DESCRIPTION

• The four major features of classic fetal alcohol syndrome (FAS) are as follows:
  • CNS neurodevelopmental abnormalities
  • Facial dysmorphisms
  • Growth retardation
  • Maternal alcohol use during pregnancy
• First described in 1973; classic FAS has since been recognized as one of the fetal alcohol spectrum disorders (FASDs), which include the following:
  • FAS, partial FAS (pFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD)
  • Taken together, FASDs are 3 times more common than classic FAS, and the effects range from very mild symptoms to very severe.

EPIDEMIOLOGY

RISK-FACTORS

• Binge drinking historically has been noted to be the primary risk factor, although not all authors agree.
• The highest prevalence of reported alcohol use during pregnancy is among those who are aged 35 to 44 years, African-American, college graduates, or employed.
• Poor maternal nutrition appears to increase risk in the presence of maternal binge drinking.
• Other risk factors include low educational attainment, history of multiple miscarriages and stillbirths, social isolation, history of physical or sexual abuse, and current interpersonal violence.
• Maternal polymorphisms of the alcohol dehydrogenase gene (ADH): The presence of the ADH1B*3 allele appears to protect the fetus.
• Concordance of FAS is higher in monozygotic than in dizygotic twins.

GENERAL-PREVENTION

• Women who are pregnant or may become pregnant should avoid alcohol. No “safe” level of alcohol consumption has been determined during pregnancy.
• Women with alcohol addiction who are or may become pregnant should enter a treatment program.
• According to the Centers for Disease Control and Prevention (CDC), 7.6% of pregnant women reported alcohol use during the month prior to being surveyed and 1.4% reported binge drinking.
• The highest risk for FAS occurs in children whose mothers consume ≥4 drinks per occasion per week (peak blood alcohol level is more important than a lower sustained blood alcohol level).
• In the United States, the Alcoholic Beverage Labeling Act passed in 1988 requires health warning labels, including risk of alcohol consumption during pregnancy.

PATHOPHYSIOLOGY

• Alcohol and its metabolite acetaldehyde are teratogens.
• Alcohol causes malformation of the developing brain, as well as abnormal brain functioning in multiple regions of the brain.
• Epigenetic changes caused by alcohol can disrupt normal gene expression.
• Abnormalities can occur with alcohol consumption across all gestational ages.