Fetal Alcohol Syndrome (FAS)

  • Medical Author:
    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Fetal alcohol syndrome (FAS) facts

  • Combined 2011 to 2012 data from the National Survey on Drug Use and Health (NSDUH) show that 8.5 percent of pregnant women aged 15 to 44 drank alcohol in the past month. Also, 2.7 percent binge drank. Among women aged 15 to 44 who were not pregnant, 55.5 percent drank alcohol in the past month, and 24.7 percent binge drank. Most alcohol use by pregnant women occurred during the first trimester. Alcohol use was lower during the second and third trimesters than during the first (4.2 and 3.7 percent vs. 17.9 percent). These findings suggest that many pregnant women are getting the message and not drinking alcohol.
  • Infants of mothers who drank during pregnancy may experience a spectrum of consequences that range from "fetal alcohol effects" (FAE), alcohol-related birth defects (ARBD), and fetal alcohol syndrome (FAS). Fetal alcohol syndrome is regarded as the most severe.
  • Some children sustain no obvious side effects of maternal alcohol consumption during pregnancy.

What is fetal alcohol syndrome?

To establish the diagnosis of fetal alcohol syndrome, specific criteria must be met. These include (1) documentation of three characteristic facial abnormalities, (2) documentation of smaller than expected prenatal and/or postnatal length, weight, and head circumference growth parameters, and (3) documentation of central nervous system abnormalities. These criteria will be further described later in this article.

What causes fetal alcohol syndrome?

Alcohol is rapidly transported via placental blood flow from mother to fetus and is known to cause miscarriage and birth defects. Within two hours of maternal ingestion, fetal alcohol blood levels are similar to maternal alcohol blood levels. There is no established relationship between the amount of alcohol consumed and side effects sustained by the infant. This puzzling observation may reflect the maternal rate of alcohol breakdown via her liver.

It has been observed that alcohol consumed at any time during pregnancy may be associated with severe and permanent consequences. First trimester pregnancy alcohol ingestion is linked to the characteristic facial abnormalities of FAS as well as a reduction of intrauterine growth rate. Alcohol consumption during the second trimester also contributes to lower IQ, growth retardation in length and birth weight, as well as cognitive deficits of reading, spelling, and math. Third trimester alcohol consumption amplifies retardation in birth length and ultimate adult height potential.

Fetal Alcohol Syndrome Treatment for Children

Behavior and Education Therapy

Behavior and education therapy can be an important part of treatment for children with FASDs. Although there are many different types of therapy for children with developmental disabilities, only a few have been scientifically tested specifically for children with FASDs.

Following are behavior and education therapies that have been shown to be effective for some children with FASDs:

  • Friendship training
    Many children with FASDs have a hard time making friends, keeping friends, and socializing with others. Friendship training teaches children with FASDs how to interact with friends, how to enter a group of children already playing, how to arrange and handle in-home play dates, and how to avoid and work out conflicts. A research study found that this type of training could significantly improve children's social skills and reduce problem behaviors.
  • Specialized math tutoring
    A research study found that special teaching methods and tools can help improve math knowledge and skills in children with FASDs.
  • Executive functioning training
    This type of training teaches behavioral awareness and self-control and improves executive functioning skills, such as memory, cause and effect, reasoning, planning, and problem solving.
  • Parent-child interaction therapy
    This type of therapy aims to improve parent-child relationships, create a positive discipline program, and reduce behavior problems in children with FASDs. Parents learn new skills from a coach. A research study found significant decrease in parent distress and child behavior problems.
  • Parenting and behavior management training
    The behavior and learning problems that affect children with FASDs can lead to high levels of stress for the children's parents. This training can improve caregiver comfort, meet family needs, and reduce child problem behaviors.

SOURCE:
U.S. Centers for Disease Control and Prevention

What are risk factors for fetal alcohol syndrome?

The Surgeon General and the Secretary for Health and Human Services recommend total abstinence from alcohol for women planning pregnancy, at the time of conception and throughout the entire pregnancy. No safe level of prenatal alcohol consumption has been documented. Multiple other countries have established similar guidelines.

Other risk factors include the following:

  1. Binge drinking (four or more drinks in one sitting) is more problematic than consumption of the same amount of alcohol spread out over time (such as four back-to-back drinks at one sitting vs. one drink per day for four days).
  2. Older maternal age (over 35 years old)
  3. African-American or Native-American ethnic groups and a listing of many varied background elements (lower socioeconomic status, smoking, unmarried, unemployed, use of illicit drugs, maternal history of sexual or physical abuse, history of incarceration, having a partner or family member who drinks heavily and experiencing psychological stress or having a mental-health disorder)

What are symptoms and signs of fetal alcohol syndrome?

