Alcohol-related birth defects: What to know

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ARBDs are physical differences in development that occur when pregnant people drink alcohol. The alcohol passes to the fetus, affecting how it grows.

Unlike other FASDs, ARBDs only cause physical symptoms. In contrast, other FASDs can affect behavior, sleep, learning, and social skills. Birth defects are also known as congenital anomalies.

Alcohol exposure in pregnancy often affects the nervous system, and a diagnosis of ARBD is uncommon. However, the effect can be significant. ARBDs can affect the development of any part of the body, but according to older 2016 research, they often affect the following:

• bones
• heart
• kidneys
• eyes
• ears

The effects may become apparent at any time during childhood and last throughout the child’s life.

ARBDs may affect the body in many ways. The differences could be:

• Skeletal: These may include:
  • radioulnar synostosis, which occurs when two of the forearm bones do not connect as they should
  • differences in vertebral segmentation, or how the bones of the spine form
  • large joint contractures, which occurs when a person cannot fully straighten or bend joints
  • scoliosis, or curvature of the spine
• Cardiovascular: These ARBDs affect the heart and blood vessels. Examples include:
  • holes in the walls that divide the chambers of the heart
  • incorrectly located great vessels, which are the arteries and veins directly connected with the heart
  • conotruncal heart defects, which are structural abnormalities of the cardiac outflow tract
• Sensory: These ARBDs affect the eyes and ears, causing:
  • strabismus, which means the eyes look in different directions
  • ptosis, or droopy eyelids
  • an underdeveloped optic nerve
  • conductive hearing loss, which occurs due to blockages in the ear
  • neurosensory hearing loss, which results from changes in the inner ear or brain
• Nephrological: This type of ARBD affects the kidneys. Examples include:
  • undeveloped, small, or differently sized kidneys
  • horseshoe kidney, where the two kidneys remain fused
  • ureteral duplications, which occur when two tubes transport urine from the same kidney to the bladder

Other differences that do not appear on this list are also possible.

The symptoms that ARBDs cause will depend on how alcohol has affected the body. For example, skeletal differences may result in:

• bone or joint pain
• mobility difficulties
• short limbs or height

Heart conditions, such as a hole in the septum, could cause:

• shortness of breath, particularly when exercising
• frequent respiratory or lung infections
• swollen legs, feet, or abdomen
• a heart murmur
• in babies, tiredness or sweating when feeding

Other indications of ARBD could result in:

• visual impairment
• hearing impairment
• reduced kidney function
• back pain or urinary tract infections

ARBDs can also lead to secondary conditions or complications. For example, a potential complication of scoliosis is spinal cord compression, which can be serious.

The effect of FASDs can be very different from person to person. Some people may grow up to have minor symptoms or none at all. Others may have significant symptoms and need ongoing treatment.

The cause of ARBDs is alcohol consumption during pregnancy. When a person drinks alcohol during pregnancy, it passes from their bloodstream to the placenta, where it may seriously affect a developing fetus. This can happen at any stage in a pregnancy.

Heavier consumption of alcohol poses a greater risk, but there is no known safe amount of alcohol people can drink during pregnancy or when trying to conceive.

Some people are at higher risk for drinking during pregnancy. According to a 2022 report, this includes people who experience frequent mental distress and have no regular primary care doctor.

To diagnose ARBDs, doctors must find differences in a child’s physical growth and development, as well as evidence that the birth parent drank alcohol during pregnancy.

To begin the process, a doctor may perform a physical examination. If there are no clear signs of ARBDs externally, they may perform other tests, such as:

• hearing or vision tests
• tests to check heart or kidney function
• medical imaging, such as X-rays, to see inside the body

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests that FASDs often go undiagnosed or misdiagnosed. This can be due to a lack of information about a child’s prenatal alcohol exposure or challenges distinguishing FASDs from other conditions.

However, early diagnosis and support can improve outcomes for children with FASDs. The American Academy of Pediatrics (AAP) emphasizes the importance of universal screening for prenatal alcohol exposure for all children.

Treatment of ARBDs can vary significantly based on how the condition has affected the child and how it changes as they grow. A team of healthcare professionals may need to work together to create a tailored treatment plan. This could include:

• Assistive devices: Mobility aids, vision aids, and hearing devices could help children with ARBD manage their day-to-day lives.
• Physical therapy: Physical therapy may help some children with movement or symptoms such as muscle aches.
• Occupational therapy: Occupational therapy can help teach children or adults ways of adapting their home, daily routine, school environment, or workplace so that they can carry out tasks more easily.
• Surgery: For some, surgery may be necessary to help an organ or system in the body to function. In other situations, a person with ARBDs might choose surgery for cosmetic reasons.

Factors that can help to reduce the effects of FASDs include:

• early diagnosis
• having a stable, nurturing home
• having support from social services or specialized education

FASDs are preventable. If someone drinks alcohol, healthcare professionals will advise them to stop drinking during pregnancy. This also applies to people who are trying to conceive or may be pregnant without knowing it yet. People may not know they are pregnant for 4–6 weeks, and drinking during this time can affect the fetus.

If stopping drinking is difficult, it is important to speak with a medical professional, therapist, or support organization as soon as possible.

For someone who is concerned about their child, it is advisable to speak with a family doctor or pediatrician.

ARBDs are some of the ways alcohol exposure can affect a growing fetus. They include physical changes in how the body’s organs develop, such as the heart or kidneys.

ARBDs include a wide range of physical differences and symptoms. They can be present from birth or become apparent as the child grows.

Early diagnosis can help children get the care and treatment they need. Depending on the effects, this may include physical therapy, assistive devices, or surgery.

It is advisable for people who have concerns about alcohol use, its effect on pregnancy, or symptoms in their child to speak with a doctor as soon as they can.