Fetal alcohol spectrum disorder
Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person who is exposed to alcohol during gestation, as a result of their mother drinking alcohol during pregnancy.[1] 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).[9] Other terms used are fetal alcohol effects (FAE), partial fetal alcohol effects (PFAE), alcohol-related birth defects (ARBD),[1][10] and static encephalopathy,[11] but these terms have fallen out of favor and are no longer considered part of the spectrum.[12]
"FASD" redirects here. For other uses, see FASD (disambiguation).Fetal alcohol spectrum disorders
Foetal alcohol spectrum disorders, FASD
Varied; Abnormal appearance, short height, low body weight, small head size, poor coordination, behavior problems similar to ADHD, learning and speech problems, Intellectual disability[1][2]
- Babies: Miscarriage, stillbirth, preterm birth
- Adults: Alcoholism, substance abuse
Prenatal
Fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, static encephalopathy, alcohol-related birth defects[1]
Based on symptoms and prenatal alcohol exposure[1]
Avoiding drinking alcohol during pregnancy[4]
Parent-child interaction therapy, efforts to modify child behavior, possibly medications[5]
Average life expectancy at death 34 years old (FAS).[6]
Unconfirmed (other types)
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 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.
The key signs of fetal alcohol syndrome (FAS) required for diagnosis include:
Popova et al. identified 428 ICD-10 conditions as co-occurring in individuals with FAS. Excluding conditions used in FAS diagnosis, co-occurring conditions with 50% prevalence or greater include:[15]
Other FASD conditions are partial expressions of FAS where the central nervous system shows clinical deficits. In these other FASD conditions, an individual may be at greater risk for adverse outcomes because brain damage is present without associated visual cues of poor growth or the "FAS face" that might ordinarily trigger an FASD evaluation. Such individuals may be misdiagnosed with primary mental health disorders such as ADHD or oppositional defiance disorder without appreciation that brain damage is the underlying cause of these disorders, which requires a different treatment paradigm than typical mental health disorders. While other FASD conditions may not yet be included as an ICD or DSM-IV-TR diagnosis, they nonetheless pose significant impairment in functional behavior because of underlying brain damage. Many indications of fetal alcohol spectrum disorders are developmental. Therefore, although a child may appear 'normal' at birth, intellectual disabilities caused by alcohol before birth may not appear until the child begins school.[16]
More broadly, alcohol use during pregnancy is also associated with:[1][17]
Alcohol can also harm the fertility of women who are planning for pregnancy. Adverse effects of alcohol can lead to malnutrition, seizures, vomiting and dehydration. The mother can suffer from anxiety and depression which can result in child abuse/neglect. It has also been observed that when the pregnant mother withdraws from alcohol, its effects are visible on the infant as well. The baby remains in an irritated mood, cries frequently, doesn't sleep properly, weakening of sucking ability and increased hunger.[24]
In 2019, a study found that individuals with FASD have a higher risk of hypertension independent of race/ethnicity and obesity.[25]
Almost all experts recommend that the mother abstain from alcohol use during pregnancy to prevent FASDs.[4][12][79] 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.[80] These two recommendations have been made by the Surgeon General of the United States,[81][80] the Centers for Disease Control,[21] the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics,[33] the World Health Organization,[82] the United Kingdom's National Institute for Health and Clinical Excellence,[83] and many others.[29][84][31][85][86][87] In the United States, federal legislation has required that warning labels be placed on all alcoholic beverage containers since 1988 under the Alcoholic Beverage Labeling Act.[88]
Women can experience serious symptoms that accompany alcohol withdrawal during pregnancy. According to the World Health Organization, these symptoms can be treated during pregnancy with brief use of benzodiazepine tranquilizers.[19] Currently, the FDA has approved three medications—naltrexone, acamprosate, and disulfiram—for the treatment of alcohol use disorder (AUD). However, there is insufficient data regarding the safety of these medications for pregnant women.[89]
