Maternal Behavioral Disorders:
Fetal Alcohol Syndrome
Biological Explanation of Fetal Alcohol Syndrome
Fetal Alcohol Syndrome occurs when a woman consumes alcohol while pregnant with a child, who then inherits the irreversible lifelong condition in-utero. Researchers Jones and Smith coined the term “Fetal Alcohol Syndrome” in 1973 to describe the abnormalities of children born to alcoholic mothers. Jones and Smith concluded Fetal Alcohol Syndrome (FAS) to be due directly to the toxic effects of alcohol on a fetus in utero (1). The Fetal Alcohol Study Group defined FAS in 1989, outlining the symptoms as: 1) prenatal/postnatal growth retardation (relating to low body weight/stunted height) 2) central nervous system retardation (including developmental, behavioral, intellectual) and 3) characteristic facial abnormalities. These aforementioned defects are called Alcohol-Related Birth Defects (ARBD) (1).
Alcohol is classified as a teratogen, which is a substance that can damage a developing fetus (4). Alcohol exposure can cause damage to the embryo at all stages of development, from the first two weeks until birth. Harm can occur early on in the development, even before a woman is aware she is pregnant. Alcohol is a small molecular substance that can move easily through membranes and into the bloodstream of the fetus (4).
Even at the 36th day of pregnancy, often before a woman realizes she is pregnant, the neural tube is open and still developing. The neural tube is the beginning stage to an embryo’s nervous system. At the 36th day, vital organs like the heart, brain, eyes, mouth, and digestive system have been formed… leaving them susceptible to damage by alcohol (10).
While alcohol is the reason for FAS deficiencies, the syndrome’s cause is actually the byproducts made by the body when metabolizing the alcohol. Ethanol is produced when the pregnant mother metabolizes alcohol. Alcohol and ethanol pass easily through the placenta and into the bloodstream of the fetus. The blood alcohol level of the fetus can be greater than that of the mother, and because it metabolizes alcohol less efficiently, the BAC is sustained for a long period of time (9).
Ethanol is metabolized in fetal tissues, where ethanol and fatty acids undergo synthetase (3). Synthetase occurs when an enzyme catalyzes the linkage of two molecules, using the energy derived from ATP (7).
Fatty Acid Ethyl Esters is one substance that is produced when the fetus metabolizes alcohol. Fatty Acid Ethyl Esters (FAEE) is nonoxidative ethanol metabolites that mediate alcohol-induced organ damage. They are consistent indicators of chronic alcoholics as opposed to casual drinkers (2). FAEE testing can indicate an infant’s exposure to alcohol in utero.
Alcohol is classified as a teratogen, which is a substance that can damage a developing fetus (4). Alcohol exposure can cause damage to the embryo at all stages of development, from the first two weeks until birth. Harm can occur early on in the development, even before a woman is aware she is pregnant. Alcohol is a small molecular substance that can move easily through membranes and into the bloodstream of the fetus (4).
Even at the 36th day of pregnancy, often before a woman realizes she is pregnant, the neural tube is open and still developing. The neural tube is the beginning stage to an embryo’s nervous system. At the 36th day, vital organs like the heart, brain, eyes, mouth, and digestive system have been formed… leaving them susceptible to damage by alcohol (10).
While alcohol is the reason for FAS deficiencies, the syndrome’s cause is actually the byproducts made by the body when metabolizing the alcohol. Ethanol is produced when the pregnant mother metabolizes alcohol. Alcohol and ethanol pass easily through the placenta and into the bloodstream of the fetus. The blood alcohol level of the fetus can be greater than that of the mother, and because it metabolizes alcohol less efficiently, the BAC is sustained for a long period of time (9).
Ethanol is metabolized in fetal tissues, where ethanol and fatty acids undergo synthetase (3). Synthetase occurs when an enzyme catalyzes the linkage of two molecules, using the energy derived from ATP (7).
Fatty Acid Ethyl Esters is one substance that is produced when the fetus metabolizes alcohol. Fatty Acid Ethyl Esters (FAEE) is nonoxidative ethanol metabolites that mediate alcohol-induced organ damage. They are consistent indicators of chronic alcoholics as opposed to casual drinkers (2). FAEE testing can indicate an infant’s exposure to alcohol in utero.
Figure 1: A chart depicting how ethanol is integrated into a fetus’s bloodstream (5).
The Cranial Neural Crest is very easily affected by ethanol in the embryo environment. The Cranial Neural Crest is responsible for the full formation of the facial skeleton (Cebra-Thomas). Alcohol consumption also kills cells that work to form the midline structures of the brain and face (8). The visible facial effects are due to damage to interior midline structures of the face and brain (8) Fetal alcohol syndrome and malformation of the head can cause cleft lip in the developing fetus. Alcohol also greatly decreases the size of a fetus’s head and brain (10).
