Parenting and Child Development Textbook Effects on Unborn Baby When Drinking

Alcohol Wellness Res World. 1997; 21(3): 192–198.

The Effects of Prenatal Alcohol Exposure

Abstruse

Exposure to booze during gestation tin crusade persistent abnormalities in physical and cognitive development. Children who come across the clinical definition of fetal alcohol syndrome (FAS) are small for their age, showroom characteristic facial anomalies, and demonstrate deficits in central nervous system development. Booze effects in children with prenatal exposure, but non FAS, are similar, although of smaller magnitude and not necessarily present in all three systems. The degree to which a person is affected by prenatal booze exposure depends on the amount, timing, and elapsing of the female parent's alcohol consumption during pregnancy every bit well as maternal characteristics (e.g., age and comorbid psychiatric disorders) and environmental factors (e.thousand., socioeconomic status and family unit issues). Some exposure-related furnishings, such every bit growth deficits, are directly related to the amount of alcohol consumed, all the same, so that even a modest amount of alcohol may affect child development. Therefore, the best policy continues to be forbearance during pregnancy.

Keywords: gestation, prenatal alcohol exposure, fetal alcohol furnishings, fetal alcohol syndrome, teratogens, congenital anomaly, fetal development, disorder definition, epidemiology, amount of AOD use, growth retardation, morphology, CNS part, mental retardation, cognitive development, demographic characteristics, psychosocial environment, literature review

Pregnant alcoholic women risk the health of their offspring in multiple ways: (one) Exposure to booze during gestation may lead to fetal alcohol syndrome (FAS) or fetal alcohol effects; (2) the physical consequences of alcoholism in the mother (eastward.k., falls or malnutrition) may independently affect the developing fetus; (iii) genetic vulnerability to alcoholism in the fetus may increase the effects of prenatal exposure; and (4) the lifestyle of an alcoholic parent may lead to negative consequences for the fetus, the pregnancy, and the developing kid. This article addresses the get-go of these bug—the effects of exposure to booze during gestation—in detail. However, any or all of the other bug listed (i.due east., concomitant genetic background and the physical and lifestyle deficits that accompany alcoholism) may exacerbate the adverse effects of prenatal alcohol exposure.

As a teratogen, alcohol is capable of directly inducing developmental abnormalities in a fetus. Alcohol use during pregnancy is one of the most common known causes of preventable birth defects, and its results can persist as long-term deficits in physical and cerebral growth and evolution.

The dangers of fetal alcohol exposure, initially identified in the late 1960's, are entirely preventable if women abstain from drinking during pregnancy. Given this fact, in 1981 the U.Southward. Surgeon General issued the offset health advisory recommending that women who are pregnant or planning a pregnancy should not drink alcohol, and this advisory was repeated in 1990 and 1995.

FAS Definition and Diagnosis

At the extreme stop of the spectrum of prenatal exposure furnishings, FAS is a clinical diagnosis applied to children who take been exposed to alcohol during gestation and exhibit deficits in growth, concrete construction (i.eastward., morphology), and the cardinal nervous organization (CNS). To run across the clinical case definition, the child must take symptoms in each of the following three categories: (1) growth deficiency in both the prenatal and postnatal periods; (2) abnormalities in facial and skull structure, including small eye openings (i.east., short palpebral fissures), alterations in nose and brow structure, an absent-minded or elongated groove betwixt the upper lip and nose (i.e., philtrum), a thin upper lip, a flattened midface, and underdevelopment of the upper or lower jaw; and (iii) CNS deficits, such every bit mental retardation and behavioral problems (Sokol and Clarren 1989). Of these symptoms, the facial abnormalities are the most characteristic of FAS, whereas the CNS anomalies have the nigh significant event on overall evolution. Separately, each of these features is defined as an alcohol-related birth defect (ARBD) or a fetal alcohol effect.

