What Are the Signs of Fetal Alcohol Spectrum Disorders?

International Fetal Alcohol Spectrum Disorders (FASD) Awareness Day, recognized every year on Sept. 9th, is an important reminder prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States. Almost 40 years have passed since it was recognized drinking during pregnancy can result in a wide range of disabilities for children, of which fetal alcohol syndrome (FAS) is the most severe. Still, 1 in 13 pregnant women report drinking in the past 30 days. Of those, about 1 in 6 report binge drinking during that time.

The disabilities associated with FASD can persist throughout life and place heavy emotional and financial burdens on individuals, their families, and society. Alcohol use during pregnancy can cause physical, behavioral, and intellectual disabilities. Often, a person with an FASD has a mix of these problems. It is recommended women who are pregnant or might be pregnant not drink alcohol. Fetal alcohol spectrum disorders are completely preventable if a developing baby is not exposed to alcohol before birth.

What We Know

  • Women who are pregnant or who might be pregnant should be aware that any level of alcohol use could harm their babies.
  • All types of alcohol can be harmful, including all wine and beer.
  • The baby’s brain, body, and organs are developing throughout pregnancy and can be affected by alcohol at any time.
  • Alcohol use during pregnancy can also increase the risk of miscarriage, stillbirth, preterm (early) birth, and sudden infant death syndrome (SIDS).

Cause and Prevention

FASDs are caused by a woman drinking alcohol during pregnancy. Alcohol in the mother’s blood passes to the baby through the umbilical cord. When a woman drinks alcohol, so does her baby.

There is no known safe amount of alcohol during pregnancy or when trying to get pregnant. There is also no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she’s pregnant. All types of alcohol are equally harmful, including all wines and beer.

To prevent FASDs, a woman should not drink alcohol while she is pregnant, or when she might get pregnant. This is because a woman could get pregnant and not know for up to 4 to 6 weeks. In the United States, nearly half of pregnancies are unplanned.

If a woman is drinking alcohol during pregnancy, it is never too late to stop drinking. Because brain growth takes place throughout pregnancy, the sooner a woman stops drinking the safer it will be for her and her baby. Resources are available here.

FASDs are completely preventable if a woman does not drink alcohol during pregnancy—so why take the risk?

Signs and Symptoms

FASDs refer to the whole range of effects that can happen to a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways and can range from mild to severe.

A person with an FASD might have:

  • Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
  • Small head size
  • Shorter-than-average height
  • Low body weight
  • Poor coordination
  • Hyperactive behavior
  • Difficulty with attention
  • Poor memory
  • Difficulty in school (especially with math)
  • Learning disabilities
  • Speech and language delays
  • Intellectual disability or low IQ
  • Poor reasoning and judgment skills
  • Sleep and sucking problems as a baby
  • Vision or hearing problems
  • Problems with the heart, kidneys, or bones

Types of FASDs

Different terms are used to describe FASDs, depending on the type of symptoms.

Fetal Alcohol Syndrome (FAS): FAS represents the most involved end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others.

Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.
Alcohol-Related Birth Defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): ND-PAE was first included as a recognized condition in the Diagnostic and Statistical Manual 5 (DSM 5) of the American Psychiatric Association (APA) in 2013. A child or youth with ND-PAE will have problems in three areas: (1) thinking and memory, where the child may have trouble planning or may forget material he or she has already learned, (2) behavior problems, such as severe tantrums, mood issues (for example, irritability), and difficulty shifting attention from one task to another, and (3) trouble with day-to-day living, which can include problems with bathing, dressing for the weather, and playing with other children. In addition, to be diagnosed with ND-PAE, the mother of the child must have consumed more than minimal levels of alcohol before the child’s birth, which APA defines as more than 13 alcoholic drinks per month of pregnancy (that is, any 30-day period of pregnancy) or more than 2 alcoholic drinks in one sitting.

Diagnosis

The term FASDs is not meant for use as a clinical diagnosis. CDC worked with a group of experts and organizations to review the research and develop guidelines for diagnosing FAS. The guidelines were developed for FAS only. CDC and its partners are working to put together diagnostic criteria for other FASDs, such as ARND. Clinical and scientific research on these conditions is going on now.

Diagnosing FAS can be hard because there is no medical test, like a blood test, for it. And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS.

To diagnose FAS, doctors look for:

  • Abnormal facial features (e.g., smooth ridge between nose and upper lip)
  • Lower-than-average height, weight, or both
  • Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination)
  • Prenatal alcohol exposure; although confirmation is not required to make a diagnosis

Treatment

FASDs last a lifetime. There is no cure for FASDs, but research shows early intervention treatment services can improve a child’s development.

There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches. No one treatment is right for every child. Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.

