Document 172355

Fetal Alcohol Syndrome:
A Preventable Disorder
Laura McConahey
A Capstone Project submitted in partial fulfillment of the
requirements for the Master of Science Degree in
Counselor Education at
Winona State University
Summer 2011
i FETAL ALCOHOL SYNDROME ii Winona State University
College of Education
Counselor Education Department
Fetal Alcohol Syndrome:
A Preventable Disorder
This is to certify that the Capstone Project of
Laura McConahey
Has been approved by the faculty advisor and the CE 695 – Capstone Project
Course Instructor in partial fulfillment of the requirements for the
Master of Science Degree in
Counselor Education
Capstone Project Supervisor: __________________
Approval Date: __________________
Prenatal alcohol exposure is the most common cause of mental retardation and the
leading preventable cause of birth defects in the United States. Fetal alcohol syndrome is
characterized by a combination of retarded growth, face and body malformations, and
disorders of the central nervous system. There is a significant need for effective
prevention strategies for both pregnant and non-pregnant women who might be at risk for
an alcohol-exposed pregnancy (AEP). Education about alcohol use during pregnancy and
treatment programs for women who are unable to stop drinking due to addiction are key
components for prevention.
Introduction ……………………………………………………………………………….1
Review of Literature ……………………………………………………………………...3
What is FAS……………………………………………………………………….3
Diagnosis of FAS……………………………………………………………….…4
History of FAS…………………………………………………….………………6
FAS Related Problems…………………………………………………….....…..11
Living with FAS………………………………………………………….……...12
References …………………………………………………………………………...…..19
Figures/Table…. …………...……………………………………………………………22
FETAL ALCOHOL SYNDROME 1 Fetal Alcohol Syndrome: A Preventable Disorder
Fetal Alcohol Syndrome (FAS) and other less severe alcohol related conditions
are estimated to occur in nearly one in every hundred births (Sokol, Delaney-Black, &
Nordstrom, 2003). Some women (and men) are under the unfortunate impression that
drinking alcohol while being pregnant is acceptable and safe. This is a misconception that
can have disastrous results. There is no amount of alcohol that is safe for consumption
during pregnancy (Center for Disease Control and Prevention, 2009). Alcohol affects an
individual’s entire body and mind. How it will affect and damage fetuses differs from
person-to-person. If an expecting mother is “buzzed”, so is the fetus, which can be
detrimental to a developing baby.
Fetal alcohol syndrome is one of the very few disorders that is completely
preventable. If the mother does not drink alcohol during any part of her pregnancy her
baby will not have fetal alcohol syndrome. Unfortunately, many women are uninformed
of the dangers, while others are unaware that they are even pregnant and therefore
unintentionally harm their babies. Pregnancy recognition does not occur in many women
until 4- to 6-weeks gestation (Floyd, Decoufle & Hungerford, 1999), and thus many
women may drink prior to realizing they are pregnant. Upon recognition of pregnancy,
most women spontaneously reduce their alcohol use (Ebrahim, Diekman & Floyd, 1999).
A recent report of alcohol use rates among women of childbearing age who are pregnant
showed that use of any alcohol remains stable at approximately 12% and binge drinking
is between 2 and 3% during pregnancy (see Table 1). Thus, alcohol use during pregnancy
continues to be an important public health concern.
FETAL ALCOHOL SYNDROME Education is the number one method of preventing FAS. The greatest
opportunities for healthy pregnancy outcomes, however, lie in the prevention strategies
implemented prior to conception (Floyd, Weber, Denny & O’Connor, 2009) If women
and men are educated about the facts of FAS the likelihoods of alcohol consumption
would hopefully decrease. Education is especially needed for at-risk mothers. Fetal
alcohol syndrome is preventable and education is the key factor in eliminating this
2 FETAL ALCOHOL SYNDROME 3 Review of Literature
Fetal Alcohol Syndrome (FAS) Defined
Fetal alcohol syndrome (FAS) is caused by a pregnant mother drinking alcohol
and exposing her fetus to the substance. FAS is a birth defect that primarily affects the
brain. People with FAS are born with the disorder and will not outgrow its affects
(Golden, 2005). Another more recent term for FAS is fetal alcohol spectrum disorders
(FASD). FASD is an umbrella term describing the range of effects that can occur in an
individual whose mother drank alcohol during pregnancy. These effects may include
physical, mental, behavioral, and/or learning disabilities with lifelong implications
(Golden, 2005). Often, a person with an FASD has a combination of these problems.
