Family: Education: Descriptions of Disorders
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FETAL ALCOHOL SYNDROME
FETAL ALCOHOL SYNDROME
What Is FAS?
Fetal alcohol syndrome (FAS) describes a set of features seen in some individuals
whose mother drank alcohol during pregnancy. These effects range from mild to
severe and include mental retardation, abnormal development, and a characteristic
pattern of craniofacial (head and face) defects:
- Small head (microcephaly)
- Low nasal bridge and short nose
- Small eye opening and skin folds at the corners of the eyes
- Thin upper lip and indistinct or absent philtrum (the indentation
between the nose and the upper lip)
- Less commonly:
- Droopy eyelids
- Cleft lip with or
without cleft palate
- Shortened fingers and underdeveloped nails (especially of the fifth
["pinky"] finger)
- Joint abnormalities and malformations of the vertebrae (bones of the
spine)
Many children with FAS also have mild to moderate mental retardation—more than
three-quarters have IQs in the 60s (the average IQ for people without mental
deficits is about 100). FAS babies are irritable and have poor sucking or
swallowing reflexes. They may be usually jittery and may startle easily. Their
muscle tone may be "floppy" and loose, or unusually stiff and tense. Older children
may have learning and memory problems, hyperactivity, and sleep disorders.
FAS children tend to be much smaller than average, both at birth and as they
get older. The heart may also be affected with any of a number of defects, such
as murmurs caused by a hole in the wall separating the chambers of the heart.
The kidneys, which may be underdeveloped, may be affected as well.
FAS is the most severe of a number of conditions caused by the fetus’s exposure
to alcohol. Children with milder effects of alcohol exposure may not have the
facial abnormalities of FAS but are born with other problems, such as heart
or kidney defects and abnormal mental development.
What Causes FAS?
In the earliest weeks of pregnancy, changes are taking place in the embryo
that will lead to the formation of the major body structures and organs. The
cells that will form the head and face are in place by about 4 weeks. These
cells, called neural crest cells, have been found to be particularly
sensitive to the effects of alcohol. By the end of 8 weeks, the elements of
all the fetus’s major body systems are in place. This is only 2 months after
fertilization—before many women even know they are pregnant.
It is not known precisely how alcohol damages the neural crest cells, but researchers
have some clues. Alcohol is known, for example, to interfere with the ways in
which cells multiply, communicate with one another, and migrate to their proper
places during fetal growth. It may be a combination of several such effects
that gives rise to FAS and other alcohol-related problems in the newborn.
Similarly, it is not known precisely what level of alcohol consumption by a
pregnant woman can be said to be safe. It is known, however, that alcohol affects
the fetus in different ways at various stages of pregnancy. In the earliest
part of pregnancy—up to about 2 weeks—heavy drinking is more likely to cause
miscarriage (loss of the pregnancy) than FAS or other alcohol-related effects.
During the first 8 weeks, the vital organs, such as the brain, heart, and kidneys
are forming. This is the time when the fetus is most vulnerable to the effects
of maternal drinking. Alcohol exposure later in pregnancy is more likely to
cause developmental and growth problems, since the major organ systems have
already formed.
Most doctors think that the safest level of drinking during pregnancy is none
at all. This also holds true for women who are thinking of becoming pregnant,
since alcohol can affect the fetus in significant ways before a woman knows
she is pregnant.
How Is FAS Diagnosed?
At one time, FAS was recognized mainly on the basis of the head and face abnormalities
that are seen in this condition. Until recently, FAS would be diagnosed only
when a child had these features and it was known that the mother drank during
pregnancy. In recent years, however, scientists and doctors have begun to realize
that the effects of prenatal alcohol exposure exist on a continuum, ranging
from mild to severe. This recognition has led to the development of three categories
of FAS:
- FAS with confirmed maternal drinking: The child has the facial features
and other signs of FAS, and it is known that the mother drank during pregnancy.
- FAS without confirmed maternal drinking: The child has FAS facial
features and other signs, but it is not known whether the mother drank during
pregnancy.
- Partial FAS with confirmed maternal drinking: The child has some
of the facial features and other signs of FAS, and it is known that the mother
drank during pregnancy.
In addition, two milder forms of alcohol-related effects are recognized. These
conditions are called alcohol-related birth defects (ARBD) and alcohol-related
neurodevelopmental disorder (ARND). ARBD and ARND are diagnosed when it
is known that the mother drank during pregnancy, even though the child does
not have the facial features of FAS. Children with ARBD or ARND do not have
the craniofacial defects of FAS but may still have some of the other characteristics
of the disorder, such as mental impairment and abnormal development. They may
also have heart or kidney problems.
Can FAS Be Treated?
Most of the damage from alcohol exposure before birth cannot be undone. Surgery
can, however, be used to repair severe craniofacial defects, some heart defects,
and cleft lip and palate. And children with FAS and other alcohol-related problems
can be helped enormously in other ways if the condition is recognized early.
Therapy can help improve and maximize learning ability, physical functioning,
and behavioral development.
Finding Support
The National Organization on Fetal Alcohol Syndrome is a nonprofit organization
dedicated to eliminating birth defects caused by alcohol consumption during
pregnancy and improving the quality of life for those individuals and families
affected. NOFAS applies a multicultural approach in its prevention and healing
strategies in communities nationwide.
NOFAS
216 G Street, NE
Washington, DC 20002
Phone: (202) 785-4585
Fax: (202) 466-6456
E-mail: information@nofas.org
Web site: www.nofas.org
The Fetal Alcohol Syndrome Family Resource Institute is a nonprofit
corporation whose mission is to identify, understand, and care for individuals
disabled by prenatal alcohol exposure and to prevent future generations with
this disability. Membership provides families and professionals with information
and support in dealing with the effects of prenatal alcohol exposure.
FAS Family Resource Institute
P.O. Box 2525
Lynnwood, WA 98036
Phone: (253) 531-2878
Toll-free: (800) 999-3429
E-mail: delindam@accessone.com
Web site: www.accessone.com/~delindam
The Arc is a national organization on mental retardation dedicated to
improving the lives of children and adults with mental retardation and their
families. The Arc’s Fetal Alcohol Syndrome Resource and Materials Guide
offers information, educational materials, and resources on many aspects of
FAS for families and professionals and is available on the web at www.thearc.org/misc/faslist.html#families.
The Arc
1010 Wayne Avenue
Suite 650
Silver Spring, MD 20910
Phone: (301) 565-3824
Fax: (301) 565-5342
E-mail: info@thearc.org
Web site: www.thearc.org
Author: Deborah J. Shuman
Date: November 1, 2000
Disclaimer: Links to support groups and relevant web sites do not signify
an endorsement.
© 2000 The Johns Hopkins University
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the article with links to term definitions
Last Updated:
12/16/03
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