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Fetal Alcohol Syndrome is a disorder that has a wide range of physical, behavioral, and cognitive impairments that occur due to an exposure to alcohol prior to birth.

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What Are Fetal Alcohol Spectrum Disorders?

The term fetal alcohol spectrum disorders (FASD) refers to the wide range of physical, behavioral, and cognitive impairments that occur due to alcohol exposure before birth (also known as prenatal alcohol exposure). These impairments may appear at any time during childhood and last a lifetime. An estimated 1% to 5% of U.S. first graders have FASD, according to a National Institute on Alcohol Abuse and Alcoholism (NIAAA)-supported study published in the Journal of the American Medical Association. ¹

What Causes Fetal Alcohol Spectrum Disorders and How Are They Prevented?

Alcohol exposure during pregnancy can result in FASD by interfering with development of the baby's brain and other critical organs and physiological functions. This can lead to deficits after birth and beyond. 2,3 Alcohol can disrupt development at any stage, even before a woman knows that she is pregnant.

Research shows that binge drinking and heavy drinking during pregnancy put a developing baby at the greatest risk for severe problems. ⁴ However, even lesser amounts can cause harm. 5,6 In fact, there is no known safe amount of alcohol consumption during pregnancy.

What Are the Types of Fetal Alcohol Spectrum Disorders?

The term fetal alcohol spectrum disorders (FASD) refers to a range of physical, cognitive, and behavioral abnormalities caused by prenatal alcohol exposure. Depending on the features identified, the disorders categorized as FASD 15,16 include:

Fetal alcohol syndrome

Partial fetal alcohol syndrome

Alcohol-related neurodevelopmental disorder

Alcohol-related birth defects

Neurobehavioral disorder associated with prenatal alcohol exposure

Prenatal alcohol exposure and central nervous system (CNS) involvement are factors common to the disorders encompassing FASD. Evidence of CNS involvement can be structural (e.g., small brain size, alterations in specific brain regions) or functional (e.g., cognitive and behavioral deficits, motor and coordination problems). For fetal alcohol syndrome-which is also characterized by growth deficiencies, distinct facial features, and other physical factors in addition to CNS involvement-confirmation of prenatal alcohol exposure is not required.

If an individual was not exposed to alcohol before birth, they will not get FASD. Given that approximately half of all pregnancies in the United States are not planned, the U.S. Surgeon General recommends that women who are pregnant, might be pregnant, or are thinking about getting pregnant should not drink alcohol at all. ⁷

Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental disorders in the United States. Women who need help to stop drinking alcohol can talk to their health care provider about treatment options. There are a variety of treatments available for pregnant women, including behavioral treatment and mutual-support groups. Visit the NIAAA Alcohol Treatment Navigator® to learn more about evidence-based treatments for alcohol-related problems.

How Common Is Alcohol Use During Pregnancy in the United States?

A study ¹⁷ that analyzed 2015-2018 data from the National Survey on Drug Use and Health reports that:

About 1 in 10 (9.8%) pregnant women report current alcohol use.

About 1 in 22 (4.5%) pregnant women report binge drinking.

Alcohol use is highest among women who are in the first trimester of pregnancy, with about 1 in 5 (19.6%) reporting current alcohol use and 1 in 10 (10.5%) reporting binge drinking.

About 40% of pregnant women who report current drinking also report current use of one or more other substances-most commonly tobacco and marijuana.

What Are the Symptoms of Fetal Alcohol Spectrum Disorders?

Individuals with FASD experience day-to-day challenges, which may include cognitive and behavioral impairments as well as secondary disabilities including medical, educational, mental health, and social challenges, throughout their life. They are also subject to stigmatization for their disorder. People with FASD may have difficulty in the following areas: 8,9,10

Learning and memory

Understanding and following directions

Switching attention between tasks

Controlling emotions and impulsivity

Communicating and developing social skills

Experiencing depression and anxiety

Performing daily life skills, including feeding, bathing, counting money, telling time, and minding personal safety

How Are Fetal Alcohol Spectrum Disorders Diagnosed?

Early identification of FASD is critical for the well-being of individuals affected by prenatal alcohol exposure and their families. Early identification can maximize help in the treatment of FASD and in building supportive networks with other individuals and families impacted by FASD. Unfortunately, FASD is often undiagnosed or misdiagnosed. This may be due, in part, to a lack of information about prenatal alcohol exposure or difficulty in distinguishing FASD from other developmental disorders that might have similar cognitive or behavioral symptoms.

