Fetal alcohol syndrome is a devastating developmental disorder caused by prenatal exposure to high amounts of alcohol. In addition to structural abnormalities and growth deficits, fetal alcohol syndrome is associated with a broad spectrum of neurobehavioral anomalies. This paper reviews the behavioral and cognitive effects of prenatal alcohol exposure. More than 20 years of research are discussed, with a focus on IQ, activity, attention, learning, memory, language, motor, and visuospatial abilities in children prenatally exposed to varying amounts of alcohol, including those with fetal alcohol syndrome.

A Review of the Neurobehavioral Deficits in Children with Fetal Alcohol Syndrome or Prenatal Exposure to Alcohol

Prenatal ethanol exposure permanently reduces the number of pyramidal neurons in rat hippocampus

. Olegard, R., Sabel, K.-G., Aronsson, M., Sandin, B., Johansson, P. R. Carlsson, C., Kyllerman, M., Iversen, K. and Hrbek, A. (Departments of Paediatrics, East Hospital, University of Goteborg and Psychiatric Clinic II and Nordhem Alcoholic Clinic, Lillhagen Hospital, Goteborg, Sweden). Effect on the child of alcohol abuse during pregnancy. Retrospective and prospective studies. Retrospective and prospective investigations of children to alcoholic women gave an incidence of fetal alcohol lesion of one per 300 deliveries of whom half had the complete fetal alcohol syndrome. Perinatal and infant mortalities were increased seven to tenfold and low birth weight (<2500 g), preterm deliveries (<37 weeks) and smallness for gestational age (<-2 S.D.) were increased eightfold, threefold and twelvefold, respectively. Small size at birth correlated with reduced mental performance later in life, 58% had IQ below 85 and 19% below 70. 8% had cerebral palsy. The incidence of cerebral palsy associated with maternal inebriety was 1/5000 deliveries, i.e. every sixth case of cerebral palsy. Tracing of alcoholic women during pregnancy and treatment gave favourable effect on intrauterine growth when sobriety could be induced early in pregnancy but could not protect from functional brain disturbance measured by neurological performance and by evoked response electroencephalography. Damage to the fetus by alcohol is now the largest known health hazard by a noxious agent that is preventable.

Effects on the child of alcohol abuse during pregnancy. Retrospective and prospective studies.

Alcohol embryo- and fetopathy

Children born to mothers who had abused alcohol throughout pregnancy had severe behavioural and intellectual problems which remained at age 11 to 14 years. Of 24 children examined, 10 had attention deficit hyperactivity disorder (ADHD) with or without developmental coordination disorder, two had Asperger syndrome, and one had an autistic-like condition not meeting the criteria for Asperger syndrome. Six of these 24 attended special schools for the mentally retarded and a further 11 were given special education, leaving only seven attending regular schools without any type of support. The children had difficulties in mathematics, logical conclusions, visual perception, spatial relations, short-term memory, and attention. Sixteen children lived in foster homes. There was a clear correlation between the occurrence and severity of the neuropsychiatric disorder and the degree of alcohol exposure in utero.

Attention deficits and autistic spectrum problems in children exposed to alcohol during gestation: a follow‐up study

68 cases of alcohol embryopathy are reported. The main symptoms are intrauterine and postnatal growth retardation (91%), microcephaly (87 per cent), psychomotor and mental retardation (84 per cent) and a typical craniofacial dysmorphism. Other malformations are frequently found such as cardiac defects (31 per cent), anomalies of joints (23 per cent) and genitalia (50 per cent). There is a marked variation in the intensity of the malformations. Taking into account the extent of the craniofacial dysmorphism and the cerebral damage, a classification into three types (I-111) of alcohol embryopathy is proposed. That ethanol has a teratogenic effect seems to be confirmed. The mother's clinical history suggests that the quantity of alcohol consumed has no marked influence on birth weight, length of gestation and severity of the symptoms. Possibly a defective ethanol metabolism in the severely affected mothers may account for the dysplasias.

[Clinical aspects of pathogenesis of alcohol embryopathy (author's transl)].

Two patients with the Dubowitz syndrome are presented. This presumably recessive inherited syndrome was first defined by Grosse et al. (1971). So far 11 patients with this syndrome have been described. Major clinical findings are intrauterine and postnatal growth retardation, considerable microcephaly, mild mental retardation, hyperactivity, hyperextensibility of joints, eczema and a characteristic appearance of the face due to marked epicanthic folds, blepharophimosis, broadening of the bridge and tip of the nose and retrognathia. Minor anomalies as clinodactyly of the fifth digits, cutaneous syndactyly of toes, foot deformity, sacral dimple and cryptorchidism may be seen. The exclusion of the non genetic fetal alcohol syndrome presents serious diagnostic problems.

A rare type of low birthweight dwarfism: the Dubowitz syndrome.

In 1973 Jones et al. were the first to report on the so-called fetal alcohol syndrome. Hitherto 16 cases have been published. Within the last 2 years our group has observed 12 additional cases. All infants were hypotrophic at birth; mean length=39 cm, mean weight=1880, mean gestational lenght=38 weeks. The main symptoms were: microcephaly /11/12/, micrognathia /10/, high arched palate /6/, epicanthus /7/; clinodactyly /6/, vitium cordis /4/, genital malformations /6/, pathological palmar creases /9/. Postnatally, growth, weight gain, statomotor and mental development were considerably retarded. The alterations of the heart, brain and dermatoglyphs which can be traced back to distinct gestational stages are ample evidence for damaging influences already occurring during the second and third month of pregnancy. Thus, the syndrome is an embryopathy rather than a fetopathy.

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Fetal alcohol syndrome

/pdf/fetal-alcohol-syndrome-62-12iy6dc6z3.pdf

Fetal alcohol syndrome: 62

Es wird uber 24 Kinder mit efAS berichtet. Die Symptomatik entsprach in den Grundzugen dem von Lemoine et al. und Jones et al. mitgeteilten Krankheitsbild; die von Jones et al. angegebene Hypoplasie des Oberkiefers und Mikrophthalmie konnten wir jedoch nicht bestatigen. Zusatzlich beobachteten wir bei 2 Madchen Virilisationen des Genitales, die einem Pseudohermaphroditismus femininus entsprachen.

Über das embryo-fetale Alkoholsyndrom

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