What is fetal alcohol syndrome in children - signs and symptoms. Fetal alcohol syndrome in a newborn baby

10.07.2019

Fetal alcohol syndrome (FAS) is a set of symptoms that appear in children born to alcoholic mothers. Under the influence of alcoholic beverages, the fetus develops irreversible anomalies; it is FAS that is considered the most common cause of the development of mental retardation.

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Why is alcohol dangerous during pregnancy?

Drinking hot drinks by a pregnant woman is fraught with the embryo and can lead to the following results:

alcoholic fetopathy;
spasm of the umbilical cord and placenta, as a result, lack of oxygen and vitamins;
changes in the structure of DNA;
the appearance of congenital deformities;
disturbances in the work of the nervous system;
metabolic disorders;
the possibility of miscarriage;
the death of a baby even before birth;
weak immunity of the child;
psychological illnesses;
developmental delay, etc.

The impact of alcohol on the health of the mother and the effect on the formation of the child is unpredictable, therefore, already at the stage of preparation for motherhood, it is worth stopping the use of alcoholic beverages.

The video posted on the Alcohol Stop channel provides information on the effect of ethanol on fetal formation.

Fetal Alcohol Syndrome Causes

The main and only reason for the development of fetal alcohol syndrome is alcoholism, the use of strong drinks by the expectant mother.

Alcohol passes through the placenta to the child, reaching the same concentration in the blood as in a woman. Since the enzyme system of the embryo matures to the end only after birth, and the liver is not yet able to break down alcohol, ethanol remains in the child's body for a long time, this provokes the onset of FAS.

Factors in the onset of fetal alcohol syndrome include:

mother's alcoholism;
poor nutrition;
a woman's refusal to register at an antenatal clinic;
low social status.

The risk of developing such a disease is highest from 1 to 12 weeks (I trimester), but it is not excluded throughout the entire period of gestation.

Symptoms of the development of fetal alcohol syndrome in children

The manifestations of FAS are varied, represented by classes of symptoms.

Distinguish:

external signs;
internal signs;
damage to the central nervous system.

External signs

External signs of fetal alcohol syndrome include:

being underweight at birth;
small growth (44-46 cm);
narrow palpebral fissure;
strabismus;
low forehead;
thinning of the upper lip;
smoothed groove above the lip;
short nose;
undeveloped lower jaw;
microcephaly;
violation of the bite;
"Hare lip", "cleft palate";
curvature of the phalanx of the little fingers (clinodactyly).

Internal signs

Internal signs of FAS include:

congenital heart disease;
pathology of the genitourinary system;
changes in the structure of the chest;
dysplasia;
hernia, etc.

Disorders in the central nervous system

Disturbances in the central nervous system in newborns are noticeable in the first minutes of life:

hyperexcitability;
hydrocephalus;
convulsions;
tremor.

With age, the following can be observed:

scattered attention;
inability to remember simple things;
difficulties in mastering the school curriculum;
problems in society;
mental retardation (PD);
epilepsy;
delayed speech and motor development.

The severity of the disease

Fetal alcohol syndrome is classified based on the degree of damage and the severity of symptoms:

First degree (easy). It is characterized by unexpressed external signs, minor delays in mental development are possible. The disease is relatively easy.
Second degree (medium). Oral and maxillofacial pathologies, serious mental abnormalities are observed. Pronounced presence of all major manifestations of FAS.
Third degree (severe). Irreversible intellectual deviations, internal and external lesions are characteristic.

How to diagnose alcohol syndrome in children?

It is possible to diagnose II and III degree fetal alcohol syndrome by assessing the appearance of the newborn. According to indications, magnetic resonance therapy of the brain, ultrasound of internal organs can be prescribed. The sooner the doctor makes a correct diagnosis, the more likely a favorable outcome.

For accurate diagnostics, it is taken into account:

medical history of the woman (alcohol history);
condition of the newborn;
the height and weight of the baby at birth, then tracked in dynamics.

To establish the fact of taking alcohol, a spectral analysis of the hair of the mother or fetus is carried out. The presence of fatty acid esters in the biomaterial indicates the use of dangerous drinks by the expectant mother.

What kind of treatment is required?

The resulting disorders in FAS are irreversible, that is, complete recovery is impossible. Symptomatic treatment is carried out. To eliminate cosmetic flaws and with serious internal lesions (heart disease, atresia of the anus, etc.), surgical methods of treatment are used.

Psychological support is extremely important for children with FAS.