The American Academy of Pediatrics (AAP) stresses the importance of universal screening for prenatal alcohol exposure for all children. ¹¹ A diagnosis of FASD can include evidence of CNS problems (see "What Are the Types of FASD?" box), physical abnormalities (e.g., growth deficits, specific facial anomalies), health concerns, and documented prenatal alcohol exposure. The AAP recommends initial assessment and diagnosis by the child's pediatrician. ¹² Referrals for additional evaluation and treatment can be made to other clinicians and health care professionals or, when available, to a specialized multidisciplinary team for a comprehensive evaluation and care.

What Are the Interventions or Treatments for Fetal Alcohol Spectrum Disorders?

There are various approaches that may help reduce the symptoms of FASD and lessen the impact on affected individuals and their families. These include education and behavioral interventions for individuals with FASD and their caretakers as well as medications, social support, case management, and other services for children and adults with FASD. 13,14 New interventions are currently being developed and evaluated. These treatments include:

Prenatal nutritional supplements for pregnant women and postnatal supplements for their children

Learning and behavioral interventions aimed at improving cognition, daily life skills, and impulsive behavior

School-based approaches focused on specialized teaching strategies and computer-based games

Mobile health apps and other interventions that support families and caregivers to assist them in caring for children with FASD

For more information about alcohol and pregnancy, how to stop drinking, and alcohol treatment options, please visit the NIAAA website at niaaa.nih.gov
1 May PA, Chambers CD, Kalberg WO, Zellner J, Feldman H, Buckley D, Kopald D, Hasken JM, Xu R, Honerkamp-Smith G, Taras H, Manning MA, Robinson LK, Adam MP, Abdul-Rahman O, Vaux K, Jewett T, Elliott AJ, Kable JA, Akshoomoff N, et al. Prevalence of fetal alcohol spectrum disorders in 4 US communities. JAMA. 2018;319(5):474-82. PubMed PMID: 29411031

2 Williams JF, Smith VC, Committee on Substance Abuse. Fetal alcohol spectrum disorders. Pediatrics. 2015 Nov 1;136(5):e1395-e1406. PubMed PMID: 26482673

³ Wozniak JR, Riley EP, Charness ME. Clinical presentation, diagnosis, and management of fetal alcohol spectrum disorder. Lancet Neurol. 2019;18(8):760-70. PubMed PMID: 31160204

4 Maier SE, West JR. Drinking patterns and alcohol-related birth defects. Alcohol Res Health. 2001;25(3):168-74. PubMed PMID: 11810954

5 Sundermann AC, Zhao S, Young CL, Lam L, Johns SH, Velez Edwards, DR, Harmann KE. Alcohol use in pregnancy and miscarriage: a systematic review and meta-analysis. Alcohol Clin Exp Res. 2019;43(8):1606-16. PubMed PMID: 31194258

6 Lees B, Mewton L, Jacobus J, Valadez EA, Stapinski LA, Teesson M, Tapert SF, Squeglia LM. Association of prenatal alcohol exposure with psychological, behavioral, and neurodevelopmental outcomes in children from the adolescent brain cognitive development study. Am J Psychiatry. 2020;177(11):1060-72. PubMed PMID: 32972200

⁷ National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention [Internet]. Advisory on alcohol use in pregnancy from the U.S. Surgeon General. 2005 [cited 2023 Jul 27]. Available from: https://www.cdc.gov/ncbddd/fasd/documents/sg-advisory-508.pdf

8 Mattson SN, Bernes, GA, Doyle LR. Fetal alcohol spectrum disorders: a review of the neurobehavioral deficits associated with prenatal alcohol exposure. Alcohol Clin Exp Res. 2019;43(6):1046-62. PubMed PMID: 30964197

9 McLachlan K, Flannigan K, Temple V, Unsworth K, Cook JL. Difficulties in daily living experienced by adolescents, transition-aged youth, and adults with fetal alcohol spectrum disorder. Alcohol Clin Exp Res. 2020;44(8):1609-24. PubMed PMID: 32472600

10 O'Connor MJ. Mental health outcomes associated with prenatal alcohol exposure: genetic and environmental factors. Current Developmental Disorders Reports. 2014;1(3):181-8.

