Alcohol in Pregnancy

Alcohol in Pregnancy

A syndrome of malformations found in infants born to mothers who have consumed alcohol during pregnancy. Abnormalities include structural malformations, growth restriction, and neurologic abnormalities including mental retardation. Estimates vary from 6 to 10000 births (1193) to 1-2 of 1000 births (2000).

Etiology and Pathogenesis

Alcohol consumption during pregnancy. There does not appear to be a lower limit of safety nor are the effects confined to one part of pregnancy. The severity of the effects does appear to be proportional to the amount and during of exposure. Clinically identifiable effects are generally not seen with sporadic exposures of less than 1 oz of alcohol per day. Although absolute safety cannot be assured even at this dose.

 

Alcohol used during pregnancy

Clinical characteristics

 Sign and Symptoms

Facial deformities- microcephaly, short palpebral fissures, flat midface, underdeveloped philtrum and thinned upper lip; low masal bridge, epicanthal folds, minor ear anomalies, small teeth with faulty enamel, foreshortened nose and micrognathia may also be seen; two or more abnormal facial features must be present to make the diagnosis.

Cardiac Malformations – these include the following:

a.       Deformities of joints, limbs, and fingers vision difficulties including nearsightedness.

b.      Intrauterine and extra uterine growth restriction.

c.       Mental retardation and developmental abnormalities, brain and spinal defects.

d.      Abnormal behavior such as short attention span, hyperactivity, poor impulse control, extreme nervousness, and anxiety.

 

Diagnostic approach

Differential Diagnosis

Other chromosomal or congenital syndromes.

Associated conditions: Maternal- other substance abuse sexually transmitted disease. Fetal- dental caries, cardiac defects, and ophthalmic problems.

Management and therapy

No pharmacological

General measures: For the mother – counseling , alcohol and substance abuse programs. For the fetus – evaluation, special education and support, surveillance for dental caries and cardiac and ophthalmic problems. 

Specific measures: None.

Diet: Reduction of elimination of alcohol for the duration of pregnancy.

Activity: No restriction.

Drug choice: None.

 

Follow-Up

Patient monitoring: Normal health maintenance, surveillance for dental caries and cardiac and ophthalmic problems.

Prevention/Avoidance: Reduction or elimination of alcohol use during pregnancy. No safe level of exposure has been demonstrated although sporadic use of less than I oz of alcohol per day has been associated with the syndrome.

Possible complications: Higher rate spontaneous miscarriage in heavy users of alcohol.

Expected outcome: Infants affected by fetal alcohol syndrome vary from mildly to profoundly mentally retard. Similarly, structural anomalies are variable, but life-long.