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Essay: Does Population Teaching Decrease Fetal Alcohol Syndrome in Teenage Parents?

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  • Published: 1 April 2019*
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In years passed, teenage pregnancy was not as widespread as it is today. In the era of social media and reality television, the allure of teenage pregnancy is more enticing and its prevalence has most certainly increased across multiple socioeconomic platforms. Adolescents facing the prospects of parenthood may struggle with their identity as teenagers and their impending adult responsibilities. Peer pressure, poor coping mechanisms and a casual consumption of alcohol may lead the undereducated and misinformed teenage parent to inadvertently expose their developing child to the harmful and even lethal effects of chemical substances such as alcoholic beverages. This begs the question; does population teaching decrease the incidence of fetal alcohol syndrome in the teenage parent?

Fetal alcohol syndrome as a phenomenon dates back a few decades however establishing the condition as an actual syndrome with described symptomatology and standards of diagnosis was not an easy feat. In order to understand the historical context of fetal alcohol syndrome one must also understand the slow progression of neonatal and female medicine. In the United States, prohibition did not end until 1933 and it wasn't until the mid 1950s that serving alcohol to women became a social norm. As a result, the actual incidence of fetal alcohol syndrome was at record lows by virtue of the societal regulation of women drinking. As the stigma of post-depression era consumption of alcohol was slowly lifted, women found a new vice. However, lack of surgeon general information and minimal knowledge created the perfect backdrop for one of the most lethal gestational health concerns that still exists today.

The first connection between neonatal abnormalities and fetal alcohol syndrome was not recognized until 1973. An article by a group of pediatricians and physicians from the University of Washington was published in the British medical journal The Lancet, where developmental delays seen in infants born to alcoholic mothers were documented and defined in detail. These physicians noticed unique birth defects in children from mothers who consumed alcoholic beverages. In their observations they noticed a broad spectrum of deficiencies such as growth and facial defects. In 1974, this same group of physicians conducted a study on a small group of eight children. A variety of common symptoms were appreciated in this small but indicative sample. The outcome of this study was the eventual enactment of a labeling act that required distilleries to appropriately indicate the negative effects of consuming alcohol during pregnancy. The government required the label specifically state “women should not drink alcoholic beverages during pregnancy because of birth defects”. It also stated the Americans should be informed of the effect of consuming alcoholic beverages.

It should be understood that fetal alcohol syndrome is singularly the most severe form of a much broader category of symptoms known as fetal alcohol spectrum disorders. Disorders of this spectrum only occur if there is known and perhaps documented consumption of alcohol by the mother. The spectrum of disorders included under this umbrella term focus on children that present with partial developmental limitations or limitations that are neurological or physical abnormalities in nature. The only cause of fetal alcohol syndrome is alcohol consumption during pregnancy and the only patient population affected is fetuses and neonates, as they are known after birth. There are obvious negative implications to alcohol consumption to the mother, but within the spectrum of fetal alcohol syndrome, none of the symptoms singularly affect the mother. In order to understand fetal alcohol syndrome or FAS, as it will be referred to from this point forward, it is important to understand that although alcohol consumption at any point of pregnancy is universally contraindicated, there are standard volumes of alcohol that have been shown to increase the incidence of FAS. In the United States, four beers or one glass of wine a day is considered enough to cause irreversible damage to the developmental progression of the fetus.

At the physiological level, the significance of the consumed alcohol in terms of volume is important since it is considered to be the only modifiable and directly related cause of the changes that occur at the molecular level. During pregnancy, the placenta normally serves as a source of nutrients and a filter between the mother and the fetus. However, the placenta does not have the anatomical and physiological capability of filtering substances as a liver or kidney would. As a result, ethanol is capable of penetrating the placenta and permeating into the amniotic fluid as well as the blood supply of the fetus. As adults, our bodies are able to metabolize ethanol and break it down to a level where it is no longer toxic to us and the effects of being inebriated eventually disappear. In a fetus, the liver is not functional and there is no ability to metabolize alcohol because it lacks the proper enzymes. The neurological system is still in its initial developmental stages and the without the ability to quickly rid the blood of the radicals present in alcohol, the system as a whole is exposed to agents that not only hinder its development but also impede appropriate nerve cell growth.

The diagnosis of fetal alcohol syndrome is made once the mother has self-reported they ingested alcohol regularly during the pregnancy or when the newborn shows any signs of FASD. It is important to note that the population discussed is teenager, a population known to respond very poorly to the perceived accusatory nature of interview-based clinical assessments by nurses and physicians. This causes the expectant mother to be reserved, isolated and oftentimes disengaged with the pregnancy as a whole. The dependence on self-reporting is barely a diagnostic tool anywhere given its poor efficacy as well as stigmatization of mothers who may not only need care for the unborn child but also placement for rehabilitative services once the child is born. Although multiple diagnostic tools currently exist, these are all derived from and initial diagnostic panel developed by the Centers for Disease Control and Prevention, CDC. Under its Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis, the CDC provides regularly updated statistical data as well as changes to the diagnostic approach of FAS. Although at this time single college graduates between the ages of 33-45 represent the highest demographic of pregnant alcohol consumers, it is important to note that teenage mothers reported the highest frequency and intensity of alcohol consumption of all age groups and demographics.

