Understanding Foetal Alcohol Syndrome

Many women choose to refrain from alcohol consumption during their pregnancies, to the extent that when a woman in our circle opts for sobriety, it often piques our curiosity and leads us to speculate if she might be expecting. Whilst we may vaguely associate pregnancy with being sober as a cultural phenomenon, we may not necessarily be aware of the risks of continuing to consume alcohol from a medical perspective.

It’s important to know the risks of drinking whilst pregnant in order to make an informed decision about your alcohol intake. Studies suggest that around 7.6% of women reported that they continued to drink after finding out they were pregnant. This number may appear high to some, as one researcher notes that ‘substance use during pregnancy and motherhood is both a public health and criminal justice concern.’

But why is this the case? What can happen if women drink throughout their gestation period. What counts as a ‘risky’ level of alcohol consumption during pregnancy? What effect does drinking alcohol during pregnancy have, and how can these manifest?

What is Foetal Alcohol Syndrome?

Foetal Alcohol Syndrome (sometimes referred to as FAS, Foetal Alcohol Spectrum Disorder, or FASDs) is a congenital disease – meaning it is a condition developed prior to birth. The World Health Organisation defines congenital diseases or disorders as ‘structural or functional anomalies that occur during intrauterine life.’ Around 6% of babies are born with a congenital disorder.

One research team defined FASDs as ‘disorders [that] classify the wide-ranging physical and neurological effects that prenatal alcohol exposure can inflict on a foetus.’
The development of foetal alcohol syndrome is one of the key factors behind medical recommendations around drinking during pregnancy. Such recommendations are in place to try and limit the risk of children developing congenital disabilities from alcohol exposure in utero.

The Causes of Foetal Alcohol Syndrome (FAS)

Foetal Alcohol Spectrum Disorders are caused by exposure to alcohol before birth, meaning that alcohol is teratogenic: an agent that causes an abnormality following ‘foetal exposure.’

Typically, medical professionals suggest that the foetus is most vulnerable during the first half of pregnancy (the first twenty weeks). However, research published in 2023 suggests that there is ‘no safe time during pregnancy in which alcohol can be consumed without risk to the foetus.’

3.4% of women who reported drinking during their pregnancies gave birth to a child with FAS.

Alcohol and Pregnancy: Alcohol’s Impact on Foetal Development

Alcohol can impact the foetus as it develops in the womb. But why is that?
During pregnancy, the foetus is connected to its mother’s body through the umbilical cord. The umbilical cord is a ‘bundle’ of blood vessels that develops during pregnancy and exists for two key reasons: to use the blood flow between the mother and foetus to

1. transfer oxygen and nutrients to the foetus
2. to eliminate waste products from the foetus

This means that the maternal and foetal bodies are connected, and what the mother consumes can be passed through the umbilical cord to the foetus – including alcohol.
Alcohol enters our blood during the digestive process. This is how we can measure levels of alcohol present in the body by establishing a thorough blood alcohol content (BAC) as early as 30 minutes after alcohol is consumed.

If it enters the blood of the mother, it will then travel in the blood through the umbilical cord to the foetus in utero. As the foetus is not fully developed, alcohol exposure can cause damage to important bodily systems. This exposure can then cause damage to the central nervous system (CNS) as well as impacting other major organs, therefore causing the development of potential congenital disabilities from alcohol.

What Increases the Risk?

Any alcohol consumption during gestation can lead to the development of FAS, but there are some cases where the risk may be higher.
These include:

if the mother is over 30 and has a long history of alcohol consumption
if the mother has poor or inadequate nutrition
if the mother has previously had a child born with FAS
if the mother’s metabolism means they break down alcohol at a slower rate
ethnicity (research into FAS and cultural differences suggests that black children are seven times as likely to develop FAS than white children, whilst white children are more likely to develop FAS than Hispanic children)

Foetal Alcohol Syndrome: The Symptoms

However, there are some key symptoms commonly experienced by individuals with FADs. These can be split into two categories: psychological or cognitive symptoms and physical symptoms.

