Running Head: FETAL ALCOHOL SPECTRUM DISORDER Pregnancy, Birth and the Newborn: Focus on Fetal Alcohol Spectrum Disorder SWHB 405: Human Behavior in the Social Environment 1 ABSTRACT From conception to birth, the mother’s role in bringing to life and nurturing a healthy baby is paramount. Factors such as the mother’s biological, psychological and social environment play important roles in determining the wellbeing of a child. Fetal Alcohol Spectrum Disorder, an irreversible condition in children caused by maternal alcohol consumption during pregnancy will be discussed.
Its biological, psychological and societal implications will be deliberated and recommendations of interventions by Social Workers in alleviating the problem will be suggested. Key words: Fetal Alcohol Syndrome, Fetal Alcohol Spectrum Disorder, Child Development Introduction All human life begins with a fertilized egg known as a zygote. By the eighth week, the zygote is transformed into a fetus which has most of its organs formed. After about 9 months (or 38 weeks) of going through transformation within the mother’s womb, the mother delivers a bouncing baby boy or girl into the world.
During this time it is imperative that special care and attention is given to the mother and the child that she is carrying. Prenatal care ensures that the mother receives the much needed medical attention, nutritional advice and a positive life style tips. Particular attention is given unusual physiological and medical manifestations which could signal an array of life threatening situations for the mother and unborn child. The culmination of a successful pregnancy is the birth of a baby. Newborns weigh an average between 5. 5 and 9. pounds and they are awake and alert in first hours of life. Newborns begin learning their environment immediately and one of the things they internalize is developing a connection with the mother’s voice. The six states that a baby maintains are: quiet alert, active alert, crying state, drowsiness, quiet sleep, and active sleep (Ashford & Lecroy, 2012). Babies oscillate from an awakening curious baby, peak at crying when uncomfortable, and dip through to active sleep. These changes may occur slowly or rapidly throughout the course of any given day.
Consequently, knowledge about this this critical life stage, helps parents to be better equipped to cope with and nurture the newborn. Risk factors during pregnancy and at birth Various physiological changes in a pregnant mother may cause or indicate a risk for both mother and child. A case in point is bleeding in the first trimester or late in the pregnancy which could mean possible loss of the child or neurological issues. In some instances, natural toxins could build in the mother’s bodies leading to high blood pressure and weight gain which may be fatal to the mother (Ashford & Lecroy, 2012).
Further, an increased weight of the mother could bring on diabetes in the child, while low weight of the child could be a precursor to mental retardation. Biological factors that may affect the fetus’ development during pregnancy include the mother’s age, the number of children prior and how far apart she has had each child (Boyce, 2010). Environmental factors, such as living conditions, diet deficiencies, and the emotional well-being of the mother can all affect the baby during its 38 week development.
Pregnant women should be mindful of substances ingested during pregnancy as these are subsequently ingested by the fetus and affect its development. This is exemplified by studies demonstrating that women who drink caffeine tend to have a lower birth rate than women who avoid caffeine (Ashford & Lecroy, 2012). Other substances that could affect fetal development by causing birth deformities, premature births and possible hyperactivity include tobacco, over the counter medications, hormones and alcohol.
Prenatal care there has been shown to dramatically improve the chances of having a healthy baby. Nevertheless, there is a possibility of certain complications during birth can have lasting repercussions on a child’s life. An example is anoxia, a deficiency of oxygen during birth that could lead to the newborn developing cerebral palsy. Alcohol’s relevance in pregnancy, birth and the newborn Alcohol is a teratogen; an agent or factor that induces or increases the incidence of abnormal prenatal development (Shiel, 2010).