Also, “protective factors” can help reduce the effects of FASDs and help people with these conditions reach their full potential. These include:

  • Diagnosis before 6 years of age
  • Loving, nurturing, and stable home environment during the school years
  • Absence of violence
  • Involvement in special education and social services

What Can Be Done to Prevent Fetal Alcohol Spectrum Disorders

Women Can

  • Talk with their healthcare providers about their plans for pregnancy, their alcohol use, and ways to prevent pregnancy if they are not planning to get pregnant.
  • Stop drinking alcohol if they are trying to get pregnant or could get pregnant.
  • Ask their respective partners, families, and friends to support their choice not to drink during pregnancy or while trying to get pregnant.
  • Ask their healthcare providers or other trusted people about resources for help if they cannot stop drinking on their own.

Healthcare providers can

  • Screen all adult patients for alcohol use at least yearly.
  • Advise women not to drink at all if there is any chance they could be pregnant.
  • Counsel, refer, and follow up with patients who need more help.
  • Use the correct billing codes so that alcohol screening and counseling is reimbursable.

Get Help!

If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about FASDs), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with FASDs. To find doctors and clinics in your area visit the National and State Resource Directory from the National Organization on Fetal Alcohol Syndrome (NOFAS).

At the same time as you ask the doctor for a referral to a specialist, call your state’s early intervention program to request a free evaluation to find out if your child can get services to help. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

If your child is younger than 3 years old, Call your state or territory’s early intervention program and say: “I have concerns about my child’s development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services.”

If your child is 3 years old or older, contact your local public school system. Even if your child is not old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.

Conclusion

Research to understand how alcohol exposure during pregnancy interferes with fetal development and how FASD can be identified and prevented is ongoing. Scientists continue to make tremendous strides, providing important new insights into the nature of FASD and potential intervention and treatment strategies.

The message is simple, not just on Sept. 9, but every day. There is no known safe level of drinking while pregnant. Women who are, who may be, or who are trying to become pregnant, should not drink alcohol.

If you or pregnant, may become pregnant, or are a new parent wondering about the effects of alcohol on your child, find a caring physician who can advise you using the first of its kind social ecosystem for HealthCare.  At HealthLynked, your can connect with providers in new and unique ways to collaborate on your wellness and the health of your family.

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Sources:
CDC.gov

References

Streissguth, A.P., Bookstein, F.L., Barr, H.M., Sampson, P.D., O’Malley, K., & Young, J.K. (2004). Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Developmental and Behavioral Pediatrics, 5(4), 228-238.

Streissguth, A.P., Barr, H.M., Kogan, J. & Bookstein, F. L., Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). Final report to the Centers for Disease Control and Prevention (CDC). Seattle: University of Washington, Fetal Alcohol & Drug Unit; August 1996. Tech. Rep. No. 96-06.

Blood Alcohol Level: MedlinePlus Lab Test Information

 

What is a blood alcohol test?

A blood alcohol test measures the level of Alcohol in your blood. Most people are more familiar with the breathalyzer, a test often used by police officers on people suspected of drunk driving. While a breathalyzer gives fast results, it is not as accurate as measuring alcohol in the blood.

Alcohol, also known as ethanol, is the main ingredient of alcoholic drinks such as beer, wine, and liquor. When you have an alcoholic drink, it is absorbed into your bloodstream and processed by the liver. Your liver can process about one drink an hour. One drink is usually defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of whiskey.

If you are drinking faster than your liver can process the alcohol, you may feel the effects of drunkenness, also called intoxication. These include behavioral changes and impaired judgment. The effects of alcohol can vary from person to person, depending on a variety of factors such as age, weight, gender, and how much food you ate before drinking.

Other names: blood alcohol level test, ethanol test, ethyl alcohol, blood alcohol content

What is it used for?

A blood alcohol test may be used to find out if you:

  • Have been drinking and driving. In the United States, .08 percent blood alcohol level is the legal alcohol limit for drivers who are aged 21 and over. Drivers younger than 21 are not allowed to have any alcohol in their system when driving.
  • Are legally drunk. The legal alcohol limit for drinking in public varies from state to state.
  • Have been drinking while in a treatment program that prohibits drinking.
  • Have alcohol poisoning, a life-threatening condition that happens when your blood alcohol level gets very high. Alcohol poisoning can seriously affect basic body functions, including breathing, heart rate, and temperature.

Teens and young adults are at higher risk for binge drinking, which can cause alcohol poisoning. Binge drinking is a pattern of drinking that raises the blood alcohol level within a short period of time. Though it varies from person to person, binge drinking is usually defined as four drinks for women and five drinks for men in a two-hour period.

Young children may get alcohol poisoning from drinking household products that contain alcohol, such as mouthwash, hand sanitizer, and certain cold medicines.

Why do I need a blood alcohol test?