The treatment regimen is established by the attending physician, depending on the symptoms and severity of the disease.

The observation and treatment of children with fetal alcohol syndrome is carried out by narrow specialists:

pediatrician - monitors the general condition of the child;
speech therapist - deals with the development of speech skills;
by a surgeon - carrying out operations;
a psychologist - correction of behavioral norms, psychological assistance;
neurologist - deals with the problems of the central nervous system;
cardiologist - treatment of heart disease;
ophthalmologist, etc.

Prognosis for Fetal Alcohol Syndrome

Children who have been diagnosed with fetal alcohol syndrome and are unable to live independently in adulthood, have created specialized neuropsychiatric institutions for them.

With timely and competent treatment, the percentage of children with mild to moderate FAS who have adapted in society and live a full life is 30%.

Disease prevention

Prevention of FAS among women is necessary and involves:

rejection of bad habits;
lectures on the harmful dangers of alcohol to an unborn child;
timely identification of pregnant women suffering from alcoholism and correction of the management of their pregnancy.

Photo gallery

The photo shows the external symptoms of fetal alcohol syndrome:

Short palpebral fissure Strabismus

It is a combination of various disorders that form during the intrauterine development of the fetus. Based on the severity of the disease, these deviations have varying degrees of severity. The main reason for the development of this terrible disease in children is alcohol dependence of pregnant women.

Fetal alcohol syndrome is caused by the toxic effects of ethanol on the body of an unborn baby.

Ethyl alcohol is able to freely pass through the placenta, it impairs the transport of nutrients to the fetus, disrupts the balance of enzymes, amino acids and vitamins. This is not a complete list of the harmful effects that alcohol can cause a developing body.

What is fetal alcohol syndrome?

External signs of FAS

Fetal alcohol syndrome develops in children whose mothers have abused hard liquor during pregnancy. From the very first minutes after birth, a child with this disease has tremors, abstinence, which is accompanied by restless sleep, impaired sucking reflex and respiratory depression. As children with this disorder grow older, characteristic disorders may appear.

Fetal alcohol syndrome has the following symptoms:

Small head size;
Low birth weight and height of the child;
Congenital malformations;
External deformities;
Epilepsy;
Heart problems;
Mental developmental disorders of the child;
Changes in the structure of the skeleton;
Various mental disorders;
Liver fibrosis;
Overactive behavior and lack of concentration;
Low learning ability;
Abnormalities of internal organs.

This is not a complete list of serious disorders that can develop in a child, whose mother liked to have a couple of drinks during the period of his gestation.

FAS has many features that can manifest themselves in a wide variety of combinations. In many cases, in children suffering from this disease, it is possible to observe features of mental development, craniofacial anomalies, failures in the functioning of the cardiovascular system and pathology in the formation of the skeleton.

In medicine, a large number of cases have been recorded when babies with alcohol syndrome died due to congenital anomalies incompatible with life.

Forms of the disease

This disease is mild, moderate and severe. Children with a mild form of the disease may not have pronounced pathologies, but, nevertheless, they have the following symptoms:

Moderate lag in weight gain and height;
Eating disorder;
Small size of the skull;
Slight deformity of the face and skull;
Poorly expressed mental disorders and lagging behind developmental norms.

The average form of the development of this disease in children is accompanied by changes in the structure of the skull and external defects. In addition, they have features of mental and mental retardation.

Children with severe FAS often have significant developmental pathologies of internal organs and the central nervous system. A child born with this diagnosis has pronounced facial deformities, signs of dementia and mental abnormalities.

FAS diagnostics

The diagnosis of fetal alcohol syndrome is made when the child has significant growth retardation, signs of central nervous system disorders and pathological deformities of the face and skull. Diagnosis is based on maternal tests and characteristic symptoms.

Drinking alcohol is strictly prohibited in any trimester of pregnancy, since even a single intake of alcohol can turn into a serious malformation of the intrauterine development of the baby.

Physical abnormalities with FAS

Ethyl alcohol freely passes through the placenta and over time accumulates in the organs and tissues of the fetus. This is due to the fact that the excretory systems responsible for removing toxins from the body are not yet sufficiently developed in the fetus.

An experienced doctor will notice the first symptoms of the disease immediately. As a rule, these are specific disorders of the structure of the skull and face. Children with this disease can have both minor deviations (small head, low-located wide bridge of the nose, irregular shape of the auricles) and severe physical defects (cleft palate, cleft lip).

