Fetal Alcohol Spectrum Disorders

When pregnant women drink alcohol, any amount, at any time during their pregnancy, they are putting their developing babies at risk for lifelong problems that range from physical birth defects to developmental, learning, and behavioral abnormalities. That is the message of a Clinical Report just released by the American Academy of Pediatrics.

Research has determined that there is no safe amount of alcohol use during pregnancy. Nor is there a safe trimester for drinking. According to the report, “Prenatal exposure to alcohol can damage the developing fetus and is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities.”

The risk is the same regardless of the forms of alcohol, from beer and wine to liquor.

Drinking in the first trimester makes it 12 times likelier a woman will give birth to a child with Fetal Alcohol Spectrum Disorder. This risk increased to 61 times the odds when drinking occurs in the second trimester. The risk is the same regardless of the forms of alcohol, from beer and wine to liquor.

The term, Fetal Alcohol Spectrum Disorders (FASD), encompasses the entire range of diagnoses that are known to be related to alcohol intake during pregnancy.

Fetal Alcohol Syndrome (FAS) is diagnosed when an infant has (a) poor growth either during gestation or after birth,(b) a characteristic appearance to the face affecting the size of the eyes and the area around the upper lip and nose, and (c) specific neurologic abnormalities.

However, not all children exposed to alcohol prenatally show this highly recognized presentation, even though their brains have been affected by exposure to alcohol in the womb. This has led to under-diagnosis of FASD, so there is the need for more descriptive categories.

The sub-category of Alcohol Related Birth Defects (ARBD) includes children who have had prenatal exposure to alcohol and have certain characteristic physical malformations and congenital anomalies that affect their organ systems but they have normal neurodevelopment.

FASD is completely preventable but once it occurs, it is not curable.

In contrast, Alcohol Related Neurodevelopmental Disorders (ARND) refer to those children who may not show characteristic physical abnormalities but they have a history of alcohol exposure and manifest problems with development and behavior.

Prenatal alcohol exposure is also known to cause small head size, underdevelopment of the jaw, and cleft palate. It affects the functions of parts of the brain, as well as other organs, including heart and blood vessels, kidney, bones and muscles, vision, and hearing systems. Research has also shown that alcohol exposure impacts the size of the brain and its sub-structures.

The developmental, behavioral, and thinking problems that occur in prenatally alcohol-exposed individuals last a lifetime. They cause academic and behavioral problems in early life and prevent adults from achieving their full potential in society. They range from subtle learning problems to significant intellectual disability and lower IQs.

Attention deficit disorder occurs more often among those with FASD; so do poor memory, poor reasoning and problem solving skills. Children and adults with FASD process information more slowly and have greater difficulty using language to express their thoughts and needs. These problems impair children's social interactions and relationships with friends, family, teachers, and colleagues.

Individuals with FASD have a higher incidence of psychiatric, emotional, and behavioral problems than the general population — just like other people with intellectual disabilities. They are highly likely to experience anxiety depression, substance use, addiction and suicide. They also have higher rates of behavioral disturbances at school, trouble with the law, and are often either underemployed or unemployed.

FASD is completely preventable, but once it occurs is not curable. Accurate identification of the syndrome can help patients and their families by providing them with education, interventions, and support. Parents can learn to manage behaviors; schools can offer educational interventions. Social settings that maximize the individual's strengths can also have helpful impact on their long-term outcome.

Women who are trying to become pregnant and those who are having unprotected intercourse and are not trying to avoid pregnancy should consider abstaining from alcohol to avoid exposing a newly developing fetus.

Sometimes medications can be helpful, but there is no one drug or class of drugs that is predictably effective for all individuals. Those with FASD must have their care individually tailored to meet their constellation of symptoms. They are served best by multidisciplinary teams addressing medical, social, educational, and emotional needs.

Reassessment of their status and modifications in recommendations will be required throughout their lives, as the disabilities associated with FASD will manifest in different ways at different life stages, and the challenges to the individual and their families will change as well.

This spectrum of defects and problems related to alcohol are completely preventable by abstaining from alcohol use during pregnancy. Unfortunately, alcohol use is highly prevalent among women of child bearing age in the United States and women may not realize that they are pregnant until they are several weeks along.

Women who are trying to become pregnant and those who are having unprotected intercourse and are not trying to avoid pregnancy should consider abstaining from alcohol to avoid exposing a newly developing fetus. Again, there is no safe amount of alcohol to consume during pregnancy and there is no safe trimester for its consumption.