What are fetal alcohol spectrum disorders (FASD)?
Fetal alcohol spectrum disorders (FASD) are a group of medical conditions that can occur in a person who was exposed to alcohol while in the womb. The problems can be physical, mental, or behavioral. They can range from mild to severe. They can start before the baby is born, or they may not be noticeable until childhood, adolescence or even adulthood. Diagnosable conditions under the FASD umbrella include Fetal Alcohol Syndrome (FAS), Alcohol-Related Neurodevelopmental Disorder (ARND), Alcohol-Related Birth Defects (ARBD), and Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE).
Is it okay to drink alcohol during pregnancy?
No. Drinking alcohol during pregnancy can be dangerous to you and your baby. No amount or type of alcohol is safe during pregnancy. Babies born to people who drink during pregnancy may have serious lifelong health problems, including FASDs.
Symptoms of fetal alcohol spectrum disorders
FASD can cause a wide range of symptoms and often presents differently based on a multitude of factors. FASD is generally considered a brain-based disorder. Effects may include physical, mental, behavioral, and/or learning disabilities with lifelong implications. Symptoms in childhood may change as the child grows older. One of the most serious problems FASD can cause is developmental delay. FASD is the leading cause of preventable developmental delays in the United States.
The specific cognitive and behavioral impairments associated with FASD vary widely from one person to another and may include:
- Adaptive functioning (skills necessary for everyday living, such as reading social cues)
- Executive function (working memory, problem-solving, planning, and response inhibition)
- Deficits in motor skills (poor coordination)
- Attention issues, hyperactive behavior
- Problems with memory
- Learning challenges (especially with math)
- Sensory processing
- Speech and language delays
- Vision/hearing problems
- Sleep disturbance
- Intellectual disability or low IQ
- Impaired reasoning and judgment
- Problems with the heart, kidneys, or bones
- Shorter-than-average height
- Small head size
- Distinct facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum) and thin upper lip
What causes FASD?
FASDs can occur when a developing baby is exposed to alcohol before birth. This can happen even prior to a person recognizing that they are pregnant. Even small amounts of alcohol will pass across the placenta and to the fetus. The baby’s liver is not developed enough to be able to process the alcohol. The alcohol can damage the baby’s organs or cause other harm. Because no amount of alcohol can be considered safe, pregnant people should avoid all alcohol during the entire pregnancy.
“Binge drinking” (having 4 or more drinks at a time) is especially dangerous for your baby. It makes the level of alcohol in your blood (and the baby’s blood) go very high very quickly. Even if you don’t drink every day, you may put your baby at risk for FASD if you drink alcohol.
While drinking alcohol in the first three months of pregnancy can be the most dangerous, alcohol exposure remains unsafe throughout the entire nine months of pregnancy. Alcohol can interfere with development and cause birth defects. Drinking at any time during pregnancy is not safe and can harm your baby.
How are fetal alcohol spectrum disorders diagnosed?
“FASD” is not a diagnostic term in the United States. However, a diagnosis can be made for a specified condition under the FASD umbrella. These conditions include: Fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorders, alcohol-related birth defects, and neurobehavioral disorders associated with prenatal alcohol exposure.
Early diagnosis and early intervention significantly improve long-term outcomes for people with FASD. There is no simple diagnostic test for an FASD. Often, a multidisciplinary team is needed. Your doctor may look for physical symptoms, such as a low birth weight and a small head. Doctors may look at behavioral symptoms, such as attention and coordination. Fetal alcohol syndrome is diagnosed based on physical features alone, while other diagnoses may involve confirmation of alcohol exposure. Your doctor may try to confirm prenatal alcohol exposure, and if so, how much. PAE can be confirmed through interviews or review of patient files.
There are a multitude of reasons why it can be difficult to receive a diagnosis for an FASD. There is a lack of sufficient diagnostic capacity in most areas. Stigma is another barrier to diagnosis, as well as healthcare access. FASDs may have similar symptoms to other disorders and are often misdiagnosed.
Can fetal alcohol syndrome be prevented or avoided?
FASDs are preventable if you are able to abstain from alcohol use throughout pregnancy. The healthiest approach is to stop drinking when you are planning to get pregnant. If you get pregnant, quit drinking alcohol right away. Drink other beverages instead, such as water or milk. Celebrate special occasions with a fun, non-alcoholic “mocktail.” Partners can be supportive by abstaining from alcohol during the pregnancy as well.
If you are pregnant and you have been drinking alcohol, be honest with your doctor. Tell them how much you are drinking. They may be able to help you stop drinking before it causes harm to your pregnancy and the developing fetus.
Treatment for fetal alcohol spectrum disorders
While there is no cure for FASD, there are many treatment options. While FASD presents lifelong challenges, there is help and hope for children and adults living with FASD. Treatment will vary greatly based on the specific diagnosis, the particular symptoms, and the environmental context. No one treatment is right for every child or adult. Early intervention has been shown to improve outcomes significantly. Physical treatments may include occupational therapy and medical and dental care. Behavioral symptoms can be treated with medicine and therapy. Developmental issues in childhood can be addressed through special education services. Parent/caregiver training and education is another potential treatment.
There are a number of evidence-based treatments developed for people with FASD. It is important that treatment providers be FASD-informed, and the parent/caregiver may be the one to inform and educate providers on FASD. Effective treatment can help to prevent some of the secondary disabilities associated with FASD, such as problems in school, trouble with the law, employment difficulties, and substance/alcohol abuse problems. Resources are available from FASD United by contacting a Family Navigator.
Living with fetal alcohol spectrum disorders
People living with FASD can thrive and succeed with the right services and support. Often, people with FASD will need ongoing therapy or special services, depending on their symptoms. Early diagnosis is associated with the most positive outcomes and allows doctors to create specialized plans for a person’s development and education.
In addition to early diagnosis, research shows that children with FASD do best if they:
- Are raised in a stable and nurturing home
- Are not exposed to violence or trauma
- Receive special education and social services
Everyone with FASD is unique, and people with FASD each have different particular challenges.
FASD is associated with an increased risk of having a mental health disorder, including:
- Depression and anxiety
- ADHD and hyperactivity
- Substance use disorders
FASD may lead to “secondary conditions.” A person is not born with a secondary condition but might develop one as a result of having an FASD. These may include:
- Disrupted school experience
- Trouble with the law
- Inappropriate sexual behavior
- Dependent living and problems with employment over 21 years
Remember that no amount of alcohol is safe during pregnancy. Quit drinking if you are trying to get pregnant or if you think you’re pregnant. If you can’t quit drinking by yourself, get help right away.
Questions to ask your doctor
If your baby was born with fetal alcohol syndrome:
- What health concerns should I be aware of for my baby?
- Does my baby need treatment?
- How should I care for my baby at home?
If you are drinking during pregnancy:
- Am I putting my baby at risk for health problems?
- How much alcohol is too much? Can I have even one drink?
- I have a drinking problem. How do I stop?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
