Alcohol as a teratogen

Two of the most common non-heritable causes of intellectual disability are Foetal Alcohol Syndrome (FAS) and Foetal Alcohol Spectrum Disorders (FASD). FASDs can occur through intrauterine exposure to alcohol when the alcohol in the mother’s blood passes through the placenta and reaches the baby. No amount of alcohol is safe to consume while trying to get pregnant or when pregnant. Sometimes it can take up to six weeks for a woman to find out that she is pregnant. If alcohol is consumed during this period when the pregnancy remains unknown, it can lead to complications such as that of FASD. For example, 14% of women in Manitoba report drinking alcohol before knowing they were pregnant. However, FASD is completely avoidable by simply not consuming any amount of alcohol at all during preconception and pregnancy.

No amount of preparation can help a woman predict pregnancy’s vicissitudes. It is a time when women can be cauldrons of emotions, which thus makes a few resort to alcohol. This can be exacerbated by conditions such as depression that sometimes accompany pregnancy. In comparison to awareness about the hazards to do with tobacco and drugs during pregnancy, alcohol remains severely underestimated. Sometimes, women suffering from addiction can look at pregnancy as a time to explore sobriety. It is important to work on harm reduction strategies prior to pregnancy rather than during the pregnancy. Rather than making an inchoate emotional mistake primarily based on feeling instead of reason, it would be good to seek help. Thus, it would be cogent to screen women for alcohol during preconception counselling as well as prenatal care, ergo issues around alcohol can be addressed through brief interventions. 

A teratogen is an agent or factor that affects the development of the embryo thus leading to malformation. Numerous studies indicate that alcohol is one such teratogen. However, studies also indicate that the rates of binge drinking among women of childbearing age are increasing at an alarming rate. FASD is a broad diagnosis encompassing patients affected by FAS, alcohol-related neurodevelopmental disorder (ARND), alcohol-related birth defects (ARBD) and neurobehavioural disorder associated with prenatal alcohol exposure (ND – PAE). The diagnosis criteria are based on the presence of numerous clinical features including prenatal or postnatal retardation of growth, dysfunction of the central nervous system, neurobehavioural disabilities and facial dysmorphology.

FAS may have a common underlying mechanism such as that of Down’s syndrome. Due to this and the prevailing stigma around maternal alcohol exposure during pregnancy, FAS can commonly be misdiagnosed as Down’s Syndrome, autism or sometimes ADHD. This misdiagnosis thus interferes with the progress in treatment for the child. Many studies also indicate that the increase in the incidence of trisomy 21 is in the second generation of alcoholic mothers. Infant exposure to alcohol
through breastmilk can also delay cognitive development, and cause skewed sleeping patterns and infant agitation.

Thus, it is important to recognise the need for integrated, holistic care to support individuals, families and communities caring for those with FASD. Multidisciplinary primary care group practice models thus would suit best for FASD. Some of the barriers to access can be due to inadequate access to service especially in rural and remote areas, and most importantly a lack of system-level awareness and capacity. Increasing awareness, information, and holistic understanding of FASD coupled with the options available for prevention, diagnostic and intervention services can thus play a momentous role in the reduction of FASDs and increase access to help for those already affected by it.

(The author is a multidisciplinary professional who works in the UK.)