January 10th, 2018
Fetal Alcohol Syndrome – challenges in arresting FAS
Ensuring that pregnant women are alcohol free is the most effective prevention method against PAS. Zoorob, Aliyu and Hayes point out that studies identifying appropriate levels of alcohol consumption in pregnancy have not been conducted. Consequently, pregnant women should abstain from alcohol in order to reduce the risk of FAS (379-385). In agreement is the National Organization on Fetal Alcohol Syndrome (NOFAS) who stress that abstaining from alcohol is the most effective prevention for FAS. The organization claims that the challenges in preventing FAS are chronic alcohol abuse by women; unplanned pregnancies; insufficient training of professionals and ineffective screening programs (1).
Chronic alcohol abuse
Women abuse alcohol more than any other drug. Almost every one in two women have consumed alcohol in their lifetime. As at 2006, nearly 5.3 million women in the United States were estimated to abuse alcohol (NOFAS 1). Hanson, Venturelli and Fleckenstein concur that the rate of alcohol abuse among women in the United States is 42.3%. This may be due to boredom, stress, lack of self esteem, trauma, societal pressure, loneliness and depression. Though women are less dependent of alcohol than men, their physiological response to chronic alcoholic consumption is greater. They have a higher risk of liver failure, mental disorders and premature death. This may be attributed to the fact that women have smaller blood volume and slower metabolism than men. The small blood volumes cause rapid absorption of alcohol into the bloodstream while slow alcohol metabolism causes alcohol to spread to the brain quicker. These factors plus societal pressures on women make them susceptible to chronic alcohol abuse (487).
Other than FAS, excessive alcohol consumption during pregnancy leads to spontaneous abortions and mortalities. This is dependent on the development stage of the fetus, period of exposure, quantity of alcohol consumed and the use of other drugs. Pregnant women who consume alcohol excessively negatively affect their hormonal and nutritional well being. Consequently, fetal cell and organ development is hampered leading to prenatal mortality (Gemma, Vichi and Testai 221-229).
Excessive alcohol consumption during pregnancy increases the mortality risks of women. Higher alcohol consumption levels of women contribute to premature death and development of diseases such as cirrhosis and cancer. It is important to note that a family history of alcoholism predisposes women to alcohol dependence and negative symptoms of alcohol use. This dependence exposes women to greater risk of maternal deaths regardless of ethnicity, race or tribe (Berg, Lynch and Coles 603-610).
Chronic alcohol consumption influences sexual behaviors that lead to unplanned pregnancies. It has been known to reduce inhibitions regarding safe sex and influences risky sexual behavior. Since the impact of alcohol on women is greater than men, women are more susceptible to practicing unsafe sex and having unplanned pregnancies. Similarly, Hanson, Venturelli and Fleckenstein link alcohol consumption with unwanted sexual behaviors and unplanned pregnancies. They state that alcohol impairs judgment of the drinker and leads to impulsive sexual behavior that may cause unwanted pregnancies (238).
Women who are chronic alcohol abusers may suffer memory lapses and may not be aware that they had unsafe sexual encounters. The results of these encounters may be pregnancies that the women may be unaware of (NOFAS 1). Consequently, these women continue consuming excessive amounts of alcohol that end up being absorbed by the developing fetus. Further maternal consumption may increase the risk of FAS by the fetus.
Insufficient training of professionals
Health professionals do not have enough knowledge on the impact of FAS and therefore are not active participants in monitoring the progression of fetal development during prenatal checkups. As a result, children with FAS are born even when the syndrome could have been avoided by training health professionals. Inadequate training means that the health professionals will not know that FAS is preventable by having pregnant women abstaining from alcohol consumption. Zoorob, Aliyu and Hayes agree that most pediatricians in the United States do not know about FAS and its symptoms. Because the pediatricians do not have this knowledge, they do not actively prevent FAS through alcohol abstinence programs. They recommend that FAS be incorporated in medical programs at graduate and pre-doctoral level. This way, residency directors are informed of the importance of knowing about FAS and will properly allocate resources to its teaching. The knowledge learned will assist health workers in promoting alcohol abstinence to pregnant women (379-385).
Additionally, lack of knowledge and training may lead to misdiagnosis of FAS by health professionals. The health providers may not have comprehensive history of its pregnant patients. This history is useful in determining the risks of the pregnancies resulting in births with FAS. It is therefore recommended that health professionals undertake full prenatal history to ensure that pregnant women do not take alcohol (Manning and Hoyme, 230-238).
Ineffective screening programs
Screening of prenatal patients is useful in determining the risk of FAS in live births. However, prenatal clinics do not have screening programs or are ineffective in monitoring implementation of the programs. Also, these programs are not carried out as routine checks in prenatal visits. This lack of commitment makes health workers ignorant of the prevalence of FAS in the community. As a result, pregnant women who abuse alcohol are not advised on the benefits of alcohol abstinence and they expose their unborn to developing FAS. Studies by Zoorob, Aliyu and Hayes show that health professionals do not screen patients for alcohol abuse. This is partly due to ignorance about FAS and also lack of commitment by the health workers. It can then be deduced that proper training and increased commitment by health workers will reduce risks of RAS in children. They further argue that health providers should discuss the impact of alcohol on pregnancy and screen for alcohol in pregnancy (379-385). Go to part 5 here.