11 American Academy of Pediatrics [Internet]. Screening for prenatal alcohol exposure [updated 2021 Nov 29; cited 2023 May 22]. Available from: https://www.aap.org/en/patient-care/fetal-alcohol-spectrum-disorders/screening-for-prenatal-alcohol-exposure

12 American Academy of Pediatrics [Internet]. Common diagnostic approaches in fetal alcohol spectrum disorder [updated 2021 Nov 29; cited 2023 May 22]. Available from: https://www.aap.org/en/patient-care/fetal-alcohol-spectrum-disorders/common-diagnostic-approaches-in-fetal-alcohol-spectrum-disorder

¹³ Reid N, Dawe S, Shelton D, Harnett P, Warner J, Armstrong E, LeGros K, O'Callaghan F. Systematic review of fetal alcohol spectrum disorder interventions across the life span. Alcohol Clin Exp Res. 2015;39(12):2283-95. PubMed PMID: 26578111

¹⁴ Petrenko CL, Alto ME. Interventions in fetal alcohol spectrum disorders: an international perspective. Eur J Med Genet. 2017;60(1):79-91. PubMed PMID: 27742482

15 Stratton K, Howe C, Battaglia F, editors. Fetal alcohol syndrome: diagnosis, epidemiology, prevention, and treatment. Washington, DC: Institute of Medicine, The National Academies Press; 1996. Executive Summary; p. 4-5.

16 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Association; 2013, p. 86, 708-801.

¹⁷ England LJ, Bennett C, Denny CH, Honein MA, Gilboa SM, Kim SY, Guy GP, Tran EL, Rose CE, Bohm MK, Boyle CA. Alcohol use and co-use of other substances among pregnant females aged 12-44 years - United States, 2015-2018. MMWR Morb Mortal Wkly Rep. 2020;69(31):1009-14. PubMed PMID: 32759915

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Understanding Fetal Alcohol Spectrum Disorders

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Fetal alcohol exposure occurs when a woman drinks while pregnant. Alcohol can disrupt fetal development at any stage during a pregnancy-including at the earliest stages before a woman even knows she is pregnant.

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People who have Fetal Alcohol Syndrome can have multiple symptoms ranging from mild to severe such as: Low body weight, Poor coordination, Hyperactive behavior, Difficulty with attention, Poor memory, Difficulty in school, Speech and language delays, Intellectual disability, Poor reasoning or judgement skills, Vision or hearing problems, Problems with the heart, kidneys, or bones, Shorter than average height, Small head size, Abnormal facial features.

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Centers for Disease Control and Prevention

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Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person who was exposed to alcohol before birth. These effects can include physical problems and problems with behavior and learning. Often, a person with an FASD has a mix of these problems.

Cause and Prevention

FASDs can occur when a person is exposed to alcohol before birth. Alcohol in the mother's blood passes to the baby through the umbilical cord.

There is no known safe amount of alcohol during pregnancy or when trying to get pregnant. There is also no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she's pregnant. All types of alcohol are equally harmful, including all wines and beer.

To prevent FASDs, a woman should avoid alcohol if she is pregnant or might be pregnant. This is because a woman could get pregnant and not know for up to 4 to 6 weeks.

It is never too late to stop alcohol use during pregnancy. Because brain growth takes place throughout pregnancy, stopping alcohol use will improve the baby's health and well-being. Resources are available here.

FASDs are preventable if a baby is not exposed to alcohol before birth.

Signs and Symptoms

FASDs refer to a collection of diagnoses that represent the range of effects that can happen to a person who was exposed to alcohol before birth. These conditions can affect each person in different ways, and can range from mild to severe.

A person with an FASD might have:

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

Shorter-than-average height

Small head size

Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)

FASD Diagnoses

Different FASD diagnoses are based on particular symptoms and include:

Fetal Alcohol Syndrome (FAS): FAS represents the most involved end of the FASD spectrum. People with FAS have central nervous system (CNS) problems, minor facial features, and growth problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others.

Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.

Alcohol-Related Birth Defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): ND-PAE was first included as a recognized condition in the Diagnostic and Statistical Manual 5 (DSM 5) of the American Psychiatric Association (APA) in 2013. A child or youth with ND-PAE will have problems in three areas: (1) thinking and memory, where the child may have trouble planning or may forget material he or she has already learned, (2) behavior problems, such as severe tantrums, mood issues (for example, irritability), and difficulty shifting attention from one task to another, and (3) trouble with day-to-day living, which can include problems with bathing, dressing for the weather, and playing with other children. In addition, to be diagnosed with ND-PAE, the mother of the child must have consumed more than minimal levels of alcohol before the child's birth, which APA defines as more than 13 alcoholic drinks per month of pregnancy (that is, any 30-day period of pregnancy) or more than 2 alcoholic drinks in one sitting.

