Fetal alcohol syndrome

Definition

Fetal alcohol syndrome is growth, mental, and physical problems that may occur in a baby when a mother drinks alcohol during pregnancy.

Alternative Names

Alcohol in pregnancy; Alcohol-related birth defects; Fetal alcohol effects; FAS

Causes

Using or abusing alcohol during pregnancy can cause the same risks as using alcohol in general. However, it poses extra risks to the unborn baby. When a pregnant woman drinks alcohol, it easily passes across the placenta to the fetus. Because of this, drinking alcohol can harm the baby's development.

A pregnant woman who drinks any amount of alcohol is at risk for having a child with fetal alcohol syndrome. No "safe" level of alcohol use during pregnancy has been established. Larger amounts of alcohol appear to increase the problems. Binge drinking is more harmful than drinking small amounts of alcohol.

Timing of alcohol use during pregnancy is also important. Alcohol use appears to be the most harmful during the first 3 months of pregnancy; however, drinking alcohol any time during pregnancy can be harmful.

Symptoms

A baby with fetal alcohol syndrome may have the following symptoms:

• Poor growth while the baby is in the womb and after birth
• Decreased muscle tone and poor coordination
• Delayed development and problems in three or more major areas: thinking, speech, movement, or social skills
• Heart defects such as ventricular septal defect (VSD) or atrial septal defect (ASD)
• Problems with the face, including:
  • Narrow, small eyes with large epicanthal folds
  • Small head
  • Small upper jaw
  • Smooth groove in upper lip
  • Smooth and thin upper lip

Exams and Tests

A physical exam of the baby may show a heart murmur or other heart problems. As the baby grows, there may be signs of delayed mental development. There also may be problems with the face and bones.

Tests include:

• Blood alcohol level in pregnant women who show signs of being drunk (intoxicated)
• Brain imaging studies (CT or MRI) after the child is born
• Pregnancy ultrasound

Treatment

Women who are pregnant or who are trying to get pregnant should avoid drinking any amount of alcohol. Pregnant women with alcoholism should join an alcohol abuse rehabilitation program and be checked closely by a health care provider throughout pregnancy.

Support Groups

The following organizations may offer assistance:

• National Council on Alcoholism and Drug Dependency -- www.ncadd.org
• National Drug and Alcohol Treatment Referral Routing Service -- 1-800-662-4357

The following organizations are good resources for information on alcoholism:

• Alcoholics Anonymous - www.alcoholics-anonymous.org
• Al-Anon/Alateen - www.al-anon.org
• National Institute on Alcohol Abuse and Alcoholism - www.niaaa.nih.gov/
• Substance Abuse and Mental Health Services Administration - www.samhsa.gov

Outlook (Prognosis)

The outcome for infants with fetal alcohol syndrome varies. Almost none of these babies have normal brain development.

Infants and children with fetal alcohol syndrome have many different problems, which can be difficult to manage. Children do best if they are diagnosed early and referred to a team of health care providers who can work on educational and behavioral strategies that fit the child's needs.

Possible Complications

Drinking alcohol during pregnancy may result in:

• Miscarriage or stillbirth
• Premature delivery

Complications seen in the infant may include:

• Abnormal heart structure
• Behavior problems
• Infant death
• Mental retardation
• Problems in the structure of the head, eyes, nose, or mouth
• Poor growth before birth
• Slow growth and poor coordination after birth

When to Contact a Medical Professional

Call for an appointment with your health care provider if you are drinking alcohol regularly or heavily, and are finding it difficult to cut back or stop. Also, call if you are drinking alcohol in any amount while you are pregnant or trying to get pregnant.

Prevention

Avoiding alcohol during pregnancy prevents fetal alcohol syndrome. Counseling can help women who have already had a child with fetal alcohol syndrome.

Sexually active women who drink heavily should use birth control and control their drinking behaviors, or stop using alcohol before trying to get pregnant.

 

References

Carlo WA. Fetal alcohol syndrome. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 100.2.

Cunningham FG, Leveno KJ, Bloom SL, et al. Teratology and medications that affect the fetus. In: Cunningham FG, Leveno KJ, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 14.