FAS is the most identifiable and most serious disorder under the FASD umbrella,
although it only accounts for approximately 25% of all alcohol related effects (National
Organization on Fetal Alcohol Syndrome, 2010). Some people with FASD are slightly
affected and manifest only mildly dysfunctional behavior; others are severely affected,
devastatingly disabled in their ability to cope or function in simple everyday interactions
(Streissguth, 2004). Also under the umbrella of FASD is alcohol-related neurobehavioral
disorder (ARND) and alcohol-related birth defects (ARBD). Children with ARND and
ARBD fail to meet the full FAS diagnostic criteria, but still exhibit the negative affects of
gestational alcohol exposure (Boyce, 2010).
FETAL ALCOHOL SYNDROME 4 Diagnosing Fetal Alcohol Syndrome
Alcohol can have a direct toxic effect on the rapidly developing cells of the
embryo and fetus (Stressguth, 2004). Prenatal alcohol exposure can damage the
developing fetus in many different ways, causing a whole spectrum of effects.
Depending on which trimester of pregnancy the mother consumes alcohol affects
the risk to the fetus and the kinds of problems that the developing infant might have
(Zieman, 2010). Drinking alcohol during the first 3 months (first trimester) of the
pregnancy is the most serious. Fetuses exposed to alcohol during that time frame often
have small brains (see Figure 1), physical problems, and develop severe mental
retardation (Zieman, 2010).
The identification of individuals who have been exposed to alcohol prenatally can
be challenging. Accurate maternal drinking histories may not be available and even if the
child exhibits the defining characteristic of FAS, they may be missed if the child is not
diagnosed by a trained dysmorphologist (Thomas, Warren & Hewitt, 2010). It can be
even more difficult to identify individuals who have been exposed to alcohol prenatally
but who do not meet the diagnostic criteria for FAS (i.e., do not exhibit all of the defining
facial features). Thus, there is a need for better tools to enhance diagnosis, particularly
because a proper diagnosis is often needed for the individual to receive appropriate
services (Thomas, Warren & Hewitt, 2010).
FAS, a birth defect caused by prenatal exposure to alcohol, is diagnosed when
children meet the following three criteria (see Table 2):
FETAL ALCOHOL SYNDROME 5 1) A specific pattern of facial characteristics. Generally defined as short palpebral
fissures (eye slits), a flat midface, a short unturned nose, a smooth or long
philtrum (the ridge running between the nose and lips), and thin upper lip.
2) Growth deficiency, prenatally or postnatally, for height and weight
3) Neurological damage, including microcephaly (small size of brain), tremors,
hyperactivity, fine or gross motor problems, attention deficits, learning disabilities
and intellectual or cognitive impairments.
A diagnosis of FAS also requires some presumed history of prenatal alcohol
exposure. (Streissguth, 2004, p. 18-19).
Diagnosing an infant or child with FASD can be difficult depending on the
severity of the syndrome. Some children are not diagnosed until adolescence due to
absence of the typical FAS physical characteristics. Currently there are no confirming
laboratory tests that can detect FAS, but recent research findings have suggested that a
test is imminent (Stressguth, 2004).
The term FASD is not intended for use as a clinical diagnosis. However, to
diagnose a child with FAS, the child must have all three findings: three facial
abnormalities (see Figure 2), growth deficits and central nervous system abnormalities
(Centers for Disease Control and Prevention, 2009). Consequently, children not meeting
these diagnostic criteria are missed. Future research designed to find ethanol-induced
gene expression alterations, as well as elucidating these mechanisms, will be important
not only to help physicians diagnose and prevent FAS, but to reverse the physical and
neurological consequences of alcohol by using in utero or postnatal treatments (Ismail,
Buckley, Budacki, Jabbar, & Gallicano, 2010). Since an early stage diagnosis in the
clinical setting is the key to reaching better outcomes in life, more research is required to
obtain the necessary diagnostic tools.