Consumption of alcohol during pregnancy is manifested in a continuum of disabilities known as fetal alcohol spectrum disorders (FASD) (Warren & Murray, in press). The most severe form of this spectrum referred to as fetal alcohol syndrome (FAS). An alarming statistic from the Center for Disease Control and Prevention (CDC) studies shows that 0. 2 to 2 cases per 1000 babies are born with Fetal Alcohol Syndrome (FAS). Since FASD presents a broad spectrum of symptoms some of which are “less severe”, it remains challenging to diagnose (Fleisher, 2010). As a result, FASD among children is either misdiagnosed or remains undetected.
On the other hand, it is relatively easier to identify the key diagnostic features of FAS are they are better established. FASD is prevalent worldwide because alcohol is so widely accepted and used in so many cultures. The teratogenic effects of alcohol were not established until the second half of the 20th century when pediatrician, Paul Lemoine, in France in 1967 and two American pediatric dysmorphologists, Kenneth Lyons Jones and David Smith in 1973, independently documented the pattern of deficits resulting from heavy prenatal alcohol exposure (Warren & Murray, in press).
Alcohol was attributed because the children in both settings had common patterns of deficits and it was observed that all of the birth mothers had been diagnosed with alcohol use disorders Biological manifestations The teratogenic effects of alcohol adversely affect the physical development of the fetus and the child. Newborns and children with FAS generally exhibit stunted growth (CDC. Gov, 1983). A distinguishing feature of children with severe FASD and FAS is facial and limb dysmorphology.
These children are generally shorter in stature and weigh less than their peers (Warren & Murray, in press). The cardinal or discriminating features include short palpebral fissures (eye opening), an elongated and hypoplastic philtrum (groove between nose and upper lip), and a thin upper vermillion lip border or hypoplastic “cupid’s bow”. Other features include a low nasal bridge, epicanthal folds (skin folds covering inner corner of the eye), minor ear anomalies, and micrognathia (abnormal smallness of the jaws). Psychological consequences
Facial and limb dysmorphology in children affected by FASD and FAS may cause the child is usually aware that something is “different” about him or her and thus affect their psychological wellbeing. Additionally, children with FASD have cognitive challenges leading to a myriad of problems such as the following: memory loss, impaired motor skills, neurosensory hearing loss, impaired visual and spatial skills, intellectual impairment, attention deficit disorder, hyperactivity, problems with reasoning and judgment and an inability to appreciate consequences of actions (Wacha & Obrzut, 2007).
Treatment and schooling can be very difficult for a child facing these challenges since their greatest challenge is learning and retaining information. Subsequently, the child may experience depression which can result in self-destructive behavior such as substance abuse, inappropriate sexual behavior, and suicide Societal implications Families are affected immensely when a child is born with FASD/FAS since he/she may exhibit anti-social behavior including an exaggerated startle response, poor wake and sleep patterns, impulsiveness, temper tantrums, lying and stealing (Fleisher, 2010).
Moreover, schools, local health care systems, childcare and social services, and the justice system are usually ill-equipped to address the problems presented by FASD. As a result; a person with FASD may experience mental health problems, disrupted schooling, and involvement with crime, substance abuse, and dependent living and employment difficulties throughout their lifetime. As previously stated, the broad spectrum of manifestations of FASD makes it difficult to diagnose.
Consequently, individuals suffering from FASD may not be properly diagnosed and are likely to be labeled social misfits and may spend a troubled life on the margins of society thus creating a monumental emotional burden on society (Wacha & Obrzut, 2007). Interventions to aid those affected by FASD These physical, mental, social, learning and behavioral limitations experienced by individuals with FASD have possible lifelong implications. Fortunately, there is help for both the individuals and their families provided by Social Service agencies in form of resources and assistance needed to have a good quality of life.
Under the Individuals with Disabilities Education Act (IDEA) (1975), school aged children with disabilities (including those diagnosed with FAS) are provided with reasonable accommodations including untimed tests, sitting in front of the class, modified homework and the provision of necessary services and often the implementation of an Individualized Education Plan (IEP). An IEP details services that will be provided to assist the child in learning and may include services like Occupational Therapy, Physical Therapy, Speech and Language Therapy, and/or the provision of a classroom aide.
