full-blown FAS. Doctors may call incomplete
forms of FAS alcohol-related neurodevelopmental
disorder (ARND) when symptoms are primarily
behavioral and alcohol-related birth defects
(ARBD) when symptoms are primarily physical.
People sometimes refer to the entire range of
these conditions as fetal alcohol spectrum disor-
ders (FASDs), though this is a general rather than
a clinical term.
Researchers first identified FAS in 1981 and are
still unable to determine any safe level of drinking
during pregnancy. Alcohol is highly teratogenic,
meaning it has strong capability to cause damage
to cells of all types during fetal development. The
highest risk for severe birth defects occurs with
heavy drinking during the first eight weeks of
pregnancy, the time when body systems and
organs are developing. The BRAINand NERVOUS SYS-
TEMare particularly vulnerable to alcohol toxicity;
exposure during any stage of pregnancy may
affect whatever neurologic development is occur-
ring at the time. The result may be a range of
intellectual, emotional, and behavioral dysfunc-
tions that become apparent as the child grows up.
Symptoms and Diagnostic PathA collaboration of US health-care agencies con-
vened as the National Task Force on Fetal Alcohol
Syndrome and Fetal Alcohol Effects issued diag-
nostic criteria and guidelines in 2004, under man-
date from the US Congress to establish consistent
diagnosis. These criteria include
- small head (microcephaly) with structural brain
abnormalities apparent with diagnostic imaging
procedures - three unique and characteristic craniofacial
anomalies, also called facial dysmorphias:
smooth philtrum (no ridges in the upper lip);
narrowly placed eyes with short slits (palpebral
fissures); and narrow, thin upper lip - impaired growth (height or weight that
remains below the tenth percentile for age) - mental delays and functional deficits (varied
and numerous intellectual, cognitive, and
behavioral problems)
Some infants who have FAS also have other
birth defects. Prenatal exposure to alcohol may be
the affirming factor, though the collective charac-
teristics of FAS are relatively unique to the effects
of alcohol. Mild symptoms are sometimes difficult
to detect and diagnose, especially when health-
care providers do not know the mother’s alcohol
consumption during pregnancy (as is common in
many adoption circumstances). From initial estab-
lishment of FAS criteria, the diagnostic path
includes further neurologic and psychologic test-
ing to more concisely define the extent of the
damage.Treatment Options and Outlook
Treatment attempts to manage symptoms and the
effects of the damage that has occurred. The ear-
lier diagnosis takes place and interventions can
begin, the more successful treatment usually is in
helping the child reach his or her full potential.
Children who have FAS are more likely also to
have psychologic conditions such as ATTENTION
DEFICIT HYPERACTIVITY DISORDER(ADHD) andCONDUCT
DISORDER. The first children diagnosed as having
FAS are only now entering adulthood, so doctors
do not know the long-term consequences of FAS.
People who have mild symptoms and receive
aggressive, targeted intervention are often able to
function in society with relative success. Those
who have severe symptoms may need ongoing
care even in adulthood.Risk Factors and Preventive Measures
The only risk for fetal alcohol syndrome is a
woman’s consumption of alcohol during preg-
nancy. FAS is entirely preventable if the woman
completely abstains from alcohol during preg-
nancy, from CONCEPTIONto birth. Because more
than half of pregnancies in the United States are
unplanned, the greatest risk exists for women
who are not planning pregnancy but become
pregnant.
Extensive education efforts have increased
awareness of the dangers of alcohol during preg-
nancy, among them warning labels placed on
alcoholic beverage containers and posted in estab-
lishments that serve alcoholic beverages such as
restaurants, lounges, taverns, and bars. However,
many people, including some health-care
providers, still erroneously believe it is safe to
drink in moderation during pregnancy. The USfetal alcohol syndrome 335