FETAL ALCOHOL SYNDROME 6 One promising, although challenging, method of early FAS diagnosis is
analyzing the levels of fatty acid ethyl esters (FAEE) in the meconium. The fetus
metabolizes alcohol producing FAEE, which can be detected in the meconium, the first
stool passed by the infant usually in the first 72 hours (Bearer, 2005). While FAEE levels
appear to be increased in newborns exposed to alcohol in utero (Bearer, 2005), further
investigation is needed to determine whether infants with high FAEE levels in the
meconium are at high risk for developmental abnormalities. In addition, the meconium is
produced only in the later part of pregnancy, which does not help in identifying infants
exposed to alcohol in only the earlier part of pregnancy (Bearer, 2005). As a result,
additional studies and markers are needed to better determine the specificity and
sensitivity of this relatively new methodology.
The use of fetal biological markers could aid in the early detection of children
with FAS (Ismail, Buckley, Budacki, Jabbar, & Gallicano, 2010). This early diagnosis
could allow for appropriate measures to be taken in order to support and assist the child
and family in regard to education and social development. In addition to early diagnosis,
fetal biological markers can be used to more thoroughly understand the pathogenesis of
FAS (Ismail, Buckley, Budacki, Jabbar, & Gallicano, 2010).
History of FAS
Since ancient times, people have been aware of the dangers of drinking alcohol
during pregnancy, perhaps without knowing the exact nature or reasoning for their
FETAL ALCOHOL SYNDROME 7 Behold, thou shalt conceive and bear a son:
And now drink no wine or strong drinks.
(Judges 13:7)
Foolish, drunken, and harebrained women
Most often bring forth children like unto
themselves, morose and languid. (Aristotle).
At the turn of the century, reports began to appear on children of alcoholic
parents in many countries, but it was not until 1973 that the term fetal alcohol syndrome
was introduced by Kenneth Jones and David Smith, two pediatric dysmorphologists, who
rediscovered the tell-tale signs of alcohol exposure in infants at birth and notable in early
childhood (Streissguth, 2004). The effect of maternal consumption of alcohol on birth
weight and the development of children was noted in the 1700s, when there was a "gin
epidemic" in England. By the middle of the 19th century, Dr. Lanceraux, a French
physician, seemed to have described some of the significant characteristics of FAS when
he stated:
As an infant he dies of convulsions or other nervous
disorders; if he lives, he becomes idiotic or imbecile, and in
adult life bears the special characteristics: the head is
small..., his physiognomy vacant [peculiar facial features],
a nervous susceptibility more or less accentuated, a state of
nervousness bordering on hysteria, convulsions, epilepsy...are
the sorrowful inheritance,...a great number of individuals
given to drink bequeath their children
(Lanceraux, 1865; quoted by Gustafson, 1885, p. 21).
FETAL ALCOHOL SYNDROME 8 Animal research brought the issue to scientific status as it proved potential harm
existed from prenatal alcohol exposure. By the 1920s, with the coming of the Prohibition
era, the issues of prenatal alcohol exposure and birth defects were virtually ignored
in the United States (Streissguth, 2004).
By the 1960s, a large amount of medical literature condoned moderate alcohol
use during pregnancy, doubting any relationship with birth defects other than a hereditary
basis. With the exception of French researchers, who reported that children of alcoholic
parents experienced high incidences of delayed growth and development and medical
disorders, most of the world's researchers expressed no concern about alcohol ingestion
and birth defects (Streissguth, 2004). However, that turned around in the 1970’s and it is
now known today that alcohol consumption while pregnant can have devastating effects.
Historically, FAS is more prevalent in lower socioeconomic classes, but certainly not
limited to them. Particularly in settings where poverty, poor housing, high
unemployment, alcohol and other drug abuse is rampant, the likelihood of FAS increases
(Boyce, 2010).
Even small amounts of social drinking may be harmful a fetus (Sokol, 2003). The
more that the mother drinks the greater the effects and damage will be. When a pregnant
woman drinks alcohol, the blood-alcohol levels in the mother and fetus are approximately
equal within minutes after consumption (Stressguth & Little, 1994). Education is a key
element to the success of the future unborn babies. If mothers are aware of the potential
damage that they could be causing their fetus they might take a moment to stop and think
FETAL ALCOHOL SYNDROME 9 about what that glass of wine or a few beers might be doing to their growing and
developing fetus.
