Fetal Alcohol Syndrome
What is fetal alcohol syndrome (FAS)?
A syndrome is a group of symptoms that occur together as the result of a particular disease or abnormal condition. The symptoms present in fetal alcohol syndrome (FAS) are at the most serious end of what are known as fetal alcohol spectrum disorders (FASDs). An FASD is found in those whose mother drank alcohol during pregnancy. An FASD can include physical, behavioral, and learning problems.
Besides FAS, the other FASDs are alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD).
How common is fetal alcohol syndrome (FAS)?
There are no exact statistics of how many people have an FASD. However, scientists believe there are three times more cases of FASD than FAS.
According to the Centers for Disease Control, 0.2 to 1.5 cases of FAS occur in every 1,000 live births in certain areas of the United States. Other studies using different measurements estimate a rate of 0.5 to 2.0 cases of FAS per 1,000 live births.
The lifetime cost to care for one person with FAS in 2002 was estimated at $2 million, with a total cost in the United States of more than $4 billion per year.
Symptoms and Causes
What causes fetal alcohol syndrome (FAS)?
The cause of FAS is a woman drinking alcoholic beverages during pregnancy. This includes not only “hard liquor” but beer and wine, as well. Whatever alcohol is in a pregnant woman’s bloodstream will pass to the developing baby (fetus) through the umbilical cord. The fetus is not able to process alcohol through the liver or other organs, so it is exposed to the same amount of alcohol as is present in the mother’s bloodstream, and for a longer period of time.
Alcohol can interfere with the normal development of the fetus, particularly the brain and central nervous system. This occurs in any of the following ways:
- Alcohol can kill cells in different parts of the fetus, causing abnormal physical development.
- Alcohol interferes with the way nerve cells develop, how they travel to form different parts of the brain, and their functioning.
- Alcohol constricts blood vessels, which slows blood flow to the placenta (the fluid-filled sac in which the fetus develops). This causes a shortage of oxygen and nutrients to the fetus.
- Toxic byproducts are produced when the body processes alcohol. These may then concentrate in and damage brain cells of the fetus.
What are the symptoms of FASD?
Someone with a FASD may have just a few or many symptoms, and these symptoms can range in intensity from mild to severe. Different terms are used to describe the FASDs, depending on which symptoms are present.
Fetal Alcohol Syndrome (FAS) is at the most severe end of the FASD spectrum. People with FAS can display any number of the following symptoms:
- Abnormal facial features, particularly a smooth ridge between the nose and upper lip.
- Small head size.
- Short height.
- Low body weight.
- Poor coordination.
- Difficulty concentrating and short attention span.
- Difficulty telling the difference between reality and fantasy.
- Poor short-term memory.
- Poor school performance.
- Learning disabilities.
- Delayed speech and language development.
- Low IQ.
- Poor reasoning and judgment skills.
- Sleep and sucking difficulties as an infant.
- Vision or hearing problems.
Alcohol-Related Neurodevelopmental Disorders (ARND)
- Intellectual disabilities.
- Learning problems.
- Behavior problems.
- Difficulties in school.
- Trouble learning math.
- Poor memory.
- Short attention span.
- Poor judgment.
- Acting impulsively.
Alcohol-Related Birth Defects (ARBD)
- Problems with the heart, kidneys, or bones.
- Problems with hearing.
Diagnosis and Tests
How is fetal alcohol syndrome (FAS) diagnosed?
Making a diagnosis of FAS can be difficult because there are no particular medical tests or procedures available to make such a determination. In addition, some of the symptoms of FAS resemble those found in other disorders such as attention-deficit/hyperactivity disorder (ADHD) and Williams syndrome.
The main clues to the presence of FAS are:
- Abnormal facial features, such as a smooth ridge between nose and upper lip.
- Lower than average height and weight.
- Problems affecting the central nervous system, such as small head size, difficulty paying attention, hyperactivity, and poor coordination.
- Alcoholic beverage consumption by the mother during pregnancy.
Management and Treatment
How is fetal alcohol syndrome (FAS) treated?
The effects of FAS last a lifetime. However, early treatment can improve a child’s development. Treatment options include:
- Medications to treat some symptoms.
- Behavior and education therapy.
- Parental training.
There are also certain “protective factors” that help reduce the negative impact of FAS on a child:
- Diagnosis before the age of 6.
- A loving, supportive, stable home environment during the school years.
- Absence of violence in the child’s life.
- Use of special education and social services.
How can fetal alcohol syndrome (FAS) be prevented?
Using alcohol during pregnancy is the leading cause of preventable birth defects, developmental disabilities, and learning disabilities. The only way to prevent FAS is for a woman to avoid drinking alcoholic beverages during pregnancy.
Women should also not drink alcohol if they are sexually active and not using effective birth control. It can take 4 to 6 weeks before a woman knows she is pregnant, during which time a developing fetus could be exposed to alcohol.
If a woman has already consumed alcohol during pregnancy, it is never too late to stop. Brain growth in the fetus takes place throughout pregnancy, so stopping alcohol consumption as soon as possible is always better than not stopping at all.
Lastly, once the baby is born a mother should not drink alcohol during the entire period in which she is breastfeeding. This is because alcohol will appear in breast milk. Although this is not directly linked to FASDs, alcohol in breast milk can hurt a child’s development and cause problems with sleep and learning.
Outlook / Prognosis
What is the long-term outlook for someone with fetal alcohol syndrome (FAS)?
Over time, a number of secondary effects can result in people with FAS, particularly in those who are not treated for the condition in childhood. These are called secondary effects because they are not part of FAS itself. Instead, they come about as a result of having FAS, perhaps from a feeling of not living up to society’s expectations. These include:
- Mental health problems.
- Getting into trouble in school or with the law.
- Confinement in jail, a mental-health facility or a substance abuse treatment center.
- Acting out in sexually inappropriate ways.
- Difficulty living on one’s own.
- Unemployment or difficulty keeping a job.
Treatment as soon as possible in childhood can help avoid these possible outcomes later in life.
What can be expected after treatment for fetal alcohol syndrome (FAS)?
No one particular treatment is correct for everyone with FAS. In all cases, it is important to monitor the person’s progress, to conduct follow-up exams, and to make changes in treatment as they become necessary.