolutely safe. [The U.S. Medical Director advised women in 1981 and 2005 to quit drinking during pregnancy to avoid damage in the early stages of pregnancy. [9] The United States also has laws after 1988 that require warning signs on vessels of alcoholic beverages.