Fetal alcohol effect (FAE) and syndrome (FAS)

The adverse and chronic effects of maternal alcohol abuse during pregnancy on her infant.

The effects of heavy maternal alcohol use during pregnancy were first described as fetal alcohol syndrome (FAS) in the United States in 1973. An estimated one to three babies of every thousand births in the United States

has FAS, making FAS the leading cause of mental retardation . It is also one of the few preventable causes of mental retardation and other birth defects. The U.S. Public Health Service estimates that between two and five of every thousand babies born in the United States exhibits one or more effects from fetal alcohol exposure. Although the precise amount of alcohol that must be consumed to cause damage is not known, it is believed that both heavy, consistent alcohol consumption and occasional binge drinking can produce FAS. In April 1997, the Centers for Disease Control and Prevention released the results of a study it had conducted in 1995. In a survey of 1,313 pregnant women, 3.5% said they "drank frequently" during pregnancy. (The agency defined "frequently" for the survey as having seven or more drinks per week, or binging on five or more drinks once within the previous month.)

Why some fetuses are affected and others are not is not completely understood. However, researchers believe that a combination of genetic and environmental factors work together to determine whether maternal alcohol consumption will affect the development of the fetus. Research has suggested that the genetic makeup of members of some racial and ethnic groups makes them less able to physically break down alcohol in the liver, and as a result, they are more susceptible to alcohol's adverse effects. When alcohol passes from the mother's bloodstream across the placenta to the developing fetus, the developing organs are unable to process it and thus are vulnerable to damage or arrested growth.

Women who drink heavily during pregnancy have a significantly higher risk of spontaneous abortion (known as miscarriage); their risk of miscarriage or stillbirth is at least twice that of nondrinkers. For the woman who carries the fetus to term (or near-term), researchers speculate that, in addition to genetic factors, her nutritional status and general health will affect her ability to tolerate alcohol. Due to these and other factors, an estimated 40% of women who drink heavily during pregnancy will give birth to an infant with FAS; all women who drink large amounts of alcohol during pregnancy risk giving birth to an infant with fetal alcohol effects (FAE). FAE describes the condition where the visible physical effects of alcohol are less pronounced than with FAS, but where the learning and psychosocial characteristics are still pronounced. Both FAS and FAE produce lifelong effects that can be managed and treated but not cured.

FAS encompasses a range of physical and mental birth defects:

• Prenatal growth retardation (low birth weight, length, and head circumference); may have difficulty bonding with caregiver
• Low Apgar scores at birth
• Postnatal growth retardation (failure to gain weight and develop normally); may show signs of developmental delay , such as delayed walking, poor coordination, delayed language development , and problems with toilet training. FAE/FAS toddlers may be prone to irritability and temper tantrums.
• Intellectual and attention deficiencies
• Behavioral problems; may exhibit antisocial behaviors, such as arson, shoplifting, lying, defiance of authority, and destructiveness. FAS/FAE adolescents often become involved in inappropriate or unsafe sexual situations, brought about by physical maturity and emotional immaturity.
• Skull or brain malformations.

Distinctive facial features may include:

• Small head (microcephaly)
• Small eyes with folds in the skin near the nose (epicanthal folds) and short horizontal eye openings (palpebral fissures)
• Underdevelopment of the upper lip with flat philtrum (ridges extending vertically between the upper lip and nose)
• Small jaw (micrognathia).

FAS/FAE is a lifelong condition that, depending on its severity, will limit the individual's ability to function productively in the world. Early diagnosis and intervention with support and education services are the keys to success in social and vocational settings.

Further Reading

Blume, Sheila B. What You Can Do to Prevent Fetal Alcohol Syndrome: A Professional's Guide. Minneapolis: Johnson Institute, 1992.

Dorris, Michael. The Broken Cord. New York: Harper and Row, 1989.

Fetal Alcohol Syndrome (FAS) and Effects: What's the Difference? Evanston, IL: Altschul Group, 1989. (For information: 1-800-421-2363) (One 24-minute videocassette.)

McCuen, Gary E., ed. Born Hooked: Poisoned in the Womb. 2nd ed. Hudson, WI: G.E. McCuen Publications, 1994.

"More Women Report Alcohol Use in Pregnancy." New York Times, (April 25, 1997): A13.

Nevitt, Amy. Fetal Alcohol Syndrome. New York: Rosen Publishing Group, 1996.

Steinmetz, George. "The Preventable Tragedy, Fetal Alcohol Syndrome." National Geographic Magazine, vol. 11, no 2, (February 1992): 36-39.

Stratton, Kathleen, Cynthia Howe, and Frederick Battaglia. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, D.C.: National Academy Press, 1997.