Fetal Alcohol Effect (FAE) and Syndrome (FAS)

The adverse, chronic, serious, and lifelong effects of maternal alcohol abuse during pregnancy on an unborn child are referred to as fetal alcohol effect (FAE) and fetal alcohol syndrome (FAS).

The seriousness of the impact of alcohol use on the developing fetus depends largely upon three factors: 1) how frequently the pregnant woman consumes alcohol; 2) what quantity (amount of alcohol, number of drinks) of alcohol she consumes per episode of use; and 3) gestational period of the pregnancy (the impact will be greater if the mother drinks a significant amount of alcohol during a period of critical or specific fetal development of the brain or other major system).




Standard test scores of children with fetal alcohol spectrum disorders (FASD) and alcohol syndrome (FAS)





Standard test scores of children with fetal alcohol spectrum disorders (FASD) and alcohol syndrome (FAS)
Source: National Organization on Fetal Alcohol Syndrome.

Although it is not possible to get definitive statistics, the Centers for Disease Prevention and Control (CDC) reports that there are between 0.2 and 1.5 cases of fetal alcohol syndrome (FAS) per 1,000 live births in some areas of the United States. They do publish state-by-state data detailing prevalence estimates for binge drinking and any alcohol use among pregnant women between the ages of 18 and 44 years. The CDC estimates the lifetime cost for treatment of FAS on one individual at about two million dollars, using data published in 2002. The costs can be far greater depending on severity of impact and resultant disabilities. It is estimated that the annual costs of FAS treatment in the United States exceeds four billion dollars.

Based on CDC data for women of childbearing age gathered between 2006 and 2010, one in 13 (7.6%) pregnant women reported alcohol use within the previous 30 days. Those most likely to drink were 35–44 years old, white, employed college graduates. Binge drinking in the previous 30 days was reported by 1.4% of the pregnant sample. The sample data defined binge drinking as occurring at least three times per month, with an average consumption of six drinks per episode. Because the survey relied on self-reported data, it is hypothesized that there may have been significant under-reporting of actual use.

Why some fetuses are more significantly affected than others, given all similar exposure, is not completely understood. Researchers believe that a combination of genetic and environmental factors determine the degree to which maternal alcohol consumption affects development of the fetus. Research suggests that the genetic makeup of members of some racial and ethnic groups makes them less able to 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 at increased risk of 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 potentially have a mitigating effect on the outcome for the developing fetus. It is estimated that up to 40% of women who drink heavily during pregnancy 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 in which 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 impacts that can, with individually varying degrees of success, be managed and treated but not cured.

FAS encompasses a range of physical and mental birth defects:

Distinctive facial features may include:

FAS/FAE is a lifelong condition that, depending on its severity, significantly affects the individual's ability to function productively. Early diagnosis and intervention with support and education services may improve outcomes in educational, social, and employment settings.

See also Addiction/addictive personality ; Alcohol dependence and abuse ; Apgar score ; Intellectual disability .

Resources

BOOKS

Abel, E. L. Fetal Alcohol Syndrome and Fetal Alcohol Effects. New York: Springer, 2013.

Angel, Charlotte, and Kyle Boyd. Alcohol. Hamilton, NJ: Cambridge Educational, 2010.

Brick, John. Handbook of the Medical Consequences of Alcohol and Drug Abuse. New York: Haworth Press, 2008.

Creasy, Robert K., et al. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. Philadelphia: Saunders/Elsevier, 2009.

PERIODICALS

Flak, A. L., et al. “The Association of Mild, Moderate, and Binge Prenatal Exposure and Child Neuropsychological Outcomes: A Meta-Analysis.” Alcohol: Clinical and Experimental Research 38, no. 1 (January 2014): 214–26.

Lucas, B. R., et al. “Gross Motor Deficits in Children Prenatally Exposed to Alcohol: A Meta-Analysis.” Pediatrics 134, no. 1 (July 2014): 192.

WEBSITES

Centers for Disease Control and Prevention. “Fetal Alcohol Syndrome.” http://www.cdc.gov/ncbddd/fas/default.htm (accessed September 18, 2015).

Centers for Disease Control and Prevention. “Fetal Alcohol Syndrome Disorders (FASDs).” http://www.cdc.gov/ncbddd/fasd/index.html (accessed September 18, 2015).

Mayo Clinic. “Fetal Alcohol Syndrome.” http://www.mayoclinic.com/health/fetal-alcohol-syndrome/DS00184 (accessed September 18, 2015).

National Institute on Alcohol Abuse and Alcoholism. “Fetal Alcohol Exposure.” http://pubs.niaaa.nih.gov/publications/FASDFactsheet/FASD.pdf (accessed September 18, 2015).