Doctor's Notes on Fetal Alcohol Syndrome
Fetal alcohol syndrome (FAS) results from women drinking alcohol while pregnant. Alcohol use during pregnancy can cause birth defects and FAS always involves brain damage, impaired growth, and head and face abnormalities in the baby. There is no amount of alcohol that has been proven safe for consumption during pregnancy.
Symptoms of fetal alcohol syndrome in children include diminished growth, low birth weight, impaired performance, irritability (in infants). Hyperactivity (in older children), impaired fine motor skills (weak grasp, poor hand-eye coordination), tremors, diminished intelligence (mild mental retardation is common), small head (microcephalic), face abnormalities (short eye openings, sunken nasal bridge, short nose, flattening of the cheekbones and midface, smoothing and elongation of the ridged area between the nose and lips, and smooth, thin upper lip), abnormal position and function of joints, shortening finger bones, heart murmur, and other birth defects such as hydrocephalus, cleft lip (sometimes with a cleft palate), narrowing of the aorta, and spina bifida.
Fetal Alcohol Syndrome Symptoms
Most of the features of FAS are variable. They may or may not be present in a given child. However, the most common and consistent features of FAS involve the growth, performance, intelligence, head and face, skeleton, and heart of the child.
Growth is diminished. Birth weight is lessened. Retardation of longitudinal growth is evident on the measurements of length in infancy and of standing height later in childhood. The growth lag is permanent.
Performance is impaired. The FAS infant is irritable. The older FAS child is hyperactive. Fine motor skills are impaired with weak grasp, poor hand-eye coordination, and tremors.
Intelligence is diminished. The average IQ is in the 60s. (This level is considered mild mental retardation and qualifies a child in the U.S. as educable mentally retarded.)
The head is small (microcephalic). This decrease may not even be apparent to family and friends. It is evident upon comparison of the child's head circumference to that of a normal child on a growth chart. The usual degree of microcephaly in FAS is classified as mild to moderate. It is primarily due to failure of brain growth. The consequences are neither mild nor moderate.
The face is characteristic with short eye openings (palpebral fissures), sunken nasal bridge, short nose, flattening of the cheekbones and midface, smoothing and elongation of the ridged area (the philtrum) between the nose and lips, and smooth, thin upper lip.
The skeleton shows characteristic changes; abnormal position and function of joints, shortening of the metacarpal bones leading to the fourth and fifth fingers, and shortening of the last bone (the distal phalanx) in the fingers. There is also a small fifth fingernail and a single transverse (simian) crease across the palm.
A heart murmur is often heard and then may go away. The basis is usually a hole between the right and left sides of the heart between the ventricles (the lower chambers) or less commonly, the atria (the upper chambers).
A number of other birth defects can occur in children with FAS. These include such major birth deformities such as hydrocephalus (increased fluid pressure on the brain that may require shunting to relieve the pressure), cleft lip (sometimes with a cleft palate), coarctation (narrowing) of the aorta, and meningomyelocele (spina bifida).
Fetal Alcohol Syndrome Causes
The ultimate cause is alcohol intake by the pregnant mother. However, alcohol itself may not be directly responsible for all (or any) of the features of FAS. What may be responsible are byproducts generated when the body metabolizes ("burns") alcohol. The end result is a decrease in the number of brain cells (neurons), abnormal location of neurons (due to disturbance of their normal migration during fetal development), and gross malformation of the brain.
Enjoy some grated Parmesan on your pasta -- but pass up the cheese dip. Soft cheeses made with unpasteurized milk can harbor listeria bacteria, which can be dangerous or even life-threatening for you and your baby. It's best to avoid brie, Camembert, feta, blue cheese, queso blanco, queso fresco, and panela -- unless the label says it's pasteurized. When in doubt or dining out, ask before you eat.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.