Alcohol embryopathy (AE), which is sometimes also called fetal alcohol syndrome, is a medical term used to describe impairments in somatic and cognitive child development. Alcohol embryopathy is triggered by alcohol consumption or alcohol abuse during pregnancy.
What is alcohol embryopathy?
Alcohol embryopathy is a medical term used to describe impairments in somatic as well as cognitive child development due to the consumption of alcohol during pregnancy. Alcohol embryopathy manifests in some cases by short stature, belpharophimosis, facial abnormalities as well as also microcephaly. Sometimes a sunken nasal root, low-set ears, malformations of the heart, genitals, and skeleton and kidneys such as blood vessels may also indicate the presence of alcohol embryopathy. Furthermore, the affected child shows abnormalities in behavior, so that many affected children suffer from hyperactivity or attention and concentration disorders. In addition to Down syndrome, alcohol embryopathy is considered the most common cause of mental or intellectual disabilities.
Causes
The cause of alcohol embryopathy is predominantly due to alcohol consumption or abuse during pregnancy. However, there is as yet no direct correlation between the extent and amount of alcohol consumed, so it is not possible to say at what “threshold” impairments occur or the likelihood is increased that the child will be affected by alcohol embryopathy. The fact is that alcohol is potentially toxic and can cross the placental barrier. Due to the fact that the children only have their own functional metabolism after birth (postnatal metabolism), the child’s body cannot break down the toxins on its own. Poisoning results, which subsequently triggers alcohol embryopathy.
Symptoms, complaints, and signs
Organic malformations or even characteristic developmental disorders are the most common symptoms. Furthermore, doctors suspect that alcohol consumption during pregnancy also inhibits the child’s cell division and subsequently damages Purkinje cells. These provide for the development of balance and are also responsible for the coordination of muscles. Classic symptoms and signs are attention deficit disorder (ADHD), short stature and hyperactivity. Sometimes there is a mental or intellectual disability; in some cases, however, the physician only detects a developmental disorder in the children. Growth disorders can also occur in the context of alcohol embryopathy. Many children also suffer from cheilognathopalatoschisis (so-called cleft lip and palate) and a marked underdevelopment of their muscles. Further symptoms can be a lack of concentration, aggressiveness and alcohol-related heart muscle damage. The course and prognosis of alcohol embryopathy vary and depend mainly on the specific impairments present. About one fifth of all affected children can lead a “normal” life or attend a “normal” school. However, 30 percent of all affected individuals are severely disabled.
Diagnosis and course
The physician diagnoses alcohol embryopathy or fetal alcohol syndrome based on characteristic symptoms and signs. Sometimes, the physician can also detect the mother’s alcohol abuse; the detection is done in the context of a blood analysis (ferritin, liver enzymes) or a medical history. The physician may also order magnetic resonance imaging and sonography. These imaging procedures ensure that any impairment of the cerebral structures and dysplasia can be detected. This also includes any impairment of the cerebellum as well as damage to the kidneys, which are also indicative of alcohol embryopathy. By means of cardiological diagnostic procedures (cardiac catheterization as well as ECG), the attending physician can also make a statement as to whether or not the heart is also affected by a malformation. Various developmental tests or neuropsychological test methods ensure that the physician obtains information about whether there are disturbances in the motor, linguistic, social and cognitive abilities.Sometimes the physician must make a differential diagnosis; in this, Edwards syndrome (also known as trisomy 18) and Dubowitz syndrome must be able to be excluded.
Complications
Alcohol abuse during pregnancy can lead to alcohol embryopathy. Depending on the time of ingestion, this can lead to various organ damage in the embryo. Alcohol consumption during the first three months of pregnancy primarily leads to organ dysfunction. Children grow up with a congenital heart defect, for example. A ventricular septal defect can lead to heart failure (cardiac insufficiency) at an early age and thus to the death of the child. Furthermore, a reduced skull (microcephaly) and a reduced brain (microencephaly) are usually found. Ingestion of alcohol during the second trimester of pregnancy (4th to 6th month) carries the highest risk of miscarriage. Furthermore, a delay in growth development is evident here. In the last three months of pregnancy, physical and mental development occurs in the fetus. This can be disturbed by the influence of alcohol. The infant may experience disturbances in physical and mental development. Damage also occurs to the mother due to regular alcohol consumption. As a result, the mother may develop a fatty liver, which in the course of time may turn into cirrhosis of the liver. Due to the liver cirrhosis, the synthesis capacity of the liver is disturbed and not enough proteins and coagulation factors are produced. This can lead to edema and also prolonged bleeding times. Abdominal dropsy (ascites) is also conceivable as a consequence of liver cirrhosis.
When should you go to the doctor?
