Fetal Alcohol Syndrome (FAS)

Fetal Alcohol Syndrome (FAS)

Introduction
It sounds simple: women who drink excessively while pregnant are at high risk for giving birth to children with birth defects. Therefore, to prevent these defects, women should stop drinking alcohol during all phases of pregnancy. Alternatively, women who drink alcohol should not become pregnant unless and until they can control their drinking. More than 20 years ago, when fetal alcohol syndrome (FAS) was first described in the published medical literature, there were high hopes for its prevention. In fact, this has not been simple, and the biomedical and public health communities are still struggling to eliminate a birth defect that should be absolutely preventable.
HISTORY
Although
references to the effects of prenatal exposure to alcohol can be found in classical and biblical literature, fetal alcohol syndrome was first described in the medical literature in France by Lemoine et al. in 1968. Researchers in the United States soon also published a landmark report describing a constellation of birth defects in children born to alcoholic women (Jones and Smith, 1973). FAS has since been described in most countries of the world. Briefly, FAS refers to a constellation of physical abnormalities, most obvious in the features of the face (see Figure 1-1) and in the reduced size of the newborn, and problems of behavior and cognition. These latter features lead to the most concern.
The degree of abnormality in any one measure can vary greatly between individuals and can change with time in the same individual. For example, people diagnosed with FAS can have IQs from well within the normal range to the severely mentally retarded range. The physical anomalies can be slight or quite striking. Some people with FAS live fairly normal lives if given adequate and structured support throughout their lives, whereas others are severely impaired. The defects may or may not be apparent or easily diagnosed at birth. Although the manifestations of the damage might change with age, FAS never completely disappears and, as with many developmental disabilities, there is no cure, although there might be some amelioration in some individuals. FAS does not refer to signs of acute alcohol exposure or withdrawal at birth. Newborns can have blood alcohol levels high enough to affect acutely their central nervous system function and not have FAS. Newborns can also have no alcohol in their bloodstream at time of delivery but still have FAS. FAS is not a "drunk" baby. The costs of FAS and related conditions can be quite high—for the individual, for the family, and for society. Three groups have tried to estimate these costs, and these estimates vary greatly (Bloss, 1994). These estimates are problematic, because of uncertainties regarding the incidence and prevalence of FAS and uncertainties related to the full extent of health (and other) problems experienced throughout the lifetime of people with FAS. Estimates of the occurrence of FAS in North American communities range from 0 per 1,000 (incidence; Abel and Sokol, 1987, 1991) to 120 per 1,000 (prevalence; Robinson et al., 1987), although rates in several of the most complete studies are similar—on the order of 0.5 to 3 cases per 1,000 births. Assuming an annual birth cohort of approximately 4 million, this translates into 2 to 12 thousand FAS births per year in this country. As described in the report, there is a lack of longitudinal data on the extent of possible problems of adults with FAS. Therefore, cost estimates for the United States range from $75 million (Abel and Sokol, 1991) to $9.7 billion (Harwood and Napolitano, 1985). The total lifetime cost per typical case of FAS for a child born in 1980 was estimated to be $596,000 undiscounted1 (Harwood and Napolitano, 1985). These incidence and cost figures are offered not as established facts but they are intended to emphasize that regardless of the details, or any one specific estimate, the costs of FAS to the individual and society are high.

FIGURE 1-1 Photographs of children with fetal alcohol syndrome.
SOURCES: Figures 4C and 4D: Reprinted with permission from Jones et al. (1973).
Copyright 1973 by the Lancet Ltd. Figure 4B: Reprinted with permission from
Clarren and Smith (1978). Copyright 1978 by the New England Journal of
Medicine, Massachusetts Medical Society.
Since publication of the papers by Lemoine and by Jones and Smith, the biomedical, public health, research, and public policy communities have devoted much time and energy to a fascinating problem of teratology (the study of the effects of chemical exposure on the developing fetus), neurobiology, disease prevention, and social disarray. The U.S. Public Health Service has spent millions of dollars in research, public education, and service programs related to the topic. Important concepts have been established through research. For example, well-controlled research studies on rats, mice, and nonhuman primates have demonstrated that alcohol exposure causes FAS. However, while alcohol is the necessary teratogen, it alone may not be sufficient to produce FAS in humans or birth defects in animals. As with most teratogens, not every fetus exposed to significant amounts of alcohol is affected. The outcomes might be modulated by numerous biologic and environmental factors, such as nutrition, threshold, timing, genetic susceptibility, pattern of alcohol exposure, or fetal resilience. Further research is needed to fully elucidate the factors that influence the expression of alcohol teratogenesis.
Public education campaigns have taught many women and their partners, as well as the medical community and society at large, that excessive alcohol consumption is dangerous during pregnancy. Reduction in the occurrence of substance abuse during pregnancy, reduction in the incidence of FAS, and an increase in the questioning of patients by health care providers about alcohol and other drug use are goals of the Public Health Service 's Healthy People 2000 initiative (U.S. Department of Health and Human Services, 1991). See Table 1-1.
Prevention of birth defects as a salient public health goal presents some exemplary success stories. A good example is the advocacy for and impact of rubella immunizations for children and women of childbearing age with no history of natural rubella or rubella immunization. An outbreak in the United States in the mid-1960s resulted in an estimated 20,000 children born with congenital rubella syndrome (CRS). CRS occurs in 20 to 25 percent of babies born to mothers who get rubella in the first trimester of pregnancy and results in congenital heart disease, deafness, mental retardation, and other fetal abnormalities. An estimate of the lifetime cost of CRS is about $330,000 per case. With widespread introduction of rubella vaccines in the late 1960s and the requirement for rubella immunization prior to school entry, the number of reported cases of CRS in the United States hit a low of 225 in 1988. As another example, new findings that folic acid deficiency during pregnancy can result in neural tube defects have led to recommendations that grain be fortified with folic acid to prevent these birth defects. Availability of effective prevention strategies led to public policy debates and recommendations for action.
The emergence of crack cocaine as a major medical and public health problem in the 1980s led to worries about a generation of crack babies who would cost the medical care system, primarily neonatal intensive care wards, huge amounts of money and who would overburden the education and social service systems with problems attributable to prenatal exposure to cocaine. Further research has shown that crack cocaine can lead to serious obstetrical complications and that some of the exposed newborns do have problems.

