Fetal alcohol syndrome

What is fetal alcohol syndrome and fetal alcohol spectrum disorders?
Fetal alcohol spectrum disorders are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can include physical problems and problems with behavior and learning. Often, a person with an fetal alcohol spectrum disorders has a mix of these problems.

Cause and prevention
Fetal alcohol spectrum disorders are caused by a woman drinking alcohol during pregnancy. Alcohol in the mother’s blood passes to the baby through the umbilical cord. When a woman drinks alcohol, so does her baby.

There is no known safe amount of alcohol during pregnancy or when trying to get pregnant. There is also no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she’s pregnant. All types of alcohol are equally harmful, including all wines and beer.

To prevent fetal alcohol spectrum disorders, a woman should not drink alcohol while she is pregnant, or when she might get pregnant. This is because a woman could get pregnant and not know for up to 4 to 6 weeks. In the United States, nearly half of pregnancies are unplanned.

If a woman is drinking alcohol during pregnancy, it is never too late to stop drinking. Because brain growth takes place throughout pregnancy, the sooner a woman stops drinking the safer it will be for her and her baby. Resources are available here.

Fetal alcohol spectrum disorders are completely preventable if a woman does not drink alcohol during pregnancy—so why take the risk?

Signs and symptoms
Fetal alcohol spectrum disorders refer to the whole range of effects that can happen to a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways, and can range from mild to severe.

A person with an fetal alcohol spectrum disorders might have:

• Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
• Small head size
• Shorter-than-average height
• Low body weight
• Poor coordination
• Hyperactive behavior
• Difficulty with attention
• Poor memory
• Difficulty in school (especially with math)
• Learning disabilities
• Speech and language delays
• Intellectual disability or low IQ
• Poor reasoning and judgment skills
• Sleep and sucking problems as a baby
• Vision or hearing problems
• Problems with the heart, kidneys, or bones

Types of fetal alcohol spectrum disorders
Different terms are used to describe fetal alcohol spectrum disorders, depending on the type of symptoms.

• Fetal alcohol syndrome: Fetal alcohol syndrome represents the most involved end of the fetal alcohol spectrum disorder spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with fetal alcohol syndrome might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with fetal alcohol syndrome can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with fetal alcohol syndrome often have a hard time in school and trouble getting along with others.
• Alcohol-related neurodevelopmental disorder: People with alcohol-related neurodevelopmental disorder might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.
• Alcohol-related birth defects: People with alcohol-related birth defects might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.

The term fetal alcohol effects (FAE) was previously used to describe intellectual disabilities and problems with behavior and learning in a person whose mother drank alcohol during pregnancy. In 1996, the Institute of Medicine (IOM) replaced FAE with the terms alcohol-related neurodevelopmental disorder and alcohol-related birth defects.

• Neurobehavioral disorder associated with prenatal alcohol exposure: Neurobehavioral disorder associated with prenatal alcohol exposure was first included as a recognized condition in the Diagnostic and Statistical Manual 5 (DSM 5) of the American Psychiatric Association (APA) in 2013. A child or youth with neurobehavioral disorder associated with prenatal alcohol exposure will have problems in three areas: (1) thinking and memory, where the child may have trouble planning or may forget material he or she has already learned, (2) behavior problems, such as severe tantrums, mood issues (for example, irritability), and difficulty shifting attention from one task to another, and (3) trouble with day-to-day living, which can include problems with bathing, dressing for the weather, and playing with other children. In addition, to be diagnosed with neurobehavioral disorder associated with prenatal alcohol exposure, the mother of the child must have consumed more than minimal levels of alcohol before the child’s birth, which APA defines as more than 13 alcoholic drinks per month of pregnancy (that is, any 30-day period of pregnancy) or more than 2 alcoholic drinks in one sitting.

Diagnosis
The term fetal alcohol spectrum disorders is not meant for use as a clinical diagnosis. CDC worked with a group of experts and organizations to review the research and develop guidelines for diagnosing fetal alcohol syndrome. The guidelines were developed for fetal alcohol syndrome only. CDC and its partners are working to put together diagnostic criteria for other fetal alcohol spectrum disorders, such as alcohol-related neurodevelopmental disorder. Clinical and scientific research on these conditions is going on now.

Diagnosing fetal alcohol syndrome can be hard because there is no medical test, like a blood test, for it. And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like fetal alcohol syndrome.

To diagnose fetal alcohol syndrome, doctors look for:

Abnormal facial features (e.g., smooth ridge between nose and upper lip)

Lower-than-average height, weight, or both

Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination)

Prenatal alcohol exposure; although confirmation is not required to make a diagnosis

Treatment
Fetal alcohol spectrum disorders last a lifetime. There is no cure for fetal alcohol spectrum disorders, but research shows that early intervention treatment services can improve a child’s development.

There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches. No one treatment is right for every child. Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.

Also, “protective factors” can help reduce the effects of fetal alcohol spectrum disorders and help people with these conditions reach their full potential.1, 2

Protective factors include:

Diagnosis before 6 years of age

Loving, nurturing, and stable home environment during the school years

Absence of violence

Involvement in special education and social services

Get Help!
If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about fetal alcohol spectrum disorders), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with fetal alcohol spectrum disorders. To find doctors and clinics in your area visit the National and State Resource Directory from the National Organization on Fetal Alcohol Syndrome (NOFAS).

At the same time as you ask the doctor for a referral to a specialist, call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

If your child is younger than 3 years old, contact your local early intervention system.

If your child is 3 years old or older, contact your local public school system.

Even if your child is not old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.

If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about fetal alcohol spectrum disorders), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with fetal alcohol spectrum disorders.

This information was developed by the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental and Disabilities.

Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental and Disabilities Fetal Alcohol Spectrum Disroders. Available at: https://www.cdc.gov/ncbddd/fasd/facts.html. Last accessed December 6, 2017.

The information in this document is for general educational purposes only. It is not intended to substitute for personalized professional advice. Although the information was obtained from sources believed to be reliable, MedLink LLC, its representatives, and the providers of the information do not guarantee its accuracy and disclaim responsibility for adverse consequences resulting from its use. For further information, consult a physician and the organization referred to herein.