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Many expectant women across the world are not informed of the complications and risks involved with pregnancy. Most of them perceive pregnancy as only a means of giving life but do not consider maintaining a healthy lifestyle during this crucial period. They do not practice precautionary habits in terms of diet and body exercises. Women should refrain from abuse of drugs in the course of pregnancy and during the breast-feeding period. This is because drug abuse may inhibit or destruct the life carried in the womb and the mother herself. It is indeed a form of child abuse. However, many women are not aware of their pregnancy during the first few weeks (first trimester) and those who abuse drugs such as alcohol put the fetus at risk. This paper focuses on Fetal Alcohol Syndrome (FAS), a non-hereditary disorder, affecting children brought forth by women who abused alcohol during pregnancy.

The problems associated with FAS vary differently among children, but the defects cannot be reversed. Since there is no curative treatment for FAS patients, lifetime therapy is the only way to control and limit the extremes of FAS. There is no amount of alcohol that can be quantified as safe, to consume during pregnancy. Greater risks are, however, believed to be in the first 3 months of pregnancy. Every bottle consumed by an expectant woman puts the fetus at risk of developing Fetal Alcohol Spectrum Disorders (FASDs) such as FAS. This syndrome is fully preventable by strictly avoiding alcohol when pregnant (Hart, 2011).

A newborn suffering from FAS will portray growth, physical, behavioral, mental and learning defects. The baby exhibits stunted growth while in the womb and following birth hence low birth weight. There is evidence of decreased muscle structure and poor coordination. These children experience a delay in the development of important aspects of human beings: thinking, movement, speech and social skills. Some children have vision intricacies and hearing problems. They also suffer cardiac complications such as Ventricular septal defect (VSD) or Atrial septal defect (ASD) (Ricci, 2009).

More evident are their facial defects such as small head circumference, smooth groove in the upper lip, small upper jaw, narrow, small eyes which have large epicanthic folds, and smooth and thin upper lip. They also have a flat face, pointed, small chin, reduced nose, and undeveloped outer ear (pinna). Their limbs, fingers and joints are deformed. Children suffering from FAS have anomalous behavioral characteristics such as hypersensitivity, impulsiveness, anxiety, extreme nervousness and a short-lived memory extent. They portray altered sleeping patterns; have feeding problems, communication problems, and mood swings. They have a hard time interacting and making friends with other children and lack curiosity and imagination. They lack the ability to concentrate effectively; they show social withdrawal, and stubbornness. In some few cases, newborns are born with major birth complications such as a heart murmur (a hole between the left ventricle and right ventricle), and hydrocephalus (augmented fluid pressure on the brain). However, some healthy children may have some of these impairments hence only a medical expert can distinguish by diagnosing (Hart, 2011).

When an expectant woman consumes an alcoholic drink such as beer, wine or liquor, alcohol and its associated chemicals traverse the placenta into the fetus. The toxic property of alcohol and its associated chemical factors harm the brain and the entire developmental system of the fetus. The fetus metabolizes alcohol at an immature and slower rate than the mother thus leading to concentrated accumulations of alcohol in the fetus bloodstream for long periods. Alcohol is a human teratogen because it causes fetal anomalies. It limits delivery of oxygen molecules to the fetus, hence interfering with crucial physiological and developmental processes, and harms the brain. When the developmental procedures are interfered with, the fetus suffers impairments such as facial defects, organ impairments such as heart or bones and an impaired Central Nervous System (CNS).  Impairment of the CNS could lead to complicated and severe conditions such as epilepsy and seizure disorders. Other CNS disorders include neural tube defects Spina bifida, which is exhibited by immature development of the spinal cord, brain, and/or meninges-which are the protective layer around the brain and spinal cord (Armstrong, 2003).

Diagnostic measures and systems for Fetal Alcohol Spectrum Disorders (FASD) have been established by medical institutions in the United States of America, such as the Institute of Medicine (IOM). The guideline for FAS by this institution was the first system to offer standardized diagnoses of people with prenatal alcohol exposure. The 4-Digit Diagnostic Code brought forth by the University of Washington uses a Likert scale of one to four to rank the key characteristics of FASD. This scale gives out two hundred and fifty six descriptive codes that can be grouped into twenty two distinct clinical classes, varying from FAS to no findings. The Center for Disease Control (CDC) also came up with guidelines for FAS referral and diagnosis, but it did not address other conditions related to FASD. It only concentrated in rolling out the general accord on the diagnosis of FAS in the United States. However, Canadian guidelines on the diagnosis of FAS harmonized the discrepancies between the Institute and the University of Washington diagnostic systems. Canadian guidelines also instituted a road-map for diagnosing and analyzing FASD in Canada (Golden, 2005).