Minor abnormalities may seem like a cosmetic deviation, but later the child may develop a number of other characteristic features of the disease on the part of the internal organs and the central nervous system.

Mental abnormalities in FAS

Nerve cells are very vulnerable to ethyl alcohol, therefore, under its influence, serious damage to the fetal brain often occurs. Immediately after the birth of a baby, it is impossible to determine the degree of mental development, therefore, all kinds of deviations can appear as the child grows.

Children with this disorder may have poor memory, decreased concentration, and withdrawn behavior. As a rule, they are characterized by unpredictable behavior, it is difficult for them to communicate with peers and adults.

The manifestation of all these deviations leads to the fact that it is difficult for the patient to master the school curriculum; in the future, he will face problems in acquiring professional skills. People with this disease often cannot become full-fledged members of society.

Another unpleasant factor is that people with FAS have low alcohol resistance. This can cause the development of alcoholism, and lead to the fact that, even having drunk once, a person will go into a long binge, since he will not be able to overcome the craving for alcohol.

Treatment of fetal alcohol syndrome

Raising a child with FAS requires some emotional strength from the parents. Therefore, it is important to find an approach to the baby and show him with all his might how much he is loved and appreciated. It will not be superfluous to receive a consultation with a psychologist in special social centers, where emotional support is provided to patients and their families.

Caring for an infant with FAS comes with some challenges. A newborn may be afraid of loud noise and bright light, so it is very important to equip a room for him in which a quiet and calm atmosphere will reign. In such a baby, the sucking reflex may be impaired, so feeding the baby may take longer than feeding a healthy newborn.

Crumbs suffering from alcohol syndrome need constant communication with loved ones. You need to carry it on your hands as often as possible, read books and engage in its general development.

As the sick baby grows up, his treatment will be accompanied by various additions and adjustments. Sick children should regularly visit the attending physician, who can determine the progress of the current course of treatment, or identify deviations.

Sick schoolchildren need constant parental care, who must provide the growing baby with all kinds of support and help in mastering the school curriculum. In many cases, children with fetal syndrome have external defects that affect their self-esteem and social development. Parents should praise special babies as often as possible and say how much they love them.

Treatment for adolescents may include occupational therapy, physical therapy, and speech therapy. This is important for instilling in the maturing person social skills and the ability to behave in society.

Occupational therapy will help a teenager gain professional skills and feel like an active member of society. If the patient has serious mental or emotional abnormalities, then he needs the constant presence of loved ones who can help calm him down and provide support.

People with fetal alcohol syndrome are more likely to become depressed, overwhelmed by anxiety and attention deficit. If they did not receive psycho-emotional help from their loved ones in time, then with a high probability they can become victims of alcohol or drug addiction.

If the child has problems with hearing, vision or any other defects, then it is imperative to visit certain specialists. The sick baby may need surgery or medication.

If the patient receives appropriate treatment, but it does not bring results, then one should undergo a thorough examination again and seek help from several specialists. The main thing to remember is that it is much easier for boys and girls, surrounded by love and care of loved ones, to deal with illness and overcome psychological difficulties.

Prevention of fetal alcohol syndrome

Any woman who wants to give birth to a healthy and strong baby should be aware of the harm that can be done to her, to an unborn baby, by the thoughtless use of intoxicating drinks. It should be borne in mind that even a single intake of a small dose of alcohol can adversely affect the intrauterine development of a new organism. In medicine, there is no drug that can eliminate or somehow reduce the toxic effects of ethanol on the fetus. Treatment for FAS is a difficult and time-consuming process, sometimes taking a lifetime. In many cases, therapy does not have the expected effect, and a sick person cannot become a full-fledged member of society.

It is very important to remember that the only way to eliminate the likelihood of developing FAS in a future baby is to completely abandon the use of any alcoholic beverages.

All materials on our site are intended for those who care about their health. But we do not recommend self-medication - each person is unique, and without consulting a doctor, one or another means and methods cannot be used. Be healthy!

Fetal alcohol syndrome (FAT) is understood as multiple and to varying degrees of pronounced deviations in the physical and mental development of the infant due to the mother's alcohol consumption before pregnancy and during gestation. Some abnormalities may appear in a child shortly after birth, while others - at a later stage of development.

Causes

Alcohol has a toxic effect on the fetus.

The cause of ASP is the toxic effect of alcohol and its cleavage products on the fetus. Alcohol easily penetrates the placenta and has an effect on the fetal tissue for a long time, since it is slowly rendered harmless due to the absence of alcohol dehydrogenase in the fetal liver.

