Fetal Alcohol Spectrum Disorder

Fetal-Alcohol-Spectrum-DisorderDrinking alcohol during pregnancy can cause physical and mental birth defects. Each year, up to 40,000 babies are born with some degree of alcohol-related damage (1, 2). Although many women are aware that heavy drinking during pregnancy can cause birth defects, many do not realize that moderate—or even light—drinking also may harm the fetus.
In fact, no level of alcohol use during pregnancy has been proven safe. Therefore, the March of Dimes recommends that pregnant women do not drink any alcohol—including beer, wine, wine coolers and hard liquor—throughout their pregnancy and while nursing. In addition, because women often do not know they are pregnant for a few months, women who may be pregnant or those who are attempting to become pregnant should abstain from drinking alcoholic beverages.
Recent government surveys indicate that about 13 percent of pregnant women drink during pregnancy. About 3 percent of pregnant women report binge drinking (five or more drinks on any one occasion) or frequent drinking (seven or more drinks per week). Women who binge drink or drink frequently greatly increase the risk of alcohol-related damage to their babies.
When a pregnant woman drinks, alcohol passes swiftly through the placenta to her fetus. In the unborn baby’s immature body, alcohol is broken down much more slowly than in an adult's body. As a result, the alcohol level of the baby's blood can be even higher and can remain elevated longer than the level in the mother's blood. This sometimes causes the baby to suffer lifelong damage.
In February 2005, Dr. Richard H. Carmona, surgeon general of the United States, warned pregnant women and women who may become pregnant about the risks of alcohol during pregnancy. To view the press release, click here.

What are the hazards of drinking alcohol during pregnancy?
Drinking alcohol during pregnancy can cause a number of birth defects, ranging from mild to severe. These include mental retardation; learning, emotional and behavioral problems; and defects involving the heart, face and other organs. The term "fetal alcohol spectrum disorder" is used to describe the many problems associated with exposure to alcohol before birth. The most severe of these is fetal alcohol syndrome (FAS), a combination of physical and mental birth defects.
Consuming alcohol during pregnancy also increases the risk of miscarriage, low birthweight (less than 5½ pounds) and stillbirth. A 2002 Danish study found that women who drank five or more drinks a week were three times more likely to have a stillborn baby than women who had less than one drink a week.

What is fetal alcohol syndrome (FAS)?
FAS is one of the most common known causes of mental retardation, and the only cause that is entirely preventable. Studies by the Centers for Disease Control and Prevention (CDC) suggest that between 1,000 and 6,000 babies in the United States are born yearly with FAS.
Babies with FAS are abnormally small at birth and usually do not catch up on growth as they get older. They have characteristic facial features, including small eyes, a thin upper lip and smooth skin in place of the normal groove between the nose and upper lip. Their organs, especially the heart, may not form properly. Many babies with FAS also have a brain that is small and abnormally formed, and most have some degree of mental disability. Many have poor coordination, a short attention span and emotional and behavioral problems.

The effects of FAS last a lifetime. Even if not mentally retarded, adolescents and adults with FAS have varying degrees of psychological and behavioral problems and often find it difficult to hold down a job and live independently.

What are fetal alcohol effects (FAE)?
The CDC estimates that about three times the number of babies born with FAS are born with lesser degrees of alcohol-related damage. This condition is sometimes referred to as fetal alcohol effects (FAE). These children have some of the physical or mental birth defects associated with FAS. The Institute of Medicine uses more specific diagnostic categories for FAE, referring to the physical birth defects (such as heart defects) as alcohol-related birth defects (ARBD), and to the mental and behavioral abnormalities as alcohol-related neurodevelopmental disorders (ARND).
In general, alcohol-related birth defects (such as heart and facial defects) are more likely to result from drinking during the first trimester. Drinking at any stage of pregnancy can affect the brain as well as growth.

During pregnancy, how much alcohol is too much?
No level of drinking alcohol has been proven safe during pregnancy. The full pattern of FAS usually occurs in offspring of women who are alcoholics or chronic alcohol abusers. These women either drink heavily (about four or five or more drinks daily) throughout pregnancy or have repeated episodes of binge drinking. However, FAS can occur in women who drink less. ARBD and ARND can occur in babies of women who drink moderately or lightly during pregnancy.
Researchers are taking a closer look at the more subtle effects of moderate and light drinking during pregnancy. A 2002 study found that 14-year-old children whose mothers drank as little as one drink a week were significantly shorter and leaner and had a smaller head circumference (a possible indicator of brain size) than children of women who did not drink at all.  A 2001 study found that 6- and 7-year-old children of mothers who had as little as one drink a week during pregnancy were more likely than children of non-drinkers to have behavior problems, such as aggressive and delinquent behaviors. These researchers found that children whose mothers drank any alcohol during pregnancy were more than three times as likely as unexposed children to demonstrate delinquent behaviors.
Other researchers report behavioral and learning problems in children exposed to moderate drinking during pregnancy, including attention and memory problems, hyperactivity, impulsivity, poor social and communication skills, psychiatric problems (including mood disorders) and alcohol and drug use.

Is there a cure for FAS?
There is no cure for FAS. However, a recent study found that early diagnosis (before 6 years of age) and being raised in a stable, nurturing environment can improve the long-term outlook for individuals with FAS. Those who experienced these protective factors during their school years were two to four times more likely to avoid serious behavioral problems resulting in trouble with the law or confinement in a psychiatric institution.
If a pregnant woman has one or two drinks before she realizes she is pregnant, can it harm the baby?
It is unlikely that the occasional drink a woman takes before she realizes she is pregnant will harm her baby. The baby’s brain and other organs begin developing around the third week of pregnancy, however, and are vulnerable to damage in these early weeks. Because no amount of alcohol is proven safe, a woman should stop drinking immediately if she even suspects she could be pregnant, and she should abstain from drinking all alcohol if attempting to become pregnant.

Is it safe to drink alcohol while breastfeeding?
Small amounts of alcohol do get into breastmilk and are passed on to the baby. One study found that breastfed babies of women who had one or more drinks a day were a little slower in acquiring motor skills (such as crawling and walking) than babies who had not been exposed to alcohol. Large amounts of alcohol also may interfere with ejection of milk from the breast. For these reasons, the March of Dimes recommends that women abstain from drinking alcohol while they are nursing. Similarly, the American Academy of Pediatrics (AAP) recommends that breastfeeding mothers avoid regular use of alcohol. However, according to the AAP, an occasional alcoholic drink probably won’t hurt the baby, but a mother who chooses to have a drink should wait at least two hours before breastfeeding her baby.

Can heavy drinking by the father contribute to FAS?
To date, there is no proof that heavy drinking by the father can cause FAS. But men can help their partner avoid alcohol by not drinking during their partner’s pregnancy.