Rose Alcohol and Pregnancy 1

Alcohol and Pregnancy

Lee Pinac
Midwestern State University
College of Robert D. and Carol Gunn College of Health & Human Services

In partial fulfillment of the requirements for

NURS 3373 Foundations of Comprehensive Pathophysiology
Professor Tanya Rose, MSN, RN
June 19, 2021
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Alcohol and Pregnancy

Alcohol can harm your baby quite dramatically. Alcohol is able to pass through the
placenta barrier very easily during pregnancy. Ingesting alcohol during pregnancy can cause
damage to the fetus. (VanMeter, 2018). The heart and brain are particularly susceptible to
damage form alcohol consumption during pregnancy. If the mother is binge-drinking, her liver
metabolism is severely diminished so the baby is subjected to high doses of alcohol. (Sharma,
2017). Fetal alcohol syndrome (FAS) is the syndrome named for this phenomenon.
FAS Effects
Ingesting alcohol during pregnancy has the ability to impair both intellectual and
neurologic development of the child. It also causes very specific physical characteristics and
growth retardation. (VanMeter, 2018). The term Fetal Alcohol Syndrome is the term used to
describe the damage done to the baby during gestation. According to Spohr, “Fetal alcohol
spectrum disorders (FASD) describe the behavioral, physical, mental and learning complications
due to prenatal alcohol exposure. Complications can last a lifetime.” (Spohr, 2018). It can cause
smaller head size, deformity and/or abnormality in the size and shape of the child’s head and
face, mental retardation, lack of growth, and psychiatric, cognitive and social abnormalities.
Clinical facial features of FAS include small head circumference, smaller eye width,
short nose, small mid-face, low nasal bridge, skin folds in the corner of the eyes, thin upper lip
and lack of vertical groove between base of nose and upper lip. (Sharma, 2017). FAS is not just a
condition seen in infants and children that is out grown later in adolescence or early adulthood.
Clinical impairments increase with age into adolescence and adulthood. (Spohr, 2018).
A teratogen is defined as an “agent that causes developmental malformations” (Merriam-
Webster, 2021). A teratogen can cause permanent damage to a fetus or embryo and has the
ability to upset the normal and healthy intrauterine development. (Spohr, 2018). The teratogen is
able to pass form the mother into the child via the placenta. The placenta barrier keeps the
circulatory system of the child and mother separate. Diffusion allows vitamins and water to
easily pass but it also allows alcohol, medications, nicotine and illegal drugs to pass also. (Spohr,
2018). Teratogen growth deficiencies are often present for the life of the individual. FAS
children do not catch up because it is not the result of decreased growth hormone. It is the result
of the “lack of peripheral responsiveness to growth hormones” (Spohr, 2018).
The QFT factor quantifies alcohol consumption by the mother during pregnancy. Q
stands for quantity of alcohol consumed during pregnancy, F stands for frequency of alcohol
consumption and T stands for timing when alcohol was consumed. (Spohr, 2018). Maternal risk
factors for FAS include, diet, genetics, ethnicity, as well as demographic, socioeconomic and
psychosocial factors. (Spohr, 2018). According to Sharma, “FAS occurs when a pregnant woman
consumes more than 4 standard drinks per day. Milder symptoms have been noticed with 2
drinks per day during the early phase of pregnancy.” (Sharma, 2017).
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Low levels of B-vitamins, iron and zinc, with combined with alcohol consumption in
pregnancy may contribute to severe damage. Folic acid deficiency is associated with
hyperactivity and low cognitive function. Alcohol consumption combined with folic acid
deficiency limit severely “protein precursors for DNA synthesis and repair” (Sharma, 2017)
especially in the developing fetal brain. Prenatal alcohol exposure correlates with cardiovascular
disease, neurological and behavioral deficits, poor nutritional status and inferior endocrine
function. (Lunde, 2016).
During the first trimester, alcohol inhibits the structure and movement of brain cells in
the developing brain. During the third trimester, the hippocampus is damaged. The hippocampus
is responsible for learning, memory and emotion. (Sharma, 2017). Neurologic abnormalities are
classified as either soft or hard. Soft signs include clumsiness, poor gait, auditory impairments,
inadequate fine motor skills, and impaired eye-hand coordination. (Sharma, 2017). Hard signs
include “epilepsy and other seizure disorders” (Sharma, 2017).
It is common for there to be no clinical facial features of FAS but for the individual to
suffer from neurobehavioral disorders such as “mental deficiency, delayed learning, reduced
intelligence, reduced memory retention and aggressive behavior.” (Sharma, 2017). Some of the
mental health issues that FAS victims may suffer from include depression, anxiety, bipolar
disorders, ADHD, impulsive hyperactivity and substance abuse. They will often need help
managing their cognitive issues, mental health disorders, and social deficits. FAS victims are
highly susceptible to depression, epilepsy, ADHD, substance abuse, PTSD, and sudden infant
death syndrome. They are highly vulnerable to drug abuse especially during adolescence.
Neurologically, FAS victims are very susceptible to seizures, learning impairment, hyperactivity,
mental deficiency and microcephaly. (Sharma, 2017).
The ingestion of alcohol during pregnancy affects multiple areas of the brain including
the cerebellum, corpus collosum, thalamus, basal ganglia, pre-frontal cortex and hippocampus.
The cerebellum is responsible for learning and motor skills, the corpus collosum connects the left
and right sides of the brain and allows the two side to communicate, the thalamus is involved in
memory, motor skills, and consciousness, the basal ganglia is responsible for emotional
processing and motor skills, the pre-frontal cortex controls planning and inhibition and the
hippocampus is involved in emotional processing, memory, and learning. (Spohr, 2018).
Sucking and swallowing problems occur in infancy which adds stress to parents. Sleep
deprivation is also a common issue with FAS children. Infants can cry for hours, and are anxious
and irritable. (Spohr, 2018). Sleep disturbances are strikingly elevated in FAS children when
compared to typical children (55% to 20%). (Dylag, et al., 2021).
FAS children tend to be more susceptible to infections especially upper respiratory and
middle ear, possibly due to midface deformities. They also tend to suffer from congenital heart
defects which often resolve with age. (Spohr, 2018).
Depending upon the genetic predisposition, quantity of alcohol consumed, frequency of
consumption, and timing of consumption in gestational cycle, each individual will present with
Rose Alcohol and Pregnancy 4

