The Neurodevelopmental Consequences of Prenatal Alcohol Exposure

Elizabeth Welch-Carre, RN, MSN, NNP

Disclosures

Adv Neonatal Care. 2005;5(4):217-229. 

In This Article

Abstract and Introduction

During pregnancy, ingestion of alcohol, a known teratogen, can cause harm to the fetus. Prenatal alcohol exposure is one of the leading causes of birth defects, developmental disorders, and mental retardation in children. The fetal central nervous system is particularly vulnerable to alcohol; this vulnerability contributes to many of the long-term disabilities and disorders seen in individuals with prenatal alcohol exposure.
Diagnoses associated with prenatal alcohol exposure include fetal alcohol syndrome (FAS), partial fetal alcohol syndrome, fetal alcohol effects, alcohol-related neurodevelopmental disorder, and alcohol-related birth defects. Once diagnosed, early intervention improves the long-term outcome of affected children. Without documentation of maternal alcohol use, a diagnosis, and consequently treatment, is often difficult to attain. It is imperative that nurses, physicians, and other healthcare providers become comfortable with obtaining a history of, and providing anticipatory guidance and counseling about, alcohol use.

The detrimental effects of maternal ingestion of alcohol during pregnancy have been scientifically documented since the late 1800s.[1] It was not until 1973 that a seminal article published in the Lancet by Jones et al[2] labeled the dysmorphology observed in the offspring of alcoholic mothers as fetal alcohol syndrome (FAS). Since that publication, there has been tremendous research on the impact of prenatal alcohol exposure on the developing fetus, infant, and child.

Despite the well-documented teratogenic effects, prenatal alcohol exposure (PAE) continues to be a widespread public health concern. The Centers for Disease Control and Prevention (CDC) report that in 2002 the rate of alcohol use among pregnant women was 10.1%.[3] In pregnant women, binge drinking, defined as 5 or more drinks on 1 occasion, and frequent alcohol use, defined as 7 or more drinks in a week, were both 1.9%.[3] It is estimated that annually 130,000 pregnant women in the United States drink alcohol at levels that may put their fetus at risk of developing alcohol-related disorders.[4] The incidence of FAS in the United States is estimated to be 1 to 2 per 1000 births.[5] The combined estimated numbers of FAS, alcohol-related neurodevelopmental disorder (ARND), and births affected by alcohol-related birth defects (ARBD) is 10 per 1000.[5]

Around the world, PAE is a public health issue as well. The Western Cape province of South Africa has a reported FAS rate of 40 to 46 per 1000 births.[6] A study in Moscow examined 2 groups of children, 1 from a boarding school and the other from an orphanage. These groups were chosen because of their probable exposure to alcohol. The incidence rate of FAS within this small population was estimated to be 14.1%.[7] The incidence rate of FAS in Europe is approximately 0.8 per 1000 births.[8]

The lifetime cost of care for one individual with FAS in the United States is approximately $2 million.[9] In 1998, it was estimated that over $4 billion was spent nationally caring for individuals with FAS.[9] These cost estimates do not include the costs associated with individuals diagnosed with ARND, ARBD, or fetal alcohol effects (FAE).

Prenatal alcohol exposure is the leading preventable cause of birth defects, developmental disorders, and mental retardation in children.[10] Yet evidence of screening for alcohol use in women of child bearing age and documentation in the records of infants with known exposure continue to be inadequate.[11,12] Possible reasons for this are healthcare providers'

  • Discomfort discussing the subject with pregnant women;

  • Lack of knowledge about the effects of alcohol on the developing fetus, and;

  • Lack of awareness of interventions once alcohol use has been discovered.[13]

Since FAS, ARND, and ARBD are completely preventable, screening women of childbearing age for alcohol use is a critical first step. The long-term outcomes of affected children are improved with early diagnosis and early intervention. Caregivers in the newborn and/or intensive care nursery play a pivotal role in identifying, documenting, and providing guidance to those at risk.[14]

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