TABLE 1-1 Examples of Healthy People 2000 Goals Relevant to Fetal Alcohol Syndrome (FAS)
Objective
1987 Baseline
Target 2000
Incidence of FAS (per 1,000 live births)
0.22
0.12
Abstinence from alcohol during pregnancy
79%
Increase by 20%
Screening by obstetrician/gynecologist for alcohol use
34%
75%
Referrals by obstetrician/gynecologist for alcohol treatment
24%
75%
Screening by obstetrician/gynecologist for drug use
32%
75%
Referrals by obstetrician/gynecologist for drug treatment
28%
75%

Cocaine-exposed children have not been followed as extensively or for as long a time as alcohol-exposed children; what data have been published show some effects of prenatal cocaine exposure at three years of age, but the problems do not seem to be nearly as devastating as predicted, nor as severe as the long-term problems associated with alcohol exposure. In fact, some of the long-term effects associated with prenatal cocaine exposure may be due in part to the concurrent use of alcohol during pregnancy. The federal government invested millions of dollars in demonstration projects for services for substance-abusing women. Some of these programs included services for women who abuse alcohol, but the emphasis was usually on drugs, particularly illegal ones, other than alcohol, or on polydrug use. The attention to crack cocaine and its effects on the fetus is curious given that the percentage of pregnant women who drink (approximately 20 percent) far exceeds the percentage who use cocaine (approximately 1 percent; National Institute on Drug Abuse, 1994).
At the time, however, the cocaine epidemic and its potential risks to unborn children led to heated public policy debates. Policies of mandatory urine testing in delivery wards, and subsequent removal of a child from the care of a mother who tested positive for illegal substances, were instituted in many places (Blume, in press; Chavkin, 1990). The unintended negative consequences of these actions have led to a reconsideration and reversal of these policies more recently.
THE FEDERAL RESPONSIBILITY FOR FAS RESEARCH
As will be described in many parts of this report, FAS is a complicated health and social problem, involving many different sectors of the government. The U.S. Public Health Service (USPHS) contains the agencies with primary responsibility for research in the area. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH) has the lead role in research on FAS. However, NIAAA is a relatively small institute of NIH. The NIAAA appropriation in 1993 was $177 million, compared with more than $400 million for the National Institute on Drug Abuse (NIDA) and slightly less than $2 billion for the National Cancer Institute (U.S. Department of Health and Human Services, 1993). NIAAA programs related to FAS include very basic animal research, which has been the mainstay of research in this area; clinical and epidemiologic research on the effects of low to moderate alcohol use by pregnant women; and prevention research. The alcohol and pregnancy program at NIAAA included $9.8 million to $13.5 million for approximately 70 grants in each of fiscal years 1990-1994. Most of these research grants were RO1, investigator-initiated awards. NIAAA funds one fetal alcohol research center.
In addition, many research programs sponsored by NIAAA have ancillary importance to FAS, for example, the research it funds on the epidemiology of drinking by women or on general approaches to the prevention and treatment of alcohol abuse. As an example of the level of commitment by NIAAA to this issue, the prevention research program at NIAAA has ranged from $15 million to $19.8 million annually in recent years. As the lead research agency on alcohol, the institute and the USPHS can serve as a bully pulpit for the prevention of FAS and other alcohol-related problems. In fact, this has been the case. The U.S. Surgeon General first issued a warning against the dangers of alcohol during pregnancy in 1981. In addition to funding and conducting research, NIAAA publishes information for the public on FAS, sponsors research workshops on FAS, and has its staff speak at public meetings.
Other NIH institutes fund research relevant to, but not directly about, FAS. For example, NIDA funded a $4 million National Pregnancy and Health Survey on substance abuse, including alcohol, during pregnancy. The data on alcohol were a small part of the entire project. In addition, NIDA funds epidemiologic and clinical research on the effects of substance abuse during pregnancy, and alcohol is frequently one of the substances used by these populations. A rather large study funded by NIDA was the Perinatal 20 demonstration project assessing prevention of substance abuse during pregnancy. Although the major purpose was to look at the abuse of illegal substances, some data were collected on alcohol use, as well.
Another key USPHS agency involved in FAS work is the Centers for Disease Control and Prevention (CDC). The FAS Prevention Section is housed in CDC 's National Center for Environmental Health, Division of Birth Defects and Developmental Disabilities. CDC 's role is to collect data to define the scope of the problem; support the development and evaluation of FAS prevention projects; and build state capacity for coordinated, state-based FAS surveillance and prevention programs (CDC submission to IOM committee). The CDC maintains and analyzes surveillance programs that include FAS, such as the Birth Defects Monitoring Program. In addition, CDC sponsors and supports efforts to prevent FAS. The CDC currently has FAS prevention and surveillance projects supported through states and universities. As with NIAAA, CDC has ancillary programs related to maternal and child health, alcohol abuse, and epidemiologic surveillance that can support and inform FAS programs.
Other agencies in the USPHS maintain important programs related to FAS, but these programs have much less emphasis on research. The Indian Health Service, the Health Resources and Services Administration (HRSA), and the Substance Abuse and Mental Health Services Administration (SAMHSA) fund services or demonstration projects directly or indirectly related to FAS. At this time, no agency has been able to support research on the clinical aspects of FAS, on the medical treatment of children with FAS, or on the education and remediation of these children.
A notable USPHS program is the Pregnant and Postpartum Women and Their Infants (PPWI) initiative. This program was authorized by the Anti-Drug Abuse Act, passed by Congress in 1988. The demonstration grant program focuses on the development of innovative, community-based models of drug prevention, education, and treatment, targeting pregnant and postpartum women and their infants (National Center for Education in Maternal and Child Health, 1993). The program is funded jointly by the Center for Substance Abuse Prevention (CSAP) of SAMHSA and the Maternal and Child Health Bureau of HRSA. It has funded 147 demonstration projects. The most common drug addressed was cocaine, followed by alcohol and polydrug use. Because demonstration projects are rigorously evaluated only infrequently, the nature, utility, and transferability of their findings are difficult to assess.
The Center for Substance Abuse Treatment (CSAT), a part of SAMHSA, was charged by Congress to support grants for residential and outpatient substance abuse treatment for pregnant and postpartum women and their infants (information provided to the committee). CSAT funded 31 residential projects in 20 states in the PPWI program and 34 projects in 24 states in its Residential Treatment for Women and Their Children program. The five treatment programs that serve Native American women include comprehensive services specific to FAS. In addition, CSAT has other activities, such as its Treatment Improvement Protocols, relevant to FAS, but the abuse substance of focus is usually cocaine or opiates, not alcohol.
CONGRESSIONAL INTEREST
In recognition of the seriousness of this problem, which affects both the health and the societal functioning of many Americans, several times in the past few years, members of Congress have introduced legislation related to FAS (see Table 1-2). The bills have focused largely on creating an interagency task force on FAS and increasing resources for prevention programs and prevention research. These bills, with one exception, have never been passed. The U.S. Congress mandated in Section 705 of Public Law 102-321, the ADAMHA Reorganization Act, that the Institute of Medicine (IOM) of the National Academy of Sciences conduct a study of FAS and related birth defects.
