Fetal Alcohol Syndrome (FAS)

  • Fetal alcohol syndrome (FAS) is a group of abnormalities that occur in babies born to mothers who consume alcohol during pregnancy. It is

    the most common known non-genetic (in other words, non-inherited) cause of mental retardation in the United States. It is estimated that as many as three babies in 1,000 will have FAS. However, the rate may be three times higher in some groups of people.

    Fetal alcohol syndrome includes a characteristic group of physical defects, including small head and brain and facial abnormalities, as well as defects in other organs.

    How Children's approaches FAS

    The Psychopharmacology Program at Boston Children's Hospital works with children and adolescents to determine if psychoactive medication would be an effective tool in their psychiatric treatment. We see thousands of patients every year. Our team sees children with a wide range of psychiatric conditions, including mood and anxiety disorders, problems with impulse control and developmental disorders and psychosis, which are sometimes brought on by FAS.

    Meanwhile, our team is at the forefront of FAS research. A study using magnetic resonance imaging (MRI) brain scans suggests that prenatal exposure to cocaine, alcohol, marijuana or tobacco (alone or in combination) may have effects on a baby's brain structure that persists into the child's early adolescence. The findings are of public health significance, since it's estimated that more than 1 million babies born annually in the United States have been exposed to at least one of these things in utero.

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  • Many drugs can pass from a mother's blood stream through the placenta to the fetus. Alcohol is no exception. Alcohol is broken down more slowly in the immature body of the fetus than in an adult's body. This can cause the alcohol levels to remain high and stay in your baby's body longer.

    The full picture of FAS usually occurs in babies born to alcoholic mothers, or those who drink more than four to five drinks each day. However, no amount of alcohol is safe. Even light or moderate drinking can affect the developing fetus.

    Why is fetal alcohol syndrome a concern?

    Alcohol use in pregnancy has significant effects on the fetus and your baby.

    • Dependence and addiction to alcohol in the mother also cause the fetus to become addicted. At birth, your baby's dependence on alcohol continues. But since the alcohol is no longer available, your baby's central nervous system becomes overstimulated causing the symptoms of withdrawal. Alcohol withdrawal may begin within a few hours after a baby's birth and symptoms may last up to 18 months.
    • Babies with FAS often have specific deformities of the head and face, heart defects and mental retardation.

    What are the symptoms of fetal alcohol syndrome?

    Symptoms may include:

    • small head, small jaw, and small, flat cheeks
    • excessive hair
    • undergrown nails
    • incomplete or lack of development of brain structures
    • heart murmurs, heart defects, abnormalities of large vessels
    • incomplete development of genitalia
    • growth, motor, and mental retardation
    • irritability in infancy and hyperactivity in childhood
    • poor coordination
  • Most often, FAS is diagnosed based on the mother's history and the appearance of your baby, based on a physician examination by a physician.

  • The U.S. Food and Drug Administration (FDA) designated specific drugs for treating the symptoms of withdrawal from alcohol in babies. However, it's important to note that there is no treatment for life-long birth defects and retardation. Babies and children with alcohol-related damage often need developmental follow-up and, possibly, long-term treatment and care.

  • More than one million babies born annually in the United States are exposed to cocaine, alcohol or tobacco before birth. Now, an NIH-funded study led by Michael Rivkin, MD, of Neurology, suggests that such exposures may have effects on brain structure that persist into adolescence.

    Rivkin and colleagues at Boston Medical Center used volumetric MRI imaging to study the brain structures of 21 young adolescents with prenatal substance exposures and 14 with no exposures. Adolescents exposed prenatally to cocaine, alcohol or cigarettes showed reductions in total brain volume and in gray matter in the brain's cerebral cortex, important in many cognitive functions. There were too few children to find statistically significant effects of any single substance after accounting for other exposures, but the more substances a child was exposed to, the greater the reduction in brain volume.

    Especially striking was the finding that prenatal tobacco exposure alone had an effect on brain volume that fell just short of statistical significance. "About 20 percent of women who smoke continue to do so during pregnancy," Rivkin notes.

    The study was published in the April Pediatrics. Rivkin and colleagues now hope to get funding to confirm their findings in a larger group of children.

    Preventing and treating disabilities
    Children’s Hospital Boston’s Intellectual and Developmental Disabilities Research Center (IDDRC) is one of 20 research centers around the country dedicated to the study of mental retardation and developmental disabilities, with the goal translating basic research into improved care approaches. Our scientists are studying fetal alcohol syndrome and the impact of environmental factors in the etiology, treatment and prevention of mental retardation and developmental disabilities.

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