Infants with the diagnostic criteria to establish fetal alcohol syndrome exhibit the following characteristic findings:

  1. Unique facial characteristics: a thin upper lip; a uniquely smooth ridge between the upper lip and nose (the "philtrum"); and a smaller than normal space between the upper and lower eyelids ("palpebral fissure")
  2. Growth delay: smaller than expected length, weight, and head circumference measurements during both intrauterine and post-birth growth
  3. Central nervous system abnormalities: (a) structural (small brain size and slower than expected growth); (b) functional (global developmental delay in motor skills, language acquisition and utilization, problems with attention/hyperactivity, social skill deficiencies, etc.)

How do physicians diagnose fetal alcohol syndrome?

The risk for potential fetal alcohol syndrome is established during the first prenatal visit. Pregnant women are questioned regarding behavioral risk factors, including illicit drug usage, alcohol consumption, smoking, and other high-risk behaviors. Several screening questionnaires may be utilized; these include (1) T-ACE, (2) TWEAK, and (3) AUDIT-C. There are several laboratory blood studies that may indicate recent use or repeated and excessive alcohol abuse.

Prenatal indicators for potential alcohol use would note smaller than expected growth in length, weight, and head measurements. Slower than expected head growth is a reflection of subnormal brain growth. Once born, the above-noted facial changes will lead the pediatrician to consideration of the diagnosis of FAS. The myriad of developmental and cognitive delays discussed above will also stimulate consideration of FAS in children who are failing in cognitive advancement or with associated behavioral deficiencies.

What is the treatment for fetal alcohol syndrome?

While no cure exists for fetal alcohol syndrome, early intervention programs have been shown to lessen the impact of language, motor, and cognitive impairments. Such aggressive programs utilize physical therapy, occupational therapy, speech therapy, and educational therapy to maximize benefit. Adolescents and adults may benefit from programs dealing with academic, legal, and psychiatric problems.

What are the complications and long-term effects of fetal alcohol syndrome?

Many of the issues faced by infants and children with FAS continue into adolescence and adulthood. These may include:

  1. problems with "regulation" (sleeping, attention and arousal),
  2. learning disorders,
  3. impairment with vision and hearing,
  4. mental retardation, and
  5. deficits in memory and reasoning.

More unique to adolescents and adults are issues with sexual behavior, legal problems, and substance abuse. It is often observed that the characteristic facial features noted in infancy and childhood seem to "soften" with age. A small-sized head and short stature do continue into adulthood.

What is the prognosis of fetal alcohol syndrome?

As noted in the above discussion, an individual with FAS may experience a lifelong litany of both physical and intellectual challenges. Early intervention programs and multi-therapy programs (including physical therapy) may often lessen the impact of the diagnosis.

Is it possible to prevent fetal alcohol syndrome?

Yes! Avoid all alcohol consumption while planning for conception and during pregnancy.

Is it safe to consume alcohol and breastfeed?

The concentration of alcohol in breast milk is very similar to maternal blood levels. Potential consequences include a reduction in breast milk consumption, alteration of newborn sleep and wake cycles, and possible delay of motor development at 1 year of age.

Where can people find more information about fetal alcohol syndrome?

Centers for Disease Control and Prevention, "Fetal Alcohol Spectrum Disorders (FASDs)"

Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCES:

Lyons Jones, Kenneth, et al. Smith's Recognizable Patterns of Human Malformation, 5th ed. Philadelphia, Pa: WB Saunders Co, 1997.

United States. Centers for Disease Control and Prevention. "Fetal Alcohol Spectrum Disorders (FASDs)." Jan. 30, 2014. <http://www.cdc.gov/ncbddd/fasd/index.html>.

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Reviewed on 11/20/2015
References
Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCES:

Lyons Jones, Kenneth, et al. Smith's Recognizable Patterns of Human Malformation, 5th ed. Philadelphia, Pa: WB Saunders Co, 1997.

United States. Centers for Disease Control and Prevention. "Fetal Alcohol Spectrum Disorders (FASDs)." Jan. 30, 2014. <http://www.cdc.gov/ncbddd/fasd/index.html>.

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