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Understanding foetal alcohol syndrome

Foetal alcohol syndrome is caused by pre-natal exposure to alcohol and can cause permanent damage to a baby's brain, leading to neurological impairment. It is the biggest cause of non-genetic mental handicap in the western world - but it is preventable.

A healthy amount of social drinking is a normal part of adult life for most people, and with about half of all pregnancies being unplanned, some women may not even realise that they are pregnant when they consume alcohol.

A developing baby is affected most in the first three months of pregnancy. This makes it important that all women of child bearing age are able to access contraceptive advice, and education on managing one's lifestyle, including the impact of alcohol on the health of a developing baby.

It is unclear whether it is the amount, the timing, or the frequency of alcohol consumption which causes foetal alcohol syndrome. For this reason, National Institute for Health and Care Excellence (NICE) guidelines recommend the following:

  • Avoid alcohol altogether for the first three months of pregnancy to avoid miscarriage
  • Thereafter, drink no more than 1-2 units of alcohol, 1-2 times per week

The UK's Chief Medical Officer has stated: "If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum."

This advice is something that can be emphasised in a GP surgery, when discussing pregnancy and the risk of alcohol with patients.

Supporting mothers with alcohol dependency

It is also important to be aware that some mothers may drink alcohol during pregnancy due to an addiction. Recognising when someone is drinking due to mental health issues is important, so that the correct treatment can be offered. Early intervention can reduce the risk of foetal alcohol syndrome occurring in the baby. Signs and symptoms to look out for in a pregnant patient include:

  • Irritability
  • Anxiety
  • Tearfulness and emotional exhaustion
  • Depression
  • Signs of clouded judgement
  • Inflexibility when it comes to stopping drinking during pregnancy
  • Increased tolerance to alcohol

If you are concerned about a pregnant woman, screening for alcohol use could be suggested. Advice on cessation should be offered, along with thorough information on foetal alcohol syndrome.

Interventions such as talking therapies can also be recommended. The greater the range of treatment options, the better the chances of positive outcomes. Some talking therapies available include:

  • Cognitive behavioural therapy (CBT)
  • Dialectical behaviour therapy (DBT)
  • Couples/family therapy
  • Eye movement desensitisation and reprocessing (EMDR)

Women who intend to start a family and are having difficulties with alcohol dependence should seek professional help and support first, to address alcohol use before becoming pregnant. Once a period of abstinence has been achieved and psychological and physical effects of alcohol have been addressed, then planning for pregnancy would be more appropriate.

Diagnosing foetal alcohol syndrome

Diagnosis is based on the history and presence of typical features that are suggestive of the condition. Physical symptoms can include:

  • A small head
  • Distinctive facial features such as small eyes and a thin upper lip
  • A flat area between the nose and the upper lip
  • Slow growth rate which remains below normal
  • Heart, liver and kidney problems
  • Seizures

Common psychological and behavioural difficulties include deficits in:

  • Concentration
  • Judgement
  • Reasoning
  • Decision making

Children with foetal alcohol syndrome may also experience:

  • Learning difficulties
  • Impulsive behaviour
  • Aggressiveness and difficulties in following rules

These are associated with poor performance at school, increased rate of mental health problems, substance misuse and problems with the law. There is increased risk of unemployment, poor interpersonal relationships and higher incidence of suicide.

Treating foetal alcohol syndrome

A multidisciplinary approach is necessary to address the symptoms and to enable the best functioning as possible for a child with foetal alcohol syndrome. This usually involves input from:

  • Paediatricians
  • Occupational therapists
  • Speech and language therapists
  • Physiotherapists

Treating psychological problems and providing mechanisms for family support can come in the form of family and group therapy which can also adopt the talking therapies mentioned above.

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