Since this is one of the few preventable birth disorders women and men need to
be properly educated about the facts of alcohol and how it can damage them and their
babies (especially the babies). Everything an expectant mother consumes makes its way
to the uterus. Alcohol will cross the placenta, just as oxygen, carbon dioxide and water do
(Papalia, Olds, & Feldman, 2009). Vulnerability is greatest in the first few months of
gestation, when development is most rapid. Unfortunately, as previously stated, some of
the most damage can be caused during those first few months, a time when many women
may not know that they are even pregnant. Once a woman does discover that she is
pregnant the best possible outcome is stopping the consumption of all alcohol
completely. FAS and other less severe, alcohol-related conditions are estimated to occur
in nearly 1 in every 100 births (Sokol, Delaney-Black, & Nordstrom, 2003). This is
higher than any other birth defect. Education about prenatal health needs to start at a very
young age and continue throughout ones lifetime. Setting a good example for other
women by not drinking is also important. Women that are at high risk of using alcohol or
other substances while pregnant should seek professional help immediately. If a women
is an alcoholic and has a difficult time stopping the use of alcohol she should receive help
from a counseling group, individual therapy or AA meetings (Stratton, Howe, &
Battaglia, 1996). Anything that will help her stay sober while she is pregnant is
important. Treatment services for people with FASD should be different for each person
depending on the symptoms. Some options include behavior and education therapy,
FETAL ALCOHOL SYNDROME 10 parent training, medications that may help with symptoms and also alternative
approaches (Streissguth, 2004).
It is believed that FAS and FASD is likely underestimated (Thomas, Warren &
Hewitt, 2010). Determining the prevalence has proven to be difficult because often
children with FASD are misdiagnosed with other disorders (such as attention deficit
hyperactivity disorder, oppositional defiant disorder, or conduct disorder). This can be
harmful to the child because they are not necessarily given the best treatment for their
Having an identification of biomarkers that can reliably reflect fetal alcohol
exposure and damage is important, especially because always getting reliable background
information is not always possible (Thomas, Warren & Hewitt, 2010). Some possible
reasons for this are that maternal memory is poor, biological parents are not available or
drinking is denied. Having such markers may be useful for early case recognition and
early intervention.
Alcohol is a teratogen (i.e. any agent or chemical that causes a birth defect).
Alcohol is the most frequently consumed teratogen in the world (National Institute on
Alcohol Abuse and Alcoholism, 2005). Since so much is unknown about the exact
mechanisms through which alcohol acts as a teratogen, the Centers of Disease Control
and Prevention (CDC) recommend that there is no safe period of time during pregnancy
to consume alcohol and that women who are considering becoming pregnant, who are at
risk for becoming pregnant or who are pregnant abstain from alcohol consumption (CDC,
2005). Alcohol may have detrimental effects at any time during brain development;
FETAL ALCOHOL SYNDROME 11 therefore, at this time, it is better to err on the side of caution and assume that alcohol
consumed at any time during pregnancy can be a potential threat to the developing fetus.
One aspect of FAS prevention involves the recognition of high-risk drinking in
women that are childbearing age by primary care physicians and prenatal clinics
(Thomas, Warren & Hewitt, 2010). Importantly, research shows that screening and brief
interventions in these settings are highly effective in reducing and eliminating risky
drinking. However, such education programs and clinics are readily available and
unfortunately, they are not routinely utilized (Thomas, Warren & Hewitt, 2010).
FAS Related-Problems
If a mother does consume alcohol while she is pregnant minor to severe problems
can be expected. FAS related problems can include, in infants, reduced responsiveness to
stimuli, slow reaction time, and reduced visual acuity (Carter, 2005) and, throughout
childhood, short attention span, restlessness, distractibility, hyperactivity, learning
disables, memory deficits, mood disorders, as well as aggression and behavioral problems
(Sokol, 2003). Older children often have difficulty keeping up with school work, and may
have low self-esteem because they recognize that they are different from peers.
Teenagers can have poor impulse control and cannot distinguish between public and
private behaviors. Adults with FAS will need to deal with many daily obstacles, such as
transportation, employment and money management (National Organization on Fetal
Alcohol Syndrome, 2010). Another possible barrier that people with FAS may face is the
reality of developing a drinking problem themselves because prenatal alcohol exposure is
a risk factor for development of a drinking problem and alcohol disorders in young
adulthood. When situations go wrong in the life of a person with FAS, often they are
unable to process, solve the problem, take responsibility and learn from their mistakes.
