Alcohol and Pregnancy and the Fetal Alcohol Syndrome

Abstract

Fetal alcohol syndrome (FAS) is a specific pattern of birth defects caused by prenatal alcohol exposure; the term fetal alcohol spectrum disorders (FASD) includes the broad range of offspring effects caused by in utero alcohol exposure. Alcohol is a teratogenic drug to which the developing brain is particularly vulnerable; thus, many alcohol‐exposed people, even without FAS, can have alcohol‐induced neurodevelopmental sequelae, ranging from mild to severe, depending on the dose, timing and conditions of exposure.

Keywords: fetal alcohol syndrome; fetal alcohol effects; birth defects; developmental disabilities; pregnancy outcome; alcohol

Figure 1.

Brain regions most vulnerable to damage from prenatal alcohol exposure. (a) a human brain viewed from its medial surface; (b) a horizontal section of human brain at the plane corresponding to the line in (a). Prenatal alcohol exposure disrupts neuronal migration of the cerebral cortex (green), and changes the shape of the corpus callosum (blue), while it kills neurons in the hippocampus (red) and cerebellum (yellow).

Figure 2.

The characteristic face of FAS is most conspicuous in the prepubescent child. Image is from: Streissguth and Little (1994) Alcohol, pregnancy and the fetal alcohol syndrome, Alcohol and its Medical Consequence: A Comprehensive Slide Teaching Program for Biomedical Education, 2nd edn, Unit 5, developed by Project Cork at Dartmouth Medical School, distributed by Milner‐Fenwick, Timonium, MD.

Figure 3.

Patient with FAS diagnosed at birth, shown here as a neonate, and at 8 and 18 years of age. In childhood he manifests the classic torso of a child with FAS: weight is low for age, and his weight‐for‐height ratio is disproportionately low. In late adolescence, he remains lean and somewhat short, but is not as growth deficient as he was during childhood. (Images (a) and (b) from Streissguth; Barr, and Martin (1984) Alcohol exposure in utero and functional deficits in children during the first 4 years of life. Mechanisms of Alcohol Damage in Utero. CIBA Foundation Monograph 105, London: Pitman; Image (c) from Streissguth and Little (1994) Alcohol, pregnancy and the fetal alcohol syndrome, Alcohol and its Medical Consequence: A Comprehensive Slide Teaching Program for Biomedical Education, 2nd edn, Unit 5, developed by Project Cork at Dartmouth Medical School, distributed by Milner‐Fenwick, Timonium, MD.

Figure 4.

FAS is only the ‘tip of the iceberg’ in terms of the proportion of people adversely affected by prenatal alcohol exposure. Many individuals prenatally exposed to alcohol lack the facial characteristics and somatic growth deficiencies of FAS, but can have brain dysfunction ranging from mild to severe, which can last for a lifetime.

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References

Bonthius DJ and West JR (1990) Alcohol‐induced neuronal loss in developing rats. Increased brain damage with binge exposure. Alcoholism: Clinical and Experimental Research 14: 107–118.

Bonthius DJ, Woodhouse J, Bonthius NE, Taggard DA and Lothman EW (2001) Reduced seizure threshold and hippocampal cell loss in rats exposed to alcohol during the brain growth spurt. Alcoholism: Clinical and Experimental Research 25: 70–82.

Bookstein FL, Sampson PD, Connor PD and Streissguth AP (2002) Midline corpus callosum is a neuroanatomic focus of fetal alcohol damage. The Anatomical Record, The New Anatomist 269(3): 162–174.

Grant TM, Ernst CC, Pagalilauan G and Streissguth AP (2003) Postprogram follow‐up effects of paraprofessional intervention with high‐risk women who abused alcohol and drugs during pregnancy. Journal of Community Psychology 31: 211–222.

Ikonomidou CP, Bittigau MJ, Ishimaru DF et al. (2000) Ethanol‐induced apoptotic neurodegeneration and fetal alcohol syndrome. Science 287: 1056–1060.

Jones KL and Smith DW (1973) Recognition of the fetal alcohol syndrome in early infancy. Lancet 2: 999–1001.

Lemoine P and Lemoine Ph (1992) Avenir des enfants de meres alcooliques (Etude de 105 cas retrouves a l'age adulte) et quelques constatations d'interet prophylactique. Annales de Pediatrie 39(4): 226–235.

May PA, Brooke L, Gossage JP et al. (2000) Epidemiology of fetal alcohol syndrome in a South African Community in the Western Cape Province. American Journal of Public Health 90(12): 1905–1912.

Sampson PD, Streissguth AP, Bookstein FL et al. (1997) Incidence of fetal alcohol syndrome and prevalence of alcohol‐related neurodevelopment disorders. Teratology 56: 317–326.

Streissguth AP, Bookstein FL, Barr HM et al. (2004) Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Developmental and Behavioral Pediatrics 25(4): 228–238.

Further Reading

Church MW and Kaltenbach JA (1997) Hearing, speech, language, and vestibular disorders in the fetal alcohol syndrome: a literature review. Alcoholism: Clinical and Experimental Research 21: 495–512.

Guerri C (1998) Neuroanatomical and neurophysiological mechanisms involved in central nervous system dysfunctions induced by prenatal alcohol exposure. Alcoholism: Clinical and Experimental Research 22: 304–312.

Institute of Medicine (1996) In: Stratton K, Howe C and Battaglia F (eds) Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press.

Mattson SN and Riley EP (1998) A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcoholism: Clinical and Experimental Research 22: 279–294.

Riley EP and Vorhees CV (1986) Handbook of Behavioral Teratology. New York: Plenum Press.

Spohr HL and Steinhausen HC (eds) (1996) Alcohol, Pregnancy, and the Developing Child. Cambridge: Cambridge University Press.

Streissguth AP (1997) Fetal Alcohol Syndrome: A Guide for Families and Communities. Baltimore: Paul H. Brookes Publishing Company.

Streissguth AP and Kanter J (eds) (1997) The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities. Seattle: University of Washington Press.

West J (ed.) (1986) Alcohol and Brain Development. New York: Oxford University Press.

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Streissguth, Ann P, and Bonthius, Daniel J(Jan 2006) Alcohol and Pregnancy and the Fetal Alcohol Syndrome. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1038/npg.els.0002251]