A qualified physician will check the four key characteristics when diagnosing FAS. Growth deficiency will be indicated by the prenatal and postnatal weight or height or both. When it is at or lower than the 10th percentile, the diagnosis is positive. It is, however, mild if it ranges between the third and tenth percentile. It is considered moderate if it is at the third percentile or below but never both. When it is at the third percentiles, it is considered severe. In a negative diagnosis, both height and weight are greater than the tenth percentile. If three main FAS facial features are present, then the diagnosis is considered positive. These three are smooth groove in the upper lip, small eyes, which have large epicanthal folds, and a flat face with reduced nose. In a severe case of FAS, all the three facial traits are graded independently as severe. In a moderate case of FAS, two facial traits are graded independently as severe and one facial trait is graded moderate. In a mild case of FAS, there can be several possible combinations. First, there can be two facial traits graded as severe, and one graded within normal bounds. Secondly, one facial trait graded as severe and two traits graded as moderate. Thirdly, one facial trait can be graded as severe, another as moderate and the third one graded as within normal bounds. In a case where FAS is negative, all the three facial characteristics are graded within normal limit (Hart, 2011).

The 4-Digit Diagnostic Code is used to diagnose damage in the CNS and classifies them into four ranks. When the damage is graded as definite, it means there are neurological and structural impairments caused by FAS. When the damage is graded as probable, it shows that there is significant dysfunction of either two or three standard deviations or more working domains. If the damage is graded as possible, it denotes that there is mild to moderate dysfunctional property of two standard deviations or in one or two working domains. This can also be graded by the accord of a team of clinicians that the CNS damage diagnosed cannot be dismissed. Otherwise, if there is no CNS damage the rank is termed as unlikely. These four diagnostic systems can also diagnose the CNS based on functional properties. By using the IOM guidelines, indication of cognitive abnormalities incoherent with developmental levels in CNS domains such as the learning disability, impulse control and communication is ranked as partial fetal alcohol syndrome (PFAS). This can also be termed as diagnosis for alcohol-related neurodevelopmental disorder (ARND) (Armstrong, 2003).

At the early stages of pregnancy, diagnosis can be carried out through screening the fetus by ultrasound. Blood samples from the mother can also determine the level of intoxication.  Brain imaging of the child can be done using CT or MRI. The expectations after diagnosis (prognosis) for the newborns with FAS can be varying, but none of these children will have typical brain development. Complications caused by alcohol abuse by an expectant woman may also arise before birth, such as miscarriages or premature deliveries (Ricci, 2009).  

Since, there is no curative treatment for FAS, families and children affected undergo emotional and psychological difficulties. Therefore, it is necessary for the parents or guardians to seek professional help. Both the parent and the affected children need to go through therapy sessions. Parents are advised on how to live with their sick children, to practice tolerance and help them learn and improve on some basics elements of life. Parents are advised to come up with daily routines, which their children can follow up and get accustomed to with time. They should also craft and implement simple rules and limitations that the children can learn to follow. Parents should also encourage and reward their children to impose acceptable behavior (Golden, 2005).

Children with FAS are weak hence their parents should protect them from being bullied. A stable home with tranquility and an amicable atmosphere is necessary for bringing up such children. Parents should also be careful of whom they leave their children with, when they are not with them because their behavior is not easy to manage. Children with FAS need to go through therapy sessions where they are taught how to mingle and build lasting friendships. They are also taught self-control, behavioral consciousness and improvement of executive operational skills such as planning, memory and reasoning. There is also a parent-child bonding session during therapy which serves to improve the relationship between the children and their parents. The children learn some positive discipline elements, and this reduces their behavior problems (Hart, 2011).

In conclusion, expectant women should avoid consuming alcohol and practice a healthy lifestyle for the sake of their health and that of the baby. These women should pay much attention to proper and valuable nutrition, resting and proper physical exercises. This would help save the high expenditure and time spent on therapeutic care for both children and parents.

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