Unfortunately, in many cases, alcohol embryopathy cannot be treated directly because various malformations and deformities of the child occur before birth. However, in any case of alcohol embryopathy, a doctor must be consulted, because with the help of medical treatment, the disorders of development can be limited. Therefore, if the parents notice growth disorders or developmental disorders, a doctor should be consulted in any case. In this case, the complaints and manifestations of the disorders can strongly depend on the alcohol consumption during pregnancy and can thereby differ. If the parents are also affected by psychological complaints or depression due to the complaints of alcohol embryopathy, they can be treated by a psychologist. In most cases, the complaints and symptoms of alcohol embryopathy can be recognized before birth, so that measures can be initiated immediately after birth. It is not uncommon for malformations and damage to organs to occur, which must also be treated by a physician. Without treatment, there will be considerable limitations in the patient’s everyday life and, as a rule, a reduced life expectancy.
Treatment and therapy
Causal treatment of alcoholic embryopathy is not possible. However, somatic impairments can sometimes be (partially) surgically corrected. These include facial abnormalities such as a cleft lip or palate, organic maldevelopment as well as underdevelopment, and hearing and visual impairments. Any developmental deficits can be compensated for – provided that favorable environmental and contextual conditions are present – or compensated for or activated by already existing potentials. Sometimes the cognitive, psychomotor as well as social and linguistic maldevelopments can also be compensated. Early childhood measures are necessary for this. These consist of occupational therapy, physiotherapy and speech and dysphagia therapy. In many cases, music therapies as well as hippotherapies and motopedias are used, so that a sensory integration is given. However, it is important that no “excessive therapy” takes place, through which the child is overstrained. It is important that inclusion aids (such as when starting school) are used. If, however, there is pronounced hyperactivity or the child suffers from ADHD, medication can be prescribed. Psychotropic medications (such as methylphenidate – Medikinet, Ritalin, among others) are mainly administered. In two thirds of all cases, the affected child grows up in a home or with a foster family. Beforehand, it is important that those caregivers have knowledge about alcohol embryopathy and also receive psychological support.
Outlook and prognosis
Alcohol embryopathy causes significant impairment and discomfort in the newborn. In most cases, various malformations of the body and internal organs occur. The brain may also be damaged, resulting in motor and mental complaints in the patient. In most cases, the children suffer from ADHD and disorders of growth and development. Likewise, there is often aggression and mild irritability. Those affected cannot concentrate properly due to alcohol embryopathy and likewise suffer from heart problems. The exact effects of alcohol embryopathy on the child depend greatly on the duration and amount of alcohol consumption, so that a general prediction is usually not possible. Often the children are severely handicapped, so that they are dependent on the help of other people in their lives. The patients’ quality of life is significantly reduced by alcohol embryopathy. If possible, alcoholic embryopathy must be treated during pregnancy. However, the children also depend on various therapies after birth and, in many cases, on surgery to continue to survive.
Prevention
Alcohol embryopathy or fetal alcohol syndrome can be 100 percent prevented in any case. The woman only needs to abstain from alcohol during pregnancy; even small amounts should not be consumed during pregnancy so that alcohol embryopathy is not promoted. There are no other preventive measures, since alcohol embryopathy can only develop in the context of alcohol abuse during pregnancy.
Follow-up
In most cases, those affected by alcohol embryopathy do not have any special options for aftercare. Therefore, they rely on treatment by a medical professional to counteract the damage caused by alcohol consumption. However, a complete cure cannot be achieved in this process. Possibly, the life expectancy of the child is limited by the alcohol embryopathy. As a rule, early diagnosis and timely treatment have a very positive effect on the further course of the disease. Above all, the child must be encouraged and intensively cared for in order to treat the damage. Since the affected children not infrequently also show hyperactivity, medications must be taken in the process. Parents must pay attention to regular intake and possible interactions with other medications. Furthermore, psychological treatment of alcohol embryopathy is often also necessary, and discussions with family or friends can be useful. Exercises from physiotherapy can also be performed in the patient’s own home and can accelerate the recovery of the affected person. To what extent the symptoms of alcohol embryopathy can be alleviated in the process cannot be universally predicted.
Here’s what you can do yourself
Parents who suspect their child has alcohol embryopathy should seek discussion with their family physician. If the damage is diagnosed early, a significant improvement in health is possible. A prerequisite for this, however, is a corresponding willingness to cooperate on the part of the parents. Accompanying the actual therapy, the mental and physical limitations can at least be compensated by additional support and measures such as physiotherapy. Accompanying this, the parents’ causative alcoholism must be treated. Through withdrawal and participation in self-help groups, a responsible approach to alcohol can be learned on the one hand. On the other hand, therapeutic measures help to take responsibility for the alcohol embryopathy and to accept the damage that has already occurred. If the parents do not show any willingness to cooperate, the affected children must learn how to deal with the disease themselves. This is also possible through therapeutic measures, but also through a change of environment and disengagement from the parental home. In addition, a healthy and active lifestyle can often improve the quality of life. Since the manifestations of alcohol embryopathy vary from case to case, the specific measures should be worked out with a doctor or therapist.
