Fetal alcohol syndrome Health Article

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

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. Many birth defects associated with fetal alcohol syndrome are commonly caused by heavy alcohol use or alcoholism.

Timing of alcohol use during pregnancy is also important. Alcohol use appears to be the most harmful during the first three months of pregnancy.

Symptoms

Symptoms of fetal alcohol syndrome may include:

• Slowed intrauterine growth
• Poor growth in the fetus and newborn
• Possible failure to thrive
• Delayed development and signs of mild-to-moderate mental retardation (IQ will range from 50 to 85, with an average in the mid 60s)
• Low muscle tone and poor coordination
• Irregularities of the face
  • Small head
  • Small upper jaw
  • Short, upturned nose
  • Smooth groove in upper lip
  • Smooth and thin upper lip
  • Narrow, small eyes with large epicanthal folds
• Heart defects such as ventricular septal defect (VSD) or atrial septal defect (ASD)
• Abnormal joints, hands, feet, fingers, and toes
• Tremors in a newborn infant
• Agitation and crying
• Strawberry birthmarks (hemangiomas) on the skin

Signs and tests

Drinking alcohol during pregnancy may be the first sign of possible fetal alcohol syndrome.

An exam of the baby may show a heart murmur or other signs of 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:

• Pregnancy ultrasound, which can show slowed intrauterine growth
• Infant ECG and echocardiogram, which can find heart problems
• Blood alcohol level in pregnant women who show signs of being drunk (intoxicated)

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/affiliates/affil.html
• National Drug and Alcohol Treatment Referral Routing Service -- 1-800-662-4357

See: 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. Heart defects may require surgery. There is no effective therapy for mental retardation.

Complications

Drinking alcohol during pregnancy may result in:

• Miscarriage or stillbirth
• Premature delivery

Complications seen in the infant may include:

• Abnormal heart or problems with other organs
• Future hyperactive behavior and learning disabilities
• Infant death
• Mental retardation
• Problems in the structure of the head, eyes, nose, or mouth
• Slow growth and poor coordination
• Small gestational age

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

American Academy of Pediatrics, Committee on Substance Abuse and Committee on Children with Disabilities. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics. August 2000;106:358-361.