When women drink while they are pregnant, fetal alcohol spectrum disorders, FASD, are the likely result. FASD is an umbrella term for a range of health effects caused by prenatal alcohol exposure. These can include growth deficiencies, facial abnormalities, as well as organ and brain damage. It now appears that the deficits that make up FASD are far more common than we had previously thought, and even drinking a little while pregnant can harm children exposed to alcohol in the womb.

Children affected by fetal alcohol syndrome may have the characteristic facial features associated with the disorder: the groove between nose and upper lip tends to be flattened and eyes are narrower. Head size and overall stature are generally smaller than normal. Kids with FASD also have developmental problems like poor coordination, below average intelligence, behavior problems such as ADHD, and visual and hearing abnormalities.

Only two of the 222 children had been diagnosed previously with a fetal alcohol-related disorder, even though they had been identified with developmental or learning delays.

This constellation of symptoms often means FASD kids function poorly at home and among peers; they often have low academic achievement and limited vocational success. The disorder can also lead to antisocial and risk-taking behaviors. For these reasons, FASD is an individual and public health concern with widespread medical, social and economic consequences.

FASD is Often Under-Diagnosed

Fetal alcohol syndrome is often under-diagnosed and misdiagnosed. Many cases go unrecognized. The prevalence of FASD has been estimated in the U.S. at 10 per 1000 children. But because these estimates are based on medical records, this means that only the children already recognized as having FASD are counted. Children who have not been formally diagnosed, even some with developmental delays, are left out of the count. A recent study, published in JAMA, found the rate of FASD in the U.S. population may be as much as ten times higher than previously thought.

The Study
To get a better sense of how common FASD is, investigators in four communities around the United State looked at over 13,000 first graders. From this group they selected close to 6600 children, evaluating them physically and neurodevelopmentally for signs and symptoms of FASD. The researchers also questioned their mothers about their use of alcohol while pregnant.

Within the study population, 222 children were diagnosed with FASD. This group included children at every level of severity of the FASD spectrum. Only two of the 222 children diagnosed by the investigators had been diagnosed with a fetal alcohol-related disorder previously, even though they had been identified as having developmental or learning delays. The authors point out that this is consistent with other studies: “[I]n a previous school-based US sample, only 1 of 7 children identified with fetal alcohol syndrome had a previous diagnosis; in another, only 2 of 26 children identified with full or partial fetal alcohol syndrome had a previous diagnosis.”

When the study data were analyzed conservatively, the researchers estimated that the prevalence of FASD is between one and five percent, that is, between 11 and 50 cases per 1000 children. A less conservative analysis found the prevalence to be from three to 10 percent, or between 31 to 99 per 1000 children. Both analyses are significantly higher than previous studies.

Prevention Begins with Educating Women

The researchers, as well as the authors of an editorial accompanying the study, call for improved diagnosis and better surveillance systems for affected children. Though there is no cure for FASD, those affected by the syndrome can receive support and accommodations to maximize their potential.

Any amount of alcohol consumed during pregnancy places the child at risk. This includes any alcohol consumed before a woman realizes that she is pregnant.

At the moment, the only way to eliminate FASD is to eliminate prenatal alcohol consumption. Any amount of alcohol consumed during pregnancy places the child at risk. This includes any alcohol consumed before a woman realizes that she is pregnant. Women trying to become pregnant should totally stop drinking alcohol, and their doctors should encourage them to refrain from drinking during any phase of their pregnancies. There is no safe time during pregnancy to drink alcohol.

“The high prevalence of fetal alcohol spectrum disorders in the United States suggests better education of girls and women of childbearing age about the detrimental consequences of alcohol use during pregnancy on the fetus is needed,” the authors of the accompanying editorial argue. “Efforts should be made to provide education on alcohol use in general as early as possible to both girls and boys, and the school system would be an ideal venue for such efforts to take place.”