Fetal alcohol syndrome

Definition

Fetal alcohol syndrome refers to growth, mental, and physical problems that may occur in a baby when a mother drinks alcohol during pregnancy.

Alternative Names

Alcohol in pregnancy; Drinking alcohol during pregnancy; Alcohol-related birth defects; Fetal alcohol effects

Causes, incidence, and risk factors

Using or abusing alcohol during pregnancy can cause the same risks as using alcohol in general. However, it poses extra risks to the fetus. When a pregnant woman drinks alcohol, it easily passes across the placenta to the fetus. Because of this, drinking alcohol can harm the baby's development.

A pregnant woman who drinks any amount of alcohol is at risk, since no "safe" level of alcohol use during pregnancy has been established. However, larger amounts appear to increase the problems. Binge drinking is more harmful than drinking small amounts of alcohol.

Timing of alcohol use during pregnancy is also important. Alcohol use appears to be the most harmful during the first 3 months of pregnancy However, drinking alcohol anytime during pregnancy can be harmful.

Symptoms

A baby with fetal alcohol syndrome may have the following symptoms:

• Poor growth while the baby is in the womb and after birth
• Decreased muscle tone and poor coordination
• Delayed development and significant functional problems in three or more major areas: thinking, speech, movement, or social skills (as expected for the baby's age)
• Heart defects such as ventricular septal defect (VSD) or atrial septal defect (ASD)
• Structural problems with the face, including:
  • Narrow, small eyes with large epicanthal folds
  • Small head
  • Small upper jaw
  • Smooth groove in upper lip
  • Smooth and thin upper lip

Signs and tests

A physical exam of the baby may reveal a heart murmur or other heart problems. As the baby grows, there may be signs of delayed mental development. There also may be structural problems of the face and skeleton.

Tests include:

• Blood alcohol level in pregnant women who show signs of being drunk (intoxicated)
• Brain imaging studies (CT or MRI) shows abnormal brain development
• Pregnancy ultrasound shows slowed growth of the fetus

See also: Toxicology screen

Treatment

Women who are pregnant or who are trying to get pregnant should avoid drinking any amount of alcohol. Pregnant women with alcoholism should join an alcohol abuse rehabilitation program and be checked closely by a health care provider throughout pregnancy.

Support Groups

The following organizations may offer assistance:

• National Council on Alcoholism and Drug Dependency -- www.ncadd.org
• National Drug and Alcohol Treatment Referral Routing Service -- 1-800-662-4357

See also: Alcoholism - support group

Expectations (prognosis)

The outcome for infants with fetal alcohol syndrome varies depending on the extent of symptoms, but almost none have normal brain development.

Infants and children with fetal alcohol syndrome have many different problems, which can be difficult to manage. Children do best if diagnosed early and referred to a team of providers who can work with their families on educational and behavioral strategies that best fit the individual child’s needs.

Complications

Drinking alcohol during pregnancy may result in:

• Miscarriage or stillbirth
• Premature delivery

Complications seen in the infant may include:

• Abnormal heart structure
• Behavior problems
• Infant death
• Mental retardation
• Problems in the structure of the head, eyes, nose, or mouth
• Poor growth before birth
• Slow growth and poor coordination after birth

Calling your health care provider

Call for an appointment with your health care provider if you are drinking alcohol regularly or heavily, and are finding it difficult to cut back or stop. Also, call if you are drinking alcohol in any amount while you are pregnant or trying to get pregnant.

Prevention

Avoiding alcohol during pregnancy prevents fetal alcohol syndrome. Counseling can help prevent recurrence in women who have already had a child with fetal alcohol syndrome.

Sexually active women who drink heavily should use birth control and control their drinking behaviors, or stop using alcohol before trying to conceive.

References

Stoll BJ. Metabolic disturbances. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 106.

Bertrand J, Floyd LL, Weber MK. Guidelines for identifying and referring persons with fetal alcohol syndrome. MMWR Recomm Rep. 2005 Oct 28;54(RR-11):1-14.