The term fetal alcohol effects (FAE) was previously used to describe intellectual disabilities and problems with behavior and learning in a person whose mother drank alcohol during pregnancy. In 1996, the Institute of Medicine (IOM) replaced FAE with the terms alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD).

Areas Evaluated for FASD Diagnoses

The term FASDs is not meant for use as a clinical diagnosis.

Diagnosing FASDs can be hard because there is no medical test, like a blood test, for these conditions. And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS.

To diagnose FASDs, doctors look for:

Prenatal alcohol exposure; although confirmation is not required to make a diagnosis

Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination)

Lower-than-average height, weight, or both

Abnormal facial features (e.g., smooth ridge between nose and upper lip)

Treatment

FASDs last a lifetime. There is no cure for FASDs, but research shows that early intervention treatment services can improve a child's development.

There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches. No one treatment is right for every child. Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.

Also, "protective factors" can help reduce the effects of FASDs and help people with these conditions reach their full potential.1, 2

Protective factors include:

Diagnosis before 6 years of age

Loving, nurturing, and stable home environment during the school years

Absence of violence

Involvement in special education and social services

Learn more about treatments "

Get Help!

If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about FASDs), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with FASDs. To find doctors and clinics in your area visit the National and State Resource Directory from FASD United (formerly NOFAS).

At the same time as you ask the doctor for a referral to a specialist, call your state or territory's early intervention program to request a free evaluation to find out if your child can get services to help. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor's referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child's age:

If your child is younger than 3 years old, Call your state or territory's early intervention program and say: "I have concerns about my child's development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services."

Find your state's early intervention contact information here.
Learn more about early intervention "

If your child is 3 years old or older, contact your local public school system.
Even if your child is not old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.
Learn more about this process "

References

Streissguth, A.P., Bookstein, F.L., Barr, H.M., Sampson, P.D., O'Malley, K., & Young, J.K. (2004). Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Developmental and Behavioral Pediatrics, 5(4), 228-238.

Streissguth, A.P., Barr, H.M., Kogan, J. & Bookstein, F. L., Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). Final report to the Centers for Disease Control and Prevention (CDC). Seattle: University of Washington, Fetal Alcohol & Drug Unit; August 1996. Tech. Rep. No. 96-06.

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Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person who was exposed to alcohol before birth.

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Fetal Alcohol Syndrome is caused by a pregnant woman drinking alcohol. Alcohol has detrimental effects on the development of a fetus. Alcohol enters the fetus through the placenta. A fetus' metabolism is slower than an adult's which leads to a higher blood alcohol content. Alcohol interferes with the delivery of oxygen and nutrition to the fetus. Alcohol damages the development of tissues and organs as well as permanent brain damage.

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Overview

Fetal alcohol syndrome is a condition in a child that results from alcohol exposure during the mother's pregnancy. Fetal alcohol syndrome causes brain damage and growth problems. The problems caused by fetal alcohol syndrome vary from child to child, but defects caused by fetal alcohol syndrome are not reversible.

There is no amount of alcohol that's known to be safe to consume during pregnancy. If you drink during pregnancy, you place your baby at risk of fetal alcohol syndrome.

If you suspect your child has fetal alcohol syndrome, talk to your doctor as soon as possible. Early diagnosis may help to reduce problems such as learning difficulties and behavioral issues.

Symptoms

The severity of fetal alcohol syndrome symptoms varies, with some children experiencing them to a far greater degree than others. Signs and symptoms of fetal alcohol syndrome may include any mix of physical defects, intellectual or cognitive disabilities, and problems functioning and coping with daily life.

Physical defects

Physical defects may include:

Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip

Deformities of joints, limbs and fingers

Slow physical growth before and after birth

Vision difficulties or hearing problems

Small head circumference and brain size

Heart defects and problems with kidneys and bones

Brain and central nervous system problems

Problems with the brain and central nervous system may include:

Poor coordination or balance

Intellectual disability, learning disorders and delayed development

Poor memory

Trouble with attention and with processing information

Difficulty with reasoning and problem-solving

Difficulty identifying consequences of choices

Poor judgment skills

Jitteriness or hyperactivity

Rapidly changing moods

Social and behavioral issues

Problems in functioning, coping and interacting with others may include:

Difficulty in school

Trouble getting along with others

Poor social skills

Trouble adapting to change or switching from one task to another

Problems with behavior and impulse control

Poor concept of time

Problems staying on task

Difficulty planning or working toward a goal

When to see a doctor

If you're pregnant and can't stop drinking, ask your obstetrician, primary care doctor or mental health professional for help.

