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The effect of alcohol on the growing and developing embryo and fetus is still not completely understood. The exact mechanisms by which alcohol induces malformations may be as a result of a direct toxic effect or it may be a combination of ethanol and acetaldehyde, its metabolite. [Abel 1984; Campbell & Fantel 1983 Dreosti et al. 1981; Sreenathan et al. 1982] The timing of the toxic event and the peak alcohol concentrations may work together to exert a teratogenic effect. [Schenker et al. 1990a] It is essential to look at alcohol as a teratogen to understand the actual physical effects of alcohol on the embryo and the fetus. A teratogen is a substance that interferes with normal development during gestation in utero. Teratogens can cause four main results: death, malformations, growth deficiencies, and functional deficits. When genes and teratogens interact, they cause very unique changes. The genetic make-up of both the mother and the developing embryo/fetus influences how and whether that child will be affected by the teratogen, in this case, alcohol. Between 25% and 45% of children born to mothers who drink during pregnancy will have FAS. [Gilliam et al. 1988; Streissguth 1997b] There are numerous animal studies that demonstrate brain damage from exposure to alcohol. [Clarren et al. 1988; Miller 1993; West et al. 1981] Postmortem findings have been reported as case studies on fetuses, infants, and children of mothers who used alcohol during pregnancy. The neuropathologic anomalies include micrencephaly, leptomeningeal glioneuronal heterotopias, holoprosencephaly-arhinencepahaly, agenesis of the corpus callosum, and dysgenesis of the cerebellum and brain stem. [Swayze et al. 1997a] Magnetic Resonance imaging (MRI) of children, adolescents, and adults with classic FAS has shown a high incidence of midline brain anomalies. [Swayze et al. 1997b]
Prostaglandins may also be involved in the pathophysiology of alcohol toxicity. [Challis & Patrick 1980] It has been postulated that alcohol may interfere with prostaglandin metabolism and may interfere with the normal balance and regulation of placental blood flow. The placenta is the organ created early in pregnancy for delivering oxygen and nutrients to the developing embryo and fetus. When there is decreased blood flow to the embryo or fetus, there will be insufficient oxygen and essential nutrients. Chronic hypoxia (decreased oxygen) has been implicated in the etiology of alcohol related disorders. [Lewis & Woods 1994a] The actual amount of alcohol necessary to produce malformations seen in alcohol related disorders is unknown. It is still not clear whether one can predict particular abnormalities, whether behavioral or physical, based on the trimesters when alcohol has been consumed. Alcohol probably has its effects throughout pregnancy. Evidence does suggest that short-lived, high concentrations of alcohol as occurs in binge drinking, can be especially deleterious. [Ernhart et al. 1987; Lewis & Woods 1994b; Schenker et al. 1990b; FDA 1981] The lowest harmless dose of alcohol during pregnancy is unknown and subsequently, complete abstinence is recommended.
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