The features associated with FAS may modify with age, complicating the diagnosis. Before age 2, CNS dysfunction is difficult to assess, and the archetype facial abnormalities (encounter figure) may not be clearly axiomatic. At older ages, growth deficits are offset by the adolescent growth spurt as well as normal changes in facial length and width associated with maturation. Because of these changes, growth deficits and facial features become less credible after puberty, and without prepubertal photographs and reliable growth records, FAS may exist difficult to diagnose in adolescents or adults.

Facial features especially feature of a kid with fetal alcohol syndrome (FAS). Discriminating features (i.e., those considered definitive signs of FAS) are shown on the left side of the analogy; characteristics listed on the right side are associated with FAS but are not sufficient to determine the presence of the syndrome. Microencephaly (small-scale head circumference) is non a facial feature per se, but a cardinal nervous system characteristic. (Palpebral fissures = eye openings; philtrum = groove between nose and upper lip; epicanthal folds = skin folds covering inner corner of the eye; micrognathia = aberrant smallness of the jaws.)

SOURCE: Streissguth and Lilliputian 1994.

Accurately assessing fetal alcohol exposure may prove even more than difficult. To obtain correct information regarding the quantity of booze consumed as well as the timing and duration of alcohol utilize during pregnancy, clinicians and researchers demand reliable methods to make up one's mind booze exposure. Although biological tests are available to measure the amount of alcohol consumed, these tests reflect use over a very short fourth dimension menstruation and do not let estimates of the pattern or duration of use to be made. In general, clinicians and researchers rely on the mother'southward self-report of booze utilize. Self-reports may be inaccurate, however, because social pressures, fearfulness of existence labeled, and anxiety near losing custody of her kid may pb a woman to underreport her alcohol consumption during pregnancy. Issues recalling the frequency and quantity of alcohol consumed likewise can lead to erroneous estimates. In the absence of an accurate report, clinicians and caretakers, such as foster and adoptive parents, will not know whether or to what extent the kid was exposed to alcohol during gestation. Therefore, both clinicians and researchers must found trust and rapport with all pregnant women to enable them to study their booze use both honestly and accurately.

Because of the difficulty in reliably ascertaining fetal alcohol exposure, a committee convened by the Plant of Medicine to report FAS recently reviewed the diagnostic criteria currently in use and recommended revisions. The committee members proposed a diagnostic classification system with v categories: (1) FAS with confirmed maternal alcohol exposure, (two) FAS without confirmed maternal alcohol exposure, (three) fractional FAS with confirmed maternal alcohol exposure, (four) ARBD with a history of maternal alcohol exposure, and (5) booze-related neurodevelopmental disorder (ARND) with a history of maternal booze exposure (Stratton et al. 1996). The last two categories are used for offspring who have morphologic and neurologic alcohol-related effects, respectively, without the full features of FAS, and they may co-occur in the same private.

FAS Epidemiology

Alcoholism and Booze Use Amidst Women

In a nationwide household survey conducted in 1992, 4.08 per centum of the women who were interviewed met the criteria¹ for alcohol abuse and/or dependence inside the 12 months preceding the survey (Grant et al. 1994). The highest prevalence rates for alcohol corruption and/or dependence were found amongst women of childbearing age (ix.84 per centum for women ages 18 to 29 and three.98 per centum for women ages 30 to 44).

Women who are alcoholic typically experience several other problems, including comorbid medical or psychiatric disorders (e.thousand., depression) and social issues (east.g., unstable marriages; spouses with drinking problems; and kid-care responsibilities, ofttimes as single mothers). This multiplicity of bug complicates the pregnancy of an alcoholic woman, because her fetus is exposed not but to the teratogenic effects of alcohol, just besides to the negative effects of the other factors that coexist in her life. By comparing nascence outcomes in upper middle class and lower class alcoholic mothers, Bingol and colleagues (1987) showed that economic or lifestyle factors play a role in the rate of FAS. They plant that, although the intake of absolute booze was equivalent in the two groups, two.7 percentage of the upper middle course mothers had a kid with FAS, compared with 40.5 percent of the lower class mothers.