The harmful effect on the fetus does not depend on the type of alcoholic beverage. Moreover, any amount of alcohol, even a small amount, is dangerous. Although the more alcoholic beverages a pregnant woman drinks, the more pronounced the damage to the fetus.

The effects of alcohol are especially dangerous in the early stages of pregnancy, when organs are being laid. Heart defects, abnormalities of internal organs, brain damage - such damage is possible when drinking alcohol in the first trimester. The normal supply of tissues (including the brain) with oxygen and nutrients is disrupted, cell synthesis is suppressed.

The brain and other parts of the nervous system develop throughout pregnancy, so they are most vulnerable and can be affected by alcohol at any time. In the second trimester, alcohol increases the risk of spontaneous abortion.

In the third trimester, alcohol delays the rapid growth of the fetus that is characteristic of this period of pregnancy. There is also an increased damage to the nerve cells of the fetus during this period.

Given the fact that the baby's body continues to grow and develop after birth, the baby may suffer from alcoholic beverages if the mother uses them during breastfeeding.

Symptoms

The symptomatology of ASP is quite varied. In terms of severity, manifestations can be mild, moderate and severe.

The clinical manifestations of ASP can be conditionally divided into 4 groups:

prenatal and postpartum dystrophy;
craniofacial pathology;
physical deformities and organ abnormalities;
damage to the central nervous system (brain).

Newborns are low birth weight and short in body length. Children lag behind in physical development even after birth. The more and more often the mother used alcohol, the more the baby lags behind in development. Sometimes the lag is so pronounced that newborns have to be hospitalized. Developmental delays occur throughout life, even when children are encouraged to do so.

Craniofacial abnormalities usually occur as follows:

small size of eyes, pronounced inner fold of the eyelid, squint, ptosis of the eyelids;
saddle nose, nasolabial fold is poorly expressed;
thin, protruding upper lip;
large size of deeply set ears;
elongated face shape;
underdevelopment of the upper or lower jaw;
Cleft palate (common).

Possible damage to the musculoskeletal system:, improper placement of the fingers, chest abnormalities, shortening of the feet. More significant are changes in the internal organs: (in boys), underdeveloped labia and a doubling of the vagina (in girls); disorders in the structure and function of the kidneys, liver fibrosis. Congenital pathology of the cardiovascular system occurs very often (up to 50% of cases): most often these are defects in the septa in the heart cavities.

On the part of the nervous system, disorders can appear after the birth of the baby: anxiety, increased muscle tone, or, conversely, decreased muscle tone, convulsions. There may be violations of the sucking and grasping reflexes.

In a later period, hydrocephalus and mental retardation, hearing and vision problems may develop. The head circumference is small, microcephaly (small brain size) develops.

The severity of mental deviations can be different: from minimal problems with thinking to a severe degree of retardation, inadequate behavior, in which social adaptation and communication with peers are impossible.

Such children are hyperactive, they have impaired self-control, low learning ability, inability to focus, and there is no abstract thinking. They are not able to generalize, they do not understand the categories of space and time. The exact sciences are especially difficult. If the cerebellum is affected, clumsiness, lack of coordination, and repetitive seizures are noted.

As you get older, some of the characteristics wear off, but the underdeveloped brain and short stature persist. Adolescents have poor memory, they have poor control over their actions, often conflict, have a tendency to depression, alcoholism, drug addiction and drug addiction, and often break the law.

Thus, it can be seen that many of the consequences of alcohol exposure on the fetus are irreversible, and some patients need medical and social assistance throughout their lives.

Diagnostics

Prenatal diagnosis of ASP is almost impossible. After the birth of a baby, ASP has to be differentiated from hereditary pathology with similar manifestations. Diagnosis is based on data on maternal alcohol abuse and clinical manifestations in the child. Genetic testing can be done if necessary.

Treatment

Organic changes that occurred in the body during the laying of organs in utero are irreversible, they cannot be changed, they remain in most cases for life. Some defects are eliminated by surgery: this concerns heart defects, cleft palate, undescended testicle, hip dysplasia, etc.

In case of problems with training, the issue is solved by using special training programs in special schools. In case of behavioral deviations, a psychologist is consulted. In some cases, symptomatic drug treatment is carried out (with convulsive syndrome, for example).

