DANIEL J. WATTENDORF, MAJ, MC, USAF, and MAXIMILIAN MUENKE, M.D.,
National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
Fetal alcohol spectrum disorders (FASD) are caused by the effects of maternal alcohol consumption during pregnancy. Fetal alcohol syndrome (FAS) is the most clinically recognizable form of FASD and is characterized by a pattern of minor facial anomalies, prenatal and postnatal growth retardation, and functional or structural central nervous system (CNS) abnormalities. The consequences are lifelong, and the behavioral and learning difficulties are often greater than the degree of neurocognitive impairment. Alcohol-related neurodevelopmental disorder also is a clinically recognizable diagnosis in the continuum of FASD and describes the clinical outcome when the facial features typical of FAS are absent.
Fetal alcohol syndrome (FAS) is a disorder of permanent birth defects that occurs in the offspring of women who drink alcohol during pregnancy. It is unknown whether amount, frequency or timing of alcohol consumption during pregnancy causes a difference in degree of damage done to the fetus. Thus, the current recommendation is not to drink at all during pregnancy. Alcohol crosses the placental barrier and can stunt fetal growth or weight, create distinctive facial stigmata, damaged neurons and brain structures, and cause other physical, mental, or behavioral problems.
The main effect of FAS is permanent central nervous system damage, especially the brain. Developing brain cells and structures are underdeveloped or malformed by prenatal alcohol exposure, often creating an array of primary cognitive and functional disabilities (including poor memory, attention deficits, impulsive behavior, and poor cause-effect reasoning) as well as secondary disabilities (for example, mental health problem, and drug addition. The risk of brain damage exists during each trimester, since the fetal brain develops throughout the entire pregnancy.
Fetal alcohol exposure is the leading known cause of mental retardation in the Western world. In the United States alone, the FAS prevalence rate is estimated to be between 0.2 and 2.0 cases per 1,000 live births, comparable to or higher than other developmental disabilities such as Down Syndrome or Spinal Bifida. The lifetime medical and social costs of each child with FAS are estimated to be as high as US $800,000.While prenatal alcohol exposure does not automatically result in FAS, the U.S. Surgeon General advises pregnant women to abstain from alcohol use due to the risk of the syndrome.