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Written by Amethyst Recovery

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What Are Fetal Alcohol Spectrum Disorders?

Fetal alcohol spectrum disorders or FASDs are a group of conditions that can occur if a woman drinks alcohol while she’s pregnant. FASDs can include physical symptoms as well as issues related to learning and behavior. Often a child born with FASDs will have a combination of physical, learning and behavioral problems.

When a woman drinks alcohol during her pregnancy, it then passes to the fetus through the umbilical cord. Essentially if a pregnant woman drinks alcohol, her baby is also consuming alcohol. This can be very detrimental as a fetus is developing. The more a pregnant woman drinks, the more likely fetal alcohol spectrum disorders are, and the more severe they are likely to be.

What Are the Signs of FASD?

The following are some of the signs and symptoms of FASDs in a baby or child:

  • Abnormal facial features
  • Smaller-than-average head size
  • Shorter-than-average height
  • Low body weight
  • Problems with coordination
  • Hyperactivity and problems with attention
  • Problems with memory
  • Difficulty in school
  • Learning disabilities
  • Delays in speech and language
  • Intellectual disability
  • Low IQ
  • Lack of judgment and reasoning skills
  • Problems sleeping and sucking as a baby
  • Vision or hearing deficiencies
  • Problems related to the bones, kidneys or heart

A child exposed to alcohol in the womb could have one of these signs of FASDs, a few of them, or almost all of them.

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FASD Facial Features

Often facial features are one of the primary ways a medical professional can determine if a child might have some level of FASD. Some of the facial features that could be linked to FASDs include:

  • A smooth philtrum which is the area between the upper lip and nose
  • Thin upper lip
  • Upturned nose
  • Underdeveloped ears
  • Flat bridge of the nose
  • Small head circumference
  • Folds at the inner corners of the eyes known as epicanthic folds or wideset eyes

Causes of FASDs

The cause of FASD is drinking alcohol while pregnant. There is not any level of alcohol use considered absolutely safe during pregnancy, and the more you drink while you’re pregnant, the greater the risk to the unborn baby.

If you’re pregnant and you drink, the alcohol goes into your bloodstream and then passes to the fetus through the placenta. When you drink, the amount of alcohol reaching your baby leads to a higher blood alcohol concentration because it’s much more difficult for a fetus to metabolize alcohol as compared to an adult.

Alcohol can impede oxygen and nutrition delivery to a fetus, and it can cause problems and damage to developing tissues and organs. The use of alcohol during pregnancy can also cause permanent brain damage in the baby.

While it’s unsafe to drink during any trimester of pregnancy, the first trimester can be the most dangerous because this is when the central nervous system, organ, and facial development are occurring.

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Long-Term FASD Outcomes

There is something called a secondary disability that can occur in children born with some level of FASD, even if it’s not something that occurred at birth. Some of the ongoing complications and associated outcomes often experienced by people who were exposed to alcohol use in the womb include:

  • ADHD
  • Aggression or problems following rules or laws
  • Antisocial behaviors
  • Alcohol or drug abuse
  • Increased likelihood of mental health disorders like anxiety or depression
  • Problems in school
  • Difficulties living independently and staying employed
  • Unsafe or risky sexual behaviors
  • Early death related to accidents, suicide or homicide

Fetal Alcohol Syndrome Statistics and Facts

Based on data that’s currently available, it’s estimated that anywhere from 2 to 5 percent of children in the U.S. have an FASD. That is 1 in 20 U.S. children.

While there are estimates and research done on FAS and FASD, it’s difficult to get an exact count of people affected by these conditions.

According to the CDC 1 in 10 pregnant women reported any alcohol use and 1 in 33 reported binge drinking in the previous 30 days before they were surveyed. Among pregnant women surveyed, the highest prevalence of any alcohol use was among those who were 35 to 44 years old, college graduates and unmarried women.

What Are the Types of FASD?

There are different types of FASD, which is something people often don’t know. The term used to categorize FASDs is based on the specific symptoms a baby or child displays. These types of FASDs include the following.

Fetal Alcohol Syndrome (FAS)

Fetal alcohol syndrome or FAS is the end of the FASD spectrum that usually shows some of the most complex symptoms seen in a baby born with prenatal exposure to alcohol. Some of the symptoms of FAS include abnormalities in the facial features, central nervous system problems, and problems with growth.

Someone born with FAS may have problems with vision, hearing, attention span, learning, memory, and communication.

It can be difficult for someone with FAS to perform adequately in school, and also to develop relationships and get along with others.

Fetal death is also possible in extreme cases where a pregnant woman drinks a significant amount of alcohol.

Alcohol-Related Neurodevelopmental Disorder (ARND)

Alcohol-related neurodevelopment disorder or ARND is often associated with symptoms related to learning and behavior.

If someone was born with ARND, they might have intellectual problems, do poorly in school settings and have trouble with memory, attention, and judgment. Someone with ARND might also have problems with impulse control, and math can be especially difficult.