FETAL ALCOHOL SYNDROME 12 They are unable to make connections between actions and consequences (Sokol, 2003).
FAS affects the baby, the family and the community as a whole. In a study of adverse
adaptive behavioral problems of individuals diagnosed with FAS, five significant areas
were noted through life history interviews with 415 patients. Of these individuals, 61%
experienced disrupted school experiences, 60% noted some form of trouble with the law,
50% reported an incidence of confinement defined as in jail, prison or psychiatric
inpatient setting, 49% described repeated inappropriate sexual behaviors, and 35%
reported alcohol and/or drug problems (Streissguth, 2004). The report went on to note
that children experienced a 2 to 4 fold increased chance of escaping these five identified
adverse life outcomes if diagnosed with FAS at an early age and reared in a good, stable
environment (Streissguth, 2004). As a result, it is of great importance to identify FAS at
an early stage, so that the child may receive appropriate counseling and guidance
throughout his/her life.
Living with FAS
Children with Fetal Alcohol Syndrome typically have multiple handicaps and
require special medical, educational, family and community assistance. Their families
need medical information, peer support, educational advocacy and financial assistance.
People with FAS are at a higher than average risk for physical and sexual abuse and
neglect when raised in their families of origin (Mack, 2010). These children need a
supportive, loving home environment with clear guidelines and clear lines of
communication in order to develop to their fullest potential.
FETAL ALCOHOL SYNDROME 13 People with FAS/FASD, like everyone else, have a variety of talents and
capabilities. They exhibit a wide range of intellectual levels and functional disabilities
that probably reflect differing degrees of prenatal brain damage due to different levels,
patterns, and timing of prenatal alcohol exposure (Streissguth, 2004). Many people with
FAS despite some differences exhibit the same general behavioral characteristics. They
are usually trusting (even overly trusting), loving, and naive regardless of age. They can
also be grumpy, irritable, and rigid. As a result of their brain damage they may have a
difficult time appropriately evaluating a situation and using their past experiences to
understand and cope with the current issue (Mack, 2010). Appropriate placement in
special education classes beginning in elementary school is often necessary for children
with FAS. A small classroom setting with clear guidelines and a great deal of individual
attention can maximize the intellectual capabilities of these students (Mack, 2010). Many
children with fetal alcohol syndrome reach an academic plateau in high school. Many
will be unable to hold a regular job. Nonetheless, all of these students need to know basic
life skills, including money management, safety skills, interpersonal relating, and so
forth. The biological, foster or adoptive parent of a child with FAS assumes a
responsibility far beyond that normally associated with parenting (Mack, 2010). The
mixture of physical, intellectual, and behavioral problems that children with FAS have
can create a very demanding situation for any family.
It takes an extraordinary amount of energy, love, and most of all, consistency in
parenting these children. Therefore, these parents need support in their efforts. Due to
their poor social judgment, underdeveloped independent living skills and impaired
intellectual functioning, most FAS children will require a structured, sheltered living
FETAL ALCOHOL SYNDROME 14 situation throughout their lives (Mack, 2010). The most severely affected may require a
completely supervised and sheltered environment. For more functional people, a group
home or halfway house for developmentally disabled adults may be appropriate if
continued residence with a family is not possible or desirable (Mack, 2010).
Indeed, prevention of FAS is an important goal primarily because so little is
understood with regard to the adverse effects that alcohol has on the developing fetus.
The CDC has a number of current prevention plans aimed at educating the potential
mothers at risk for conceiving a child with FAS. One of these projects includes the
Changing High-Risk Alcohol Use and Increasing Contraception Effectiveness Study
(CHOICES). The CHOICES program is currently funded by CDC and developed brief
interventions aimed at preventing alcohol exposed pregnancies among women of
childbearing age. The targeted groups were women who drank at high risk levels and did
not use contraceptives effectively (CDC, 2009). The objectives of the CHOICES study
were to characterize the women in the high risk setting, reduce the rate of alcohol
consumption among women who were not using contraception effectively, and increase
contraceptive effectiveness among women who do not reduce their alcohol consumption.
The project was done in three phases: (1) conducting an epidemiologic survey of women
in special settings; (2) developing, implementing, and evaluating a behavioral
intervention; and (3) measuring the effectiveness of this behavioral intervention further in
a scientifically rigorous manner.