different cognitive impairments. Extensive neuropsychological exams should be performed to

ascertain cognitive strengths and weaknesses. (Spohr, 2018).
Cognitive deficits reinforce one another, impaired attention challenges language skills,
which exacerbates social skills. There is a ‘sum is greater than the parts affect’ of the child’s
cognitive ability. Executive function is impaired. Executive function allows us to plan actions,
set goals, manage impulses and concentrate on the activity at hand. (Spohr, 2018).
On average, FAS children have an IQ of 70%, which is considered below average.
Intelligence levels remain over time and have a negative effect on the psychiatric condition,
educational level, and quality of life. FAS children are challenged with integrating new
information and processing it. They are not able to switch back and forth between tasks easily.
(Spohr, 2018).
FAS children show verbal communication problems and speech hardships. Language and
speech are often delayed. They tend to respond with one or two words. They jabber to
themselves and do not participate in conversation. They do not wait for the other person to
respond. There is no give and take in their conversations. These language impairments lead to
scholastic, behavioral and social challenges. They are not able to process emotions easily or
adequately solve social issues so socialization with peers is uncomfortable and their behavior
often fluctuates. They do not understand others needs or reactions correctly. They tend to be
dominant with no personal limits and little impulse control. They are often socially isolated due
to these behavioral issues. (Spohr, 2018).
Both fine and gross motor skills are affected by prenatal alcohol exposure, but especially
fine motor skills. They are often clumsy and unable to play normal sports, ride a bicycle or
scooter, and have difficulty writing and painting. (Spohr, 2018).
By adolescence, FAS children tend to suffer from depression and ADHD, lack
independence, suffer for education difficulties, criminal conduct, inappropriate sexual behavior,
employment challenges, and weight gain. The physical characteristics of FAS are often still
present but often less perceptible. (Spohr, 2018).
As FAS children age their desire for independence grows but they are unfit to manage the
demands of daily life. This adds more conflict with their parents. Lack of acceptance by peers,
struggles with parents and learning problems at school combine to create a child that is anxious,
depressed, is delinquent in school with hostile behavior. (Spohr, 2018).
We know that alcohol ingestion during pregnancy has a very destructive effect on the
behavioral, physical and neurological development of the child. (Sharma, 2017).
In February 2005, the U.S. Surgeon General issued an Advisory on Alcohol Use in
Pregnancy to raise public awareness about this important health concern. Per the Surgeon
General, “Based on the current, best science available we now know the following: Alcohol
consumed during pregnancy increases the risk of alcohol related birth defects, including growth
deficiencies, facial abnormalities, central nervous system impairment, behavioral disorders, and
impaired intellectual development. No amount of alcohol consumption can be considered safe
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during pregnancy. Alcohol can damage a fetus at any stage of pregnancy. Damage can occur in
the earliest weeks of pregnancy, even before a woman knows that she is pregnant. The cognitive
deficits and behavioral problems resulting from prenatal alcohol exposure are lifelong. Alcohol-
related birth defects are completely preventable. For these reasons: 1. A pregnant woman should
not drink alcohol during pregnancy. 2. A pregnant woman who has already consumed alcohol
during her pregnancy should stop in order to minimize further risk. 3. A woman who is
considering becoming pregnant should abstain from alcohol.” (CDC advisory, 2005).
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References

https://www.cdc.gov/ncbddd/fasd/documents/sg-advisory-508.pdf (2005).

Dylag, K. A., Bando, B., Baran, Z., Dumnicka, P., Kowalska, K., Kulaga, P., Przybyszewska, K., Radlinski, J.,
Roozen, S., & Curfs, L. (2021). Sleep problems among children with Fetal Alcohol Spectrum Disorders
(FASD)- an explorative study. Italian Journal of Pediatrics, 47(1), 1–11.

Merriam-Webster. (n.d.). Teratogenic. In Merriam-Webster.com dictionary. Retrieved June 15, 2021,

from https://www.merriam-webster.com/dictionary/teratogenic

Lunde ER, Washburn SE, Golding MC, Bake S, Miranda RC, Ramadoss J. Alcohol-Induced Developmental
Origins of Adult-Onset Diseases. Alcohol Clin Exp Res.2016Jul;40(7):1403-1414.

Sharma, S. (2017). Fetal Alcohol Spectrum Disorders: Concepts, Mechanisms, and Cure. Nova Science
Publishers, Inc.

Spohr, Hans-Ludwig. (2018). Fetal Alcohol Syndrome: A Lifelong Challenge. De Gruyter.

VanMeter, K. C. (2018). Gould's Pathophysiology for the Health Professions. St. Louis: Elsevier.