TABLE 1-2 Congressional Bills Related to Fetal Alcohol Syndrome (FAS) or Women and Alcohol
Bill No. and Date Introduced

Bill Name

Major Sponsor

Overview
H.R. 1322 3/7/91
Comprehensive Indian Fetal Alcohol Syndrome Prevention and Treatment Act
Campbell (D-CO)
Authorize services for the prevention, intervention, treatment and aftercare of American Indian and Alaskan Native children and their families at risk for FAS and fetal alcohol effect (FAE). Authorization of grants to Native American tribes for training, prevention, and intervention programs. Convening of FAS/FAE task force including federal representation and representation from Native American tribes. Would have authorized $10 million annually for FY 1993-1995 and $15 million annually for FY 1996-2000.
S. 923
5/7/93
Comprehensive Fetal Alcohol Syndrome Prevention Act
Daschle (D-SD)
Expand resources for basic and applied epidemiological research related to FAS/FAE. Establish programs to coordinate and support national, state, and community-based public awareness, prevention, and educational programs on FAS/FAE. Establish and facilitate a national surveillance program to monitor the incidence of FAS/FAE and the effectiveness of prevention programs. Establish a task force to foster coordination among federal agencies that conduct FAS/FAE research, prevention, and treatment.
H.R. 3569 11/19/93
Women and Alcohol Research Equity Act of 1993
Morella (R-MD)
Provide for an increase in the amount of federal funds expended to conduct research on alcohol abuse and alcoholism among women. Would have authorized up to $23,250,000 to enable NIAAA to increase such research.
H.R. 3783 2/2/94
Comprehensive Fetal Alcohol Syndrome Prevention Act
Richardson (D-NM)
Establish a comprehensive program to help prevent FAS and FAE and to coordinate federal efforts to prevent FAS and FAE. CDC to coordinate and support applied epidemiologic research on FAS and FAE. NIAAA to conduct and support basic research targeted to developing data to improve prevention and treatment of FAS and FAE. Develop a plan to disseminate diagnostic criteria to health care and social services providers. Establish an interagency task force on FAS and FAE. SAMHSA to support, conduct, and evaluate training programs for professionals; and prevention and education programs for the public.
S 170
1/5/95
Comprehensive Fetal Alcohol Syndrome Prevention Act
Daschle (D-SD)
Establish interagency task force on FAS and FAE. Organize a program of basic research on services and effective prevention, treatment and intervention for pregnant alcohol-dependent women and those with FAS or FAE [Originally introduced as S. 1821 in previous session but died in committee.]
H.R. 1649 5/16/95
Comprehensive Fetal Alcohol Syndrome Prevention Act
Richardson (D-SD)
Establish a program for the conduct and support of research and training and the dissemination of health information about the cause, diagnosis, prevention and treatment of FAS and related conditions. Establish an Interagency Coordinating Committee on Fetal Alcohol Syndrome. Develop uniform criteria for the collection and reporting of data on FAS and related conditions.
NOTE: CDC = Centers for Disease Control and Prevention; NIAAA = National Institute on Alcohol Abuse and Alcoholism; and SAMHSA = Substance Abuse and Mental Health Services Administration.

The National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health funded the project. This report is in response to that mandate.
The Committee to Study Fetal Alcohol Syndrome was convened in mid-1994. Committee expertise included pediatrics, developmental psychology and neurology, obstetrics, nosology, teratology, epidemiology, sociology, substance abuse prevention and treatment, and psychiatry. The charge to the committee was to improve the understanding of available research knowledge and experience on:
•
tools and approaches for diagnosing FAS and related disorders,
•
the prevalence of FAS and related disorders in the general population of the United States,
•
the effectiveness of surveillance systems, and
•
the availability and effectiveness of prevention and treatment programs for these conditions.
As part of its work, the committee assessed and reviewed U.S. Department of Health and Human Services agency research on the topic and provided guidance for the future.
SOME IMPORTANT DEFINITIONS
Before going further, some clarification of terms is warranted. Several terms are used in this report to refer to drinking patterns and problems. The terms used here are intended to be consistent in spirit with an earlier IOM report Broadening the Base of Treatment for Alcohol Problems (IOM, 1990), particularly in their emphasis on the heterogeneity of alcohol problems, the course of alcohol use disorders, patterns of consumption, and etiology. In this schema, alcohol consumption is seen as ranging from none to light to moderate to heavy. Alcohol-related problems (e.g., medical, legal, social, psychological) also range from none to mild to moderate to severe. Research has pointed to a positive correlation between level of alcohol consumption and level of alcohol problems, with the most severe problems generally seen at the highest levels of drinking. This relationship is, however, variable across individuals; that is, in some cases, severe problems can be seen at comparatively moderate levels of drinking.
The fourth edition of the American Psychiatric Association 's Diagnostic and Statistical Manual (DSM-IV; 1994) defines alcohol use disorders as alcohol dependence and alcohol abuse. In general, these terms refer to maladaptive patterns of drinking and consequences which constitute a syndrome, usually associated with moderate to heavy alcohol consumption and moderate to severe alcohol-related problems (Edwards et al., 1981; IOM, 1990). In DSM-IV, alcohol dependence is diagnosed when the individual meets three or more of the following seven criteria in a 12-month period: (1) tolerance; (2) withdrawal; (3) drinking in larger amounts or over a longer period than intended; (4) persistent desire or unsuccessful efforts to cut down on drinking; (5) a great deal of time spent drinking or recovering from alcohol effects; (6) declining involvement in social, occupational, or recreational activities because of alcohol use; and (7) use of alcohol despite knowledge of a persistent or recurrent physical or psychological problem caused or exacerbated by that use.
Alcohol abuse is a less severe syndrome characterized by significant adverse consequences associated with alcohol use and is diagnosed when at least one of the following four criteria is met recurrently during a 12-month period: (1) failure to fulfill major role obligations because of alcohol use; (2) recurrent alcohol use in situations when it is physically hazardous; (3) recurrent alcohol-related legal problems; or (4) continued use despite social or interpersonal problems. In addition, the symptoms have never met the criteria for alcohol dependence (American Psychiatric Association, 1994). Alcohol abuse and alcohol dependence have fairly specific meaning in DSM-IV. However, these terms are frequently used as umbrella terms for maladaptive patterns of alcohol use.
In this report on FAS, the committee has chosen to use alcohol abuse as an umbrella term to indicate heavy drinking, including binge drinking, that is risky for the given individual circumstances. If it is clear that a strict DSM-IV diagnosis is intended, it will be so noted. Similar conventions will be used for substance abuse, which is treated very similarly in DSM-IV (American Psychiatric Association, 1994). DSM-IV does not define the term alcoholic, but the National Council on Alcoholism and Drug Dependence does (Morse et al., 1992). Alcoholism, too, is used but only occasionally in this report. It should be noted that there are no specific levels of consumption associated with alcohol abuse, either as used in DSM-IV or as an umbrella term in this report. Survey data from 1992 show that approximately 4 percent of all women and approximately 4 percent of women between the ages of 30 and 44 years of age could be considered to satisfy the DSM-IV criteria for alcohol abuse and alcohol dependence (Grant et al., 1994).