Figure 2: Photos of a mouse embryo show normal development of the eyes, nostrils, and mouth on the control in left A & B, while the embryo exposed to alcohol in C & D show abnormal positioning of nostrils and a lack of midline structure in the brain (11).
Since fetal organs form at different stages of incubation, the timing and amount of a mother’s drinking adds to the variability of FASD disorders. The below chart illustrates the baby’s sensitivity to acquiring certain disorders as it develops in the womb.
Since fetal organs form at different stages of incubation, the timing and amount of a mother’s drinking adds to the variability of FASD disorders. The below chart illustrates the baby’s sensitivity to acquiring certain disorders as it develops in the womb.
Figure 3: The above chart illustrates the stages of development that a fetus undergoes in forming vital functions and organs. The chart highlights times where the fetus is most sensitive to developing a FASD disorder (6).
Ethanol production leads to a decreased the number of neurons in the child’s brain, an abnormal location of the neurons, and malformation of the brain. Alcohol constricts blood vessels, so that blood flow is disrupted in the placenta, and obstructs the delivery of vital oxygen and nutrients. Dangerous and toxic byproducts of alcohol breakdown can concentrate in the fetal brain and contribute to further development of the condition (4).
Ethanol production leads to a decreased the number of neurons in the child’s brain, an abnormal location of the neurons, and malformation of the brain. Alcohol constricts blood vessels, so that blood flow is disrupted in the placenta, and obstructs the delivery of vital oxygen and nutrients. Dangerous and toxic byproducts of alcohol breakdown can concentrate in the fetal brain and contribute to further development of the condition (4).
Symptoms and Effects
Problems that may arise during a pregnancy for a child can often be cause by a mother who drank alcohol during their pregnancy. Physical, behavioral and learning disabilities can be caused due to the alcohol consumed during pregnancy. A mother who chooses to drink is only putting their child at risk for long term problems which may in turn ruin their lives.
[Click the image to enlarge it.]
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Physical
Physical problems which may be associated with mothers drinking alcohol during pregnancy may be that the birth weight of the baby may be lessened, mental retardation of longitudinal growth, impaired fine motor skills and the central nervous system may be affected, smaller head or brain, heart murmurs and specific facial and skeletal characteristics.
Roll over the animation below to see the physical symptoms of FAS (15).
[Click the image to enlarge it.]
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Physical
Physical problems which may be associated with mothers drinking alcohol during pregnancy may be that the birth weight of the baby may be lessened, mental retardation of longitudinal growth, impaired fine motor skills and the central nervous system may be affected, smaller head or brain, heart murmurs and specific facial and skeletal characteristics.
Roll over the animation below to see the physical symptoms of FAS (15).
Behavioral
Behavioral problems include difficulties with learning in school, social complications, irritability, hyperactivity, diminished intelligence, problems with memory, being able to follow directions, controlling emotions and basic life skills such as bathing and feeding.
Behavioral problems include difficulties with learning in school, social complications, irritability, hyperactivity, diminished intelligence, problems with memory, being able to follow directions, controlling emotions and basic life skills such as bathing and feeding.
The Fetal Alcohol Spectrum
Fetal Alcohol Syndrome
FAS is the most extreme end of the spectrum which may result in the death of the fetus or they may have growth problems, abnormal facial features or even problems with their central nervous system. They also struggle with memory, learning normally, have short attention spans, problems with communication, vision or hearing. This results in difficulty in school and social situations (14).
Fetal Alcohol Syndrome
FAS is the most extreme end of the spectrum which may result in the death of the fetus or they may have growth problems, abnormal facial features or even problems with their central nervous system. They also struggle with memory, learning normally, have short attention spans, problems with communication, vision or hearing. This results in difficulty in school and social situations (14).
Alcohol-Related Neurodevelopmental Disorder
People with ARND may have intellectual disabilities and have difficulty with subjects such as math, and have poor memory and judgement (14).
Alcohol-Related Birth Defects
ARBD may cause problems with organs such as the heart and kidneys, and other issues with the bones or even hearing (14).
With all of these possible outcomes of alcohol related problems, patients may have between one or even all of these symptoms. It is difficult to say what amount of alcohol will be damaging to the fetus, so the best option would to be just to stay away from alcohol to prevent causing any type of problems.
People with ARND may have intellectual disabilities and have difficulty with subjects such as math, and have poor memory and judgement (14).
Alcohol-Related Birth Defects
ARBD may cause problems with organs such as the heart and kidneys, and other issues with the bones or even hearing (14).
