Fetal alcohol syndrome (FAS) is characterized by abnormalities in three areas: growth restriction, neurological impairment, and a distinctive pattern of abnormal facial features. Most children who are exposed to large amounts of alcohol while in the womb do not develop FAS. However, many children exposed to alcohol prenatally experience developmental difficulties that fall under a broader term called fetal alcohol spectrum disorder (FASD). Because children with FASD may not have the distinctive facial features of FAS, it may be harder for clinicians to identify their history of prenatal alcohol exposure and refer them for appropriate treatment.
Researchers in the Epidemiology Branch within the Division of Intramural Population Health Research screened nearly 10,000 pregnant women and identified 101 who were drinking very heavily. They then collected data to determine how the quantity and pattern of maternal alcohol consumption affected outcomes for the children. Subsequently, scientists followed the children and children whose mothers did not drink during pregnancy for up to 8.5 years, assessing growth, neurological impairment, and facial features.
The results of the study showed that 80% of children whose mothers drank heavily during pregnancy had one or more abnormalities associated with alcohol exposure. Patterns of alcohol use that posed the greatest risk for adverse outcomes were binge drinking at any time and high total alcohol weekly intake before the women knew that they were pregnant. Functional neurological abnormalities were the most common problem, and affected learning, behavior, language, or mental function. Notably, almost one-half of the children with functional abnormalities showed none of the more readily identifiable features associated with alcohol exposure (abnormal facial features and abnormal growth).
The researchers concluded that prenatal alcohol exposure should be considered in all children with developmental delay. They added that the lack of the abnormal facial features and abnormal growth could otherwise result in a delayed or missed diagnosis, increasing the risk of poor long-term outcomes (PMID: 22823161).