As described in the report, the relation between levels and patterns of drinking during pregnancy and the risk of delivering an infant with FAS is complex. In this report, terms such as ' 'heavy drinking" and "heavier drinking" are used to refer to levels of drinking associated with the highest risk for delivering an infant with FAS. "Binge drinking" is used to refer to a pattern of episodic heavy drinking, which is also associated with higher risk for FAS. Terms such as "risk drinking," or "moderate drinking" are used to indicate lower levels of drinking, usually not associated with FAS, but which may be associated with alcohol-related effects in infants.
It is important to note that definitions of these terms have varied across studies, settings, and samples. In particular, operational definitions of terms used to describe the level and pattern of drinking in studies of pregnant women frequently have not corresponded to definitions for women in general, which in turn often do not correspond to definitions for men. For example, a prospective study of the effects of prenatal alcohol exposure defines heavy drinking as an average of one or more drinks per day (Day et al., 1989); a seminal FAS prevention intervention project defined heavy drinking as five or six drinks on some occasions and at least 45 drinks per month (Rosett et al., 1981); large-scale surveys of drinking in women usually define heavy drinking as two or more standard drinks per day, where a standard drink contains approximately 0.5 ounce of absolute alcohol); some clinical research projects define heavy drinking in women as four or more drinks per day (Wilsnack et al., 1994), which differs from parallel definitions of heavy drinking in men (six or more standard drinks per day). The lack of consistency in terms regarding level of alcohol consumption across studies has led to confusion regarding the relationship between specific levels of drinking and risk for fetal alcohol syndrome and alcohol-related effects (see Abel and Kruger, 1995 for a review of this problem). The committee defines the relevant history for diagnosis of FAS (see Chapter 4) as one of a pattern of excessive intake characterized by substantial, regular intake or heavy episodic drinking. Evidence of this pattern may include: frequent episodes of intoxication, development of tolerance or withdrawal, social problems related to drinking, legal problems related to drinking, engaging in physically hazardous behavior while drinking, or alcohol-related medical problems such as hepatic disease.
REFERENCES
Abel EL, Kruger ML. Hon v. Stroh Brewery Co.: What do we mean by "moderate" and "heavy" drinking? Alcoholism: Clinical and Experimental Research 1995; 19:1024-31.
Abel EL, Sokol RJ. Incidence of fetal alcohol syndrome and economic impact of FAS-related anomalies. Drug and Alcohol Dependence 1987; 19:51-70.
Abel EL, Sokol RJ. A revised conservative estimate of the incidence of FAS and its economic impact. Alcoholism: Clinical and Experimental Research 1991; 15:514-524.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: 4th Edition. Washington, DC: American Psychiatric Association, 1994.
Bloss G. The economic cost of FAS. Alcohol Health & Research World 1994; 18:53-54.
Blume SB. Women and Alcohol: Issues in Social Policy in Alcohol and Gender. R. W. Wilsnack and S. C. Wilsnack (eds.). New Brunswick, New Jersey: Rutgers University Center of Alcohol Studies, in press.
Chavkin W. Drug Addition and Pregnancy: Policy crossroads. American Journal of Public Health 1990; 80:483-487.
Clarren SK, Smith DW. The fetal alcohol syndrome. New England Journal of Medicine 1978; 298; 1063-1067.
Day NL, Jasperse D, Richardson G, Robles N, Sambamoorthis U, Taylor P et al. Prenatal exposure to alcohol: Effect on infant growth and morphologic characteristics. Pediatrics 1989; 84:536-541.
Day NL, Robles N, Richardson G, Geva D, Taylor P, Scher M et al. The effects of prenatal alcohol use in the growth of children at three years of age. Alcoholism: Clinical and Experimental Research 1991; 15:67-71.
Edwards G, Arif A, Hodgson R. Nomenclature and classification of drug- and alcohol-related problems: A WHO memorandum. Bulletin of the World Health Organization 1981; 59:225-242.
Grant BF, Harford RC, Dawson DA, Chou P, Dufour M, Pickering R. Epidemiologic Bulletin No. 35: Prevalence of DSM-IV alcohol abuse and dependence: United States, 1992. Alcohol Health & Research World 1994; 18:243-248.

Alcohol (wine, beer, or liquor) is the leading known preventable cause of developmental and physical birth defects in the United States.
When a woman drinks alcohol during pregnancy, she risks giving birth to a child who will pay the price — in mental and physical deficiencies — for his or her entire life.
Yet many pregnant women do drink alcohol. It 's estimated that each year in the United States, 1 in every 750 infants is born with a pattern of physical, developmental, and functional problems referred to as fetal alcohol syndrome (FAS), while another 40,000 are born with fetal alcohol effects (FAE).
Fetal alcohol syndrome (FAS) is a condition that results from alcohol exposure during pregnancy.
Problems that may be caused by fetal alcohol syndrome include physical deformities, mental retardation, learning disorders, vision difficulties and behavioral problems.
The problems caused by fetal alcohol syndrome vary from child to child, but defects caused by fetal alcohol syndrome are irreversible. There is no amount of alcohol that 's known to be safe to consume during pregnancy.
Early diagnosis may reduce the risk of problems, including learning difficulties and substance abuse.
Signs and Symptoms
Fetal alcohol syndrome isn 't a single birth defect. It 's a cluster of related problems and the most severe of a group of consequences of prenatal alcohol exposure. Collectively, the range of disorders is known as fetal alcohol spectrum disorders (FASDs).
Fetal alcohol syndrome is a common — yet preventable — cause of mental retardation. The severity of mental problems varies, with some children experiencing them to a far greater degree than others.
Signs of fetal alcohol syndrome may include:
Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper
lip
Deformities of joints, limbs and fingers
Slow physical growth before and after birth
Vision difficulties or hearing problems
Small head circumference and brain size (microcephaly)
Poor coordination
Mental retardation and delayed development
Learning disorders
Abnormal behavior, such as a short attention span, hyperactivity, poor impulse control, extreme nervousness and anxiety
Heart defects low birth weight failure to thrive developmental delay organ dysfunction facial abnormalities, including smaller eye openings, flattened cheekbones, and indistinct philtrum (an underdeveloped groove between the nose and the upper lip) epilepsy poor coordination/fine motor skills poor socialization skills, such as difficulty building and maintaining friendships and relating to groups lack of imagination or curiosity learning difficulties, including poor memory, inability to understand concepts such as time and money, poor language comprehension, poor problem-solving skills behavioral problems, including hyperactivity, inability to concentrate, social withdrawal, stubbornness, impulsiveness, and anxiety
The facial features seen with fetal alcohol syndrome may also occur in normal, healthy children.