Some of the participants received information plus a brief motivational
intervention, while others received only information. The brief motivational intervention
FETAL ALCOHOL SYNDROME 15 consisted of four counseling sessions and one contraception consultation and services
In-depth assessment of alcohol use and contraceptive use patterns.
Counseling about the consequences of alcohol use during pregnancy.
Brief advice and counseling for moderate-to-heavy drinkers to reduce intake
levels, or referral to community treatment services for alcohol-dependent
Reproductive health education about contraceptive methods, provision of
contraceptive services, and client follow-up.
The group that received both information and a brief motivational intervention
were twice as likely to be at reduced risk for an alcohol-exposed pregnancy compared to
the group that received only information. This shows that a brief motivational
intervention can reduce the risk of an alcohol-exposed pregnancy. Project CHOICES has
become a model program embraced by researchers and used in other federal initiatives
(CDC, 2009).
Another project being conducted is the Birth Control and Alcohol Awareness:
Negotiating Choices Effectively (BALANCE) project (CDC, 2009). This project focuses
on the many young women in the United States who drink alcohol and have unprotected
sex are putting themselves at risk for an alcohol-exposed pregnancy. Not much is known
about the relationship between moderate-to-heavy alcohol use, unprotected sex, and
unplanned pregnancies in young women. Well-designed epidemiological and behavioral
studies are needed to better understand and intervene with this population. Project
BALANCE’s objectives were to identify the prevalence of risky drinking and
FETAL ALCOHOL SYNDROME 16 contraceptive behaviors in this population, and to test the efficacy of an intervention in a
randomized trial comparing a group receiving both assessment and one face-to-face
session with a group receiving assessment only. A brief survey was administered to
college women to identify those eligible for intervention and to further characterize the
population. Focus groups with college women also explored qualitative issues related to
drinking, contraception, and sexual behavior. The intervention focused both on drinking
and unprotected sex, allowing a woman to modify either or both behaviors. Follow-up
occurred at 1 month and 4 months. The campaign was built around four core messages:
(1) drinking alcohol during pregnancy harms unborn babies, (2) pregnant women should
abstain from alcohol, (3) sexually active women should not drink if they could be
pregnant, and (4) women at risk for an alcohol-exposed pregnancy should see a physician
(CDC, 2009).
These prevention plans revolve around the goal of providing education about
effective birth control methods and the risks of alcohol use (CDC, 2009). More
education, research, and programs such as CHOICES and BALANCES need to be
implemented nationally. The key component to success revolves around having accurate
information and motivational intervention for at-risk mothers. Education should start
early and be reinforced continually.
Fetal alcohol syndrome and fetal alcohol spectrum disorders are 100%
preventable, however the affects and devastation of FAS last a lifetime. No two people
with FASD are exactly alike (CDC, 2009). FASD can include physical or intellectual
disabilities, as well as problems with behavior and learning. These symptoms can range
from mild to severe.
Unfortunately, despite prevention efforts many women continue to drink alcohol
during pregnancy. Furthermore, many people have yet to acknowledge that FASD occurs
in their communities so polices and education to reduce alcohol consumption are not in
The greatest opportunities for healthy pregnancy outcomes, however, lie in
prevention strategies implemented prior to conception (Floyd, Weber, Denny &
O’Connor, 2009). Counseling is an effective intervention in reducing a woman’s risk of
FASD. Education started at an early age for both males and females will be instrumental
in reducing this disorder.
Progress is being made in diagnosing FAS, but much still needs to be done.
Research has made great strides forward since the 1970s, when FAS was originally
recognized as a syndrome. Today we have a better understanding of the consequences
of prenatal alcohol exposure and the prevalence and alcohol related damage. Although
we have developed diagnostic, prevention, and treatment strategies, challenges remain.
Better identification and diagnosis of the full range of FASD are needed, which could be
improved with the development of biomarkers that aid in detection and accurate
FETAL ALCOHOL SYNDROME quantification of prenatal alcohol consumption (Thomas, Warren, & Hewitt, 2010).
Continued development of effective prevention and treatment strategies also is critical.
