Early Management of Children with Foetal Alcohol Syndrome in France

INTRODUCTIONDespite its status in France as a legal culturally well accepted drug, alcohol is clearly the most dangerous addictive product for the foetuses. Moderate-to-high alcohol intake during pregnancy can be responsible for a variety of more-or-less complete malformations and dysmorphic anomalies, pre and postnatal growth retardation, and severe neurological and behavioural developmental disorders,1 which, depending on their severity, are classified under the foetal alcohol syndrome (FAS) or the foetal alcohol syndrome disorders (FASD) in accordance with the criteria in use at the time of our examination as defined by the American Institute of Medicine2 revised in 2000.3,4Perinatal management of infants born to alcohol-abusing mothers and their families is difficult. We evaluated 11 children suffering from foetal alcohol syndrome (FAS) or foetal alcohol spectrum disorders (FASD). In the region of Upper Normandy in France alcohol consumption is particularly prevalent and at least 3/1000 newborns have obvious signs of prenatal alcohol exposure and are diagnosed with FAS.5 In France, the incidence of FAS varies between 1 and 1.3/1000 births versus 5.83 and 8/1000 births for FASD .6,7 For comparison, the incidence of FAS varies between 0.3 and 1.5/1000 births in Norway,8 0.3 and 4.8/1000 births in the United States,9 0.02 and 2.76/1000 births in West Australia,10 1.0 and 3/1000 births in industrialized countries.11,12 According to the Canadian Pediatric Society, in the world this incidence would be 1.9/1000 births. In addition to the possible physical handicaps, FAS is usually responsible for central nervous system disorders, intellectual incapacities and social, professional and familial inaptitudes.13 The association between the physiological involvement and social handicaps seems rather obvious.The future of these children is severely impaired. Attenuating the handicaps and disturbances associated with FAS/FASD requires early and intensive management in medical departments or specialized centres which today are still too few.SUBJECTS AND METHODSThe paediatric medical files of FAS/FASD children followed in French Centres d'Action Medico-Social Precoce (CAMSP, Centres for Early Medical-Social Intervention) between 2000 and 2005 were identified in the database of a university hospital neonatology department. These files were retrospectively analyzed by comparing different criteria (weight, length and head circumference at birth, intrauterine growth retardation (IUGR), weeks of amenorrhea, etc.) concerning the 11 FAS/FASD newborns. When available, the mothers' obstetrical files were also analyzed. Finally, to retrace the itineraries of these children after their discharge from the neonatology department, questionnaire-oriented interviews were conducted by the CAMSP director.RESULTSCharacteristics of the MothersThe sociodemographic and obstetrical characteristics of the mothers of the 11 FAS/FASD children are given in Table 1 . The women, self-declared or presumed excessive alcohol consumers, lived in rather difficult socioeconomic conditions. These women were married and usually financially dependent on their partners, who were often alcohol abusers themselves, rarely had a professional activity, and they lived in their own housing (Table 1). During the prenatal consultations to monitor their pregnancies, almost all the women interviewed declared having no professional activity, (versus 34% in the French general population), with six women unemployed and four staying at home (Table 1).These women had a mean of more than 3 children (Table 1). Their mean age at the time of the pregnancy was higher than the age of the French female population described by the 2003 national inquiry.14 Primipara mothers represented only 18% (2/11) of this population, while for 45% (5/11) of them this was the fourth child. The total number of pregnancies was slightly higher than the number of babies (Table 1), as it included abortions and miscarriages. …

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