With all of these possible outcomes of alcohol related problems, patients may have between one or even all of these symptoms. It is difficult to say what amount of alcohol will be damaging to the fetus, so the best option would to be just to stay away from alcohol to prevent causing any type of problems.
Critical Thinking Questions
1. Should women be punished by the law for putting their baby in harm by drinking during pregnancy?
2. Should women be evaluated to see if they are fit to be a good parent if they drink during their pregnancy?
2. Should women be evaluated to see if they are fit to be a good parent if they drink during their pregnancy?
Works Cited
1. "Fetal Alcohol Syndrome." Fetal Alcohol Syndrome. About.com & the National Institute on Alcohol Abuse and Alcoholism, n.d. Web. 20 Nov. 2012. <http://alcoholism.about.com/cs/alerts/l/blnaa13.htm> - National Institute on Alcohol Abuse and Alcoholism
2. Best, Catherine A., Soderberg, Cluette-Brown, Joanne E., MS, Laposata, Michael, MD, PhD., Raneem L., Britt, Salem O., MS, and "Fatty Acid Ethyl Esters." Diss. Division of Laboratory Medicine, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 2003. Fatty Acid Ethyl Esters. Pathology Patterns Reviews, 2003. Web. 18 Nov. 2012. <http://ajcp.ascpjournals.org/content/supplements/119/Suppl_1/S94.full.pdf>. – pathology patterns reviews
3. Dachel, Jennifer M., Larson, Palmela L., Parimi, Nair, and Anuradha, Venu G. K. "Fetal Alcohol Syndrome." Diss. Department of Environmental and Public Health, University of Wisconsin at Eau Claire, 2003-2004. Abstract. Alcohol as a Teratogen: Fetal Alcohol Syndrome. University of Wisconsin at Eau Claire, 08 Dec. 2003. Web. 15 Nov. 2012. <http://people.uwec.edu/piercech/fas/fas...htm> - Department of Environmental and Public Health, University of Wisconsin
4. "Effects of Alcohol on a Fetus." FASD Center for Excellence. Department of Health and Human Services, 2007. Web. 16 Nov. 2012. <http://www.fasdcenter.samhsa.gov/documents/wynk_effects_fetus.pdf>.
5. (FIGURE 1) Kaskutas, Lee Ann & Graves, Karen. Addiction (2001) 96, 1199-1209. Provided by “Effects of Alcohol on a Fetus.” FASD Center for Excellence. Department of Health and Human Services, 2007. Web. 16 Nov. 2012.
6. (FIGURE 3) Medical State of Mind: Critical Periods of Human Development. Digital image. Medical State of Mind. Tumblr, 12 Apr. 2012. Web. 26 Nov. 2012. http://medicalstate.tumblr.com/post/21484975947/critical-periods-of-human-development
7. "Synthetase." Merriam-Webster. Merriam-Webster, n.d. Web. 28 Nov. 2012. http://www.merriam-webster.com/dictionary/synthetase - - Miriam webster
8. Alcohol-Related Birth Defects. National Institute on Alcohol Abuse and Alcoholism, n.d. Web. 20 Nov. 2012. http://pubs.niaaa.nih.gov/publications/Science/Power%20Point/FAS.pdf - NIAA
9. Perlstein, David. "Fetal Alcohol Syndrome (FAS) Symptoms, Cause, Diagnosis, Signs, Facts and Statistics by MedicineNet.com." MedicineNet. Ed. William C. Shiel, Jr. MedicineNet, 21 Dec. 2010. Web. 16 Nov. 2012. <http://www.medicinenet.com/fetal_alcohol_syndrome/article.htm>.
10. Tourmaa, Tuula E. The Adverse Effects of Alcohol on Reproduction. The Adverse Effects of Alcohol on Reproduction. FORESIGHT, The Association for the Promotion of Preconceptual Care, 28 The Paddock, Godalming, Surrey GU17 1XD, n.d. Web. 19 Nov. 2012. <http://www.come-over.to/FAS/alcohol.html>. – Tourmaa
11. (FIGURE 2) United States of America. National Institutes of Health. Department of Health and Human Services. Better Safe Than Sorry: The Biological Basis of Fetal Alcohol Syndrome and Other Alcohol-Related Birth Defects. National Institute of Alcohol Abuse and Alcoholism, n.d. Web. 20 Nov. 2012. <http://pubs.niaaa.nih.gov/publications/Science/Power%20Point/FAS.pdf>.
12. "Data & Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Aug. 2012. Web. 28 Nov. 2012. <http://www.cdc.gov/ncbddd/fasd/data.html>.
13. "Fetal Alcohol Spectrum Disorders: MedlinePlus." U.S National Library of Medicine. U.S. National Library of Medicine, 31 Oct. 2012. Web. 28 Nov. 2012. <http://www.nlm.nih.gov/medlineplus/fetalalcoholspectrumdisorders.html>.