Prophylaxis

There is no safe type or safe dose of alcoholic beverage for the fetus, nor is there a safe pregnancy period. Wine and beer are just as harmful to the fruit as spirits. Any of them is dangerous to the fetus.

The problem is that a woman in the first weeks of pregnancy may not yet know about her, so a woman of reproductive age who has sex and does not use contraceptives should stop drinking alcohol altogether.

As a last resort, you should stop drinking any alcoholic beverages as soon as you become aware of the pregnancy. It is not recommended to even take medicinal tinctures or balms, use mouth rinses, or consume confectionery products containing alcohol.

Women suffering from alcoholism need to undergo treatment with a narcologist, and only then plan a pregnancy.

Resume for parents

Given such dire consequences for a child when a pregnant woman drinks alcohol, the only way to protect a child is not to drink them. Family members and other close people need to create a healthy environment for the expectant mother and not arrange "feasts" and parties. On holidays, non-alcoholic drinks should be consumed. You should never refer to someone else's experience and argue that one sip is not dangerous, one sip will not harm.

Which doctor to contact

The first thing that parents of a child with alcohol syndrome face is developmental disorders. Of course, the pediatrician becomes their main assistant. In his direction, the baby is consulted by various specialists: a neurologist, cardiologist, ophthalmologist, hepatologist, nephrologist, ENT doctor and others, depending on the affected organ. If surgical treatment is necessary, the child is examined by a cardiac surgeon, orthopedist, and a plastic surgeon. In the future, you may need the help of a speech therapist, a psychologist, and with a pronounced decrease in intelligence, even a psychiatrist.

The diagnosis of fetal alcohol syndrome (FAS) in children is understood as a number of mental and physical defects, different in combination and severity, which are caused by the mother's alcohol abuse during pregnancy and before pregnancy. The syndrome in children manifests itself after birth and remains for life.

In many cases, the presence of FAS can be suspected immediately after the birth of the child, focusing on the indicators of height and weight, as well as the size and shape of the skull. Meconium and newborn hair contain esters of fatty acids. For the final confirmation of the diagnosis, specialists will have to conduct tests, observe the child's development in dynamics for some time.

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To clarify the diagnosis, the methods of neurosonography, MRI of the brain are used, which make it possible to accurately determine the structural disorders of the brain, the size of the cerebellum, and the caudate nucleus. To exclude the presence of severe consequences of FAS, it is recommended to conduct the following examinations:

Echocardiography;
Ultrasound of the abdominal organs, kidneys;
screening audiological examination.

To assess the psychomotor and intellectual development of a child, specialists use tests, and questionnaires are widely used. Children suffering from this syndrome have to be constantly monitored by many doctors of different profiles:

pediatrician;
pediatric surgeon;
neurologist;
nephrologist;
cardiologist;
orthopedic traumatologist;
ophthalmologist, etc.

A child with a severe degree of fetal alcohol syndrome can die in infancy with diseases and malformations incompatible with life

The manifestations of FAS are distinguished from changes caused by intrauterine infections and from chromosomal abnormalities, although all of the above can occur simultaneously in the same patient.

Alcohol syndrome is diagnosed according to the following criteria:

small height and weight during intrauterine development and after birth;
specific structure of the body, head, face;
severe developmental retardation, neuralgic pathologies.

Today, an experienced physician can identify FAS by its appearance. At the same time, diagnosis is difficult if the external manifestations of the syndrome are weak or absent altogether, which is typical for a certain number of patients. Continuous observation of the child's behavior and further development may be required to confirm the diagnosis. In addition, it should be noted that FAS can be combined with other diseases caused, among other things, by the abuse of alcohol by the child's parents.

Classification of fetal alcohol syndrome

FAS is considered the leading cause of mental retardation. This syndrome determines the whole life of a person and, naturally, leaves an imprint on his appearance. Anomalies can be traced in several areas:

deficiency in height, weight;
violation of the structure of internal organs, external genital organs;
specific structure of the skull, a certain facial expression.

Here is the classification of FAS according to the degree of impairment of physical and mental development.

A mild degree is manifested by minor developmental disorders, hidden or significantly pronounced signs of craniofacial deformity, in the disturbed activity of the digestive system and accounts for 44% of cases;
Medium - the symptoms are pronounced, it is possible to determine the child's underdevelopment by appearance. Makes up 34% of all cases;
The severe degree is characterized by craniofacial dysmorphism, severe somatic defects, and gross intellectual disabilities.

Internal pathologies of intrauterine alcohol syndrome are diagnosed over time. Among them there are both congenital malformations of individual organs and diseases of the whole organism.