Psychological/ cognitive symptoms of Foetal Alcohol Syndrome:

Difficulties with attention
Difficulties with coordination Hyperactivity
Difficulties with memory
Difficulties with speech or language delays
Difficulties with learning different concepts, specifically in areas like maths
Hyperactivity
Learning or intellectual disabilities
Lower IQ

Physical Symptoms of Foetal Alcohol Syndrome:

Complications with the bones and skeletal system
Issues with heart or kidney function
Low (or lower than average) body mass
Low (or lower than average) height
Small (or smaller than average) head
Impaired hearing
Difficulties with sight / impaired vision
Specific facial features (smooth ridge in the philtrum area – between nose and upper lip)

Diagnosing Foetal Alcohol Syndrome

FAS and Diagnosis

There is no specific test doctors can do to diagnose FADs – it cannot be detected through blood sampling or screenings such as X-rays.
This means that in the vast majority of cases, FAD diagnoses are context-dependent, and for a diagnosis to be given, the CDC states that you may need to provide some information that fits within the following categories:

Any knowledge of alcohol exposure in utero
Experiences of issues associated with the central nervous system (such as a range of cognitive difficulties)
Physical symptoms (such as low or lower than average height, weight and build)
Facial characteristics associated with FASDs

The Different Kinds of FADs

There are a range of different disorders that fit under the ‘umbrella’ of FASDS.

These include:

Foetal alcohol syndrome (FAS)
Partial foetal alcohol syndrome (pFAS)
Alcohol-related neurodevelopmental disorder (ARND)
Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE)
And alcohol-related congenital disabilities (ARBD)

This means that the exact symptoms that are experienced will largely depend on the specific diagnosis given.

Foetal Alcohol Syndrome (FAS) is often considered the most serious of the FASD diagnosis. Individuals with this diagnosis are likely to have the physical characteristics associated with the disorder (such as facial structure and lower height and weight) as well as issues with their central nervous system. They may grow either more slowly or less than their peers. They may also experience learning issues, face speech and sight challenges and have particular difficulties at school.

Individuals with Partial foetal alcohol syndrome (pFAS) may have some of the symptoms listed – for example, the physical features associated with the disorder—but may not experience some of the cognitive difficulties.

Alcohol-related Neurodevelopmental Disorder (ARND) is typically characterised by learning disabilities and difficulties that are linked with learning and behaviour.

A diagnosis of Alcohol-Related Birth Defects (ARBD) relates to problems with the functioning of key organs, such as the heart and the kidneys, as well as potential issues with the skeletal system and hearing.

Difficulties with Diagnosis

Because of the broad spectrum of characteristics that fit under the criteria of FADs, there is a chance that individuals can be misdiagnosed with a disorder that echoes the symptomology of FADs. For example, foetal alcohol syndrome has similar characteristics to ADHD, so it is possible that these diagnoses can be given in place of one another.

Treatment for Foetal Alcohol Syndrome

As foetal alcohol syndrome is a congenital condition, there is no cure to reverse the effects of intrauterine alcohol exposure. However, early detection of FAS (before the age of six) can lead to appropriate interventions to support young people with the condition.

Appropriate forms of support include:

Medication to help alleviate symptoms where appropriate
Therapies to help support potential difficulties with behaviour
Specialist support to help with educational difficulties
Support in the school setting
Support for parents – both teaching parents about the condition and how to help their child manage difficult symptoms

This kind of support can be offered through a developmental paediatrician, psychologist or educational specialist. Diagnosis should be followed with routine follow-ups to ensure adequate support is in place.

Preventing Foetal Alcohol Syndrome

The best method of preventing foetal alcohol syndrome is through abstaining from alcohol during pregnancy. However, this is not always as easy as it seems for several reasons. According to one study, nearly 10% (7.6%) of women reported drinking during pregnancy. This can have a variety of different causes, including:

The mother was unaware of her pregnancy for some period of her gestation
The mother did not stop drinking recreationally as she was unaware of the health effects of doing so
The mother was not able to stop drinking due to difficulties with substance use or alcohol addiction

Getting Help for Alcohol Addiction:

If you are planning to try for a baby and you are struggling with alcohol addiction, you can access support at a specialist alcohol rehab, such as our centres across the country.

Similarly, if you or a loved one are pregnant and are unsure how to stop drinking, our staff can provide you with confidential support and guidance on how to navigate this. We can offer you information about the support available and explain the physical and psychological medical interventions that can assist you during this difficult time.

If you are struggling with addiction while pregnant, seeking support as soon as possible is crucial. Continued drinking can harm both you and your unborn child. Similarly, attempting to achieve sobriety on your own can be risky; undergoing alcohol detox without appropriate medical supervision can be challenging, and pregnancy can complicate the process further.

To receive non-judgmental, confidential advice from industry professionals, please contact our team today to learn how to make a referral for help with alcohol addiction during pregnancy.