14. "Stop and Think. If You're Pregnant, Don't Drink." FASD Center for Excellence. FASD Center, 13 Nov. 2012. Web. 28 Nov. 2012. <http://fasdcenter.samhsa.gov/Index.aspx>.
15. http://fasd.brighttomorrow.com/index.asp?page=2_4
2. Best, Catherine A., Soderberg, Cluette-Brown, Joanne E., MS, Laposata, Michael, MD, PhD., Raneem L., Britt, Salem O., MS, and "Fatty Acid Ethyl Esters." Diss. Division of Laboratory Medicine, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 2003. Fatty Acid Ethyl Esters. Pathology Patterns Reviews, 2003. Web. 18 Nov. 2012. <http://ajcp.ascpjournals.org/content/supplements/119/Suppl_1/S94.full.pdf>. – pathology patterns reviews
3. Dachel, Jennifer M., Larson, Palmela L., Parimi, Nair, and Anuradha, Venu G. K. "Fetal Alcohol Syndrome." Diss. Department of Environmental and Public Health, University of Wisconsin at Eau Claire, 2003-2004. Abstract. Alcohol as a Teratogen: Fetal Alcohol Syndrome. University of Wisconsin at Eau Claire, 08 Dec. 2003. Web. 15 Nov. 2012. <http://people.uwec.edu/piercech/fas/fas...htm> - Department of Environmental and Public Health, University of Wisconsin
4. "Effects of Alcohol on a Fetus." FASD Center for Excellence. Department of Health and Human Services, 2007. Web. 16 Nov. 2012. <http://www.fasdcenter.samhsa.gov/documents/wynk_effects_fetus.pdf>.
5. (FIGURE 1) Kaskutas, Lee Ann & Graves, Karen. Addiction (2001) 96, 1199-1209. Provided by “Effects of Alcohol on a Fetus.” FASD Center for Excellence. Department of Health and Human Services, 2007. Web. 16 Nov. 2012.
6. (FIGURE 3) Medical State of Mind: Critical Periods of Human Development. Digital image. Medical State of Mind. Tumblr, 12 Apr. 2012. Web. 26 Nov. 2012. http://medicalstate.tumblr.com/post/21484975947/critical-periods-of-human-development
7. "Synthetase." Merriam-Webster. Merriam-Webster, n.d. Web. 28 Nov. 2012. http://www.merriam-webster.com/dictionary/synthetase - - Miriam webster
8. Alcohol-Related Birth Defects. National Institute on Alcohol Abuse and Alcoholism, n.d. Web. 20 Nov. 2012. http://pubs.niaaa.nih.gov/publications/Science/Power%20Point/FAS.pdf - NIAA
9. Perlstein, David. "Fetal Alcohol Syndrome (FAS) Symptoms, Cause, Diagnosis, Signs, Facts and Statistics by MedicineNet.com." MedicineNet. Ed. William C. Shiel, Jr. MedicineNet, 21 Dec. 2010. Web. 16 Nov. 2012. <http://www.medicinenet.com/fetal_alcohol_syndrome/article.htm>.
10. Tourmaa, Tuula E. The Adverse Effects of Alcohol on Reproduction. The Adverse Effects of Alcohol on Reproduction. FORESIGHT, The Association for the Promotion of Preconceptual Care, 28 The Paddock, Godalming, Surrey GU17 1XD, n.d. Web. 19 Nov. 2012. <http://www.come-over.to/FAS/alcohol.html>. – Tourmaa
11. (FIGURE 2) United States of America. National Institutes of Health. Department of Health and Human Services. Better Safe Than Sorry: The Biological Basis of Fetal Alcohol Syndrome and Other Alcohol-Related Birth Defects. National Institute of Alcohol Abuse and Alcoholism, n.d. Web. 20 Nov. 2012. <http://pubs.niaaa.nih.gov/publications/Science/Power%20Point/FAS.pdf>.
12. "Data & Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Aug. 2012. Web. 28 Nov. 2012. <http://www.cdc.gov/ncbddd/fasd/data.html>.
13. "Fetal Alcohol Spectrum Disorders: MedlinePlus." U.S National Library of Medicine. U.S. National Library of Medicine, 31 Oct. 2012. Web. 28 Nov. 2012. <http://www.nlm.nih.gov/medlineplus/fetalalcoholspectrumdisorders.html>.
14. "Stop and Think. If You're Pregnant, Don't Drink." FASD Center for Excellence. FASD Center, 13 Nov. 2012. Web. 28 Nov. 2012. <http://fasdcenter.samhsa.gov/Index.aspx>.
15. http://fasd.brighttomorrow.com/index.asp?page=2_4