Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders

 

Am Fam Physician. 2017 Oct 15;96(8):515-522A.

  Patient information: A handout on this topic is available at https://familydoctor.org/condition/fetal-alcohol-syndrome.

Author disclosure: No relevant financial affiliations.

Fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD) result from intrauterine exposure to alcohol and are the most common nonheritable causes of intellectual disability. The percentage of women who drink or binge drink during pregnancy has increased since 2012. FAS is commonly missed or misdiagnosed, preventing affected children from receiving needed services in a timely fashion. Diagnosis is based on the presence of the following clinical features, all of which must be present: prenatal and/or postnatal growth retardation, facial dysmorphology, central nervous system dysfunction, and neurobehavioral disabilities. FASD is a broader diagnosis that encompasses patients with FAS and others who are affected by prenatal alcohol exposure but do not meet the full criteria for FAS. Management is multidisciplinary and includes managing comorbid conditions, providing nutritional support, managing behavioral problems and educational difficulties, referring patients for habilitative therapies, and educating parents. The Centers for Disease Control and Prevention and other organizations recognize no safe amount of alcohol consumption during pregnancy and recommend complete abstinence from alcohol. All women should be screened for alcohol use during preconception counseling and prenatal care, and alcohol use should be addressed with brief interventions.

Fetal alcohol spectrum disorders (FASD) result from prenatal exposure to alcohol and include fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (PFAS), alcohol-related neurodevelopmental disorder, and alcohol-related birth defects.1 FAS is the most severe form of FASD.2

WHAT IS NEW ON THIS TOPIC: FETAL ALCOHOL SPECTRUM DISORDERS

According to the Centers for Disease Control and Prevention, the percentage of pregnant women who consume alcohol increased from 7.6% in 2012 to 10.2% in 2015, and the number of pregnant women reporting binge drinking (at least four alcoholic beverages at once) increased from 1.4% to 3.1%.

A study demonstrated that more than one-half of children with fetal alcohol spectrum disorders do not consume the recommended dietary allowance of fiber, calcium, or vitamins D, E, and K.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

The diagnosis of fetal alcohol syndrome and partial fetal alcohol syndrome is based on defined clinical characteristics and does not require confirmed alcohol use during pregnancy.

C

1

Neurobehavioral testing should be conducted in all children with suspected fetal alcohol spectrum disorders when feasible. Comprehensive evaluation may not be possible using conventional assessment tools until after three years of age.

C

1

Contraception should be offered to women of childbearing age who drink. If they desire pregnancy, abstinence from alcohol should be recommended.

C

44

Pregnant women should be screened for alcohol use. This can be done using the TACER-3 tool.

C

42, 45, 46


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

The diagnosis of fetal alcohol syndrome and partial fetal alcohol syndrome is based on defined clinical characteristics and does not require confirmed alcohol use during pregnancy.

C

1

Neurobehavioral testing should be conducted in all children with suspected fetal alcohol spectrum disorders when feasible. Comprehensive evaluation may not be possible using conventional assessment tools until after three years of age.

C

1

Contraception should be offered to women of childbearing age who drink. If they desire pregnancy, abstinence from alcohol should be recommended.

C

44

Pregnant women should be screened for alcohol use. This can be done using the TACER-3 tool.

C

42, 45, 46


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

According to the Centers for Disease Control and Prevention, the percentage of pregnant women who consume alcohol increased from 7.6% in 2012 to 10.2% in 2015, and the number of pregnant women reporting binge drinking (four or more alcoholic beverages at once) increased from 1.4% to 3.1%.3,4 These trends are concerning because alcohol is the most common teratogen, and FASD is the most common cause of nonheritable intellectual disability.5 Binge drinking is associated with the development of behavioral problems and physical deformities.6

Although there is wide variation in the estimated pre

The Authors

show all author info

LEEANNE DENNY, MD, is residency faculty at the University of Arizona College of Medicine Family Medicine Residency, Phoenix....

SARAH COLES, MD, is residency faculty at the University of Arizona College of Medicine Family Medicine Residency.

ROBIN BLITZ, MD, is a clinical associate professor of child health at the University of Arizona College of Medicine, Phoenix.

Address correspondence to LeeAnne Denny, MD, Banner University Medical Center–Phoenix, 1300 N. 12th St., Phoenix, AZ 85006 (e-mail: LeeAnne.Denny@bannerhealth.com). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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