HISTORY OF FETAL ALCOHOL SPECTRUM DISORDERS

For centuries, people have known that alcohol can harm a fetus. However,

a specific medical link was not identified until 1899. Dr. William Sullivan

compared the pregnancy outcomes of 120 alcoholic prisoners with 28

of their relatives. The infant mortality rate among the alcoholic women

was higher.1

In 1957, Jacqueline Rouquette wrote about prenatal alcohol exposure. Then,

in 1968, Dr. Paul Lemoine published a study in which he described 127 children

with distinctive facial features and other symptoms related to prenatal alcohol exposure.2

Five years later, researchers in Seattle published findings of a similar study. They named

the condition fetal alcohol syndrome (FAS).3

DEFINITION OF FETAL ALCOHOL SPECTRUM

DISORDERS

Experts now know that the effects of prenatal alcohol

exposure extend beyond FAS. “Fetal alcohol spectrum

disorders” (FASD) is an umbrella term describing the

range of effects that can occur in an individual whose

mother drank alcohol during pregnancy. These effects

may include physical, mental, behavioral, and/or learning

disabilities with possible lifelong implications. FASD is

not a diagnostic term used by clinicians. It refers to

conditions such as:

• Fetal alcohol syndrome, including partial FAS

• Fetal alcohol effects (FAE)

• Alcohol-related neurodevelopmental disorder

• Alcohol-related birth defects

FETAL ALCOHOL SYNDROME

FAS consists of a pattern of neurologic, behavioral, and

cognitive deficits that can interfere with growth, learning,

and socialization. FAS has four major components:

• A characteristic pattern of facial abnormalities

(small eye openings, indistinct or flat philtrum, thin

upper lip)

• Growth deficiencies, such as low birth weight

• Brain damage, such as small skull at birth,

structural defects, and neurologic signs, including

impaired fine motor skills, poor eye-hand

coordination, and tremors

• Maternal alcohol use during pregnancy

Behavioral or cognitive problems may include mental

retardation, learning disabilities, attention deficits,

hyperactivity, poor impulse control, and social, language,

and memory deficits.

Partial FAS describes persons with confirmed alcohol

exposure, facial anomalies, and one other group of

symptoms (growth retardation, central nervous system

defects, or cognitive deficits).

FETAL ALCOHOL EFFECTS

Fetal alcohol effects (FAE) describes children with

prenatal alcohol exposure who do not have all the

symptoms of FAS. Many have growth deficiencies,

behavior problems, cognitive deficits, and other

symptoms. However, they do not have the facial features

of FAS. Although the term FAE is still used, the Institute

of Medicine has coined more specific terms. These

include alcohol-related neurodevelopmental disorder

and alcohol-related birth defects.

WHAT YOU NEED TO KNOW

THE LANGUAGE OF

FETAL ALCOHOL SPECTRUM DISORDERS
REFERENCES

1. Abel, E.L. 1990. Fetal Alcohol Syndrome. Oradell, NJ: Medical Economics.

2. Lemoine, P.; Harousseau, H.; Borteyru, J.-P., et al. 1968. Les enfants de parents alcooliques: Anomalies observees. A propos de 127 cas [Children

of alcoholic parents: Abnormalities observed in 127 cases]. Ouest Medical 21:476–482.

3. Jones, K.L., and Smith, D.W. 1973. Recognition of the fetal alcohol syndrome in early infancy. Lancet 2:999–1001.

4. May, P.A., and Gossage, J.P. 2001. Estimating the prevalence of fetal alcohol syndrome: A summary. Alcohol Research & Health 25(3):159–167.

5. Kellerman, C., and Kellerman, T. 1999. The five million dollar baby: The economics of FAS.

(http://come-over.to/FAS/economicsFAS.htm on 04/04/02).

Origin and Impact of FASD

CAUSE OF FASD

The only cause of FASD is alcohol use during pregnancy.

When a pregnant woman drinks, the alcohol crosses

the placenta into the fetal blood system. Thus, alcohol

reaches the fetus, its developing tissues, and organs.

This is how brain damage occurs, which can lead to

mental retardation, social and emotional problems,

learning disabilities, and other challenges.

No alcohol consumption is safe during pregnancy. In

addition, the type of alcohol (beer, wine, hard liquor,

wine cooler, etc.) does not appear to make a difference.

PREVALENCE OF FASD

FASD occurs in about 10 per 1,000 live births, or about

40,000 babies per year. FAS, the most recognized

condition in the spectrum, is estimated to occur in 0.5

to 2 per 1,000 live births.4 It now outranks Down

syndrome and autism in prevalence.

ASSESSMENT OF FASD

It is extremely difficult to diagnose a fetal alcohol

spectrum disorder. A team of professionals is needed,

including a physician, psychologist, speech pathologist,

and physical or occupational therapist. Diagnostic tests

may include physical exams, intelligence tests, and

occupational and physical therapy, psychological, speech,

and neurologic evaluations.

Diagnosis is easier if the birth mother confirms alcohol

use during pregnancy. However, FAS can be diagnosed

without confirming maternal alcohol use, if all the

symptoms are present.

IMPACT OF FASD

Children with FASD often grow up with social and

emotional problems. They may have mental illness or

substance abuse problems, struggle in school, and become

involved with the corrections system. Costs of FAS alone

are estimated at between 1 and 5 million dollars per

child, not including incarceration. This estimate does

not include cost to society, such as lost productivity,

burden on families, and poor quality of life.5

ALCOHOL-RELATED NEURODEVELOPMENTAL

DISORDER

Alcohol-related neurodevelopmental disorder (ARND)

refers to various neurologic abnormalities, such as problems

with communication skills, memory, learning ability, visual

and spatial skills, intelligence, and motor skills. Children

with ARND have central nervous system deficits but not

all the physical features of FAS. Their problems may include

sleep disturbances, attention deficits, poor visual focus,

increased activity, delayed speech, and learning disabilities.

ALCOHOL-RELATED BIRTH DEFECTS

Alcohol-related birth defects (ARBD) describe defects

in the skeletal and major organ systems. Virtually every

defect has been described in some patient with FAS.

They may include abnormalities of the heart, eyes,

ears, kidneys, and skeleton, such as holes in the

heart, underdeveloped kidneys, and fused

bones.

Pregnancy is Sacred

For more information, visit fasdcenter.samhsa.gov or call 866-STOPFAS.

www.stopalcoholabuse.gov

DHHS Publication No. (SMA) 07–4264

Printed 2007