Medical Management Considerations
Fetal Alcohol Syndrome (FAS) is a constellation of physical and mental birth defects that is the direct result of prenatal alcohol exposure (maternal alcohol ingestion during pregnancy). The National Council on Alcoholism outlines three necessary criteria for diagnosis: abnormalities in growth, central nervous system dysfunction, and characteristic facial features. FAS is the most common preventable cause of mental retardation. Fetal Alcohol Effect (FAE), or Alcohol Related Neurodevelopmental Disorder (ARND), is a less severe condition with similar symptoms. This includes those children who may have significant neuropathology related to fetal alcohol exposure, but may not have classical findings of growth failure and facial dysmorphology The term Fetal Alcohol Spectrum Disorders (FASD) can also encompasses another diagnostic category called Alcohol Related Birth Defects (ARBD) this could also be used interchangeably with FAE or ARND.
Although there is much debate on the amount of alcohol ingestion required to cause Fetal Alcohol Syndrome, animal research shows that a single exposure to high levels of ethanol can kill nerve cells in the developing brain. In general, FAS occurs in the following frequencies based on the amount and frequency of alcohol ingestion during pregnancy:
*One drink is approximately 12 oz. beer, 4 oz. wine, or 1 oz. liquor/spirits.
Note: The effect of alcohol on the growing, developing embryo and fetus is still not completely understood. The exact mechanisms by which alcohol induces malformations may be a direct toxic effect of ethanol or a combination of ethanol and metabolite acetaldehyde.
Note: These considerations are in addition to the normal medical care provided to an individual without Fetal Alcohol Syndrome. In general, children with Fetal Alcohol Syndrome do not require significantly more than routine medical care. All recommendations can be addressed through clinical examination by the primary care provider, unless otherwise noted.
American Academy of Pediatrics. (1993). Fetal Alcohol Syndrome and Fetal Alcohol Effects. Pediatrics 91(5), 1004-1006.
Bagheri, M. M., et al. (1998). Fetal Alcohol Syndrome: Maternal and Neonatal Characteristics. Journal of Perinatal Medicine 26(4), 263-269.
Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Birth Defects and Developmental Disabilities. (2005). FAS Guidelines for Referral and Diagnosis Retrieved on January 30, 2006 from http://www.cdc.gov/ncbddd/fas/documents/FAS_guidelines_accessible.pdf
Johnson V.P., et al. (1996). Fetal Alcohol Syndrome: Craniofacial and Central Nervous System Manifestations. American Journal of Medical Genetics 61(4), 329-339.
National Academy of Sciences, Institute of Medicine. (1996). Fetal Alcohol Syndrome. Retrieved on January 30, 2006 from http://www.nap.edu/readingroom/books/fetal/summary.html
Stratton, K., Howe, C., & Battaglia, F. (1996). Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. National Academy of Sciences, Institute of Medicine, Committee to Study Fetal Alcohol Syndrome.
Hagerman, R. J. (1999). Fetal Alcohol Syndome. In: Neurodevelopmental Disorders: Diagnosis and Treatment (pp. 3-60.) New York: Oxford University Press.
Leppert, M. & Hofman, K. (1996). In: Developmental Disabilities in Infancy and Childhood vol II: The Spectrum of Developmental Disabilities. In A.J. Capute, & P.J. Accardo (Eds) Baltimore: Paul H. Brookes Publishing Co.
National Organization on Fetal Alcohol Syndrome. (2005). What is Fetal Alcohol Syndrome (FAS). Retrieved on January 30, 2006 from http://www.nofas.org/faqs.aspx?id=9
Streissguth, A. (1997). A Guide for Families and Communities: Fetal Alcohol Syndrome. Brooks Publishing.
California Department of Developmental Services, 916-654-1690,
California Fetal Alcohol Spectrum Organization,
California Regional Centers, 915-654-1958,
The Clearinghouse for Drug Exposed Children (UC San Francisco), 415-476-9691
Exceptional Parent Magazine, 800-247-8080,
FAS/FAE Newsletter, 907-456-2866
Fetal Alcohol Education Program (Boston, MA)
The Fetal Alcohol Network Newsletter, 610-384-1133
Fetal Alcohol Syndrome Consultation, Education and Training Services, Inc.,
The Fetal Alcohol Syndrome Family Resource Institute, 253-531-2878,
March of Dimes Birth Defects Foundation, 914-428-7100,
National Clearinghouse for the Prevention of Perinatal Abuse of Alcohol and Other Drugs, 800-354-8824
National Family Empowerment Network: Supporting Families Affected by FAS and FAE, 800-462-5254
National Organization on Fetal Alcohol Syndrome, 202-785-4585,
Substance Abuse and Mental Health Services Administration
National Center on Birth Defects and Developmental Disabilities, 404-498-3947
Theodore A. Kastner, M.D., M.S.
Felice Weber Parisi, M.D., M.P.H.
Robin L. Hansen, M.D.
Patrick J. Maher, M.D.
Terrance D. Wardinsky, M.D.
Samuel P. Yang, M.D.
Funded by a grant from the California Department of Developmental Services
For more information, contact:
Center for Health Improvement
1330 21st Street, Suite 100
Sacramento, CA 95814
This document does not provide advice regarding medical diagnosis or treatment for any individual case, and any opinions or statements contained in this document are not intended to serve as a standard of medical care. Physicians are encouraged to view the considerations presented in this document in light of evolving scientific information. This document is not intended for use by the layperson. Reproduction of this document may be done with proper credit given to California Department of Developmental Services and the Center for Health Improvement.