Prenatal Alcohol Exposure, FAS, and FASD: An Introduction

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Prenatal Alcohol Exposure (PAE) can result in a wide range of physical, psychological, behavioral, and social problems that affect the individuals, their families, and their communities. Indeed, PAE is a major public health issue placing undue burden on all aspects of society. Among the most severe outcomes of PAE is the Fetal Alcohol Syndrome (FAS), which is characterized by growth deficits, facial anomalies, and neurobehavioral problems. However, FAS is not the only detrimental outcome of heavy gestational alcohol exposure, and the majority of individuals affected by such exposure do not meet the diagnostic criteria of FAS.  Currently, PAE is increasingly understood as the cause of a continuum of effects across many domains. 

Fetal Alcohol Spectrum Disorder (FASD) is a nondiagnostic term used to identify the wide array of outcomes resulting from prenatal exposure to alcohol. These outcomes range from isolated organ damage or subtle developmental disabilities to stillbirths and FAS. Perhaps the most pervasive outcome following prenatal alcohol exposure is what is now commonly referred to as an Alcohol - Related Neurodevelopmental Disorder (ARND).  While individuals with ARND may exhibit many of the alcohol - related brain and behavioral abnormalities of FAS, they may not display the characteristic facial dysmorphia required for an FAS diagnosis. Although cases of FASD are often not as easily recognized as FAS, they can be just as serious.

Unfortunately, missed diagnoses of FASD can have devastating consequences, placing heavy emotional, financial and social stresses on the individual and all parties involved (Riley and McGee, 2005). 

Although the relationship between alcohol consumption during pregnancy and abnormal fetal development has been alluded to throughout history (Warren and Hewitt, 2009), FAS went unrecognized until the late 1960s and early 1970s (Lemoine et al., 1968 ; Jones and Smith, 1973 ; Jones et al., 1973). Since those initial defining case studies, the scientific literature on the effects of PAE on the developing fetus has grown rapidly.

A simple search of pubmed.gov (U.S. National Library of Medicine) using “fetal alcohol syndrome” as a search term turned up almost 3500 citations. This research has improved our understanding of the relationship between alcohol exposure and developmental deficits, and has resulted in an increased social awareness of the risks of drinking during pregnancy, prevention efforts to reduce these risks, and development of intervention programs to help promote positive outcomes for individuals with FASD.

However, despite our current knowledge and the progress that has been made, many challenges remain in understanding how alcohol exerts its effects, in developing efficacious and effective prevention and intervention programs, and how best to improve the daily functioning of these individuals. 

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Tanya T. Nguyen, Jennifer Coppens, and Edward P. Riley
Edited by Edward P. Riley, Sterling Clarren, Joanne Weinberg, and Egon Jonsson

Tanya T Nguyen practices as a Pediatrician in Alhambra, CA.
Jennifer Coppens, Medical Student, University of Alberta
Prof. Dr. Edward P. Riley San Diego State University Center for Behavioral Teratology

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REFERENCES

1. Abel, E.L. (1999) Was the fetal alcohol syndrome recognized by the Greeks and Romans?  Alcohol Alcohol., 34 (6), 868 – 872.
   
2. Adnams, C.M., Sorour, P., Kalberg, W.O., Kodituwakku, P., Perold, M.D., Kotze, A., September, S., Castle, B., Gossage, J., and May, P.A. (2007) Language and literacy outcomes from a pilot intervention study for children with fetal alcohol spectrum disorders in South Africa.  Alcohol, 41 (6), 403 – 414.
   
3. Barry, K.L., Caetano, R., Chang, G., DeJoseph, M.C., Miller, L.A., O’ Connor, M.J., Olson, H.C., Floyd, R.L., Weber, M.K., DeStefano, F., Dolina, S., Leeks, K., and National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect (March 2009) Reducing Alcohol - Exposed Pregnancies: A Report of the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect, Centers for Disease Control and Prevention, Atlanta, GA.
   
4. Bertrand, J. (2009) Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects.  Res. Dev.  Disabil., 30 (5), 986 – 1006.

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RELATED STORIES:
Fetal alcohol spectrum disorder requires new approach   What is fetal alcohol spectrum disorder (FASD)?   Fetal Alcohol Spectrum Disorder (FASD) Interventions   Fetal Alcohol Spectrum Disorder (FASD) Prevention   Prevalence and Impact of FAS and FASD   Risk factors influencing FAS and FASD Conditions   Fetal Alcohol Syndrome   FASD History

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