These include:

heart defects;
doubling of the urethra, other anomalies of the genitourinary system;
umbilical hernia;
liver fibrosis;
aortic stenosis;
hearing impairment;
vision problems;
epilepsy.

Central nervous system disorders are the most common signs of FAS. Alcohol, even in small amounts during pregnancy, causes mental disorders in babies without external developmental disabilities. These features are revealed immediately after the birth of a child. Newborn children with FAS experience difficulty sleeping, cry many times more than their peers. With age, the number of problems only grows.

So, children with fetal alcohol syndrome differ:

mental retardation;
attention problems, poor memory;
increased excitability, aggressiveness;
hyperactivity;
nervous tics, stuttering;
uncontrollable behavior;
hypersensitivity to alcohol.

As a result, it is extremely difficult for children with this diagnosis to fit into the team, study is given to them with great difficulty, they easily fall into bad company and quickly get drunk, often end up in prison.

Physical defects in children with FAS are manifested:

small head;
short, wide nose;
narrow chin;
small eyes;
cleft lip or underdeveloped lips;
low protruding ears;
undescended testicles in boys, labia majora in girls;
shortened foot, toes;
lack of anus;
bone abnormalities.

Such children in most cases need the services of special teachers, lifelong medical support, and the help of social workers. Usually, due to the peculiarities of physical and intellectual development, they are poorly adapted to independent life, poorly trained and, as mentioned above, are at risk. Due to intrauterine alcohol intoxication, the likelihood of developing alcoholism in them is very high, and the addiction to alcoholic beverages occurs instantly and even after little alcohol consumption.

The changes caused by FAS are irreversible. Unfortunately, since it is impossible to completely recover, only symptomatic therapy is carried out. For example, in case of heart defects and other disorders in the structure of internal organs, surgical intervention is performed whenever possible. A child psychiatrist deals with psychopathic disorders, prescribing psychostimulants, antipsychotics, and other medications that are designed to correct behavior, eliminate aggression, etc.

Rehabilitation of children provides for medical and pedagogical correction, therefore, children are taught in special schools. Increased attention, the correct approach of specialists and special techniques allow the child to achieve noticeable results in mental development, to adapt to society. Under the guidance of specialists, children improve their speech, motor ability, and emotional stability.

It should be noted that a child with a severe degree of FAS can die in infancy in the presence of diseases and malformations that are incompatible with life.

Prophylaxis

Statistics show that children with FAS are often unnecessary for their parents. This is due to the fact that they, as a rule, are initially born in dysfunctional families of alcoholics, and with the fact that young parents are afraid of difficulties upon learning about the diagnosis of the baby, and refuse it. The childhood of FAS patients takes place in specialized orphanages, neuropsychiatric boarding schools. In the future, they are rarely accepted by society, but they themselves often cannot take care of themselves on their own. Although we note that the degree of social adaptation depends on the severity of the syndrome. At the same time, even mild forms of FAS contribute to the emergence of asocial behavior, alcoholism, and sexual deviations.

They talk about the dangers of alcohol on the female body and the development of the fetus from the school bench, obstetricians-gynecologists warn during pregnancy. It would seem that there is nothing more obvious than the refusal to use alcohol for the period of conception and bearing a child. But the presence of babies with FAS suggests otherwise. Therefore, we will repeat again:

FAS can be prevented by completely avoiding alcohol at least one month before planning conception and throughout pregnancy.

- a set of congenital malformations caused by the teratogenic effects of ethyl alcohol on the developing fetus. Fetal alcohol syndrome is characterized by prenatal hypotrophy, child lagging behind in physical and neuropsychic development, mental retardation, manifestations of craniofacial dysmorphism, congenital heart defects, skeletal developmental disorders, and other anomalies. Diagnosis of fetal alcohol syndrome is based on the presence of an alcoholic history in the mother, multiple developmental disorders in the child. Treatment of fetal alcohol syndrome is aimed at correcting severe anatomical defects, organizing medical, psychological and pedagogical support of the child.