Alcohol-Related Birth Defects (ARBD)

Symptoms of alcohol-related birth defects can include issues with the kidneys, bones or heart. Hearing problems may occur, and someone may have some or all of these symptoms.

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE)

ND-PAE was only first included in the Diagnostic and Statistical Manual 5 (DSM 5) in 2013. This condition refers to a child who has problems in three separate areas.

First, a child with ND-PAE would have problems with thinking and memory. Then, there are often behavior problems such as mood problems, extreme tantrums, and moving from one task to the next quickly.

The third set of symptoms would be related to problems with daily life. For example, a child might have problems dressing, interacting with other kids or bathing.

An ND-PAE diagnosis requires the mother to have consumed more than minimal levels of alcohol before a child’s birth. That’s defined as more than 13 alcoholic beverages per month of pregnancy or more than two alcoholic drinks consumed in a setting.

What Is Partial Fetal Alcohol Syndrome?

Another condition related to prenatal alcohol use is called partial fetal alcohol syndrome or pFAS. Partial fetal alcohol syndrome was at one time known as atypical FAS but has since been renamed. With partial fetal alcohol syndrome, there is a history of prenatal alcohol exposure, but there may not be the more apparent signs of fetal alcohol syndrome.

The criteria used to diagnose partial fetal alcohol syndrome include:

  • Is there a growth deficiency? Growth or height can range from normal to deficient.
  • Are there two or three facial features of FAS that are present?
  • Is there structural, neurological or functional impairment in at least three of the Ten Brain Domains?
  • Is there confirmed prenatal alcohol exposure?

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Diagnosing FASDs

People often wonder how FASDs are diagnosed, and it can be difficult because a lot of other disorders will have similar signs and symptoms.

How to Test for FASD

There is not one particular test that can be used to make a diagnosis of FASDs. Instead, a medical professional will look at a set of criteria. Whether a child has any of those features on the criteria list will be used to make a diagnosis and also to determine the specific area of the FASD spectrum where the individual is.

First, abnormal facial features are a key factor used to make a diagnosis. Growth problems are also used to make a diagnosis. Children with prenatal alcohol exposure often have heights, weights or both that are lower than normal.

Central nervous system problems are also considered. The central nervous system includes the brain and spinal cord. The effects of prenatal alcohol exposure on the central nervous system are why symptoms include issues with coordination, learning, speaking, memory and social skills.

In some children with FAS, there are differences that can be seen in the structure of the brain. MRIs or a CT scan may be used to look at the brain. Also, having a smaller-than-normal head size can indicate an issue related to FAS.

Cognitive deficits may be used to make a diagnosis in older children and younger children, looking at things such as fine and gross motor skills may be used as part of the diagnosis process.

A mother’s reported alcohol use during pregnancy can also be part of diagnosing FASDs. If a mother said she didn’t use alcohol during her pregnancy, then a medical professional would rule out the potential for fetal alcohol syndrome and would instead consider other possibilities for the symptoms the child was experiencing. However, confirmed alcohol use isn’t always required to make a diagnosis.

For a child to be specifically diagnosed with fetal alcohol syndrome, they would need all three of the facial features that are markers of the condition, growth deficits, and problems related to the central nervous system.

Treating Fetal Alcohol Syndrome and FASDs

There isn’t a cure or one specific treatment for FASD, but there are certain interventions that can be used to treat specific symptoms.

Primarily, behavioral interventions can be helpful. There may be a focus on learning theory, special education, and behavior modification. There is also research looking at different interventions that can take place at different developmental phases to help stay ahead of potential milestones a child with FAS or FASD might miss.

Certain factors have also been linked to reducing ongoing complications and secondary disabilities from FAS or FASD. These factors include living in a stable and nurturing home, having basic needs met, and eligibility for developmental disability services.

Preventing Fetal Alcohol Spectrum Disorders

The only thing a pregnant woman can do to prevent fetal alcohol spectrum disorders is to abstain from alcohol completely. There are varying schools of thought as to whether minimal alcohol use is safe during pregnancy, but most medical professional and public health organizations say that it’s better to avoid alcohol altogether because it’s just not known whether even a small amount of alcohol during pregnancy could be harmful.

If you are pregnant or could become pregnant and you feel you’re unable to stop drinking, help and resources are available to you. Contact Amethyst Recovery for more information.

Sources:

https://www.mayoclinic.org/diseases-conditions/fetal-alcohol-syndrome/diagnosis-treatment/drc-20352907

https://www.cdc.gov/ncbddd/fasd/facts.html

https://www.nofas.org/factsheets/

https://www.researchgate.net/figure/Characteristic-facial-features-in-a-child-with-fetal-alcohol-syndrome-These-includes-a_fig1_258626689

https://www.clinicaladvisor.com/fetal-alcohol-spectrum-disorders/slideshow/585/

https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Fetal-Alcohol-Spectrum-Disorders.aspx

https://en.wikipedia.org/wiki/Fetal_alcohol_spectrum_disorder

https://www.cdc.gov/ncbddd/fasd/diagnosis.html

https://www.cdc.gov/ncbddd/fasd/data.html

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