Because early diagnosis may help reduce the risk of long-term problems for children with fetal alcohol syndrome, let your child's doctor know if you drank alcohol while you were pregnant. Don't wait for problems to arise before seeking help.

If you have adopted a child or are providing foster care, you may not know if the biological mother drank alcohol while pregnant - and it may not initially occur to you that your child may have fetal alcohol syndrome. However, if your child has problems with learning and behavior, talk with his or her doctor so that the underlying cause might be identified.

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Causes

When you're pregnant and you drink alcohol:

Alcohol enters your bloodstream and reaches your developing fetus by crossing the placenta

Alcohol causes higher blood alcohol concentrations in your developing baby than in your body because a fetus metabolizes alcohol slower than an adult does

Alcohol interferes with the delivery of oxygen and optimal nutrition to your developing baby

Exposure to alcohol before birth can harm the development of tissues and organs and cause permanent brain damage in your baby

The more you drink while pregnant, the greater the risk to your unborn baby. However, any amount of alcohol puts your baby at risk. Your baby's brain, heart and blood vessels begin to develop in the early weeks of pregnancy, before you may know you're pregnant.

Impairment of facial features, the heart and other organs, including the bones, and the central nervous system may occur as a result of drinking alcohol during the first trimester. That's when these parts of the fetus are in key stages of development. However, the risk is present at any time during pregnancy.

Risk factors

The more alcohol you drink during pregnancy, the greater the chance of problems in your baby. There's no known safe amount of alcohol consumption during pregnancy.

You could put your baby at risk even before you realize you're pregnant. Don't drink alcohol if:

You're pregnant

You think you might be pregnant

You're trying to become pregnant

Complications

Problem behaviors not present at birth that can result from having fetal alcohol syndrome (secondary disabilities) may include:

Attention deficit/hyperactivity disorder (ADHD)

Aggression, inappropriate social conduct, and breaking rules and laws

Alcohol or drug misuse

Mental health disorders, such as depression, anxiety or eating disorders

Problems staying in or completing school

Problems with independent living and with employment

Inappropriate sexual behaviors

Early death by accident, homicide or suicide

Prevention

Experts know that fetal alcohol syndrome is completely preventable if women don't drink alcohol at all during pregnancy.

These guidelines can help prevent fetal alcohol syndrome:

Don't drink alcohol if you're trying to get pregnant. If you haven't already stopped drinking, stop as soon as you know you're pregnant or if you even think you might be pregnant. It's never too late to stop drinking during your pregnancy, but the sooner you stop, the better it is for your baby.

Continue to avoid alcohol throughout your pregnancy. Fetal alcohol syndrome is completely preventable in children whose mothers don't drink during pregnancy.

Consider giving up alcohol during your childbearing years if you're sexually active and you're having unprotected sex. Many pregnancies are unplanned, and damage can occur in the earliest weeks of pregnancy.

If you have an alcohol problem, get help before you get pregnant. Get professional help to determine your level of dependence on alcohol and to develop a treatment plan.

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Fetal alcohol syndrome - Symptoms and causes

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Fetal alcohol syndrome results from alcohol exposure during the mother's pregnancy, causing irreversible brain damage and growth problems in the child.

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Fetal Alcohol Syndrome has no cure. Early Intervention Services can help a child with learning important skills in early development. Medical intervention by various specialists can alleviate some of the difficulties caused by the disorder. There are no medications that are specifically for Fetal Alcohol Syndrome. However there are plenty of medications available for treating the various symptoms caused by the disorder. In order to help students with Fetal Alcohol Syndrome I would pay special attention to their progress in the class. I would work closely on an individual level to ensure that they get the assistance they need to succeed. Using technology such as screen casts would make sure they have access to the lesson materials at all times. Obviously the challenges I would face would be trying to get the student to understand the material as they would likely have intellectual impairment.

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Centers for Disease Control and Prevention

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Treatment services for people with FASDs should be different for each person depending on the symptoms.