Fetal alcohol spectrum disorder

Fetal alcohol spectrum disorders
Other names	Foetal alcohol spectrum disorders, FASD, FAS, PAE, Prenatal substance exposure, PSE
Only 10% of individuals with FASD have associated facial features.
Specialty	Embryology, toxicology, psychiatry, neurology, gynaecology, obstetrics, neonatology, pediatrics
Symptoms	Varied; Craniofacial abnormality, short height, low body weight, small head size, poor coordination, behavior problems similar to ADHD, learning and speech problems, Intellectual disability[1][2]
Complications	Babies: Miscarriage, stillbirth, preterm birth Adults: Alcoholism, substance abuse
Usual onset	Prenatal
Duration	Lifelong[1][3]
Types	Fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, static encephalopathy, alcohol-related birth defects[1]
Causes	Drinking alcohol during pregnancy[1]
Diagnostic method	Based on symptoms and prenatal alcohol exposure[1]
Differential diagnosis	ADHD, autism, bipolar disorder, conduct disorder, learning disability, oppositional defiant disorder
Prevention	Avoiding drinking alcohol during pregnancy[4]
Treatment	Parent-child interaction therapy, efforts to modify child behavior, possibly medications[5]
Prognosis	Varies based on severity with FAS having a life expectancy of 34 years old without interventions.[6] Unconfirmed (other types)
Frequency	Unconfirmed; between 1 in 20 (~390 million)[7] and 1 in 13 (~600 million) (all types)[8] 0.2 and 9 per 1,000 (FAS)

Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person who is exposed to alcohol during gestation.^[1] FASD affects 1 in 20 Americans, but is highly mis- and under-diagnosed.^[9]

The several forms of the condition (in order of most severe to least severe) are: fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND),^[1] and neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE).^[10] Other terms used are fetal alcohol effects (FAE), partial fetal alcohol effects (PFAE), alcohol-related birth defects (ARBD),^[1][11] and static encephalopathy,^[12] but these terms have fallen out of favor and are no longer considered part of the spectrum.^[13]

Not all infants exposed to alcohol in utero will have detectable FASD or pregnancy complications. The risk of FASD increases with amount consumed, the frequency of consumption, and the longer duration of alcohol consumption during pregnancy, particularly binge drinking. The variance seen in outcomes of alcohol consumption during pregnancy is poorly understood. Diagnosis is based on an assessment of growth, facial features, central nervous system, and alcohol exposure by a multi-disciplinary team of professionals. The main criteria for diagnosis of FASD is nervous system damage and alcohol exposure, with FAS including congenital malformations of the lips and growth deficiency. FASD is often misdiagnosed as or comorbid with ADHD.

Almost all experts recommend that the mother abstain from alcohol use during pregnancy to prevent FASDs. As the woman may not become aware that she has conceived until several weeks into the pregnancy, it is also recommended to abstain while attempting to become pregnant. Although the condition has no known cure, treatment can improve outcomes. Treatment needs vary but include psychoactive medications, behavioral interventions, tailored accommodations, case management, and public resources. Globally, one in 10 women drink alcohol during pregnancy, and the prevalence of having any FASD disorder is estimated to be at least 1 in 20. The rates of alcohol use, FAS, and FASD are likely to be underestimated, because of the difficulty in making the diagnosis and the reluctance of clinicians to label children and mothers. Some have argued that the FAS label stigmatizes alcohol use, while authorities point out that the risk is real. The condition has appeared in several works of fiction.