What is fetal alcohol syndrome?

Fetal alcohol syndrome is part of a group of conditions, in which a baby develops long-term complications due to exposure to alcohol, from the mother drinking during pregnancy. These complications include intellectual, physical and behavioural issues.

Fetal alcohol syndrome is at the extreme end of a class of conditions known as fetal alcohol spectrum disorders. Globally, these disorders are a significant cause of intellectual impairment.

Causes

The time spent in the uterus is a unique period in human life. During these months, the unborn baby must build itself from a single cell to a fully developed baby. The body undergoes many growth and development processes that will never be repeated later in life. These processes rely on the accurate action of a small number of developmental genes and signal molecules, which have a major effect on the overall development of the unborn baby.

When a pregnant woman drinks alcohol, it passes via her bloodstream to the unborn baby. It then has a profound effect on the operation of genetic mechanisms that are crucial to the development of the brain and nervous system. This may lead to the baby being born with a range of disorders, from mild to severe.

The risk to an unborn baby of developing a fetal alcohol spectrum disorder is usually higher the earlier and the more frequently in a pregnancy its mother drinks alcohol. However, even with heavy maternal alcohol consumption, a baby may not develop an obvious fetal alcohol spectrum disorder. Researchers do not know why some babies exposed to seemingly similar levels of alcohol in the uterus develop a disorder while others do not.

A lower 'safe' level of consumption is unknown, so guidelines in many countries, including Australia, recommend that a woman who is pregnant (or who believes she might be pregnant) stops consuming alcohol completely until the baby is born. This 'safe rather than sorry' approach is likely to continue until more definitive research and evidence is available. However, it is very difficult to give a good estimate of the overall influence of alcohol on fetal development. Signs of problems related to alcohol exposure are not always evident at birth and may not be suspected until years later. Even then, it often cannot be proven that a problem in a child's health or behaviour was actually caused by alcohol exposure in the uterus years before. Self-reporting of current or past alcohol consumption is not always accurate by people while pregnant or otherwise, so research and evidence can be hard to gather and interpret.

Genes

A unit of inheritance (heredity) of a living organism. A segment of genetic material, typically DNA, that specifies the structure of a protein or related molecules. Genes are passed on to offspring so that traits are inherited, making you who you are and what you look like.

Genetic

Related to genes, the body's units of inheritance or origin.

Nervous system

The extensive network of cells and structures that is responsible for activating and coordinating the body's functions, sensory input and cognition.

Uterus

The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.

Risk factors

Alcohol consumption

The risks to an unborn baby from the mother's alcohol consumption are related to three main factors:

  • Quantity - how much alcohol the mother drinks;
  • Timing - at what point in the pregnancy she drinks, and;
  • Frequency - how often she drinks.

The risk of alcohol-related damage to the baby increases the more, the earlier and the more frequently the mother drinks. Maternal binge drinking is particularly risky.

Additional risk factors

Other factors that can affect a baby's chances of developing fetal alcohol syndrome include:

  • Maternal smoking and use of recreational drugs;
  • Maternal stress and anxiety during pregnancy, or poor prenatal care;
  • Low socio-economic status - this is linked to a higher incidence of fetal alcohol syndrome, and;
  • Genetic susceptibility - some people and some populations have been found to be genetically more susceptible to fetal alcohol syndrome than others.

Genetic

Related to genes, the body's units of inheritance or origin.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

Types

Fetal alcohol syndrome is the most extreme of the fetal alcohol spectrum disorders. The other disorders in this group include:

  • Partial fetal alcohol syndrome - people showing only some of the diagnostic signs of fetal alcohol syndrome;
  • Alcohol-related neurodevelopmental disorder (ARND) - problems in the central nervous system, and;
  • Alcohol-related birth defects (ARBD) - physical problems in the heart, bones, kidneys, vision and hearing.

Central nervous system

The part of the body's nervous system that includes the brain and the spinal cord.

