Distinct facial features not seen in many cases, NIH study finds
Most children exposed to high levels of alcohol in the womb do not develop the distinct facial features seen in fetal alcohol syndrome, but instead show signs of abnormal intellectual or behavioral development, according to a study by researchers at the National Institutes of Health and researchers in Chile.
These abnormalities of the nervous system involved language delays, hyperactivity, attention deficits or intellectual delays. The researchers used the term s functional neurologic impairment to describe these abnormalities.. The study authors documented an abnormality in one of these areas in about 44 percent of children whose mothers drank four or more drinks per day during pregnancy. In contrast, abnormal facial features were present in about 17 percent of alcohol exposed children.
Fetal alcohol syndrome refers to a pattern of birth defects found in children of mothers who consumed alcohol during pregnancy. These involve a characteristic pattern of facial abnormalities, growth retardation, and brain damage. Neurological and physical differences seen in children exposed to alcohol prenatally— but who do not have the full pattern of birth defects seen in fetal alcohol syndrome—are classified as fetal alcohol spectrum disorders.
“Our concern is that in the absence of the distinctive facial features, health care providers evaluating children with any of these functional neurological impairments might miss their history of fetal alcohol exposure,” said Devon Kuehn, M.D., of the Epidemiology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute involved in the study. “As a result, children might not be referred for appropriate treatment and services.”
The Centers for Disease Control and Prevention provides information on the treatments for FASD.
Dr. Kuehn conducted the study with NICHD colleagues Tonia C. Carter, Ph.D., Mary R. Conley and Jim Mills, M.D, as well as researchers at the National Heart, Lung and Blood Institute, the National Capital Consortium, in Bethesda, Md., and the University of Chile in Santiago.
Their findings appear online in Alcoholism: Clinical and Experimental Research.
The research was conducted as part of a long-term study of heavy drinking in pregnancy known as the NICHD–University of Chile Alcohol in Pregnancy Study. To conduct the study, the researchers asked over 9000 women at a community health clinic in Santiago, Chile about their alcohol use during pregnancy. They found 101 pregnant women, who had four or more drinks per day during their pregnancies and matched them with 101 women having similar characteristics but who consumed no alcohol when they were pregnant. After these women gave birth, the researchers evaluated the infants’ health and conducted regular assessments of their physical, intellectual and emotional development through age 8.
The researchers documented differences in the rate of children affected in the following areas:
| Alcohol exposed | Unexposed | |
|---|---|---|
| Abnormal facial features | 17 percent | 1 percent |
| Delayed growth | 27 percent | 13 percent |
| Cognitive delays (including intellectual) | 35 percent | 6 percent |
| Language delays | 42 percent | 24 percent |
| Hyperactivity | 27 percent | 2 percent |
Some of the women with heavy drinking habits also engaged in binge drinking (5 or more drinks at a time). Even though these women already had high levels of alcohol consumption, the researchers found that this habit increased the likelihood of poor outcomes for their children.
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About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at http://www.nichd.nih.gov/.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.
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