Distinguishing normal facial features from those of fetal alcohol syndrome requires expertise.
Doctors may use other terms to describe some of the signs of fetal alcohol syndrome. An alcohol-related neurodevelopmental disorder is a mental or behavioral impairment that occurs as a result of fetal exposure to alcohol. Alcohol-related birth defects are physical defects that occur from fetal alcohol exposure.
Diagnosis and Long-Term Effects
Problems associated with FAS tend to intensify as children move into adulthood. These can include developmental health problems, troubles with the law, and the inability to live
independently.
Kids with FAE are frequently undiagnosed. This also applies to those with alcohol-related neurodevelopmental disorder (ARND), a recently recognized category of prenatal damage that refers to children who exhibit only the behavioral and emotional problems of FAS/FAE without any signs of developmental delay or physical growth deficiencies.
Often, in kids with FAE or ARND, the behavior can appear as mere belligerence or stubbornness. They may score well on intelligence tests, but their behavioral deficits often interfere with their ability to succeed. Extensive education and training for the parents, health care professionals, and teachers who care for these kids are essential.
How Much Alcohol Is Too Much?
It 's clear that abusing alcohol during pregnancy is dangerous, but what about the occasional drink? How much alcohol constitutes too much during pregnancy?
No evidence exists that can determine exactly how much alcohol ingestion will produce birth defects. Individual women process alcohol differently. Other factors vary the results, too, such as the age of the mother, the timing and regularity of the alcohol ingestion, and whether the mother has eaten any food while drinking.
Although full-blown FAS is the result of chronic alcohol use during pregnancy, FAE and ARND may occur with only occasional or binge drinking.
Because alcohol easily passes the placental barrier and the fetus is less equipped to eliminate alcohol than its mother, the fetus tends to receive a high concentration of alcohol, which lingers longer than it would in the mother 's system.
Mothers who drink during the first trimester of pregnancy have kids with the most severe problems because that is when the brain is developing. The connections in the baby 's brain don 't get made properly when alcohol is present. Of course, in the early months, many women don 't even know they 're pregnant.
It 's important for women who are thinking about becoming pregnant to adopt healthy behaviors before they get pregnant.
Women who abstain from alcohol in early pregnancy may feel comfortable drinking in the final months. But some of the most complex developmental stages in the brain occur in the second and third trimesters, a time when the nervous system can be greatly affected by alcohol. Even moderate alcohol intake, and especially periodic binge drinking, can seriously damage a developing nervous system.
Prevention Is the Key
FAS can be completely prevented by not drinking any alcohol during pregnancy.
Reviewed by: Louis E. Bartoshesky, MD, MPH
Date reviewed: November 2011
Originally reviewed by: Linda Nicholson, MS, MC

http://kidshealth.org/parent/medical/brain/fas.html#
09 SEPTEMBER 2013
Foetal alcohol syndrome higher in adopted kids
Children adopted from orphanages or in foster care have a high rate of problems related to alcohol exposure before birth, according to a new review.
Children adopted from orphanages or in foster care have a high rate of foetal alcohol syndrome and other physical, mental and behavioural problems related to alcohol exposure before birth, according to a new review of past studies.
Among those children, researchers found that rates of alcohol-related problems which can include deformities, mental retardation and learning disabilities were anywhere from nine to 60 times higher than in the general population.
"It 's increasingly well recognised that this is a very high-risk population and one that we should really be paying attention to," Phil Fisher, a psychologist who studies foster and adopted children at the University of Oregon in Eugene, said.
"We know that one of the main reasons that kids end up in foster care or being made eligible for adoption is because their parents have substance abuse problems," added Fisher, who wasn 't involved in the new research.
Delayed development
The findings are based on a review of 33 studies of children in the care of child welfare agencies or foster parents, as well as kids before and after their adoption from orphanages.
Most of the studies were conducted in Russia or the United States. Compiling the studies with the most accurate reporting techniques, Dr Svetlana Popova from the Centre for Addiction and Mental Health in Toronto and her colleagues found 6% of children in those settings had foetal alcohol syndrome. The condition includes a distinctive set of facial features, including a small head, jaw and eyes, and other physical developmental defects, especially of the heart.
Slow growth and delayed development after birth are also typical of foetal alcohol syndrome. Close to 17% of the children had a more loosely-defined foetal alcohol spectrum disorder, which covers any physical, mental or behavioural issues caused by prenatal alcohol exposure.
The highest rates of foetal alcohol syndrome were seen among children in a Russian orphanage for kids with special needs and among those adopted from Eastern Europe by families in Sweden.
In those studies, anywhere from 29% to 68% of children showed severe alcohol-related damage. In other cases, such as a study of Chinese children adopted and brought to the United States, there were no reported instances of foetal alcohol syndrome, the study team reported Monday in Pediatrics.
Fisher said it 's important to know that although problems related to alcohol exposure are common among adopted and foster children, not all kids have been exposed and some with prenatal exposure are "quite resilient" and do fine.
Early intervention
"I don 't think anyone wants to create the impression that every child in the foster care system... and every child who 's adopted has very severe problems," he told Reuters Health.
Still, he said there is a need for more recognition of the challenges faced by children who have been exposed to drugs and alcohol in the womb. Rather than focusing only on their obvious current symptoms, he said foetal alcohol disorders should be treated as chronic diseases, like diabetes. "The supports need to be available in an ongoing way," Fisher said.
He also pointed to the importance of identifying children who have some of the effects of drug and alcohol exposure – but not ones as obvious as the distinct facial features seen with foetal alcohol syndrome and getting them support as soon as they enter the child welfare system or are adopted. "If we don 't do the early screening and detection... then I think we 're in a much more challenging position," he said.
"We hope that the results of this study will attract attention to the needs of children in care affected by prenatal alcohol exposure," Popova told Reuters Health in an email. She agreed that spotting problems as soon as possible is important.
"Early screening may lead to early diagnosis, which can lead to early participation in developmental interventions, which can in turn, improve the quality of life for children with a (foetal alcohol spectrum disorder)," she said. Early intervention, Popova added, may also help prevent future mental health problems and trouble in school. http://www.health24.com/Parenting/Child/News/Foetal-alcohol-syndrome-higher-in-adopted-kids-20130909 Definition
By Mayo Clinic staff
Symptoms
By Mayo Clinic staff
When to see a doctor
If you 're pregnant and can 't stop drinking, ask your obstetrician or other health care provider for help.