Kidneys

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

Nervous system

The extensive network of cells and structures that is responsible for activating and coordinating the body's functions, sensory input and cognition.

Signs and symptoms

At birth

A baby born with fetal alcohol syndrome may have some or all of the following symptoms:

  • Small birth size and weight;
  • Small head;
  • Problems with muscle control and suckling;
  • Heart defects, and;
  • Kidney problems.

Facial features

Babies born with fetal alcohol syndrome share some distinctive facial features, including:

  • Small head;
  • Wide-set eyes, small eye openings;
  • Small upper jaw;
  • Thin upper lip;
  • Area between nose and upper lip (philtrum) is flat and long;
  • Flat mid-face;
  • Short nose, and;
  • A smooth ridge between nose and mouth.

Distinctive facial features of a child with fetal alcohol syndrome. 

In later life

As the baby grows, some or all of the following symptoms may appear:

  • Thinking and learning disabilities;
  • Cognitive defects, low intelligence;
  • Behavioural problems, poor social skills, criminal or inappropriate behaviour;
  • Emotional disorders, rapid mood changes;
  • Poor memory skills;
  • Speech delays;
  • Attention deficits, difficulty with processing information, reasoning, planning and problem solving;
  • Hyperactivity;
  • Sleep problems;
  • Vision and hearing difficulties;
  • Poor coordination;
  • Tremors, and;
  • Balance difficulties.

These problems can remain for a person's lifetime.

Cognitive defects

A deficiency in intellectual functioning, or a specific cognitive impairment. Can be congenital, or caused later in life such as through brain injury.

Kidney

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

Methods for diagnosis

There is no single test for fetal alcohol syndrome. A diagnosis of fetal alcohol syndrome will be made by the severity of symptoms, including:

  • The distinctive facial features;
  • Brain abnormality or mental problems, and;
  • Growth deficits.

If the condition is diagnosed early on in the child's life, early intervention strategies can be used to better effect.

Brain imaging tests

In recent years, several kinds of brain imaging techniques such as magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scans are being used to identify and classify defects in the brains of people with fetal alcohol syndrome.

Early intervention

A program of services designed to help babies and young children who have, or are at risk of having, developmental delays or disabilities.

Magnetic resonance imaging

A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.

Positron emission tomography

During positron emission tomography (PET) scan, an injection with a radioactive label is administered and then combined with a computerised tomography (CT) scan to produce functional images.

Functional magnetic resonance imaging

A technique that enables measurement of the brain activity from magnetic resonance imaging of the changes in the blood flow.

Treatment and prognosis

There is no cure for fetal alcohol syndrome. By the time the baby is born, the effects of the syndrome are already in place and cannot be reversed. They are different for every person, but these effects can last a lifetime.

Professional treatment by healthcare professionals (occupational therapists, speech pathologists, psychologists) and a stable, nurturing social environment can help reduce and manage the effects of fetal alcohol syndrome to some degree.

Some medications can help manage behavioural and other problems caused by fetal alcohol syndrome. The specific course of medication varies from case to case.

Occupational therapists

A healthcare professional trained to deliver occupational therapy, which involves teaching a person self care, work and play activities to promote independence and reduce disability.

Speech pathologists

A health professional trained in the diagnosis, management and treatment of individuals with speech and language problems, or those who have difficulty with feeding and swallowing.

Psychologists

A professional specialising in mental development, diagnoses and management of mental health conditions.

Prevention

On an individual level, fetal alcohol syndrome can be prevented by not consuming any alcohol during pregnancy. A 'safe' level of alcohol consumption in pregnancy is unknown.

On a wider level, prevention of fetal alcohol syndrome focuses on:

  • Educating women about known and potential risks of alcohol consumption during pregnancy so they can make informed choices;
  • Encouraging women to seek assistance preferably before they conceive if they have trouble with alcohol, and;
  • Providing support for pregnant women who are at risk of drinking during pregnancy and may be facing difficult circumstances.