You may need a blood alcohol test if you are suspected of drunk driving and/or have symptoms of intoxication. These include:

  • Difficulty with balance and coordination
  • Slurred speech
  • Slowed reflexes
  • Nausea and vomiting
  • Mood changes
  • Poor judgment

You or your child may also need this test if there are symptoms of alcohol poisoning. In addition to the above symptoms, alcohol poisoning can cause:

  • Confusion
  • Irregular breathing
  • Seizures
  • Low body temperature

What happens during a blood alcohol test?

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This process usually takes less than five minutes.

Will I need to do anything to prepare for the test?

You don’t need any special preparations for a blood alcohol test.

Are there any risks to the test?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

What do the results mean?

Blood alcohol level results may be given in different ways, including percentage of blood alcohol content (BAC). Typical results are below.

  • Sober: 0.0 percent BAC
  • Legally intoxicated: .08 percent BAC
  • Very impaired: .08–0.40 percent BAC. At this blood alcohol level, you may have difficulty walking and speaking. Other symptoms may include confusion, nausea, and drowsiness.
  • At risk for serious complications: Above .40 percent BAC. At this blood alcohol level, you may be at risk for coma or death.

The timing of this test can affect the accuracy of the results. A blood alcohol test is only accurate within 6–12 hours after your last drink. If you have questions or concerns about your results, you may want to talk to a health care provider and/or a lawyer.

Is there anything else I need to know about a blood alcohol test?

A police officer may ask you to take a breathalyzer test if you are suspected of drunk driving. If you refuse to take a breathalyzer, or think the test wasn’t accurate, you may ask for or be asked to take a blood alcohol test.

References

  1. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; Alcohol and Public Health: Frequently Asked Questions [updated 2017 Jun 8; cited 2018 Mar 8]; [about 3 screens]. Available from: https://www.cdc.gov/alcohol/faqs.htm
  2. ClinLab Navigator [Internet]. ClinLab Navigator; c2018. Alcohol (Ethanol, Ethyl Alcohol) [cited 2018 Mar 8]; [about 2 screens]. Available from: http://www.clinlabnavigator.com/alcohol-ethanol-ethyl-alcohol.html
  3. Drugs.com [Internet]. Drugs.com; c2000–2018. Alcohol Intoxication [updated 2018 Mar 1; cited 2018 Mar 8]; [about 2 screens]. Available from: https://www.drugs.com/cg/alcohol-intoxication.html
  4. Hinkle J, Cheever K. Brunner & Suddarth’s Handbook of Laboratory and Diagnostic Tests. 2nd Ed, Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Ethyl Alcohol Levels (Blood, Urine, Breath, Saliva) (Alcohol, EtOH); 278 p.
  5. Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c2001–2018. Ethanol [updated 2018 Mar 8; cited 2018 Mar 8]; [about 3 screens]. Available from: https://labtestsonline.org/tests/ethanol
  6. Mayo Clinic: Mayo Medical Laboratories [Internet]. Mayo Foundation for Medical Education and Research; c1995–2018. Test ID: ALC: Ethanol, Blood: Clinical and Interpretive [cited 2018 Mar 8]; [about 4 screens]. Available from: https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8264
  7. National Institute on Alcohol Abuse and Alcoholism [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Alcohol Overdose: The Dangers of Drinking Too Much; 2015 October [cited 2018 Mar 8]; [about 3 screens]. Available from: https://pubs.niaaa.nih.gov/publications/AlcoholOverdoseFactsheet/Overdosefact.htm
  8. National Institute on Alcohol Abuse and Alcoholism [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Drinking Levels Defined [cited 2018 Mar 8]; [about 3 screens]. Available from: https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
  9. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests [cited 2018 Mar 8]; [about 3 screens]. Available from: https://www.nhlbi.nih.gov/health-topics/blood-tests
  10. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2017. Health Encyclopedia: Ethanol (Blood) [cited 2018 Mar 8]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=ethanol_blood
  11. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2018. Blood Alcohol: Results [updated 2017 Oct 9; cited 2018 Mar 8]; [about 8 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/blood-alcohol-test/hw3564.html#hw3588
  12. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2018. Blood Alcohol: Test Overview [updated 2017 Oct 9; cited 2018 Mar 8]; [about 2 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/blood-alcohol-test/hw3564.html
  13. TEUW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2018. Blood Alcohol: What To Think About [updated 2017 Oct 9; cited 2018 Mar 8]; [about 10 screens].XT Available from: https://www.uwhealth.org/health/topic/medicaltest/blood-alcohol-test/hw3564.html#hw3598
  14. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2018. Blood Alcohol: Why It is Done [updated 2017 Oct 9; cited 2018 Mar 8]; [about 3 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/blood-alcohol-test/hw3564.html#hw3573

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