Because early diagnosis may help reduce the risk of long-term problems for children with FAS, let your child 's doctor know if you drank alcohol while you were pregnant. Don 't wait for problems to arise before seeking help.
If you 've adopted a child or are providing foster care, you may not know if your child 's biological mother drank alcohol while pregnant — and it may not initially occur to you that your child may have fetal alcohol syndrome. However, if your child has learning and behavioral problems, talk with your child 's doctor so that the underlying cause might be identified.
Causes
By Mayo Clinic staff
When you 're pregnant and drink alcohol, it enters your bloodstream and reaches your developing fetus by crossing the placenta. Because a fetus metabolizes alcohol more slowly than an adult does, your developing baby 's blood alcohol concentrations are higher than those in your body. Alcohol also interferes with the delivery of oxygen and optimal nutrition to your baby 's developing tissues and organs, including the brain.
The more you drink while pregnant, the greater the risk to your unborn baby. The risk is present at any time during pregnancy. However, impairment of facial features, the heart and other organs, including the bones, and the central nervous system may occur as a result of drinking alcohol during the first trimester. That 's when these parts of the fetus are in key stages of development. In the early weeks of the first trimester, many women may not be aware that they 're pregnant.
Risk factors
By Mayo Clinic staff
Although doctors aren 't sure how much alcohol you 'd have to drink to place your baby at risk, they do know that the more you drink, the greater the chance of problems. Because there 's no known safe amount of alcohol consumption during pregnancy, don 't drink alcohol if you are or think you are pregnant or you 're attempting to become pregnant. You could put your baby at risk even before you realize you 're pregnant.
Tests and diagnosis
By Mayo Clinic staff
Although doctors can 't diagnose fetal alcohol syndrome before a baby is born, they can assess the health of mother and baby during pregnancy. If you report the timing and amount of alcohol consumption, your obstetrician or other health care provider can help determine the risk of fetal alcohol syndrome.
If you let your child 's doctor know that you drank alcoholic beverages during your pregnancy, he or she can watch for signs and symptoms of this syndrome in your child 's initial weeks, months and years of life. To make a diagnosis, doctors will assess:
Growth
Facial features
Heart health
Hearing
Vision
Cognitive ability
Language development
Motor skills
Behavior
Doctors may refer a child with possible fetal alcohol syndrome to a medical genetics specialist to rule out other disorders with similar signs and symptoms.
If one child in your family is diagnosed with fetal alcohol syndrome, it 's important to evaluate his or her siblings to determine whether they also have fetal alcohol syndrome.
Treatments and drugs
By Mayo Clinic staff
There 's no cure or specific treatment for fetal alcohol syndrome. The physical defects and mental deficiencies typically persist for a lifetime. Heart abnormalities may require surgery. Learning problems may be helped by special services in school. Parents often benefit from counseling to help the family with a child 's behavioral problems.
Coping and support
By Mayo Clinic staff
The psychological and emotional problems associated with fetal alcohol syndrome can be difficult to manage. Families and children with fetal alcohol syndrome may benefit greatly from the support of professionals and other families who have experience with fetal alcohol syndrome. Ask your doctor or public health nurse for local sources of support for families and children with fetal alcohol syndrome. If you know or suspect you have a problem with alcohol or other substances, ask a professional, such as a doctor or a psychologist, for advice.
As a parent of a child with fetal alcohol syndrome, you may find the following suggestions helpful in dealing with behavioral problems associated with the syndrome:
Implement daily routines to which your child can become accustomed.
Create and enforce simple rules and limits.
Point out and use rewards to reinforce acceptable behavior.
Because many children with fetal alcohol syndrome are vulnerable, guard against their being taken advantage of by others.
Teach your child skills for daily living.
Carefully chose who you ask to care for your child when you can 't be there, because some behaviors may be difficult to manage.
A stable, nurturing home is the single most important factor in protecting children with FAS from some of the problems they 're at risk of later in life, including drug abuse, dropping out of school and encounters with the juvenile justice system.
If you 've given birth to a child with fetal alcohol syndrome, you may benefit from substance abuse counseling and treatment programs that can help you overcome your misuse of alcohol.
Prevention
By Mayo Clinic staff
Doctors haven 't identified a safe level of alcohol that a pregnant woman can consume. But experts do know that FAS is completely preventable if women don 't drink alcohol during pregnancy.
These guidelines can help prevent fetal alcohol syndrome:
Don 't drink alcohol if you 're trying to get pregnant, because your baby 's brain, heart and blood vessels begin to develop in the early weeks of pregnancy, before you may know you 're pregnant. If you haven 't already stopped drinking, stop as soon as you know you 're pregnant or if you even think you might be pregnant. It 's never too late to stop drinking during your pregnancy, but the sooner you stop, the better it is for your baby.
Continue to avoid alcohol throughout your pregnancy. Fetal alcohol syndrome is completely preventable in children whose mothers don 't drink during pregnancy.
Consider giving up alcohol during your childbearing years if you 're sexually active and you 're having unprotected sex. Many pregnancies are unplanned, and damage can occur in the earliest weeks of pregnancy.
If you have an alcohol problem, get help before you get pregnant. Get professional help to determine your level of dependence on alcohol and to develop a treatment plan. http://www.mayoclinic.com/health/fetal-alcohol-syndrome/DS00184/DSECTION=prevention Fetal alcohol syndrome
Alcohol in pregnancy; Alcohol-related birth defects; Fetal alcohol effects; FAS
Last reviewed: August 8, 2012.
Fetal alcohol syndrome is growth, mental, and physical problems that may occur in a baby when a mother drinks alcohol during pregnancy.
Causes, incidence, and risk factors
Using or abusing alcohol during pregnancy can cause the same risks as using alcohol in general. However, it poses extra risks to the unborn baby. When a pregnant woman drinks alcohol, it easily passes across the placenta to the fetus. Because of this, drinking alcohol can harm the baby 's development.
A pregnant woman who drinks any amount of alcohol is at risk for having a child with fetal alcohol syndrome. No "safe" level of alcohol use during pregnancy has been established. Larger amounts of alcohol appear to increase the problems. Binge drinking is more harmful than drinking small amounts of alcohol.
Timing of alcohol use during pregnancy is also important. Alcohol use appears to be the most harmful during the first 3 months of pregnancy; however, drinking alcohol any time during pregnancy can be harmful.
Symptoms
A baby with fetal alcohol syndrome may have the following symptoms:
Poor growth while the baby is in the womb and after birth
Decreased muscle tone and poor coordination
Delayed development and problems in three or more major areas: thinking, speech, movement, or social skills
Heart defects such as ventricular septal defect (VSD) or atrial septal defect (ASD)
Problems with the face, including:
Narrow, small eyes with large epicanthal folds
Small head
Small upper jaw
Smooth groove in upper lip
Smooth and thin upper lip
Signs and tests
A physical exam of the baby may show a heart murmur or other heart problems. As the baby grows, there may be signs of delayed mental development. There also may be problems with the face and bones.