The trouble of alcohol exposure during pregnancy is not limited to alcoholic women, however. A majority of women drinkable, equally evidenced by a national household survey (Hilton 1991) in which 64 percent of the women surveyed were drinkers (i.e., drank at least once a year), 4 percent reported daily drinking, 6 pct drank five or more drinks on occasion at least weekly, and 1 percentage reported drinking plenty to feel drunk at least weekly. Age, race, social class, and occupation all predicted drinking patterns among women. For example, younger women were most likely to drink, and white women drank more than their black or Hispanic counterparts. Drinkers had a higher education level and income than nondrinkers and were more likely to work full fourth dimension outside the home. These same four characteristics also described women who were heavy drinkers.ⁱⁱ

Despite the fact that women's drinking rates have remained relatively constant since the 1960's (Hilton 1991), the charge per unit of drinking during pregnancy appears to exist increasing. For example, the Behavioral Risk Factor Surveillance Arrangement reported that amongst pregnant women, the charge per unit of drinking increased from 12.4 percentage in 1991 to 16.three percent in 1995 and that the charge per unit of frequent drinking^three was four times higher in 1995 than in 1991, increasing from 0.8 per centum in 1991 to iii.five percent in 1995 (Centers for Disease Control and Prevention 1997).

Prevalence of FAS

Abel and Sokol (1987) estimated that approximately 6 percent of the offspring of alcoholic women accept FAS, although for offspring born afterward an FAS sibling, the risk is very high (70 per centum) (Abel 1988). The high probability that all subsequent offspring will be affected later on an initial case ways that some issue of chronic alcoholism in addition to booze exposure must lead to the higher rate of FAS among offspring built-in later. Even in the absence of full-blown FAS, babies of alcoholic women accept a higher charge per unit of the carve up characteristics of FAS.

Among the general population, a national surveillance program known as the Birth Defects Monitoring Programme reported a rate of 5.2 FAS cases per 10,000 live births (Cordero et al. 1994). Similarly, in a recent summary of findings from prospective studies, Abel and Sokol (1991) estimated the overall rate of FAS to be 3.3 cases per x,000 live births. The rate of FAS is likely to be considerably underestimated, however, because of the difficulty in making the diagnosis and the reluctance of clinicians to label children and mothers. For example, Niggling and colleagues (1990) studied the outcomes of 40 pregnancies of 38 women whose alcohol abuse was noted in their medical records. Although one-half of the 34 liveborn infants demonstrated poor postnatal growth and development and six neonates met the diagnostic criteria for FAS, none of the infants was diagnosed as having FAS.

Relationship of Exposure and Furnishings

Fetal development is a sequential, multistaged process. To determine the furnishings of prenatal exposure on child development, factors such equally the timing, dose, and pattern of alcohol exposure must be considered, because growth, morphologic abnormalities, and CNS deficits occur at different points during gestation. Major morphologic abnormalities result from exposure early in pregnancy, growth is virtually affected past late exposure, and CNS deficits occur throughout gestation. Thus, offspring who are exposed to alcohol throughout pregnancy will not have the aforementioned outcome as offspring who are exposed simply during early pregnancy or only at specific times during pregnancy.

Identifying the nature of the relationships between prenatal alcohol exposure and outcome is also important for inquiry and clinical reasons. Exposure to a toxin may touch fetal outcome in two ways: The effect may be directly related to the corporeality of exposure (i.e., a linear human relationship), or exposure may be problematic but above a sure level (i.e., a threshold relationship). A linear human relationship between alcohol exposure and child development means that no "condom" level of drinking during pregnancy exists, considering even a small amount of alcohol could produce an effect. In contrast, the threshold model implies that a "safe" level of drinking does exist, below which negative effects do not occur. Data from studies to date demonstrate that the relationship between booze exposure and outcome varies depending on the type of event under consideration, even so. For case, reports from the animal (Schenker et al. 1990) and human being literature (Sampson et al. 1989; Goldschmidt et al. 1996) support a threshold relationship between prenatal alcohol exposure and CNS evolution, whereas the data on physical growth indicate that the effect of gestational exposure to alcohol is linear (Twenty-four hour period et al. 1994). Therefore, no "safe" level of consumption exists, and the best policy for women continues to be abstinence during pregnancy to avoid any negative effects on their offspring.

