Fetal Alcohol Syndrome

Fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders are caused by the ingestion of alcohol during pregnancy, which exposes the developing fetus to alcohol. Although the true prevalence rate of FAS in the United States is believed to be underestimated, it is reported to occur in .2 to 1.5 per 1000 births. The percentage of births affected by maternal alcohol consumption increases to around 1 in 100 when the larger category of fetal alcohol spectrum disorders is included. These prevalence rates vary based on such factors as socioeconomic status and race, with for example, very high prevalence reported for some Native American populations. Although it is fortunate that FAS and related disorders are 100% preventable, the prevalence rates indicate that they continue to represent a substantial health risk. Indications of this health risk are clear from reports by such agencies as the Centers for Disease Control, which indicate that FAS is one of the leading causes of birth defects and is the single most common cause of mental retardation, accounting for as much as 40% of the new cases each year.

From a historical perspective, it is apparent that many early civilizations such as the Greeks and Romans believed that alcohol consumption was dangerous during conception and pregnancy. However, it is not fully known whether these early civilizations understood the true relationship between alcohol consumption and the resulting problems exhibited by infants born to mothers who consumed alcohol during pregnancy. In fact, it was not until the late 1960s that patterns of maternal alcohol consumption and abnormalities in fetal development were identified and reported in France, and it was not until the 1970s that the initial diagnostic criteria for FAS were established by a group of physicians in the United States. However, because alcohol is known to be a pervasive neurotoxin and a teratogen, it has the potential to [Page 403]impact all areas of development of the fetus, a potential which explains the various physical abnormalities that are characteristic of FAS.

In fact, physical abnormalities called dysmorpholo-gies are hallmark features of FAS. Some of the more prominent facial abnormalities include a flattened mid face, narrow eye openings, lack of a defined philtrum (the vertical groove in the upper lip between the upper lip and bottom of the nose), and a thin upper lip. FAS is also associated with a lower than average birth-weight in full-term infants, developmental delay, a variety of medical disorders, and abnormal brain development. Developmental delays in walking, talking, and toilet training are common. Medical disorders that commonly occur include abnormal immune system function and heart defects, among others. Alcohol can also have devastating effects on the developing brain. Indeed, recent research has suggested that alcohol can differentially impact specific areas of the brain, and the apparent susceptibility of these brain areas is believed to be responsible for the cognitive, behavioral, and emotional problems seen in children with FAS. Cognitive problems with learning and memory, problem-solving ability, and response inhibition are common, as are behavioral and emotional disturbances such as hyperactivity, agitation, impulsivity, and emotional instability. Individuals with FAS often lack normal motor abilities including fine motor coordination and tend to have an awkward, unsteady gait.

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