The American Association of Pediatrics recently issued updated guidelines for the diagnosis of fetal alcohol spectrum disorders (FASD). The list of physical features recommended to be used when diagnosing dysmorphology include height, weight, head circumference, small palpebral fissure, oddly morphed philtrum and a thin vermilion border of the upper lip. The recommendations will help clinicians to better identify and categorize their patients’ condition along the spectrum of the disorder.
The guidelines provide a clear cut description for what kind of alcoholic behavior observed by the mother should be used to verify that the child is prenatally exposed. The criterion for establishing prenatal exposure to alcohol is: if the mother drinks six or more drinks per week for at least two weeks during the pregnancy or three or more drinks on a single occasion for at least two occasions. The recommendations have specified that the diagnosis of neurodegeneration caused by the syndrome should include the following: global intellectual ability, cognition, behavior and self-regulation and lastly, adaptive skills.
A massive team of professionals was assembled in the collaboration between the Institute on Alcohol Abuse and Alcoholism (NIAAA), Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD) and Collaboration on FASD Prevalence (CoFASP) to come up with the latest guidelines. These scientists used data from over 10,000 children with Fetal Alcohol Spectrum Disorder, intricately collected and reviewed over a span of one year.
Fetal alcohol spectrum disorder is the leading cause of developmental disabilities which can be prevented. 1-5% of American kids are ridden with this malady, depending on the region. Director of the NIAAA George F Coob hailed the current effort: “They represent the most data-driven diagnostic criteria for fetal alcohol syndrome and fetal alcohol spectrum disorder produced to date.”
Because the ailment lies on a spectrum, there is no clear minimum alcohol amount one can consume while pregnant. Hence the American Academy of Pediatrics officially warns that no amount of alcohol during pregnancy can be considered safe.
The first iteration of guidelines for the diagnosis of this syndrome came out in 2005. However, they were not clear enough to help physicians accurately assign their patients a place along the spectrum of the disorder. There are four major categories of the disease: fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental and alcohol-related birth defects. The condition only spares the last group from neurodegeneration.
Currently there is no cure for the disorder. However, early detection of the syndrome helps physicians and family members to properly deal with the syndrome through the developmental years of a child, the time period it does most harm. CDC reports that 1 in 10 women report drinking while pregnant in the US.
Unexpectedly, a research in Taylor and Francis has shown that exposure of male mouse to alcohol before conception also poses the risk of FASD for the offspring. Therefore, fathers who indulge in drinking need to be wary when trying to conceive. The researchers suggest that alcohol upsets genes inside the sperm, which in turn causes abnormal development of the fetus.
The therapy provided to patients once they have been diagnosed with FASD is focused around the following:
Family Support: Parents are guided to be extra careful and provide a more stable environment which is caring and free of violence.
Diet: A pregnant mother or her newborn will often be recommended a special diet with supplements.
Psychological: As behavior is typically the cause of suffering for the family and the patient, this type of intervention is also included as therapy. It can include special classes and exercises in social skills.
The current guidelines by the NIAAA, which is a part of the National Institute of Health, have yet to get incorporated into the clinical practice. These recommendations will now be processed by the US Preventive Services Task Force (USPSTF). However, because of the large number of case studies and the diverse background of the authors (dysmorphology, epidemiology, neurology, psychology, and developmental/behavioral pediatrics), the credibility of the research is high.
In the meanwhile, researchers are anticipating how these new diagnostic techniques will alter the number of registered prevalent cases. They optimistically concluded the paper with saying: “The improved specificity of these guidelines will aid clinicians in assignment of more accurate diagnoses of alcohol-exposed infants and children, thereby leading to more widespread early intervention and improved prevention efforts”. In the long run, how these guidelines will play out in the treatment of victims of FASD is yet to be seen.