American Psychiatric Association guidelines recommend that medications not be used to treat alcohol use disorder in pregnant women except in cases of acute alcohol withdrawals or other co-existing conditions.[93] Instead, behavioral interventions are usually preferred as treatments for pregnant women with AUD. Medications should only be used for pregnant women after carefully considering potential risks and harms of the medications versus the benefits of alcohol cessation.[89]
History[edit]
Before designation[edit]
Some hold that ancient sources describe the negative effects of alcohol during pregnancy,[10] identifying admonitions from ancient Greek, Roman, the Talmud, and the Bible.[116] For example, Plato writes in his fourth-century B.C. Laws (6.775): "Drinking to excess is a practice that is nowhere seemly ... nor yet safe. ... It behooves both bride and bridegroom to be sober ... in order to ensure, as far as possible, in every case that the child that is begotten may be sprung from the loins of sober parents." The sixth-century AD Talmud (Kethuboth 60b) cautions, "One who drinks intoxicating liquor will have ungainly children." However, ancient sources rarely if ever distinguish maternal alcohol consumption from paternal, and are more concerned with conception than pregnancy. The sources can often be viewed as expressing heredity, that children are likely to turn out like their (alcoholic) parents, rather than presenting the modern viewpoint that alcohol itself has an impact.[117][71]
Society and culture[edit]
Criminalization[edit]
Criminalization of substance use during pregnancy because of harm to the fetus or child is fiercely debated.[142][143] Elizabeth Armstrong has questioned the zero-tolerance approach taken towards alcohol consumption during pregnancy, describing it as a moral panic.[144][145] While heavy alcohol consumption during pregnancy is known to be damaging to the unborn child, the effects of low intakes remain debatable, particularly in the absence of randomized controlled trials (c.f. § Causes).[42][41] The UK's abstinence recommendation was not chosen based on scientific evidence, but rather because it was simple advice that would ensure no one underestimated the risk.[146] Tennessee's 2014 fetal assault law (which expired in 2016) was criticized for not addressing alcohol use.[147][148] The law criminalized opioid use during pregnancy and resulted in women avoiding professional medical care for fear of prosecution.[149] A wide variety of professional organizations oppose criminalization.[150][151] Minnesota, North Dakota, Oklahoma, South Dakota, and Wisconsin have statutory authorization for the involuntary civil commitment of women who abuse alcohol during pregnancy.[152]
2016 CDC controversy[edit]
In 2016, a CDC press release and infographic entitled "More than 3 million US women at risk for alcohol-exposed pregnancy" caused controversy.[153] The CDC release contained the message "The risk is real. Why take the chance?".[154][155] Darlena Cunha of Times Magazine interpreted the infographic as telling all women of child bearing age not to drink at all, in case they might accidentally fall pregnant, and called them "scare tactics" and "shaming recommendations".[156] Julie Beck said that the infographic insinuated that "your womb is a Schrodinger's box and you shouldn't pour alcohol into it unless you've peeked in there to be 100 percent sure the coast is clear".[157] The CDC later clarified that the infographic was not intended to make any new guidelines or recommendations for women who are pre-pregnant, but rather to encourage conversations about alcohol with health professionals.[158] Nonetheless, half of the pregnancies in developed countries and over 80% in developing countries are unplanned. Many women don't realize they are pregnant during the early stages and continue drinking when pregnant.[34]
In fiction[edit]
In Aldous Huxley's 1932 novel Brave New World (where all fetuses are gestated in vitro in a factory), lower caste fetuses are created by receiving alcohol transfusions (Bokanovsky Process) to reduce intelligence and height, thus conditioning them for simple, menial tasks. Connections between alcohol and incubating embryos are made multiple times in the novel.[159]
The main character of the 2009 film Defendor is implied to have the condition.
Tony Loneman, a character in Tommy Orange's 2018 novel There There, was born with fetal alcohol syndrome, which he calls "the Drome".