Fetal alcohol syndrome

# Overview
Fetal alcohol spectrum disorders (FASDs) are a group of  disorders that encompass fetal alcohol syndrome (FAS), partial fetal alcohol syndrome, alcohol-related birth defects (ARBD), alcohol-related neurodevelopmental disorder (ARND), and neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). The most potent risk factor for FASD's include prenatal exposure to alcohol.  FASD's is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities in children. Early recognition, diagnosis, and therapy for FASD is associated with improved outcomes.

# History
- In 1899. Dr William Sullivan, a Liverpool prison physician was the first to report a case study describing an association between maternal alcohol use and fetal damage in female prisoners.
- In 1968, Fetal alcohol syndrome was discovered and separated as a entire new diseases at the University of Washingtons Harborview Medical Center in Washington.
- By 1973, sufficient research evidence had accrued to devise basic diagnostic criteria such that FAS became established as a diagnostic entity.
- In 1973, Dr keneth Lyons Jones and David W Smith professors of University of Washington Medical School in Seattle was the first to introduce the term Fetal alcohol syndrome.
- By 1978, 245 cases of FAS had been reported by medical researchers, and the syndrome began to be described as the most frequent known cause of mental retardation.
- In 1981, The US Surgeon General issued the first public health advisory that alcohol during pregnancy is responsible birth defects.
- In 1989, US Congress mandated warning labels about potential birth defects on alcohol products.

# Classification
According to American Academy of Pediatrics fetal alcohol spectrum disorders (FASDs)  encompasses group of disorders based upon the manifestations into 5 sub types.
- Fetal alcohol syndrome (FAS)
- Partial fetal alcohol syndrome
- Alcohol-related birth defects (ARBD)
- Alcohol-related neurodevelopmental disorder (ARND)
- Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE).

# Pathophysiology
- Drinking alcohol during pregnancy is the most potent etiological factor for the development of fetal alcohol syndrome disorders.
- The developing embryo is susceptible to dysmorphogenisis during the first few weeks of pregnancy.
- Alcohol can pass through umbilical cord to the baby effecting morphogeneisis leading to
Miscarriage
Stillbirth
Behavioral, and intellectual disabilities
- Miscarriage
- Stillbirth
- Behavioral, and intellectual disabilities

# Risk Factors
The most potent risk factor in the development of FASD's include prenatal exposure of alcohol. Other risk factors include:
- Alcohol consumption
- Increase in maternal age
- Maternal genotype|
ADH1B*1/ADH1B*3
ADH1B*1/ADH1B*1
- ADH1B*1/ADH1B*3
- ADH1B*1/ADH1B*1
- Increase in parity/gravidity
- Higher birth order of the child
- Low socioeconomic status

# Epidemiology and Demographics

## Prevalence
- According to National Institute on Alcohol Abuse and Alcoholism study, CDC and AAP it is estimated that FASD's is prevalent in 2-5% of children in the United States.
- CDC released a fact sheet in 2016, according to which prevalence of  fetal alcohol syndrome is believed to be 1 in 20 children.
- Comprehensive data on the number of individuals with an FASD in the general population of the Unites States, or by state, race or ethnicity, is currently not available.
- Journal of the American Medical Association published the results of a National Institute on Alcohol Abuse and Alcoholism study that measured the prevalence of fetal alcohol spectrum disorders (FASD) among first-grade students in four US communities. 
Over 6,500 children were evaluated and the most conservative estimate for FASD ranged from 1 to 5 percent, or 1 in 20 students.
- Over 6,500 children were evaluated and the most conservative estimate for FASD ranged from 1 to 5 percent, or 1 in 20 students.
- Data from the Centers for Disease Control and Prevention (CDC)  asserts that 10 percent of pregnant women report drinking alcohol and 3 percent report binge drinking, putting over 100,000 births in the US each year at high risk for FASD.

# Differential Diagnosis
Fetal alcohol syndrome must be differentiated from other genetic diseases, with similar manifestations such as smooth philtrum, thin vermillion border and  small palpebral fissures. American academy of pediatrics and CDC reviewed and recommended 9 genetic diseases that has to screened and differentiated from FAD's which include Aarskog syndrome, Williams syndrome, Noonan syndrome, Dubowitz syndrome, Brachman-DeLange syndrome, Toluene syndrome, Fetal hydantoin syndrome, Fetal valproate syndrome, and Maternal PKU fetal effects.
The following tables summarizes the differential diagnosis of individual features associated with FAS

# Diagnosis
FASD is clinical diagnosis and there are no specific diagnostic laboratory findings associated with FASD. However, American Academy of Pediatrics and CDC brought up a diagnostic criteria. 

## Diagnostic criteria for Fetal alcohol spectral disorders
Diagnostic criteria for Fetal alcohol syndrome
4 diagnostic criteria had been developed in the recent times to diagnose fetal alcohol syndrome
- Four digit code
- Hoyme- Revised IOM
- ChudleyCanadian
- National Task Force/CDC

# History and Symptoms
Common symptoms of FASDs include :
- 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

# Prognosis

# Treatment
There is no specific cure for FAS as the CNS damage is irreversible leading to permanent disability. Treatment can be focused on halting the progression and behavioral therapy to improve the quality of life.
- Management of fetal alcohol spectrum disorders classically is divided into two main areas.
Pre-conceptual: Recognition of the dangers of alcohol consumption in ] and the prevention of damage to the fetus.
Post diagnosis: Relates to the management of people who have the condition.
- Pre-conceptual: Recognition of the dangers of alcohol consumption in ] and the prevention of damage to the fetus.
- Post diagnosis: Relates to the management of people who have the condition.
Behavioral management of FASD can be summarized in the following table:

# Prevention
The only certain way to prevent FAS is to simply avoid drinking alcohol during pregnancy. Some studies have shown that light to moderate drinking during pregnancy might not pose a risk to the fetus, although no amount of alcohol during pregnancy can be guaranteed to be absolutely safe. The Royal College of Obstetricians and Gynaecologists conducted a study of  over 400,000 women, all of whom had consumed alcohol during pregnancy. No case of fetal alcohol syndrome occurred and no adverse effects on children were found when consumption was under 8.5 drinks per week. A review of research studies found that fetal alcohol syndrome only occurred among alcoholics; no apparent risk to the child occurred when the pregnant women consumed no more than one drink per day.  A study of moderate drinking during pregnancy found no negative effects and the researchers concluded that one drink per day provides a significant margin of safety, although they did not encourage drinking during pregnancy. A study of pregnancies in eight European countries found that consuming no more than one drink per day did not appear to have any effect on fetal growth. A follow-up of children at 18 months of age found that those from women who drank during pregnancy, even two drinks per day, scored higher in several areas of development. An analysis of seven medical research studies involving over 130,000 pregnancies found that consuming two to 14 drinks per week did not increase the risk of giving birth to a child with either malformations or fetal alcohol syndrome.
In the United States, the Surgeon General recommended in 1981, and again in 2005, that women abstain from alcohol use while pregnant or while planning a pregnancy, the latter to avoid damage in the earliest stages of a pregnancy, as the woman may not be aware that she has conceived. In the United States, federal legislation has required that warning labels be placed on all alcoholic beverage containers since 1988 under the Alcoholic Beverage Labeling Act.