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Fetal alcohol syndrome is the manifestation of specific growth, mental, and physical birth defects associated with the mother's high levels of alcohol use during pregnancy.

Alcohol use or abuse by the pregnant woman subjects her to the same range of risks that alcohol has in the general population. However, it poses extreme and unique risks to the fetus and is associated with fetal alcohol syndrome (FAS).

Timing of alcohol use during pregnancy is also of importance. Alcohol use during the first trimester is more damaging than during the second trimester, which is, in turn, more damaging than use in the third trimester.

Alcohol ingested by a pregnant woman easily passes across the placental barrier to the fetus. Because of this, drinking alcohol can adversely affect the development of the baby.

A pregnant woman who drinks any amount of alcohol is at risk, since a "safe" level of alcohol ingestion during pregnancy has not been established. However, larger amounts appear to cause increased problems. Multiple birth defects associated with "classical" fetal alcohol syndrome are more commonly associated with heavy alcohol use or alcoholism.

Fetal alcohol syndrome consists of the following abnormalities:

• Intrauterine growth retardation: growth deficiency in the fetus and newborn in all parameters -- head circumference, weight, height
• Delayed development with decreased mental functioning (mild to severe)
• Facial abnormalities including small head (microcephaly); small maxilla (upper jaw); short, up-turned nose; smooth philtrum (groove in upper lip); smooth and thin upper lip; and narrow, small, and unusual-appearing eyes with prominent epicanthal folds
• Heart defects such as ventricular septal defect (VSD) or atrial septal defect (ASD)
• Limb abnormalities of joints, hands, feet, fingers, and toes

Consumption of alcohol by a pregnant woman may be the first indicator of potential fetal alcohol syndrome.

Others indicators may be:

• Slow intrauterine and neonatal growth with occasional diagnosis of failure to thrive
• Delayed development and evidence of mild to moderate mental retardation (IQ range from 50 to 85 with reported average in the mid 60s)
• Facial abnormalities, skeletal limb abnormalities, tremors (in the newborn infant), agitation and crying (in the newborn infant)

Examination of the baby may show a heart murmur or other evidence of cardiac anomalies. As the baby grows, there may be evidence of delayed mental development. Facial and skeletal abnormalities may also be present.

Tests include:

• Pregnancy ultrasound, which can demonstrate the presence of intrauterine growth retardation
• Infant ECG and echocardiogram, which can detect heart abnormalities
• Blood alcohol level in pregnant women who exhibit signs of intoxication (see toxicology screen)

Pregnant women, or women trying to conceive, are encouraged to avoid drinking alcohol in any quantity. Pregnant alcoholic women should be involved in alcohol abuse rehabilitation programs, and monitored closely throughout pregnancy.

Support groups can benefit the pregnant woman by providing interaction with members who share common experiences and problems. For this condition, see alcoholism - support group.

For free information on how to stop drinking contact:

• The National Drug and Alcohol Treatment Referral Routing Service at 1-800-662-HELP (4357)
• The National Council on Alcoholism and Drug Dependency at 1-800-NCA-CALL (622-2255)

Outcome for infants with fetal alcohol syndrome is variable depending on the extent of symptoms, but almost none are normal when it comes to brain development.

The problems of the infant and child with fetal alcohol syndrome are diverse and difficult to manage. Cardiac defects may necessitate surgery. There is no effective therapy for mental retardation.

Alcohol consumption during pregnancy may result in:

• Miscarriage or stillbirth
• Premature delivery
• A mentally retarded baby
• A baby who is small for gestational age
• A baby who may die in infancy
• A baby with a small head, defects, or malformations of the eyes, nose, or mouth
• A baby with malformation of the heart or other vital organs
• A baby with slow growth and poor coordination
• A restless, overactive baby that may later exhibit hyperactive behavior and learning disabilities

Call for an appointment with your health care provider if you are drinking alcohol regularly or heavily, and are finding it difficult to cut back or stop. Also, call if you are drinking alcohol in any quantity while pregnant or trying to become pregnant.

Abstinence from alcohol during pregnancy absolutely prevents fetal alcohol syndrome. Counseling is indicated to help prevent recurrence in women who have previously delivered a child with fetal alcohol syndrome.

Sexually active women who drink heavily or are alcoholics should use highly effective contraceptive measures and control drinking behaviors, or discontinue the use of alcohol prior to attempting to conceive.