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VI. Special Populations

I was drinking during my first trimester of pregnancy before I knew I was pregnant. What are the risks to my unborn baby?

My baby was born with fetal alcohol syndrome. What is that, and what does it mean for my baby?

How do I know whether my child is just experimenting with alcohol and drugs or has a real problem with them?

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I was drinking during my first trimester of pregnancy before I knew I was pregnant. What are the risks to my unborn baby?

Because many pregnancies are unplanned, women may unintentionally expose their offspring to alcohol. Potential mothers need to be aware of the risks associated with unplanned pregnancy and the use of alcohol. As noted in Question 85, alcohol is quickly absorbed into a woman's bloodstream, and if she is pregnant, alcohol quickly passes through the placenta and exposes the baby. Alcohol is broken down more slowly in a baby than in the adult because of the baby's size and immaturity. As a result, alcohol remains elevated in the baby's blood stream longer than it remains in the mothers, potentially causing damage to the baby. Thus, even light to moderate drinking may affect the fetus in several ways, including premature birth, low birthweight, and cognitive and physical deformities. Heart defects have been found in babies whose mothers drank during the first trimester of their pregnancy. Sometimes a baby can appear normal at birth, although subtle effects may present later in the child's development, even if the mother drank only one drink per week during the pregnancy. One study reported that children 6 and 7 years old exhibited more aggressive behaviors and had other behavior problems, including delinquency, than children whose mothers did not drink at all. Another study demonstrated that moderate alcohol consumption during pregnancy resulted in a higher incidence of offspring having problems with alcohol by the age of 21 years, even after controlling for family history and other environmental factors.

Potential mothers need to be aware of the risks associated with unplanned pregnancy and the use of alcohol.

Although a clear dose-dependent relationship exists between amounts of alcohol one drinks during pregnancy and the extent of damage to one's unborn child, no definitive answer is available regarding exact amounts of exposure. One or two drinks before you knew you were pregnant will most likely not affect your baby. The baby's brain and other vital organs begin developing around the third week, so if you stopped drinking by then, the baby is probably safe. The baby is vulnerable, however, by the third week and thereafter; thus, continued exposure to alcohol will place the baby's brain and other vital organs at risk. To conclude, the risk is low within the first 2 to 3 weeks, increases dramatically after that and throughout the first trimester, and then decreases, although not enough to recommend any alcohol until after the baby is born. The risk is that you may have a baby who in the beginning has serious physical, mental, or behavioral problems or who seems normal and healthy at first but later develops behavioral or cognitive problems. Speak openly with the obstetrician about your drinking and your fears about the baby. The most serious risk to your unborn child is fetal alcohol syndrome (FAS), which is addressed in the following question.

My baby was born with fetal alcohol syndrome. What is that, and what does it mean for my baby?

Fetal alcohol syndrome disorder (FASD) is one of the most devastating disorders found in newborn children. It results from exposure to alcohol by mothers who drink throughout their pregnancy. Experts believe that the degree of severity of the symptoms depends on the amount of alcohol circulating in the mother's and baby's bloodstreams, the timing of the toxic exposure, and genetic factors. Currently, no way is available to determine which baby will be affected by exposure to fetal alcohol. Although only a few drinks may be required at a crucial time during pregnancy to cause sufficient damage to the fetus, how much alcohol and at what crucial time have yet to be determined. One in every 750 babies has the full syndrome. It is the leading known cause of mental retardation in newborn children. Alcohol, therefore, is the leading teratogen causing birth defects.

Fetal alcohol syndrome disorder (FASD) a disorder that is found in infants whose mothers ingested alcohol during pregnancy, resulting in the infant being mentally retarded along with having other distinguishing features.

Teratogen an agent, such as a virus, drugs or alcohol, or radiation, that causes malformations in a fetus or embryo.

Microcephaly an abnormally small head with associated mental retardation.

Some children show signs of cognitive and behavioral problems after exposure to alcohol in the absence of physical features.

Most children exposed to alcohol in utero do not have the full-blown syndrome, which includes not only cognitive and behavioral problems but also distinct physical features. FASD is manifested by specific birth defects characterized by low birthweight, failure to thrive, developmental and psychological delays, autism, and mild to moderate mental retardation (an IQ around 60), along with rather distinct physical abnormalities. Thirty to forty percent of these children have heart defects, which occur in the first trimester of the pregnancy. The distinct physical abnormalities include a cranial malformation known as microcephaly, a narrow forehead, flattening of the mid face, both the cheekbones, and the bridge of the nose, a short nose, and a long, thin upper lip. Other eye, ear, and occasionally hand malformations may also be present. Children who are the less obviously deformed may go undetected until later in life.

Some children show signs of cognitive and behavioral problems after exposure to alcohol in the absence of physical features. When this occurs, the symptoms are referred to as alcohol-related neurodevelopmental disorder (ARND). These children may go unrecognized because they do not have the physical features, although they have the developmental, cognitive, and behavioral deficits. Some may suffer from minimal brain damage, have difficulty concentrating and focusing, may be irritable and/or hyperactive, have difficulty in problem solving, and may be emotionally labile. These children may be diagnosed later on with psychiatric disorders such as attention deficit hyperactivity disorder (ADHD), depression, or bipolar disorder (or manic depression). Such children may not be identified until they are in school. All children who have been exposed to alcohol in utero should have early screenings, close monitoring, and early interventions.

The National Organization of Fetal Alcohol Syndrome estimates that at least 12,000 children each year are born with FASD, and as many as 36,000 more children have ARND. A smaller group of children has had some developmental and cognitive effects, but the effects are less severe than the other two syndromes. This population of mentally retarded/developmentally delayed children who were exposed to alcohol while they were in uteri is larger than the number of children born with Down's syndrome, cerebral palsy, and spina bifida combined. FASD and ARND are the most preventable of all of the mental retardation and physical deformities found in newborn children.

Alcohol-related neurodevelopmental disorder (ARND) a disorder in the development of the nervous system In a fetus. It is related to the exposure of the fetus to alcohol.

National Organization of Fetal Alcohol Syndrome an organization to educate young women about the dangers of drinking while pregnant, hopefully to prevent the incidence and prevalence of fetal alcohol syndrome.

To conclude, FASD is entirely preventable and is the only form of childhood mental retardation that is preventable.

Centers for Disease Control a federally mandated program that was established In 1973 to monitor the nation's health.

Early diagnosis has been shown to be effective in preventing secondary disabilities, such as school failure, juvenile delinquency, mental health problems, homelessness, and unemployability. Individuals with undiagnosed FASD often end up in institutional settings, including jails, mental health programs, psychiatric hospitals, and homeless shelters. Early intervention is critical. The earlier those children can be treated the better their outcomes will be. Families must be included in the therapeutic plan because parents often become overwhelmed by the difficulty in caring for a multiply handicapped child and they need to deal with the guilt of having caused harm to the child. FASD children require environments that are stable, structured, and nurturing. Caregivers must be creative, consistent, and compassionate. During the early life of the child, helping the parents and the child to develop healthy relationships is the first and most important intervention. To conclude, FASD is entirely preventable and is the only form of childhood mental retardation that is preventable. It is a life-long condition that affects every aspect of the lives of the child and the family. Table 16 outlines Centers for Disease Control criteria that are guidelines for the diagnosis of FASD.

 
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