Medical Abbreviation: A Closer Look at Fetal Alcohol Syndrome

Written By:
Paulette Campbell RN-BC, BSN, MJ
Certified Legal Nurse Consultant

Maternal use of alcohol is the leading cause of birth defects and developmental delays in the United States. In a 2003 survey, 9.8% of pregnant women admitted to using alcohol while being pregnant. About four percent admitted to binge drinking (defined as four or more drinks on a single occasion). The prevailing guideline regarding pregnant women and drinking is that a pregnant woman should abstain from alcohol use during her pregnancy and even while attempting to get pregnant.

Fetal Alcohol Syndrome refers to a group of physical, behavioral and cognitive abnormalities. These include;

• Dysmorphic facial features
• Prenatal and postnatal growth abnormalities
• Mental Retardation (in fact, FAS is the leading cause of Mental Retardation)
• Microcephaly
• Behavioral Abnormalities
• Poor Coordination
• Low Tone
• Attention Deficit Hyperactivity Disorder
• Decrease Adipose Tissue
• Facial Abnormalities
• Cardiac Defects
• Hemangiomas
• Eye or ear abnormalities

In 1996, the Institute of Medicine defined Alcohol Related Neurodevelopmental Disorder (ARND) as the behavioral and cognitive changes seen with fetal alcohol exposure but not the full spectrum of FAS. They also defined Alcohol Related Birth Defects as a maternal history of alcohol use that causes damage to the heart, kidneys, bones and hearing. Some times, these disorders are referred to as Fetal Alcohol Spectrum Disorder although that is not a clinical diagnosis.

During pregnancy alcohol crosses the placenta and rapidly reaches the fetus. In fact, the amniotic sac often acts like a reservoir for the alcohol that has been ingested by the mother, prolonging the exposure of the fetus to the alcohol. Further, the fetal liver is not able to absorb the alcohol and therefore depends on the adult liver of the mother to absorb the alcohol.

Fetal development is altered by the disruption in cellular differentiation and growth. This occurs due to a disruption in the DNA and protein synthesis which then inhibits cell migration. Fetal exposure to alcohol also causes a decrease in the transfer of amino acids, glucose, folic acid, zinc, and nutrients across the placental barrier. This indirectly affects fetal growth and development. Studies have also suggested that fetal alcohol exposure causes chronic fetal hypoxia.

The US Institute of Medicine has set up guidelines regarding the diagnosis of Fetal Alcohol Syndrome. Those guidelines state the following:

• Fetal Alcohol Syndrome with confirmed maternal alcohol exposure must occur with three of the following;
  • Confirmed maternal alcohol exposure
  • Evident of characteristic facial anomalies
  • Evidence of prenatal/postnatal growth restriction
  • Evidence of CNS/Neurodevelopmental abnormalities
• Fetal Alcohol Syndrome without confirmed maternal alcohol exposure
  • Evidence of characteristic facial anomalies
  • Evidence of prenatal/postnatal growth restriction
  • Evidence of CNS/Neurodevelopmental anomalies

Prompt diagnosis of FAS and its related syndromes is needed for the child with FAS to function at their optimal ability. Therefore the best time for diagnoses to occur is at birth; however, many children are not diagnosed until school age. In fact, most children with FAS are not diagnosed until 4-6 years of age. FAS not only has implications for impeding the child from achieving in school but there is a substantial amount of research which demonstrates the ill-effects that FAS has on adults, including criminal behavior.

Contact our medical legal consulting firm today at Medical Jurisprudence, Inc to discover how our staff can help make a difference in your medical related cases such as those involving FAS. We can be reached at info@medicaljurisprudenc.com or 630-551-0978.