Tests include:
Blood alcohol level in pregnant women who show signs of being drunk (intoxicated)
Brain imaging studies (CT or MRI) after the child is born
Pregnancy ultrasound
Treatment
Women who are pregnant or who are trying to get pregnant should avoid drinking any amount of alcohol. Pregnant women with alcoholism should join an alcohol abuse rehabilitation program and be checked closely by a health care provider throughout pregnancy.
Support Groups
The following organizations may offer assistance:
National Council on Alcoholism and Drug Dependency -- www.ncadd.org
National Drug and Alcohol Treatment Referral Routing Service -- 1-800-662-4357
The following organizations are good resources for information on alcoholism:
Alcoholics Anonymous - www.alcoholics-anonymous.org
Al-Anon/Alateen - www.al-anon.org
National Institute on Alcohol Abuse and Alcoholism - www.niaaa.nih.gov/
Substance Abuse and Mental Health Services Administration - www.samhsa.gov
Expectations (prognosis)
The outcome for infants with fetal alcohol syndrome varies. Almost none of these babies have normal brain development.
Infants and children with fetal alcohol syndrome have many different problems, which can be difficult to manage. Children do best if they are diagnosed early and referred to a team of health care providers who can work on educational and behavioral strategies that fit the child 's needs.
Complications
Drinking alcohol during pregnancy may result in:
Miscarriage or stillbirth
Premature delivery
Complications seen in the infant may include:
Abnormal heart structure
Behavior problems
Infant death
Intellectual disability
Problems in the structure of the head, eyes, nose, or mouth
Poor growth before birth
Slow growth and poor coordination after birth
Calling your health care provider
Call for an appointment with your health care provider if you are drinking alcohol regularly or heavily, and are finding it difficult to cut back or stop. Also, call if you are drinking alcohol in any amount while you are pregnant or trying to get pregnant.
Prevention
Avoiding alcohol during pregnancy prevents fetal alcohol syndrome. Counseling can help women who have already had a child with fetal alcohol syndrome.
Sexually active women who drink heavily should use birth control and control their drinking behaviors, or stop using alcohol before trying to get pregnant. References
1. Carlo WA. Fetal alcohol syndrome. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 100.2.
2. Cunningham FG, Leveno KJ, Bloom SL, et al. Teratology and medications that affect the fetus. In: Cunningham FG, Leveno KJ, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 14. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001909/ What is Fetal Alcohol Syndrome?
Fetal alcohol syndrome (FAS) is a serious health problem that tragically affects its victims and their families, but that is completely preventable. Causing a child to suffer from fetal alcohol syndrome is really nothing short of child abuse and it lasts for life. Babies born with FAS tend to weigh less and be shorter than normal. They usually suffer from: smaller heads deformed facial features abnormal joints and limbs poor coordination problems with learning short memories 1
Victims of fetal alcohol syndrome often experience mental health problems, disrupted school experience, inappropriate sexual behavior, trouble with the law, alcohol and drug problems, difficulty caring for themselves and their children, and homelessness. 2 http://www2.potsdam.edu/hansondj/FetalAlcoholSyndrome.html Fetal Alcohol Syndrome
Fetal alcohol syndrome (FAS) is the more severe end of a continuum of birth defects known as fetal alcohol spectrum disorders (FASDs).
Fetal alcohol effects (FAEs), otherwise known as alcohol-related birth defects (ARBDs), may represent the milder end of the spectrum.
Other terms for conditions which come under the umbrella of FASD are alcohol-related neuro-developmental disorder (ARND) and partial fetal alcohol syndrome (pFAS). These are caused by maternal use of alcohol during pregnancy.
There are three main components of FAS:
Typical facial abnormalities
Intrauterine growth restriction and failure to catch up
Neuro-developmental abnormalities causing learning disability, cognitive impairment and behavioural problems
Epidemiology
Alcohol is the most common teratogen affecting humans. It is rated as the most common non-genetic cause of mental and behavioural problems in children.[1] Exact numbers are difficult to define in this spectrum of disorder and there are no accurate figures for prevalence in the UK. This is due to a number of factors, including the differing definitions and conditions along the spectrum, the poor accuracy in self-reporting of alcohol consumption, lack of standardisation of levels of drinking, reluctance to make or accept the diagnosis, and paucity of reliable data collection. Most figures come from the USA, where it is estimated that FAS occurs in 0.5-2 live births per 1,000 and fetal alcohol spectrum conditions occur at least three times as often as this.[2]
There is much difference between communities, depending on habits and tradition. Studies across the world have shown vastly different figures for incidence of FASD as high as 40 per 1,000 children in Italy, and 89 per 1,000 in the Western Cape province in South Africa.[1]
Risk factors
The sole risk factor is maternal consumption of alcohol during pregnancy. Alcohol is a teratogenic substance which crosses the placenta with ease. Development of the fetus can be affected by alcohol at any stage. Different effects may occur depending on the stage of exposure, however.[3]
Not all women who drink heavily during pregnancy have babies with FAS, and it is clear that other factors affect the vulnerability of the fetus. These include the stage of pregnancy affected, the pattern of drinking, the health, age, stress levels and nutritional status of the mother and the use of other toxic substances, including tobacco.[1] Genetic makeup and gene polymorphisms also affect fetal vulnerability for FAS, and other genetic abnormalities can be confused with FAS.[4]
There has been enormous debate about the safe level of alcohol in pregnancy; there have also been many studies to try to ascertain the effects of different levels and patterns of drinking. National Institute for Health and Care Excellence (NICE) guidelines on antenatal care detail some of these, and attempt recommendations on the basis of them.[5] Studies are not conclusive and many feel total abstinence is the safest advice.[6] In the UK, NICE guidelines, the British Medical Association (BMA) guidance and the Royal College of Obstetricians and Gynaecologists (RCOG) statement concur that women should be advised to abstain if possible in view of the uncertainty, and in particular in the first three months, due to the increased risk of miscarriage.[7] If women choose to drink alcohol, they are advised to have no more than 1-2 units of alcohol no more than 1-2 times a week, as there is no evidence of harm at this level. They are also advised that binge drinking may harm the baby.
The fact of alcohol abuse may not be known to others. Alcoholism, diagnosis and treatment in primary care can be very difficult and self-reported levels of consumption must be treated with circumspection.
Clinical features
Diagnosis of FAS and FASD is difficult. There is no test, so diagnosis depends on a history or suspicion of in-utero alcohol exposure, and the presence of typical clinical features. Criteria for diagnosis vary, and are better defined for FAS than other conditions within the spectrum, so it is not surprising that prevalence figures are a challenge to establish.
