Preventing Fetal Alcohol Spectrum Disorders

Primary care clinicians form the bastion, the driving force, in preventing birth defects and developmental problems associated with fetal exposure to alcohol, according to the U.S. Centers for Disease Control and Prevention. [1] About 1 in 8 women report alcohol use during pregnancy, and about 1 in 50 pregnant women binge drink.[2] The sad reality is that every drink consumed places infants at risk for Fetal Alcohol Spectrum Disorders (FASD).[3]
FASD produces physical, behavioral, learning, and other developmental problems in individuals exposed to alcohol or other intoxicating substances during pregnancy.  These conditions can affect each person in different ways, and can range from mild to severe.

A person with an FASD might have:

  • Abnormal facial features, such as a smooth ridge between the nose and upper lip (the philtrum)
  • Small head size
  • Shorter-than-average height
  • Low body weight
  • Poor coordination
  • Hyperactive behavior
  • Difficulty paying attention
  • Poor memory
  • Difficulty in school (especially with math)
  • Learning disabilities
  • Speech and language delays
  • Intellectual disability or low IQ
  • Poor reasoning and judgment skills
  • Sleep and sucking problems as a baby
  • Vision or hearing problems
  • Problems with the heart, kidneys, or bones

glass of wine on the stomach

 

 

 

 

Types of FASD

Different terms are used to describe FASD depending on the type of symptoms.

  • Fetal Alcohol Syndrome (FAS): FAS represents the severe end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing or they might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others.
  • Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.
  • Alcohol-Related Birth Defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these

The term FASDs is not meant for use as a clinical diagnosis. The CDC worked with a group of experts and organizations to review the research and develop guidelines for diagnosing FAS. The guidelines were developed for FAS only. CDC and its partners are working to put together diagnostic criteria for other FASDs, such as ARND. Clinical and scientific research on these conditions is going on now.

Diagnosing FAS can be difficult because it resembles other disorders, such as ADHD and Williams syndrome.

To diagnose FAS in children, look for:

  • Abnormal facial features (e.g., smooth ridge between nose and upper lip)
  • Lower-than-average height, weight, or both
  • Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination)
  • Prenatal alcohol exposure; although confirmation is not required to make a diagnosis

The CDC has reported that a large number of providers use outdated clinical assumptions. There is also a tendency to avoid screening because of time and limited resources. Providers have little access to current education or tools to prevent FASD and there is an urgent need for education on ways to effectively communicate with patients to prevent FASD. The message to patients is, “No level of alcohol is safe during pregnancy.”

A survey of the Primary Care Network Advisory Board on the Prevention of FASD indicated that they ask their female patients about their alcohol drinking habits at least once a year, more often if there are other pertinent symptoms. Most do not use a screening tool but ask how often and how much they drink alcohol daily, weekly, or monthly. Depending on the amount and frequency of alcohol consumed, the clinicians explain how drinking affects health or if heavy drinkers, they are referred to AA or another local alcohol treatment agency. They routinely ask their patients about their preferred method of birth control and discuss with them the importance of not drinking alcohol during pregnancy because of the risk of FASD.

The three major gaps in professional practice with the prevention of FASD are:

(a) Lack of time
(b) Assuming that someone else in the practice has already addressed the issues of alcohol intake and birth control
(c) Failing to remind patients about how alcohol affects health.

Screenings in the Primary Care setting tend to identify women with a substance abuse problem, instead of a step towards the prevention of alcohol use during pregnancy

  1. Do you routinely screen women of reproductive age about their use of alcohol or drugs?
  2. Do you believe that there should be no consumption of alcohol or drugs during pregnancy?
  3. Do you counsel women of reproductive age about abstinence from alcohol and drugs during pregnancy?

 

References:

  1. Sokol RJ, Delaney-Black V, Nordstrom B. Fetal alcohol spectrum disorder. JAMA. 2003;290(22):2996-2999.
  2. Brems C, Boschma-Wynn RV, Dewane SL, Edwards AE, Robinson RV.  Training needs of healthcare providers related to Centers for Disease Control and Prevention core competencies for fetal alcohol spectrum disorders.  J Popul Ther Clin Pharmacol. 2010 Fall;17(3):e405-417.
  3. Centers for Disease Control and Prevention. Fetal Alcohol Spectrum Disorders (FASDs). http://www.cdc.gov/ncbddd/fasd/index.html