Fetal alcohol spectrum disorders (FASDs)

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FASDs are a group of conditions that occur when fetuses have exposure to alcohol during pregnancy. They can affect brain development, behavior, and growth. In the United States, FASDs affect an estimated 1–5% of children in the first grade of school.

According to the Centers for Disease Control and Prevention (CDC), FASDs can manifest in various physical, behavioral, and cognitive differences, including:

• difficulty paying attention
• difficulty remembering
• speech and language delays
• vision or hearing problems
• problems with the heart, kidneys, or bones
• below average height
• small head size
• difference in facial features
• learning disabilities

The exact presentation and severity of FASDs varies from person to person, so each case is unique.

There are five types of FASDs, including:

• Fetal alcohol syndrome (FAS): This is the most severe type. It causes distinct facial features, low weight or height, and central nervous system damage.
• Partial fetal alcohol syndrome (pFAS): This is a less severe form of FAS. People may get this diagnosis if they meet most, but not all, of the diagnostic criteria for FAS.
• Alcohol-related birth defects (ARBD): A diagnosis of ARBD applies to people who only have physical differences due to prenatal alcohol exposure but do not have other symptoms.
• Alcohol-related neurodevelopmental disorder (ARND): Conversely, ARND applies to people who have neurological and behavioral symptoms of prenatal alcohol exposure but no physical signs.
• Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE): This diagnosis is similar to ARND but can involve some physical symptoms too.

FASDs can cause a wide variety of symptoms and complications. The physical symptoms may include:

• thin upper lip
• a lack of a ridge in the skin between the nose and upper lip
• narrow lower eyelids, giving the eyes a small or rounded appearance
• low weight, height, or both for the child’s age
• atypical organ or bone development

Neurological symptoms may include:

• difficulty with sleeping or suckling as a baby
• developmental delays, such as speech or language delays
• difficulty with attention or memory
• difficulty with physical coordination and balance
• difficulty with reasoning, logic, and judgment
• intellectual or learning disabilities
• impaired executive functioning, which is the ability to plan one’s actions
• impaired social skills

Behavioral signs could include:

• difficulty regulating emotions
• hyperactivity or impulsivity
• causing disruption at school
• inappropriate sexual behavior
• difficulty maintaining employment in adulthood

It is important to note that many of these symptoms can occur for a range of reasons, so a person should consult a doctor if a child has any of them.

The cause of all FASDs is alcohol consumption during pregnancy. Alcohol in the parent’s blood passes to the fetus through the umbilical cord, exposing them to its effects as they grow.

The timing, frequency, and amount of alcohol all contribute to the chance and severity of FASDs. However, the exact way alcohol disrupts fetal development is complex and not fully understood. As such, there is no known safe amount of alcohol people can drink during pregnancy or while trying to get pregnant.

In a 2022 report, CDC researchers found that 13.5% of pregnant adults in the United States reported current drinking between 2018 and 2020. This is equivalent to nearly 1 in 7 pregnant people.

The risks of drinking during pregnancy are higher in those who do not have a usual doctor they see throughout pregnancy and those who experience frequent mental distress.

There is no single test for any of the FASDs. Instead, a team of healthcare professionals will assess a person’s symptoms against a list of criteria. This team may include a doctor or pediatrician with experience diagnosing FASDs, a psychologist, a speech-language therapist, and an occupational therapist.

Primary care physicians cannot make a firm diagnosis of an FASD. This is because there is some overlap between the symptoms of FASDs and the symptoms of exposure to other types of drugs, such as tobacco or illegal drugs. It can be difficult to tell them apart.

As a result, a diagnosis requires insight from specialists from different fields who can carry out a thorough assessment of the different ways FASD can affect people. This can help them rule out other explanations.

Each of the five FASD conditions has a different criteria. For example, if a child has two of the three characteristic facial signs of FAS and evidence of damage to the nervous system, a doctor may diagnose FAS. Other FASDs have fewer signs or only cause either physical or neurological symptoms.

In most cases, the diagnostic team will also need documentation of alcohol consumption during pregnancy. FAS is an exception to this, as the symptoms are often distinctive enough to confirm a diagnosis on their own.

There is no cure for FASDs, but early intervention and support can significantly help with child development. No two cases are exactly the same, so specialists will tailor the treatment plan to each person’s needs.

Interventions may include:

• medical care to address any physical symptoms or complications
• behavior and education therapy to help children with social and physical skills, executive functioning skills, and learning at school
• parent training to help caregivers understand how best to support their child
• medications to manage symptoms such as hyperactivity, anxiety, aggression, or sleep issues

Complementary therapies that some people try for FASDs include yoga, meditation, relaxation, art therapy, and animal-assisted therapy. Speak with a doctor before trying these.

The outlook for individuals with FASDs varies based on the severity of their symptoms and how much support they receive. Diagnosis and support at any age can be beneficial, but early intervention is especially helpful.

The nature of these disorders means that challenges may continue into adulthood, needing ongoing support and accommodations.

People who are pregnant or trying to become pregnant in the near future should not drink alcohol. If stopping alcohol consumption is difficult, it is essential to seek help as soon as possible. This could be from a doctor, an addiction support service, or a mental health professional.

Caregivers who notice developmental delays, behavioral issues, or physical differences in their child should also seek help promptly.

FASDs are a group of medical conditions that occur due to alcohol exposure during pregnancy. Alcohol can affect developing fetuses in a variety of ways, and the symptoms a person has determine which type of FASD diagnosis they receive.

Stopping alcohol consumption as early as possible can help reduce the chance of FASDs. Ideally, people who are trying to get pregnant should not drink at all, as this is the only way to prevent these conditions.

Treatment for FASDs involves providing medical care and support to help children learn life skills and improve their quality of life. Anyone who has concerns about their alcohol consumption or a child’s symptoms should speak with a health professional.