Failure of growth
Weight, length and head circumference are all reduced and, whilst the infant who has suffered from placental insufficiency tends to emerge ravenous and eagerly feeds to restore weight, the child with FAS remains stunted for life. Adequate nutrition and a caring environment are not enough to reverse the damage.
Craniofacial abnormalities
These may include any permutation of the following:
Microcephaly (small head)
Flat philtrum (flattening of the groove under the nose)
Thin upper lip
Retrognathia in infancy, micrognathia or relative prognathism in adolescence and a low nasal bridge
Microphthalmia, strabismus, ptosis and short palpebral fissures
Cleft palate - may occur
Posterior rotation of the ears
Neuro-developmental abnormalities
These may include:
Low IQ, but can be normal or even higher than average
Hyperactivity
Attention deficits
Memory problems
Problems with perceiving consequences, and inability to learn from experience. Poor judgement
Poor problem-solving skills
Immature behaviour. Poor social skills and lack of control of impulsive behaviour
Poor co-ordination
Speech and language delay
Difficulty with concepts such as maths, money and time
Sucking and feeding problems in the neonate. Occasionally, features of delirium tremens due to alcohol withdrawal
These first three categories of abnormality are the classic triad of FAS, but alcohol may have had further effects on the developing fetus, including:
Musculoskeletal abnormalities
These range from contractures of the finger joints to more severe lesions, such asdevelopmental dysplasia of the hip and abnormalities of the thoracic cage.
Urogenital abnormalities
These include cryptorchidism and hypoplastic labia as well as other abnormalities of the kidneys and urinary tract.
Cardiac abnormalities
Congenital heart disease is common in children with FASD.[8] The most common problems are atrial septal defects and ventricular septal defects but more complex and even lethal lesions may arise.
Hearing and visual impairments
There may be partial deafness and significant visual disability.
Some of these features can be measured and ranked by criteria such as the 4-Digit diagnostic code; however, there are several different systems with differing criteria.[9]Moreover, some of these guidelines cover FAS, whereas others address the full FASD continuum.[1]
PatientPlus
Alcohol-related Problems
Other conditions within the fetal alcohol spectrum disorder definition
The scale of the problem of the FASD as a whole is difficult to determine, as it may not be recognised as such without the classic criteria for FAS (ie growth restriction, typical facial anomalies, neuro-developmental abnormalities). The milder cases may be less likely to be diagnosed. The conditions under this umbrella describe any of the disabilities which may be caused by maternal drinking in pregnancy, and which may occur in isolation or as more than one.
Conditions on the lower end of the spectrum compared to FAS include pFAS, FAE or ARBDs, and ARND. Clinical features of these conditions are less well defined.
Prognosis
As children with FAS mature into adolescence and adulthood the craniofacial deformities become less noticeable but the short stature and microcephaly remain.
There may be more likelihood of other stresses and major life events in a childhood of a baby born to a mother who drinks heavily, which may further affect them. Educational achievement may be extremely limited. Children with FAS are more likely to have been in trouble in school and have poor relationships and, as they grow up, be more likely to be in trouble with the law, have inappropriate sexual relationships, mental health issues, addictive behaviours, and difficulty living independently. Impulsivity, poor judgement and lack of comprehension cause adults born with FAS to experience major psychosocial and adjustment problems for the rest of their lives.
Factors improving outcome include early recognition and diagnosis, support, a stable home life, a lower IQ, which may make the disability more apparent and make the patient less vulnerable to expectation of normality.[2]
Prevention
Both FAS and FAEs are entirely preventable. The pattern of alcohol consumption in this country has shown a marked rise since 1990 in total intake and in binge drinking, especially amongst young women, although the trend showed some reduction from 2006 in the latest report from the Office for National Statistics.[10] These figures also show that the vast majority of women do not drink more than the guidelines recommend during pregnancy. Health promotion must continue to emphasise the need for moderation, if not complete abstinence, perhaps from before conception. Doctors, midwives and even nurses giving advice about family planning must emphasise the dangers of alcohol in pregnancy.[11] The social and economic costs are enormous. The dangers of alcohol in pregnancy must be as well known as the dangers of smoking.
Historical note
Alcohol has been used and abused since antiquity, but FAS was unrecognised until it was first described in France in 1968 and again in the USA in 1973. That is not to suggest that problems were previously unnoticed. During the 'gin epidemic a report from the Royal College of Physicians in 1725 noted that 'weak, feeble and distempered children ' were the result. In 1834 a parliamentary report 'Effects of Drunkenness on the Nation ' remarked that children tend to be 'born starved, shrivelled and imperfect in form '.
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Further reading & references
Fetal Alcohol Syndrome Information Website (FAS Info)
1. Fetal alcohol spectrum disorders. A guide for healthcare professionals; BMA Board of Science, 2007
2. Fetal Alcohol Spectrum Disorders; Centers for Disease Control and Prevention
3. Blackburn C et al; Facing the challenge and shaping the future for primary and secondary aged students with Foetal Alcohol Spectrum Disorders (FAS-eDProject) Literature Review, National Organisation on Fetal Alcohol Syndrome UK, September 2009
4. Warren KR, Li TK; Genetic polymorphisms: impact on the risk of fetal alcohol spectrum disorders. Birth Defects Res A Clin Mol Teratol. 2005 Apr;73(4):195-203.
5. Antenatal care: routine care for the healthy pregnant woman; NICE Clinical Guideline (March 2008)
6. Mukherjee RA, Hollins S, Abou-Saleh MT, et al; Low level alcohol consumption and the fetus. BMJ. 2005 Feb 19;330(7488):375-6.
7. Alcohol Consumption and the Outcomes of Pregnancy; Royal College of Gynaecologists, March 2006
8. Burd L, Deal E, Rios R, et al; Congenital heart defects and fetal alcohol spectrum disorders. Congenit Heart Dis. 2007 Jul-Aug;2(4):250-5. doi: 10.1111/j.1747-0803.2007.00105.x.
9. Astley SJ; Comparison of the 4-digit diagnostic code and the Hoyme diagnostic guidelines for fetal alcohol spectrum disorders. Pediatrics. 2006 Oct;118(4):1532-45.
10. A report on the 2011 general lifestyle survey - Chapter 2: Drinking, Office for National Statistics (March 2013)
11. Walker DS, Fisher CS, Sherman A, et al; Fetal alcohol spectrum disorders prevention: an exploratory study of women 's use of, attitudes toward, and knowledge about alcohol. J Am Acad Nurse Pract. 2005 May;17(5):187-93.
Original Author: Dr Hayley Willacy
Current Version: Dr Mary Harding
Peer Reviewer: Dr Hayley Willacy
Last Checked: 12/08/2013
Document ID: 2146 Version: 22
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