A third of women continue to drink alcohol during pregnancy, yet alcohol passes easily from the mother’s blood to the blood of the fetus and is toxic for it. In the most severe cases, the baby will present with fetal alcohol syndrome at birth.
Every year in France, approximately 15,000 babies are born with alcohol use disorders during pregnancy. According to the government data, a third of pregnant women continue to drink alcohol during pregnancy. “It is estimated in France thatone in 100 children suffers or will suffer from directly caused fetal alcohol disorder (FASD), and that’one child in 1000 is born with an alcohol syndrome fetal (FAS)”, writes the Interministerial Mission for the Fight against Drugs and Addictive Behavior (Mildeca). THE lack of information and knowledge on this subject is flagrant. Dr Catherine Maingueneau, pediatrician and addictologist in maternity, recalls that “Professionals who follow pregnant women must know how to inform them. To do this, they must ask about alcohol consumption and recall the ”No alcohol during pregnancy” in order to protect the unborn child or to identify if it is at risk of being affected by fetal alcohol”.
What is Fetal Alcohol Syndrome?
Fetal alcohol syndrome is a set of symptoms observed in newborns exposed during pregnancy to alcohol consumption from his mother. We distinguish :
- Fetal Alcohol Spectrum Disorder (FASD)
- fetal alcohol syndrome complete (FAS)
All alcohols are neurotoxic during pregnancy (no distinction between strong or lighter alcohols such as beer, wine or Champagne, they all should be avoided). The baby may suffer from several dysfunctions or malformations. The first to establish a connection between the symptoms of sick children and their mother’s alcohol consumption was the Dr. Paul Lemoine. In 1968, this doctor from Nantes described, through a study initiated ten years earlier, the clinical picture of 127 children placed in a nursery, from 62 “alcoholic families” and suffering from fetal alcohol syndrome. This work will not be recognized until 1985.
What are the 4 characteristic signs of this syndrome?
Catherine Maingueneau explains to us that there are four major items of syndromes due to fetal alcohol. “For each child, there is a different declination. In the the most serious caseswhen alcohol consumption is high, the child has abnormalities present in all four items. He then suffered from fetal alcohol syndrome, which corresponds to the complete clinical form. He may also only suffer from a single attack, but this will be serious if it is a neurological attack. she explains.
- Growth retardation. This intervenes on baby’s weight, height, head circumference or on all three in severe forms. This growth retardation can occur antenatally during gestation, at birth and postnatally throughout the child’s growth. It can be such that it requires termination of pregnancy notably if the head circumference is so small that it suggests irreversible neurological damage and of particular gravity.
- A facies particular. Children with fetal alcohol syndrome may have facial dysmorphism the main signs of which are narrow palpebral fissures with small eyes, a much thinner upper lip, a smooth, long and domed philtrum (furrow above the lip). “Facial dysmorphism decreases with age“says the pediatrician.
- Various malformations. Fetal alcohol can cause heart defects, kidneys, bones (the typical radioulnar synostosis which consists in the fact that the radius and ulna are fused) or even cleft lip. Children can also suffer from brain defects such as agenesis of the corpus callosum (the corpus callosum makes it possible to connect the left and right hemispheres of the brain to each other. During a malformation of the corpus callosum, the passage of information from one side to the other becomes difficult) .
- Neurological abnormalities. People affected by fetal alcohol syndrome more often suffer from intellectual weakness with an IQ of 80-85 on average (the norm being between 70 and 120). This neurological impairment is due to a microcephaly that does not allow the child’s brain to fully develop.
“These children are often small and puny”
What are the consequences for the baby?
“These children are often small and stunted and may have visual, hearing, cognitive, language, arithmetic, comprehension impairments and social behavior.” Alcohol destroys cells and connections resulting in a malformed brain with abnormal areas such as an underdeveloped cortex, but also a poorly connected brain. All this explains the intelligence, social integration, behavior and learning disorders especially at school: attention disorder, difficulty memorizing information, procedures, to understand the second degree and abstract things, and dyslexia, dysphasia, dyscalculia… “This syndrome is the leading cause of neurological disability of non-genetic origin.“says the pediatrician. “Of the dead in utero sometimes occur because of alcohol consumption”, she adds. Once the child is born, its development is monitored. “During the first years, we watch him grow, grow and we check his cranial circumference, his motor and cognitive development and his learning. What matters most to us, is to follow its long-term development. We want to know how he will integrate and behave at home, in society and at school, if he will learn and understand from kindergarten to high school… in order to support him if necessary to allow him to ‘to be independent in adulthood.
Can fetal alcohol syndrome be detected on ultrasound?
All the malformations mentioned above are detectable on ultrasound although they are not not syndrome specific fetal alcohol. To check if there is a link, “the health professional must ask questions and the mother must be confident in reporting her consumption. It is therefore important to know if the alcohol consumption took place during the fetal state or the embryonic state to understand the malformation is possibly attributable to alcohol consumption.“, explains Catherine Maingueneau. The feeling of guilt is often very strong in mothers, especially in cases of denial of pregnancy. It is therefore rare that they speak spontaneously and, if they do not, the diagnosis of fetal alcohol then remains a probability and not a validation.
What are the treatments ?
“During pregnancy, alcohol is no!”
There really isn’t a treatment to treat disorders caused by alcohol consumption during pregnancy. Deformities of the face, heart or kidneys can be operated on. For growth retardation, it is necessary that he be of legal age to administer growth hormone, which is very rare. But concerning neurological disorders, if there is no treatment, it is essential to diagnose the origin in order to offer appropriate aids such as speech therapy, psychomotricityeducation in good behavior to adopt at school, etc. “The most important remains information and prevention. We must raise awareness among women but also young people who will be future parents and remember that during pregnancy, alcohol is no.”
Thank you to Dr. Catherine Maingueneau, pediatrician specializing in neonatology, child neuropsychology and learning disabilities. She accompanies vulnerable children or children suffering from these pathologies within the “Growing Together” network of the “Birth Safety Network” of Pays-de-la-Loire. She is also a maternity addictologist at the Jules Vernes clinic in Nantes, and offers prenatal information consultations in conjunction with the midwives and obstetrician-gynecologists of the structure.