Fetal Alcohol Syndrome

What is fetal alcohol syndrome?

Fetal alcohol syndrome, or FAS, is the most severe of of several fetal alcohol spectrum disorders (FASD).^[1] Contrary to common belief, fetal alcohol syndrome isn’t only caused by consuming large quantities of alcohol while pregnant. Any amount of alcohol can prove detrimental to the fetus and might result in FAS.^[2]

The signs of fetal alcohol syndrome vary from one child to the next.^[1] But, as explained in the next section, some hallmark symptoms are shared by most children with this condition. These symptoms can be classified into one of three areas - central nervous system problems, behavioral issues, and physical abnormalities.

Fetal alcohol syndrome symptoms

The type and severity of fetal alcohol syndrome symptoms largely depends on how much a mother drinks during pregnancy. The frequency with which she drinks is also a crucial factor. As the amount and frequency increase, the severity of FASD symptoms also increases.^[3]

Central Nervous System Problems

Central nervous system related FASD symptoms often include poor balance and coordination, seizures, and learning disabilities, especially in math. Some children with fetal alcohol syndrome also have memory, attention, and problem-solving difficulties.

Furthermore, FAS reduces the ability to process information, identify the consequences of one’s actions, and limits a child’s capacity for reasoning. Children with FAS typically display poor judgment skills due to the impacts of this disorder on their nervous system development.

It’s not uncommon for children on the FASD spectrum to have a low IQ or an intellectual disability. Speech and language delays are also quite common.^[1]

Behavioral Issues

Fetal alcohol syndrome symptoms on the behavioral spectrum include hyperactivity, rapidly changing mood, and poor social skills. The lack of social skills might lead to difficulty making friends and getting along with peers.^[3]

The reduced ability to problem-solve and reason noted earlier manifests as difficulty with goal setting, attending to tasks, and making smooth transitions from one task to the next. Many children with FAS also have a poor concept of time, which exacerbates the difficulties with completing assignments, particularly in a structured environment like school.^[1]

Physical Abnormalities

Internal and external physical abnormalities are also common among this population. These include:^[4]

• Slow physical growth (both in the womb and after birth)
• Deformed fingers, limbs, and joints
• Vision problems
• Hearing problems
• Small head size
• Small eyes
• Very thin upper lip
• Smooth philtrum, or the area between the nose and upper lip
• A short, upturned nose
• Heart defects
• Kidney defects
• Bone abnormalities

Again, it is worth noting that the signs of fetal alcohol syndrome and the specific symptoms vary widely from child to child.

What’s more, each type of FASD has different characteristics. The wide-ranging symptoms listed above are typical for fetal alcohol syndrome and partial fetal alcohol syndrome or pFAS. But the symptoms of Alcohol-Related Neurodevelopmental Disorder (ARND) are much more focused on the behavioral spectrum. For example, people with ARND commonly have:^[2]

• Intellectual disabilities
• Learning disabilities, especially in math
• Poor memory and attention
• Low impulse control
• Poor judgment
• Behavioral problems

People with Alcohol-Related Birth Defects tend to have symptoms that focus on the physical spectrum, such as:^[2]

• Heart abnormalities
• Kidney abnormalities
• Hearing difficulties
• Skeletal problems

A newer FASD diagnosis is Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure or ND-PAE. This class of FASDs first appeared in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), in 2013. The symptoms include the following:^[1]

• Thinking and memory problems
• Behavioral issues, such as irritability, tantrums, and difficulty transitioning from one task to another
• Difficulties with activities of daily living, such as trouble dressing appropriately for the weather, difficulty maintaining personal hygiene, and problems playing with other children

An ND-PAE diagnosis is also contingent upon the mother consuming at least 13 alcoholic drinks each month during the pregnancy or more than two alcoholic beverages in a single sitting.

What causes fetal alcohol syndrome?

Fetal alcohol syndrome and other FASDs are caused by the ingestion of alcohol during pregnancy. As mentioned earlier, alcohol intake of any kind during pregnancy can result in damage to the fetus and the development of an FASD.

Moreover, there is also no safe time during pregnancy to drink alcohol. Fetal brain development occurs throughout gestation, so ingesting alcohol, even in the early weeks of pregnancy - before a woman even knows she is pregnant - poses risks for fetal development.^[2]

The risks of drinking while pregnant are severe because alcohol is passed from the mother to the child through the placenta. Babies can’t process alcohol like adults can, so alcohol stays in the fetus’ system much longer and can cause long-term, severe damage. In the most serious cases, drinking alcohol while pregnant can lead to losing the baby.^[2]

Fetal alcohol syndrome prevention

The best prevention of fetal alcohol syndrome and other FASDs is not drinking while pregnant or trying to become pregnant. Alternatively, if you drink alcohol and discover you’re pregnant, the sooner you quit drinking, the better it will be for your baby.

If you have an alcohol use disorder, professional help might be necessary to help you quit. Speak with a mental health professional for guidance on quitting and resources to help you stay sober, such as details about local support groups like Alcoholics Anonymous.

Fetal alcohol syndrome diagnosis

Fetal alcohol syndrome and other FASDs can be complicated to diagnose, particularly if the symptoms are mild. Other developmental and behavioral disorders (ADHD, Williams syndrome) share many of the same symptoms, further complicating diagnosis.^[5][1]

The most significant aid in diagnosis is information from the mother or another source that alcohol was ingested during pregnancy. This information and a close examination of the symptoms outlined earlier (e.g., central nervous system problems, behavioral issues, and physical abnormalities) can help doctors and other health professionals make the proper diagnosis.

Fetal alcohol syndrome treatment

FASDs are lifelong disorders with no treatment or cure. However, many treatments are effective in helping minimize FASD symptoms and improving a child’s ability to develop more normally.

Common treatments include:

• Psychoeducation for families to learn how to help children with FASDs
• Skills training for children with FASD to address common behavioral and social difficulties
• Medications for common co-occurring disorders (e.g., anxiolytics for anxiety or stimulants for hyperactivity)
• Cognitive-behavioral therapy to teach children new ways of thinking and behaving
• Speech and language therapy to improve a child’s ability to communicate
• Special education services to address school-related issues, such as developmental delays and learning disabilities

Above all else, early intervention is the key. The sooner treatments are provided to a child with FASD, the more symptoms will be minimized.^[4]

What is the outlook for people with fetal alcohol syndrome?

Fetal alcohol syndrome and other FASDs are chronic, lifelong disorders without a cure. The average life expectancy of people with fetal alcohol syndrome remains quite low at 34 years of age.^[6]

However, as outlined earlier, many interventions and treatments can help minimize symptoms, improve quality of life, and lengthen the lifespan of people with FASDs. A complete intervention plan that includes therapies, drug treatments, social support, family support, and educational support will likely improve the outlook of someone with this disorder.

How common is fetal alcohol syndrome?

The prevalence of fetal alcohol syndrome and other FASDs is challenging to pin down. This is partly due to the difficulty of diagnosis, especially when FASD symptoms are mild.

However, estimates suggest that one in 1,000 children born in the United States have fetal alcohol syndrome. Other research estimates that anywhere from 0.3-9 out of 1,000 children between the ages of six and nine have this disorder.

On a larger scale, it’s estimated that between one and five out of every 100 schoolchildren in the U.S. has fetal alcohol syndrome. Estimates for the entire population range from one to five percent.^[7]