Specific Effects of Prenatal Exposure

People with FAS demonstrate growth deficits, morphologic abnormalities, mental retardation, and behavioral difficulties. In a systematic followup study, Streissguth and colleagues (1991) examined 61 subjects identified as having FAS or fetal alcohol effects to determine adolescent and adult manifestations of the syndrome. The study results give an overview of the long-term impact of prenatal alcohol exposure. At adolescence and adulthood, the subjects were short in stature and pocket-size in head circumference; they also exhibited a high rate of aberrant facial features, although these characteristics were non equally pronounced every bit they had been at younger ages. The subjects' IQ scores ranged from twenty to 105 with a mean of 68. Half-dozen percent of the subjects took regular school classes, but the remainder of the written report participants were unable to achieve this schooling level or maintain regular exterior employment. In addition, the subjects demonstrated poor concentration and attention; an inability to alive independently in adulthood; stubbornness; social withdrawal; and conduct issues, such as lying, adulterous, and stealing. Their characteristics and long-term outcome predict the expected outcome for people who were prenatally exposed to alcohol only do not have the full syndrome. At lower levels of exposure, a subset of fetal alcohol furnishings, rather than the total extent of FAS features, is most likely to occur.

The following sections describe the effects of prenatal alcohol exposure on growth, morphology, and CNS development in turn. Many of the examples are taken from the Maternal Health Practices and Child Development (MHPCD) project, a longitudinal study of the long-term furnishings of prenatal alcohol exposure. In this study, researchers recruited developed women in their 4th month of pregnancy from a prenatal dispensary. All women who consumed an boilerplate of iii or more drinks per week during their first trimester, plus a random sample of one-third of the women who drank booze less often, were selected as study subjects. In general, alcohol apply during pregnancy was light to moderate amid the women participating in the report, although subjects who represented the entire spectrum of use were included in the sample.

Growth Deficits

Children with FAS are small for their age (Streissguth et al. 1991)—indeed, such smallness is ane of the criteria for diagnosis, although growth deficits also are found among children who were exposed to alcohol during pregnancy simply exercise non fulfill the full criteria for FAS. As noted previously, notwithstanding, growth retardation is somewhat ameliorated at puberty. In the MHPCD projection, these growth deficits are symmetrical, affecting pinnacle, weight, and head circumference to the same degree, and remain pregnant through historic period x. The relationship between prenatal exposure and growth deficits is linear (i.e., the greater the prenatal alcohol exposure, the more than pronounced the result on postnatal growth). Smith and colleagues (1986) likewise found that the duration of exposure, in addition to amount, afflicted nativity weight.

Postnatal environment and maternal characteristics influence the human relationship between prenatal alcohol exposure and growth, all the same. Whereas studies of disadvantaged populations (Coles et al. 1991; Twenty-four hour period et al. 1994; Jacobson et al. 1994b; Russell 1991) have found that prenatal booze exposure continues to affect growth at followup, studies of more advantaged cohorts (Barr et al. 1984; Fried and O'Connell 1987; O'Connor et al. 1986) have found that growth deficits are not maintained as the children get older. Another study (Jacobson et al. 1994a) found that booze exposure was associated with decreased birth weight, length, and caput circumference, although simply among infants of women over historic period xxx. Thus, postnatal environs and maternal characteristics plain exacerbate the effects of prenatal booze exposure.

Morphologic Abnormalities

Another benchmark of FAS is the presence of the specific grouping of facial anomalies mentioned previously (i.e., curt palpebral fissures, a flattened nasal bridge, an absent or elongated philtrum, and a thin upper lip). From embryological studies, investigators know that these morphologic abnormalities occur when the midline of the face is formed during the kickoff trimester. A significant correlation betwixt first-trimester booze exposure and the rate of these physical anomalies was found in the MHPCD project (Day et al. 1990). Equally noted in other studies of FAS, however, the relationship between prenatal booze exposure and the characteristic facial features associated with FAS diminished as the children matured.

