Most countries of the world are facing the direct and indirect consequences of alcoholism. Harmful and inappropriate consumption of alcohol has effects not only on those who drink but also on those around them, on the society.
We have no data on alcoholism in the Indian Ocean, and if the mental impact is of 3% in Reunion Island (Reunion Island is the first French region in terms of the effects of alcoholism on Mental Health) they are 3.2% in Mauritius. This means that Mauritius is as concerned as Reunion Island. Alcoholism in these countries, affecting both men and women.
Presentation
The problem of female alcoholism therefore also relates to Mauritius. Alcohol consumption during pregnancy is revealed in its most severe consequence: the Fetal Alcohol Syndrome (FAS).
As elsewhere, the denial and the taboos of female alcoholism, coupled with ignorance of the consequences of prenatal alcohol on the child, do not allow collective awareness and the implementation of a prevention policy effective. Faced with this preventable disabilities, it seems important to act quickly on the behavior of the mother during pregnancy, inform her, empower her, and accompany her.
In France, during pregnancy, 5% of women consume three alcoholic drinks per day on average, which is already a danger to the unborn child. It is estimated that « All the Troubles Caused by Fetal alcohol spectrum disorder (FASD) » affect 1% of births, that is to say 7000 children each year. This means that about 500,000 French suffer varying degrees of fetal alcohol effects. It is estimated that in industrialized countries, 1-3 in 1000 children are suffering from Fetal Alcohol Syndrome (FAS) at birth, while the percentage of children affected by the effects of alcohol on the fetus (FAE) (learning difficulties and social integration) could be much higher, around 10 per 1000 births.
This day of September 9, 2009 will mark the 11th International Day of prevention of FAS and All Disorders Caused by Alcoholization of the fetus in general. Maurice thus demonstrates its commitment to the prevention of avoidable disability that could also represent a public health problem.
When the mother drinks, the fetus toast!
Alcohol consumed by the mother pass directly by simple diffusion across the placenta. Half an hour to an hour after absorbtion of the alcohol fetal alcohol and the mothers’ one are equivalent. This alcohol passes into the fetal liver. Because of its enzymatic immaturity, it is not able to degrade the alcohol to remove it. The elimination of the alcohol will be 2-3 times longer than in adults.
Alcohol causes a decrease in maternal-fetal exchanges by spasm of blood vessels, causing fetal distress or death in utero.
Alcohol also has a direct toxicity on tissue formation, we call it teratogenicity. The risk of irreversible neurological damage depends on the dose received by the fetus, and the duration of the exposure period. If alcohol is particularly harmful during the period of organogenesis, ie during the first trimester of pregnancy, toxicity is exercised throughout pregnancy, and resounding on the overall growth of the fetus as well as brain development, the brain being the most vulnerable organ of the body. Once established, the lesions are final.
The Fetal Alcohol Syndrome (FAS)
The fetal alcohol syndrome was first described in 1968 by Lemoine who identified in children of women who consumed large amounts of alcohol during pregnancy, morphological abnormalities of the face: short palpebral fissures (small eyes ) facies flattened, thin upper lip and philtrum flat or smooth. These children also exhibited growth retardation and behavioral disorders and cognition.
Today, the diagnosis of a child with FAS is based on a combination of the following criteria, in the context of consumption of alcohol by the mother during pregnancy :
- Growth retardation
- Central nervous system (neurological abnormalities, developmental delays, behavioral disorders, cognitive disorders or other cognitive deficits)
- Facial features
In developed countries, FAS is the leading cause of non-genetic mental retardation.
Effects of Alcohol on the Fetus (EAF)
It is a term used to describe children with some of the anomalies associated with maternal alcohol consumption during pregnancy, sometimes with only small amounts of alcohol. Neurobehavioral disorders that sometimes shows children with FAE may be as severe as those found in the typical form of FAS, but they often occur secondarily. Thus, the child often appear normal at birth. Only can be noted :
- A discrete delay of growth or a simple slowdown
- Most often, no malformations or minor malformations
- But almost always emerge during the early years some learning and behavioral disabilities that are school and social integration difficulties
Future of these children
Growth retardation persists. In severe forms, it is important and hopeless even with proper diet and appropriate care. Catching up to adolescence and adulthood will be only partial for plus size appreciable weight. The cranial volume remains well below normal and more depending on how maternal alcohol consumption has been important during pregnancy. Malformations will sometimes require surgery during the first year. Neurological disorders persist or appear, even in children who seemed little affected in the neonatal period.
As a teenager and adult, behavioral disorders predominate: Academic Achievement and Professional are compromised. In these impressionable children, acts of petty crime are common due to lack of judgment or because of their impulsivity. They are easily depressed. Most affected live in institutionalization: 15 to 20% are found in communities for the mentally handicapped. Nearly half abuse alcohol and / or drugs.
Prenatal exposure to alcohol represents a risk for the unborn baby at all stages of pregnancy.
This risk is the same for all varieties of alcoholic beverages and exists also in frequent consumption.
Indeed, we do not know the minimum dose below which there would be no risk to the fetus. It is recognized that the typical picture of FAS (with severe growth retardation, microcephaly, mental retardation and malformations) corresponds to a regular consumption of alcohol that is of more than 2 drinks / day or acute alcohol consumption greater than 4 drinks on one occasion, he is now also proven that even small amounts of alcohol can cause neurological damage in the fetus. Experts now believe that the risk is from the first drink: this is why, during pregnancy, it should maintain a strict abstinence.
Screening and early treatment: two major issues
Early detection of FAS and FAE
Early identification of FAS or FAE is an important step to understand the root cause of the behavior and learning difficulties of a child. This is the key to define the intervention but also prevent further births to be affected by the same problems.
Early support
Facilitate access to appropriate early intervention and can alleviate many physical problems, emotional, social and educational facing children with FAS or FAE.
Maternal Alcohol screening
Maternal alcoholism screening is to recognize the suffering of the woman is to overcome her modesty and her denial is to reduce guilt is to initiate and maintain a long and hard dialogue with her
Inform all women
Since alcohol, even in small amounts, can have adverse effects on the unborn child, it is now essential to educate all women to his misdeeds, ideally before conception.
4th National Assembly of Mauritius 12 May 2009…
