Fetal Alcohol Syndrome

FASD

Fetal Alcohol Spectrum Disorder: an umbrella term includes Fetal Alcohol Syndrome, partial Fetal Alcohol Syndrome, Neurobehavioral Disorder associated with Prenatal Alcohol Exposure. However, FASD in itself is not a dx.

Definition

A condition occurring in fetus or newborn due to in utero ethanol exposure when mother consumed alcohol during pregnancy. It is characterized by a cluster of irreversible birth defects including abnormalities in physical, mental, and behavior development (such as fetal growth retardation; mental retardation; attention deficit and disruptive behavior disorders) with varied degree of severity in an individual.

Diagnosis

A diagnosis of FAS requires the presence of all three of the following findings: 1. Documentation of all three facial abnormalities, 1) smooth philtrum (the vertical groove between the upper lip and the nose), 2) thin vermillion border (the border between the lip and the adjacent normal skin), and 3) small palpebral fissures (the space between the corners of the eye opening); 2. Documentation of growth deficits 3. Documentation of central nervous system abnormalities (structural, neurological or functional, or combination thereof).

Partial Fetal Alcohol Syndrome (pFAS)

A diagnosis of pFAS requires: 1. A confirmed history of prenatal alcohol exposure 2. Central nervous system abnormalities at the same level as FAS Individuals may or may not have growth deficiency or one or more of the facial abnormalities associated with FAS. Individuals with pFAS have the same functional disabilities but "look" less like an individual with FAS

Other physical features

Abnormal facial features (smooth ridge b/w the nose and upper lip) Small head size Shorter-than average height Low body weight Poor coordination Hyperactive behavior Difficulty with attention Poor memory Difficulty in school (especially with math) Learning disabilities Speech and language delays Intellectual disability or low IQ Poor reasoning and judgment skills Sleep and sucking problems as a baby Vision or hearing problems Problems with the heart, kidneys, or bones Shortened life span

Timeline

Lack of consensus on diagnostic criterion and terminology used to label the conditions 1970s: emerged as a straightforward condition including growth failure, ID, and facial structure effects FAE emerged to describe those whose deficits weren't severe enough to warrant this dx 2004: FASD introduced as an umbrella term 2013: Neurodevelopmental Disorder-Prenatal Alcohol Exposure listed as a condition needing further study

Behavioral and intellectual disabilities

Learning disabilities and low ID Hyperactivity Difficulty with attention Poor ability to communicate in social situations Poor reasoning and judgment skills

Physical issues

Low birth weight and growth Problems with heart, kidneys and other organs Damage to parts of the brain

Facial features

Low nasal bridge Short nose and flat midface Smooth philtrum Thin upper lip Micrognathia (small jaw) Microcephaly (Small forehead) Epicanthal folds Short palpebral fissures Minor ear abnormalities

Lifelong issues with

School and social skills Living independently Mental health Substance use Keeping a job Trouble with the law

Prevalence/Incidence

Up to 1 in 20 US school children may have FASDs First graders: 1-5%, and overall estimate of 3 to 9.8% 10% of pregnant women report drinking alcohol while pregnant, 3% report binge drinking 50,000 children born a year are affected by FAS