General information

Fetal alcohol syndrome (FAS, fetal alcohol syndrome, alcoholic embryopetopathy) is a symptom complex that develops in children born to mothers suffering from chronic alcoholism. The frequency of birth of children with fetal alcohol syndrome in different countries ranges from 0.2 to 7 cases per 1000 births. These data indicate a high prevalence of fetal alcohol syndrome among congenital disorders. Fetal alcohol syndrome is the most common cause of mental retardation in children (more often than Down syndrome). Taking into account the polymorphism of manifestations of alcoholic embryophetopathy, the observation of children with fetal alcohol syndrome is carried out by specialists in the field of neonatology, pediatrics, pediatric neurology, pediatric surgery, pediatric traumatology and orthopedics, pediatric cardiology, psychology, speech therapy, and special pedagogy.

Fetal Alcohol Syndrome Causes

The main and only reason leading to the development of fetal alcohol syndrome is the use of alcohol by a woman in any trimester of pregnancy. Being the strongest chemical teratogen, ethyl alcohol causes severe and multiple damage to the fetus. Ethanol quickly penetrates the placental and blood-brain barriers, so its concentration in the fetal blood reaches the same level as in the mother's blood, and sometimes even higher. Due to the immaturity of the enzyme systems involved in the metabolism of ethanol, it circulates for a long time unchanged in the blood and tissues of the fetus, in the amniotic fluid, causing the development of fetal alcohol syndrome. It is believed that the critical dose for the fetus is the dose of ethyl alcohol, equal to 30-60 ml per day, although many researchers are inclined to believe that there is no safe dose of alcohol during pregnancy.

The damaging effect of alcohol on the fetus appears to be in different ways. The main role in the pathogenesis of fetal alcohol syndrome is attributed to the violation of the molecular structure of cells (including genital) by alcohol and its metabolites, in particular, acetaldehyde. Other damaging mechanisms may be associated with a deficiency of vitamins and trace elements in the mother's diet, impaired transplacental transport of essential amino acids, fetal hypoglycemia, decreased placental blood flow and fetal hypoxia, etc.

The fetus is exposed to the embryotoxic effects of alcohol throughout pregnancy. Thus, the use of alcohol by a woman in the first trimester of pregnancy causes a high risk of developing birth defects and intrauterine fetal death; in the second trimester - structural disorders of the central nervous system and malformations of the musculoskeletal system; in the third trimester - functional disorders of the central nervous system, fetal growth retardation, etc.

Risk factors for the development of fetal alcohol syndrome are alcoholic "experience" of the mother, the number and frequency of alcohol abuse, unfavorable social conditions, poor nutrition of the pregnant woman, lack of monitoring of the course of pregnancy, etc.

Fetal alcohol syndrome symptoms

The manifestations of fetal alcohol syndrome are diverse and in most cases are represented by the following groups of symptoms: prenatal and postnatal malnutrition, craniofacial dysmorphism, brain damage and somatic deformities.

At birth, a child with fetal alcohol syndrome is underweight (on average 2200 g) and body length (on average 44-46 cm). After a year, the lag in indicators of physical development is 35-40%. The degree of pre- and postnatal malnutrition / dystrophy correlates with the amount of alcohol consumed by the pregnant woman.

The signs of craniofacial dysmorphism are so typical that they gave rise to a specific concept - "the face of a child with fetal alcohol syndrome." The appearance of children with fetal alcohol syndrome is characterized by blepharophimosis (often ptosis, strabismus), a smoothed nasolabial groove, a thin upper lip, micrognatia, microcephaly, a low forehead and bridge of the nose, deeply located auricles, etc. bite, cleft upper lip ("cleft lip") and palate ("cleft palate").

About half of children with fetal alcohol syndrome have congenital heart defects - VSD, ASD, pulmonary artery stenosis, patent ductus arteriosus, tetrad of Fallot. Relatively often, anomalies of the genitourinary system are found: in boys - hypospadias, one- or two-sided cryptorchidism; in girls - a doubling of the vagina, hypertrophy of the clitoris, hypoplasia of the labia; in children of both sexes - hypoplasia or aplasia of the kidney, hydronephrosis, urogenital fistulas, bladder diverticula. Among other somatic anomalies in children with fetal alcohol syndrome, there are hearing loss, severe myopia; chest deformities, hip dysplasia, syndactyly; diaphragmatic, inguinal, umbilical hernia, pyloric stenosis, atresia of the anus; cavernous angiomas, hirsutism, etc.

The death of a newborn with fetal alcohol syndrome can occur due to asphyxia, prematurity and functional immaturity, congenital malformations incompatible with life.

