Alcohol embryopathy: some facts and speculations about pathogenesis.

Signs and symptoms of 108 cases with alcohol embryopathy are presented. In addition to the well-known features (e.g., intrauterine growth retardation, microcephaly, mental retardation and typical craniofacial abnormalities), 29% of the cases had heart defects, 10% had G.U. tract malformations, and 1.8% had spina bifida. Brain malformations of 3 cases and 4 fetuses are described. Auxological measurements demonstrated some catch-up growth for height, but none for head size. Facial anomalies tended to normalize with increasing age. A proposal for classifying alcohol embryopathy (AE) into 3 degrees of severity is presented. Cases with the mild degree showed milder (or no) mental retardation compared to cases with the severe degree. The degree of AE was related to the stage of maternal alcoholism. With increasing severity of maternal alcoholism, the frequency and severity of AE among the offspring increased too. Among siblings, the elder siblings were less affected than the younger. This difference in outcome might be caused by the increasing inability of the alcoholic mothers to metabolize acetaldehyde. It is hypothesized that embryonic disturbance is not as dependent on the amount of daily alcohol consumption as it is on the stage of maternal alcoholism.