Fetal Alcohol Spectrum Disorders

Fetal alcohol spectrum disorders (FASD) describe a range of lifelong conditions that can occur in people who were exposed to alcohol before birth.

Overview

Fetal alcohol spectrum disorders (FASD) describe a wide range of physical, behavioral, and cognitive impairments that occur because of alcohol exposure before birth (prenatal alcohol exposure). These impairments may appear at any time during childhood and last a lifetime. Prenatal alcohol exposure is a leading cause of birth defects and neurodevelopmental disorders in the United States.

Early diagnosis and treatment can improve the child’s health and behavior. Although some of the lifelong effects of FASD can be recognized early, other issues become apparent later in life.

Related Terms: FASD describe a range of lifelong conditions that can occur in people who were exposed to alcohol before birth. FASD is an umbrella term, which includes the following diagnoses:

  • FAS - Fetal alcohol syndrome
  • PFAS Partial fetal alcohol syndrome
  • ARND - Alcohol-related neurodevelopmental disorder
  • ARBD - Alcohol-related birth defects
  • ND-PAE Neurobehavioral disorder associated with prenatal alcohol exposure

Signs and Symptoms

People with FASD may experience day-to-day challenges throughout their lives. People with FASD have a higher risk for health problems across the body. These include an increased risk for problems with hearing, vision, sleep, and metabolism. They also have increased risk for heart and kidney issues. 

Children with FASD are more likely to have:

  • Low birthweight
  • Problems eating and sleeping
  • Problems with vision and hearing
  • Trouble following directions and accomplishing everyday tasks, including feeding, bathing, counting money, telling time, and minding personal safety
  • Difficulty paying attention and learning in school
  • Difficulty switching attention between tasks
  • Cognitive problems, such as learning and memory
  • Academic problems and need special educational services
  • Trouble controlling their emotions and behavior
  • Trouble communicating
  • Trouble developing social skills and getting along with others

FASD symptoms continue into adulthood. Adults:

  • May have behavioral and physical health that can become apparent at different life stages
  • Be prone to develop depression, anxiety, and alcohol and other substance use disorders
  • Often need extra medical and behavioral care, assistance, and social support throughout life

How Does Alcohol Harm a Developing Baby?

Alcohol exposure during pregnancy can result in FASD by interfering with the baby’s growth, especially development of the brain, face, and other organs. A developing baby is exposed to the same concentration of alcohol as the mother during pregnancy. Alcohol can disrupt development at any pregnancy stage, even before a woman knows she is pregnant.

Binge drinking and heavy drinking during pregnancy put a developing baby at the greatest risk for severe problems. The National Institutes of Health (NIH) defines binge drinking as a drinking that brings blood alcohol concentration to 0.08%—or 0.08 grams of alcohol per deciliter—or higher. For women, this generally takes drinking four or more drinks in about two hours. NIH defines heavy drinking for adult women as consuming four or more drinks on any day or eight or more drinks per week. However, even lesser amounts can cause harm. There is no known safe amount of alcohol consumption during pregnancy.

Prenatal alcohol exposure is also associated with an increased risk of miscarriage, stillbirth, prematurity, and sudden infant death syndrome (SIDS). Drinking during pregnancy can also increase the risk for preterm labor.

No Type of Alcohol Is Safe

Exposure to alcohol from all types of beverages — including beer, wine, hard seltzer, hard cider, alcopops, distilled spirits (liquor), and mixed drinks — is unsafe for developing babies at every stage of pregnancy. A glass of wine, a can of beer, and a shot of liquor all have about the same amount of alcohol. Cocktails (mixed drinks) may have twice as much alcohol as these other beverages.

Every Pregnancy Is Different

Just because alcohol didn’t cause problems in one pregnancy, doesn’t mean it won’t cause problems in another. Alcohol exposure before birth may harm one child more than another. A person could have one child born healthy, and another child born with problems. Some intellectual and behavioral problems related to FASD may not be apparent initially and can appear or be noticed at any time.

Prevention Guidance

If a person was not exposed to alcohol before birth, they will not develop FASD. Given that approximately half of all pregnancies in the United States are not planned, the U.S. Surgeon General recommends that women who are pregnant, might be pregnant, or are thinking about getting pregnant should not drink alcohol.

If someone drank alcohol before they knew they were pregnant or before they knew that alcohol could harm the baby, every day still matters. The sooner someone stops drinking, the better for the baby.

Diagnosis

Early identification of FASD is critical for the well-being of individuals affected by prenatal alcohol exposure and their families. Early identification can maximize help, including the treatment of FASD and building supportive networks with other individuals and families impacted by FASD.

Unfortunately, FASD is often undiagnosed or misdiagnosed. This may be due, in part, to a lack of information about prenatal alcohol exposure or difficulty in distinguishing FASD from other developmental disorders that might have similar cognitive or behavioral symptoms.

The American Academy of Pediatrics (AAP) stresses the importance of universal screening for prenatal alcohol exposure for all children. A diagnosis of FASD can include evidence of central nervous system problems, physical abnormalities (such as growth deficits and specific facial anomalies), health concerns, and documented prenatal alcohol exposure.

The AAP recommends initial assessment and diagnosis by the child’s pediatrician. Referrals for additional evaluation and treatment can be made to other clinicians and healthcare professionals or, when available, to a specialized multidisciplinary team for a comprehensive evaluation and care.

For fetal alcohol syndrome specifically, confirmation of prenatal alcohol exposure is not required for diagnosis. It is also characterized by growth deficiencies, distinct facial features, and central nervous system impairment.

Treatment and Management

Various approaches may help reduce the symptoms of FASD and lessen the impact on affected individuals and their families. These include education and behavioral interventions for individuals with FASD and their caretakers. Treatments can also include medicines, social support, case management, and other services for children and adults with FASD.

Find Treatment For Alcohol Use Disorder

Women who need help to stop drinking alcohol can talk to their healthcare provider about treatment options. There are a variety of treatments available for pregnant women, including behavioral treatment and mutual support groups. 

Visit the NIAAA Alcohol Treatment Navigator® to learn more about evidence-based treatments for alcohol-related problems. Additionally, SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service for individuals and families facing mental and/or substance use disorders: 1-800-662-HELP (4357).

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on FASD.

Community Support

Additional Sources for Support for FASD Prevention and Treatment:

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.  

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

New interventions for FASD are currently being tested, including:

  • Prenatal nutritional supplements for pregnant women and postnatal supplements for their children
  • Learning and behavioral interventions aimed at improving cognition, daily life skills, and impulsive behavior
  • School-based approaches focused on specialized teaching strategies and computer-based games
  • Mobile health apps and other interventions that support families and caregivers to assist them in caring for children with FASD

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.