What is Fetal Alcohol Syndrome? FAS is a lifelong yet completely preventable set of physical, mental and neurobehavioral birth defects associated with alcohol consumption during pregnancy. FAS is the leading known cause of mental retardation and birth defects. What are Alcohol-Related Neurodevelopmental Disorder (ARND) and Alcohol-Related Birth Defects (ARBD)? Prenatal alcohol exposure does not always result in FAS—although there is no known safe level of alcohol consumption during pregnancy. Most individuals affected by alcohol exposure before birth do not have the characteristic facial abnormalities and growth retardation identified with FAS, yet they have brain and other impairments that are just as significant. Alcohol-Related Neurodevelopmental Disorder (ARND) describes the functional or mental impairments linked to prenatal alcohol exposure, and Alcohol-Related Birth Defects (ARBD) describes malformations in the skeletal and major organ systems. What are the Primary Characteristics of FAS, ARND and ARBD? Individuals with FAS have a distinct pattern of facial abnormalities, growth deficiency and evidence of central nervous system dysfunction. In addition to mental retardation, individuals with FAS, ARND and ARBD may have other neurological deficits such as poor motor skills and hand-eye coordination. They may also have a complex pattern of behavioral and learning problems, including difficulties with memory, attention and judgment. How often do FAS, ARND and ARBD Occur? As many as 12,000 infants are born each year with FAS and three times as many have ARND or ARBD. FAS, ARND and ARBD affect more newborns every year than Down syndrome, cystic fibrosis, spina bifida and Sudden Infant Death Syndrome combined. How can Alcohol-Related Effects be prevented? FAS, ARND and ARBD are 100% preventable when a woman completely abstains from alcohol during her pregnancy. NOFAS prevents alcohol-related effects through public awareness and education, and by increasing access to prenatal health care. Another key to prevention is to screen all women of reproductive age for alcohol problems and to use appropriate strategies, such as treatment for alcohol problems, to eliminate drinking before conception. How does a mother’s drinking affect her unborn child? When a pregnant woman drinks alcohol, so does her baby; through the blood vessels in the placenta, the mother’s blood supplies the developing baby with nourishment and oxygen. If the mother drinks alcohol, the alcohol enters her blood stream and then, through the placenta, enters the blood supply of the growing baby. Alcohol is a teratogen, a substance known to be toxic to human development. Depending on the amount, timing and pattern of use, if alcohol reaches the growing baby’s blood supply, it can interfere with healthy development. If a woman drinks wine, beer or liquor when she is pregnant, her baby could be born with FAS. There is no known safe amount of alcohol during pregnancy. What if I am pregnant and have been drinking? If you consumed alcohol before you knew you were pregnant, stop drinking now. Abstaining from alcohol for the remainder of your pregnancy can have a beneficial effect even on functions that might have been affected by earlier drinking. The sooner you stop drinking, the better the chance of having a healthy baby. You could be pregnant and not know it. So if you are trying to get pregnant or are sexually active and not using contraception, don’t drink alcohol. The following summary is excerpted from the 10th Special Report to the U.S. Congress on Alcohol and Health produced by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The passage further describes FAS and the issues associated with prenatal alcohol exposure and serves as an introduction to the report’s comprehensive chapter on the subject. To view the full report, visit the NIAAA Web site at www.niaaa.nih.gov. Fetal Alcohol Syndrome (FAS) is a set of birth defects caused by maternal consumption of alcohol during pregnancy. At birth, children with FAS can be recognized by growth deficiency and a characteristic set of minor facial traits that tend to become more normal as the child matures. Less evident at birth—but far more devastating to FAS children and their families—are the lifelong effects of alcohol-induced damage to the developing brain. FAS is considered the most common nonhereditary cause of mental retardation. In addition to deficits in general intellectual functioning, individuals with FAS often demonstrate difficulties with learning, memory, attention, and problem solving as well as problems with mental health and social interactions. Thus these individuals and their families face persistent hardships in virtually every aspect of life. Estimates of FAS prevalence vary from 0.5 to 3 per 1,000 live births in most populations, with much higher rates in some communities (Stratton et al. 1996). However, the diagnosis of FAS identifies only a relatively small proportion of children affected by alcohol exposure before birth. Children with significant prenatal alcohol exposure can lack the characteristic facial defects and growth deficiency of FAS but still have alcohol-induced mental impairments that are just as serious, if not more so, than in children with FAS. The term "alcohol-related neurodevelopmental disorder" (ARND) has been developed to describe this condition. In addition, prenatally exposed children without FAS facial features can have other alcohol-related physical abnormalities of the skeleton and certain organ systems; these are known as alcohol-related birth defects (ARBD). Because the effects of prenatal alcohol exposure on the developing brain appear to be especially long lasting and debilitating, a significant proportion of research has concentrated on brain malformations as well as cognitive and behavioral abnormalities. In this chapter, the section on "Prenatal Alcohol Exposure: Effects on Brain Structure and Function" describes research using neuroimaging techniques to provide precise pictures of brain abnormalities found in persons exposed to alcohol before birth. The studies strongly support the notion that alcohol has specific, rather than global, effects on the developing brain. The section also describes current research on the many behavioral manifestations of this structural brain damage, including problems with cognitive and motor functions as well as mental health and psychosocial behavior. It is unlikely that a single mechanism can explain all of the deleterious effects that result from alcohol exposure during pregnancy. As described in the section "Underlying Mechanisms of Alcohol-Induced Damage to the Fetus," alcohol exerts its effects on the developing fetus through multiple actions at different sites. In the developing brain, for example, alcohol has been shown to interfere with the development, function, migration, and survival of nerve cells. Also, in the embryonic cell layer that develops into the bones and cartilage of the head and face, alcohol exposure at critical stages of development induces premature cell death that is thought to be linked to the FAS facial defects. These actions of alcohol have provided scientists with numerous paths for pursuing possible biochemical mechanisms for these actions. Better understanding of the mechanisms may point to pharmacologic approaches for intervening or for preventing alcohol-related fetal injury. Although research in animals and humans is continuing to provide details about alcohol-induced deficits, efforts to prevent these problems are not nearly so advanced. The section "Issues in Fetal Alcohol Syndrome Prevention" notes that numerous strategies to prevent FAS have been implemented in recent years, but that rigorous analysis of the effectiveness of these approaches is in its infancy. The section summarizes major reviews of FAS prevention efforts, presents issues related to research methods and evaluations, and describes research on prevention approaches targeted to women at different levels of risk. Recent research underscores an intensifying need for effective prevention strategies. One study found that although alcohol use among pregnant women decreased between 1988 and 1992 (from 22.5 to 9.5 percent), by 1995 it had increased to 15.3 percent (Ebrahim et al. 1998). Moreover, binge drinking (defined in the study as five or more drinks per occasion) among pregnant women, a particularly haz References Ebrahim, S.H.; Diekman, S.T.; Floyd, L.; and Decoufle, P. Comparison of binge drinking among pregnant and nonpregnant women, United States, 1991–1995. Am J Obstet Gynecol 180(1 pt. 1):1–7, 1999. Ebrahim, S.H.; Luman, E.T.; Floyd, R.L.; Murphy, C.C.; Bennett, E.M.; and Boyle, C.A. Alcohol consumption by pregnant women in the United States during 1988–1995. Obstet Gynecol 92(2):187–192, 1998. Stratton, K.; Howe, C.; and Battaglia, F., eds. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press, 1996.