Alcohol and the foetus

One of the difficulties in determining the impact of alcohol on the foetus is the extent to which any effects can be directly attributed to alcohol alone, and to what extent other environmental or genetic factors combine to create harm. Plant (2003) reiterates the importance of being clear about the difference between ‘cause’ and ‘association’. “A substance taken by the pregnant woman can be completely harmless to the foetus or it can be associated with foetal harm or it can be the cause of the harm to the foetus”.

Current thinking suggests there is a spectrum of problems that are associated with foetal harm, particularly chronic use of high doses of alcohol. This spectrum of problems is known as Foetal Alcohol Spectrum Disorder (FASD). Other terms that are also used include Foetal Alcohol Syndrome (FAS) and Foetal Alcohol Effects (FAE), however these appear to have been superseded by FASD in recent years. The first trimester of pregnancy is thought to be the most risky as the foetus is in its early stages of growth. The prevalence of FASD is not known. However, anecdotal evidence suggests that social workers hearing about FASD for the first time have identified children with whom they are working who may well fit the signs and symptoms described below. Of course these signs and symptoms need to be set alongside knowledge of, or concerns about, maternal alcohol consumption.

Signs and symptoms include:

• Pre and post-natal growth deficiencies, eg. shorter body length, small head, failure to thrive
• Physical anomalies, eg. small upturned nose, heart and kidney problems, smooth philtrum, small eye openings, thin upper lip, genital defects
• CNS dysfunction, eg. difficulties with feeding, severe learning difficulties, heightened sensitivity to touch, low attention span, slow reaction times, delays in reaching normal developmental milestones

Social workers assessing the development of the child and its parental attachment may note that some of the signs and symptoms of FASD, eg. ‘failure to thrive’, may potentially be related to the child’s physical anomalies as a result of FASD and may not necessarily be to do with inadequate parenting at this stage. Similarly, the reported ‘heightened sensitivity to touch’ may be misinterpreted by a social worker who repeatedly sees the child in greater distress when held by a parent. Care needs to be taken not to jump to conclusions about lack of parental attention in cases where a full history and assessment of maternal drinking has not been completed.

Equally, it is important that no assumptions are made about the presenting problems being FASD without further investigation. It would be a mistake to assume FASD and respond accordingly when environmental factors and/or parenting issues could be associated with the behaviours and harm identified. The important issue for social workers is to know enough about alcohol use, maternal drinking and FASD to be able to consider it as a possibility in their assessment and support of a pregnant woman. Further, they need to know enough to feel confident about seeking specialist advice while at the same time monitoring the child’s development, parenting capacity and environmental factors.

References
Plant, M. (2003) ‘Drinking in pregnancy.’ Available online at www.fas-info.uwe.ac.uk/info/drinking.htm Accessed 7th July 2005


Introduction | Alcohol drugs and the menstrual cycle | Drugs and the foetus
Male fertility and reproductive disorders | After the birth: child and parents' needs
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