Gravidanza

Alcool in gravidanza e allattamento

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Alcool e gravidanza: L’alcool in gravidanza è nocivo per il feto, specialmente nel I° trimestre ma anche nel II-III° trimestre, potendo provocare gravi malformazioni (1,2), aborto e parto prematuro (3). Il consumo di alcool fra le donne è in aumento:  il rapporto maschi/femmine è attualmente 3:1.  Il fenomeno è particolarmente diffuso fra le donne di 30-40 anni ma si va sempre più diffondendo fra i giovani e le teen-agers. In Germania colpisce in percentuale doppia rispetto alla Sindrome di Down. L’etanolo passa facilmente la barriera placentare e raggiunge nel sangue fetale una concentrazione pari a quella materna, decisamente troppo alta in rapporto all’esiguo peso fetale. Gli effetti negativi dell’alcool sulla gravidanza prevedono una percentuale del 30-40% di malformazioni fetali soprattutto nel 1° trimestre, fino alla grave   “Sindrome Feto-Alcolica” (FAS) che comprende anomalie cranio-facciali, malformazioni dei setti interventricolari e interatriali, ipoplasia del nervo ottico, fessura palpebrale ridotta, pieghe agli angoli degli occhi, microftalmia, strabismo e miopia, naso corto e piatto, labbro superiore assottigliato, solitamente la faccia ha un aspetto tirato con un profilo piatto (4). Inoltre l’etanolo può provocare IUGR, morte fetale intrauterina, aborto e parto prematuro. Il potere dannoso dell’alcool sul feto è dovuto alla carenza di enzimi epatici fetali deputati alla metabolizzazione dell’etanolo che esplica una modulazione negativa sull’assorbimento degli aminoacidi. I neonati da madre alcolista presentano basso peso alla nascita in rapporto all’epoca gestazionale e difficoltà a recuperarlo successivamente, L’allattamento al seno da mamma alcolista presenta rischi per il lattante in quanto l’alcool è secreto nel latte materno e può provocare intossicazione etilica con turbe neurologiche di varia gravità: disturbi della motricità fine, iperattività e impulsività, disturbi dell’eloquio e dell’udito, ritardo di apprendimento che molte volte si manifesta dopo anni quando il bambino inizia la scuola. Molti AA. Raccomandano di non superare ½ litro di vino al dì ma in pratica è meglio astenersi completamente dal consumare alcool perché non ci sono dati certi sulla minima soglia di sicurezza come affermato da recenti estesi studi promossi dal Ministero della Salute della Germania e dall’inglese NHS   (National Health Service). Un bicchiere di vino o spumante va concesso solo occasionalmente e tenendo conto anche dell’apporto calorico. Un bicchiere di birra da 200 ml contiene 100-150 KCal ed un bicchiere da 100 cc di vino rosso da pasto fornisce 85 KCal. Le bevande alcoliche devono quindi necessariamente rientrare nel computo delle calorie della razione alimentare. Gli alcolici vanno assolutamente vietati in caso di reflusso gastro-esofageo, pirosi gastrica ed esofagite.

 

Prevenzione dei danni fetali da alcool:

Dal punto di vista medico, finché non viene identificato il danno indotto dall’alcool, è difficile suggerire misure preventive efficaci. Tuttavia alcune indicazioni generali possono risultare utili:

  • la somministrazione di antiossidanti (vitamina E, C e β-carotene), nell’ipotesi che l’alcol determini il danno attraverso la liberazione di radicali liberi
  • l’uso di fattori antiapoptosici (folati, Vitamina B12, Xeronina)
  • Ac. retinoico: è purtroppo esso stesso gravato da grave rischio di teratogenicità
  • Soluzione glucosate per via sistemica
  • Disulfiram (Antabuse): è un farmaco che può dissuadere il paziente dal bere, poiché se il soggetto beve bevande alcoliche esso provoca: vomito, sensazione di nausea, nausea, hot flashes al volto, tachicardia, difficoltà respiratorie, ipotensione e collasso cardiocircolatorio. Queste sensazioni iniziano 5-15 minuti dopo l’ingestione e possono durare dai 30-60 minuti fino a diverse ore nei casi gravi. Rassicurare la paziente sulla transitorietà dei sintomi ed invitarla a riposarsi per qualche ora a letto. Non presenta controindicazioni in gravidanza, ma cautela e controllo medico.
  • Psicoterapia individuale e familiare
  • Acido folico a dosaggio pieno (400-750 µg/die per il diminuito assorbimento nelle persone alcolist

references:

  1. MJ Ashley: “Alcohol use during pregnancy: a challenge for the ’80s”. Can Med Assoc J. 1981 July 15; 125(2): 141–143.
  2.  Warren KR (ed.): Critical review of the fetal Alcohol Syndrome”. National Institute on alcohol abuse and alcoholism”.  Rokville MD. 1977; 11.
  3. Harlap S, Shiono PH. Alcohol, smoking, and incidence of spontaneous abortions in the first and second trimester. Lancet. 1980 Jul 26;2(8187):173–176.
  4. Jones KL, Smith DW. Recognition of the fetal alcohol syndrome in early infancy. Lancet. 1973 Nov 3;302(7836):999–1001

 Queste pagine, ancora in fase di completamento,  fanno parte del sito fertilitycenter.it in internet da marzo 2011. I testi, le tabelle, i disegni e le immagini pubblicati in queste pagine sono coperte da copyright ma a disposizione di tutti per copia e riproduzione purchè venga citata la fonte con link al sito www.fertilitycenter.it.

Ringrazio i lettori per la cortese attenzione e li prego di voler comunicare le loro osservazioni e consigli su eventuali errori o esposizioni incomplete.

Grazie. Enzo Volpicelli.

 

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