CNS Deficits

Both animal and human studies accept demonstrated that brain structures, including the hippocampus, frontal lobes, corpus callosum, and basal ganglia, are important sites of alcohol'southward action on the fetal encephalon (Clarren et al. 1978; Coulter et al. 1993; Mattson et al. 1992, 1996b; Pfeiffer et al. 1979; Riley et al. 1995; Shapiro et al. 1984; Wisniewski et al. 1983). Indeed, researchers have documented anomalies of encephalon structure and role amid children with FAS. Evidence of CNS deficits in FAS children as well appears in their tendency to accept delayed motor and speech development and speech and hearing impairments (Steinhausen et al. 1982; Church and Gerkin 1988). In prenatally exposed children who exercise non accept FAS, researchers accept identified neurologic effects at nascence that reverberate abnormalities in sleep patterns (Scher et al. 1988) and in the newborn'due south ability to respond and adapt, as measured past the Brazelton Neonatal Behavioral Assessment Scale (Coles et al. 1985; Streissguth et al. 1983).

1 way to approximate CNS functioning is to use neuropsychological measures designed to assess brain performance. Using such measures, Mattson and colleagues (1996a) found that five- to 16-year-old children with FAS had significant verbal learning and memory deficits. Similarly, Kodituwakku and colleagues (1995) reported retentiveness deficits in thirteen-yr-old children with FAS, and Coles and colleagues (1997) found that children with FAS had deficits in trouble-solving, information processing and storage, and visual and spatial skills.

The neuropsychological findings are similar for children who were exposed to alcohol during gestation only exercise non have FAS. Jacobson and colleagues (1993) reported that prenatally exposed 13-month-old infants were slower or less efficient at information processing. Such deficits apparently persist: In a written report by Streissguth and colleagues (1994), 14-twelvemonth-old children who had been prenatally exposed to alcohol had difficulty performing tasks that required processing information in guild to make complex decisions. Researchers also have found that prenatally exposed children accept detail difficulty in mathematical tasks (Kopera-Frye et al. 1996). In another study, Coles and colleagues (1991) compared the cognitive performance of children whose mothers drank an average of 11.8 ounces of accented alcohol (i.due east., approximately 24 drinks) per week throughout pregnancy and children whose mothers stopped drinking in the second trimester or did not beverage at all during pregnancy. The researchers found that the children exposed throughout gestation performed more poorly than children in the other ii groups, exhibiting deficits in brusque-term memory and encoding (i.e., sequential processing) and overall mental processing at an average age of 5 years and ten months.

People with FAS often are mentally retarded, although the degree of arrears varies (Landesman-Dwyer 1982; Streissguth et al. 1991). Streissguth and colleagues (1996) reported that the IQ scores of FAS patients ranged from 29 (severely retarded) to 120 (loftier average). Like other exposure-related effects, the impact of prenatal alcohol exposure on cerebral development demonstrates a continuum. Although report results are not completely consequent, booze exposure is related to decreased cognitive abilities even at lower levels of exposure. For example, Streissguth and colleagues (1989a) reported that the daily consumption of i½ ounces of absolute alcohol (i.e., approximately three drinks) was associated with an average decrease of 5 points in the kid'south IQ score at age 4. At historic period 7½, children exposed to more than 1 ounce of accented booze (i.due east., approximately two drinks) per day scored an average of 7 IQ points lower compared with children not exposed to this corporeality (Streissguth et al. 1990).

People with FAS commonly exhibit behavioral problems likewise (Majewski 1978a; Majewski 1978b; Olegard et al. 1979; Shaywitz et al. 1980; Steinhausen et al. 1982; Streissguth et al. 1991). These problems can include poor concentration and attention, lack of independent living skills, stubbornness, and social withdrawal. In addition, children with FAS showroom higher rates of conduct problems (e.g., lying, adulterous, and stealing). Streissguth (1993) reported that as children with FAS mature, they demonstrate poor socialization and advice skills and commonly experience problems with alcohol and drug abuse and antisocial behavior.

