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
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
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
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
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
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
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
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
Stratton, K.; Howe, C.; and Battaglia, F., eds.
Fetal Alcohol Syndrome: Diagnosis, Epidemiology,
Prevention, and Treatment. Washington, DC:
National Academy Press, 1996.