Sometimes a child with fetal alcohol syndrome is born in a state of alcohol withdrawal, which is accompanied in the first hours of life by tremors, convulsive syndrome, episodes of tachypnea and apnea, muscle hypotension, and vomiting. The defeat of the central nervous system in a child by fetal alcohol syndrome in the first months of life is characterized by a syndrome of hyperexcitability, hydrocephalus, and in the long-term period - impaired attention, memory, motor coordination, ADHD, learning difficulties at school, mental retardation, mental retardation, speech disorders, epilepsy.

At an early age, anemia, rickets, atopic dermatitis, and frequent ARVI prevail in the structure of the general morbidity of children with fetal alcohol syndrome.

Classification of fetal alcohol syndrome

The existing classifications of fetal alcohol syndrome are based on the principles of the severity of the lesion and the predominance of certain manifestations.

According to the degree of developmental disorders, they are distinguished:

Fetal alcohol syndrome I (mild) degree(about 44% of cases). It is characterized by pre- and postnatal malnutrition, microcephaly; latent or weakly expressed signs of craniofacial dysmorphism; minor manifestations of mental disorders.
Fetal alcohol syndrome II (moderate) degree(about 34% of cases). All the main symptoms of FAS are expressed, including abnormalities in the structure of the face and skull.
Fetal alcohol syndrome III (severe)(about 23% of cases). There are gross violations of intellectual development, severe somatic defects, pronounced craniofacial dysmorphism.

Some authors consider the number of detected dysembryogenias in a child as criteria for the severity of fetal alcohol syndrome: severe degree - 8-10, medium - 6-8, mild - 4-6 stigmas of dysembryogenesis.

In accordance with the leading manifestations, the following variants of fetal alcohol syndrome are distinguished: craniofacial dysmorphism, growth dysfunction and central nervous dysfunction.

Diagnosis of fetal alcohol syndrome

The presence of fetal alcohol syndrome in a child may be evident immediately after birth. In this case, the neonatologist must take all the necessary measures for the early detection of severe malformations in the child and their correction. When diagnosing fetal alcohol syndrome, the presence of an alcohol history in the mother and typical anomalies in the child, the condition of the child immediately after birth, height and weight indicators, the dynamics of the early development of the child according to anthropometry data (weight gain, length, head circumference), etc. are taken into account.

Esters of fatty acids found in meconium and in the baby's hair can serve as biomarkers of the mother's alcohol consumption. Spectral analysis of hair can also be performed on the mother.

Methods of neuroimaging (neurosonography, MRI of the brain), which can reveal a decrease in the cerebellum, caudate nucleus, brain volume in general, agenesis of the corpus callosum, and other structural disorders, can provide some assistance in the diagnosis of fetal alcohol syndrome. To exclude severe malformations, children with fetal alcohol syndrome need echocardiography, ultrasound of the abdominal organs,

The manifestations of fetal alcohol syndrome must be differentiated from chromosomal abnormalities, intrauterine infections.

Fetal Alcohol Syndrome Treatment

The changes that occur with fetal alcohol syndrome are irreversible and cannot be cured. Nevertheless, children with FAS need symptomatic treatment and psychological and pedagogical support. For heart defects, genitourinary system, gastrointestinal tract, surgical treatment is possible.

Habilitation and rehabilitation of persons with fetal alcohol syndrome provides for medical and pedagogical correction from an early age: classes with a child psychologist, speech therapist, and correctional teacher. This allows the child to achieve a higher level of development in the motor, emotional, cognitive, speech sphere, to acquire the skills of social interaction in a team. Children with intellectual disabilities are taught in special correctional schools.

Treatment of psychopathological disorders is carried out by a child psychiatrist with the prescription of antipsychotics and psychostimulants.

Prediction and prevention of fetal alcohol syndrome

Children with fetal alcohol syndrome often spend their entire lives in specialized orphanages, and then in neuropsychiatric boarding schools, since they are unnecessary for their parents and unable to take care of themselves on their own in adulthood. Even mild forms of fetal alcohol syndrome can be accompanied by antisocial behavior, alcoholism, and sexual deviations.

Women at risk of having a child with fetal alcohol syndrome are women who consume 4 or more standard doses of alcohol per week (1 dose = 42.5 g of vodka or brandy, or 142 g of wine, or 340 g of beer). We can say that drinking any amount of alcohol at the planning stage of pregnancy, and even more so after its onset, is risky. Therefore, it is so important to completely abandon alcohol, smoking and other bad habits even before conception.

Obstetricians-gynecologists of antenatal clinics should conduct explanatory preventive work, timely identify pregnant risk groups and adjust the pregnancy management program, taking into account their bad habits.