These individuals often have social workers or case managers working with them to ensure that the services documented in the IEP’s are being provided and working effectively. Implications of FASD on Social Work FASD provides opportunities for Social Workers to play an important role in impacting positive change. Social Workers could take the lead in screening for alcohol use among women of child-bearing age and educate them about the FASD (Boyce, 2010).
Women who choose to continue drinking should be encouraged to use contraceptives to reduce the likelihood of giving birth to a child with FASD. Social Workers should also be actively involved in nutrition education to ensure that pregnant mothers are following balanced diet for optimum fetal development. Nutrition education should especially target participants of the Supplemental Nutritional Assistance Program (SNAP) and Women, Infants and Children (WIC) as these populations’ income may limit their food choices.
FASD often have significant lifelong deficits in functional life skills that can lead to problems with day to day functioning. In adulthood, these deficits can be manifested in mental health difficulties, disrupted job experiences, trouble with the law, substance abuse and difficulties with independent living. Hence Social Workers play the important role of advocating for individuals affected by FASD, helping them to navigate their immediate environment and linking them with support services (Warren & Murray, in press).
Prevention of FASD is of great importance and this implies that Social Workers have the responsibility of mobilizing campaigns against drinking during pregnancy. This can be done through community education, incorporating medical personnel in research and preventive practice as well as holding alcohol producers accountable for posting health warning labels on publicity items. Conclusion Maternal alcohol use is a worldwide phenomenon that indiscriminately affects families and children of all ethnicities in all societies.
Fortunately, it is possible to classify and tackle the treatment problems raised by individuals with FASD. The hope is that with continued research, education, and support from Social Service agencies, this problem can be prevented. While resources are available to help individuals and their families, it is important to know that the best treatment of FASD is prevention. It is not yet known the specific timing, frequency and quantity of alcohol use throughout the gestational period that are responsible FASD and FAS.
Drinking early in the gestational period, before the woman even knows she is pregnant may present special risks for the developing embryo. Thus strategies to prevent alcohol use in pregnancy need to take into consideration that the prevalence of drinking by women of child-bearing age is on the rise in many parts of the world and most pregnancies are not planned. Bibliography CDC. Gov. (1983, January 13). Retrieved from Perspectives in Disease Prevention and Health Promotion Fetal Alcohol Syndrome: Public Awareness Week: http://www. dc. gov/mmwr/preview/mmwrhtml/00000257. htm Ashford, J. B. , & Lecroy, C. W. (2012). Human Behavior in the Social Environment: A Multidimensional Approach. Belmont, CA: Cole Cengage. Boyce, M. (2010, June). A Better Future for Baby: Stemming the tide of Fetal Alcohol Syndrome. Journal of Family Practice, 59(6). Fleisher, S. (2010, May). Foetal Alcohol Syndrome: Raising Awareness about Alcohol in Pregnancy. British Journal of Midwifery, 18(5). Shiel, W. C. (2010, December 21). Fetal Alcohol Syndrome.
Retrieved from Medicinenet. com: http://www. medicinenet. com/fetal_alcohol_syndrome/article. htm Wacha, V. , & Obrzut, J. (2007, June). Effects of Fetal Alcohol Syndrome on Neuropsychological Function. Journal of Development and Physical Disabilities, 19(3). Warren, K. , & Murray, M. (in press). Alcohol and Pregnancy: Fetal Alcohol Spectrum Disorders and the Fetal Alcohol Syndrome. Alcohol: Science, Policy and Public Health. ——————————————– [ 1 ].
The purpose of prenatal care is to monitor the development, health and nutritional status of both the mother and the baby during the pregnancy to ensure an uncomplicated pregnancy and the delivery of a live and healthy infant. [ 2 ]. Some pregnant women may develop gestational diabetes (or gestational diabetes mellitus, GDM), a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially during third trimester). [ 3 ]. Cerebral palsy is a term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development.