In conclusion, FAS and all other conditions under the umbrella of FASD are
entirely preventable as long as the pregnancy is alcohol free. Awareness and education
are needed and will help to dramatically decrease FAS and FASD.
Bearer, C. (2005): Fatty acid ethyl esters: quantitative biomarkers for maternal alcohol
consumption. Journal of Pediatrics 146, 824–830.
Boyce, M. (2010). A better future for baby: Stemming the tide of fetal alcohol syndrome.
Journal of Family Practice, 59(6) 337-345.
Carter, R. (2005). Effects of prenatal alcohol exposure on infant visual acuity. Journal of
Pediatrics, 147(4), 473-479
Center for Disease and prevention. Alcohol and public health/ binge drinking. Quick
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among pregnant and nonpregnant women. American Journal of Obstetrics and
Gynecology, 180, 1-7.
Floyd, R., Decoufle, P., & Hungerford, D. (1999). Alcohol use prior to pregnancy
recognition. American Journal of Preventative Medicine, 12, 101-107.
Floyd, R., Weber, M., Denny, C., & O’Connor, M. (2009).Prevention of fetal alcohol
spectrum disorders. Developmental Disablities Research Reviews 15, 193-199
Golden, J. (2005). Message in a Bottle. Cambridge: Harvard University Press.
FETAL ALCOHOL SYNDROME 20 Ismail, S., Buckley, S., Budacki, R., Jabbar, a., & Gallicano, I. (2010). Screening,
diagnosing and prevention of fetal alcohol syndrome. Journal of Developmental
Neuroscience, 32, 91–100.
Kulp, L., & Kulp, J. (2007). The Best I Can Be- living with fetal alcohol syndrome or
effects. (2nd ed.). Brooklyn Park: Better Endings New Beginnings.
Mack, M. (2005). Living with Fetal Alcohol Syndrome. Colorado: Lighthouse
National Institute on Alcohol Abuse and Alcoholism. Drinking and your pregnancy.
2005. Available at:
Papalia, D., Olds, S., & Feldman, R. (2009). Human Development (11th ed.). New York:
Sokol, R. J., Delaney-Black, v., & Nordstrom, B. (2003). Fetal alcohol spectrum disorder.
Journal of the American Medical Association, 209, 2996-2999.
Stratton, K., Howe, C., & Battaglia, F. (1996). Fetal Alcohol Syndrome. Washington,
D.C.: National Academy Press.
Streissguth, A. (2004). Fetal Alcohol Syndrome- A guide for families and communities.
Baltimore: Paul H. Brookes Publishinig Co.
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Hanover: Dartmouth Medical School.
Thomas, J., Warren, K., & Hewitt, B. (2010). Fetal alcohol spectrum disorder. Journal of
Alcohol Research & Health, 33, 118-126.
FETAL ALCOHOL SYNDROME Zieman, G. (2010). Fetal Alcohol Problems. New York: RelayHealth
Percentage of women aged 18–44 years who reported any alcohol use or binge drinking,
by pregnancy status; defined as five or more drinks on at least one occasion. In 2006, the
definition of binge drinking by women changed to four drinks on at least one occasion.
Because of this change, data collected after 2005 are not included.
The following is a chart that show the criteria of FAS and other alcohol related
Summary of diagnostic categories and methods. (Hoyme 2005).
1. Fetal Alcohol Syndrome : Confirmed alcohol exposure
a. Alcohol Exposure.
Facial pattern of Short palpebral fissures < / = 10 percentile, Thin
upper lip vermillion, Smooth philtrum.
c. Evidence of pre / postnatal growth retardation.
d. Evidence of Neurocognitive deficits.
2. Fetal Alcohol Syndrome: No confirmed alcohol exposure.
a. As above but no alcohol exposure found.
3. Partial Fetal Alcohol syndrome: Confirmed Alcohol Exposure
Not all of the above features are present but neurocognitive and some
facial features needed.
4. Alcohol Related Birth Defect (ARBD)
Confirmed maternal alcohol consumption as well as some but not all
a. of the facial features are present however the behavioral features or
structural abnormalities are more pronounced.
5. Alcohol Related Neurodevelopmental Disorder (ARND)
Confirmed maternal alcohol consumption with the absence of growth
a. retardation or facial features and with the neurocognitive features
being prominent.
Normal Infant Brain
FAS Infant Brain
Figure 2
Facial features of FAS.