As it relates to the fetus, these symptoms present may vary from individual to individual since the height and weight of the mother as well as the amount of alcohol consumed concomitantly with other contraindicated agents such as cigarettes may cause a variety of symptoms in one fetus and none in the other. That said, universally “the typical clinical presentation of FAS should include: deficiency in the weight and height growth before and after birth, abnormalities in the neurodevelopment of the nervous central system, and a series of typical facial abnormalities including small palpebral fissures, thin upper lip and smooth philtrum” (Esper and Furtado, 2014). Determining the severity of FAS in a fetus has much to do with the exposure the expectant mother has had. Individuals considered to be at high risk are those that have presented with blood alcohol levels greater than 100mg/dL within the first trimester of pregnancy. When consumption is denied or reported but determined to be of low incidence and late in pregnancy, the risk is markedly less.

Disabilities related to FAS are seen in ten sensory-receptor areas of the brain. According to the area presenting with a deficit, the CDC has determined conditions that represent central nervous system change. Contextualizing these symptoms and how they affect the fetus may be easier to understand if actual clinicians present their experience with the syndrome. Understandably, the benefit of clinician expertise is appreciated on all levels of care ranging from the needs of the patient to those of the staff. Given the current structure of the nursing profession, these professionals are normally those who spend the longest amount of time with the patients. As a result, it is not unusual for those who provide care directly at the bedside to be the ones who witness and assess abnormal findings in the neonatal patient. I recently had the pleasure of interviewing a physician who specializes in obstetrics and gynecology in the greater Lehigh Valley area. According to this clinician, the Lehigh Valley area is very fortunate to have very low rates of fetal alcohol syndrome especially in the teenage population. That said, he recounts when he was completing his residency years in Philadelphia, the urban setting was very much a breeding ground for infants born with dependency on methadone as well as multiple symptoms delineated in the FASD category. It is the belief of this clinician that much of the higher rates of FAS are secondary to higher depression rates and poor coping skills in the childbearing population. Another interesting fact he pointed out was that though term pregnancies have remained relatively unchanged, the amount of planned pregnancies is beginning to increase which in turn, decreases the burden on young parents who were not planning on having a child while still in college or barely securing that first entry level position.

As it relates specifically to the symptoms seen in babies born with FAS, those presented in the context of this written piece align with what he has seen in practice. In fact, of those infants where FAS has been diagnosed, he states many have been in the years to follow and although his limited exposure to the sample could possibly skew his perception of FAS as a problem, most FAS infants do not present with every severe symptom mentioned unless there is polypharmacy abuse and smoking in addition to drinking in which case usually the former represent a much more lethal risk to than infant than the actual alcohol abuse alone. In terms of the population affected with these types of cases, it seems to be an issue in the older parents than the very young ones. Teenage girls are represented as the most severe of drinkers in terms of volume consumed, but in terms of the actual sample size, teenage mothers are amongst the lowest participants of alcohol abuse during gestation.

When asked about the types of interventions performed on the infant to treat them for FAS, the OB/GYN stated that all interventions during the birthing stage are directed towards the stabilization of the patient rather than treating secondary symptoms. The neonates are treated in the same way that any other unstable newborn is treated which means securing and airway and maintaining appropriate vital signs. In the years to follow, it will be the focus of disciplines like speech, physical, and occupational therapy to help bridge the functional gap that exists between FAS children and their non-FAS counterparts. As far as teaching, the teaching done with the parent oftentimes related to identifying the needs they have to care for themselves first. Oftentimes, alcohol is not the only substance consumed by the parents at home and so the focus shifts from trying to teach the parent about caring for the child and more on teaching the parents to take care of themselves.

All in all, FAS is a condition that will affect the infant and his or her parents for the rest of their lives. The signs and symptoms of FAS can be as mild as a slight learning disability or as severe as mental and physical incapacities. As nurses the goal is to provide support and valuable feedback to the parents in order to solidify a trusting and therapeutic relationship that will allow for an exchange of ideas conducive to the overall benefit of the child. Ultimately, bridging a knowledge gap and linking the family with clinicians and specialists that will formulate care plans to optimize the developmental progression of the child is the end goal. In years to follow by increasing awareness and addressing community deficiencies hopefully the incidence of FAS will decrease.

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