Behavior problems too have been reported among offspring prenatally exposed to alcohol but without FAS. In 1 study, iv-twelvemonth-one-time children whose mothers drank one to five drinks per day during pregnancy were less attentive and more active when observed in the domicile, compared with children of control mothers who drank less (Landesman-Dwyer 1982). At historic period seven½, the children were less attentive and took a longer fourth dimension to react to a stimulus on a Continuous Performance Task (Streissguth et al. 1986). In children ages 7 (Streissguth et al. 1989b) and 14 (Streissguth et al. 1994), researchers demonstrated the effects of prenatal exposure to booze on both attention and memory. These furnishings were linear (i.due east., the extent of the effect was direct correlated with the amount of alcohol exposure), implying that no "safe" threshold of alcohol exposure exists.

In the MHPCD project, mothers and teachers described children ages 3, half-dozen, and 10 who were prenatally exposed to alcohol as showing increased action and poorer attending, likewise as social problems, feet, and depression (Twenty-four hour period 1997). Dark-brown and colleagues (1991) noted that children who had been exposed to alcohol throughout pregnancy showed deficits in their ability to sustain attending, and their teachers reported that they had bug with both attention and behavior in school.

Clinical studies provide further evidence of the neurobehavioral consequences of prenatal booze exposure. Such studies have reported that people with FAS feel trouble in schoolhouse and maintaining jobs, a likely chemical compound of their lower IQ scores, neuropsychological deficits, and beliefs problems. Even amidst children and adults who practise not have FAS, lower academic accomplishment is significantly related to prenatal alcohol exposure (Coles et al. 1991; Streissguth et al. 1990). An analysis of the outcomes amongst 6-year-olds in the MHPCD projection, for case, demonstrated effects of 2nd-trimester booze exposure on reading, spelling, and mathematics skills (Goldschmidt et al. 1996). Coles and colleagues (1991) also constitute that children who were exposed in early pregnancy performed more poorly in mathematics and reading than their peers who had not been exposed.

Summary and Conclusions

In summary, cases of FAS are characterized by abnormalities in growth, morphology, and CNS development. Among exposed offspring who practice not have FAS, deficits are seen in the same design, although they may be of smaller magnitude and do not touch on all 3 systems in each person. Therefore, the effects of prenatal alcohol exposure range over a continuum from fully developed FAS to the milder constellation of fetal alcohol effects.

Studies testify that the furnishings of prenatal alcohol exposure tin be influenced by maternal characteristics, such equally historic period and comorbid psychiatric disorders, or by factors in the postnatal environment such equally socioeconomic status and family unit problems. Thus, the interaction between a vulnerable child and a disadvantaged environment compounds the negative outcomes.

There is a pressing need to understand the broad picture of the combined effects of alcohol exposure, poverty, and lifestyle on the developing fetus. Each of these risk factors for poor pregnancy result must be considered in evaluating the furnishings of prenatal alcohol use, because it is unclear whether booze effects occur independently or in interaction with risk factors such equally an impoverished social environment.

Given that booze is a teratogen, an appropriate goal would be to eliminate drinking during pregnancy. This means finding effective methods to help women who are alcoholic abstain during pregnancy and to motivate other drinking women to abstain from levels of booze consumption that would be insignificant exterior of pregnancy. Clinicians demand to inquire pregnant women about their alcohol consumption, even at a "social drinking" level, and have appropriate tools available to intervene when necessary. Little inquiry has been conducted on the effectiveness of alcohol treatment during pregnancy or the treatment of significant alcoholics, although these women are at greatest risk for having an FAS child.

Footnotes

¹The criteria used in this study corresponded to the criteria for booze abuse and dependence listed in the American Psychiatric Association'south Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. In general, the terms "alcoholic" and "alcoholism," as used in this commodity, comprehend both diagnoses.

²In this study, "heavy drinkers" were defined every bit people who consumed eight or more than drinks per mean solar day equally oftentimes as three times per week.

³"Frequent drinking" was divers in this written report as consuming seven or more drinks per week or 5 or more drinks on an occasion in the past calendar month.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826810/

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