Alcohol and Pregnancy
Fetal Alcohol Spectrum Disorder
Alcohol is a teratogen and a neurotoxin i.e. an agent that is known to adversely affect fetal development and cause birth defects and brain damage.
Alcohol crosses the placenta freely and produces equivalent concentrations in fetal circulation to that in the mother.
FASD is not a diagnosis but captures a range of disorder described below:
Fetal Alcohol Syndrome
Fetal Alcohol Syndrome (FAS) is most noticeable typically due to the presence of particular facial features and small growth for age. There is always some level of brain injury and maternal alcohol use is confirmed. A diagnosis of partial FAS (pFAS) can be made when some but not all of the features of FAS are present. Again, there will always be some level of brain injury. Global estimates suggest this occurs in about 1:1000 live births.
Alcohol Related Birth Defects
Alcohol Related Birth Defects (ARBD) describes organ damage caused by fetal alcohol exposure.
Alcohol Related Neurodevelopmental Disorder
Alcohol Related Neurodevelopmental Disorder (ARND) is all about brain injury and the disabilities are unique to each affected individual. Individuals who might be diagnosed with ARND do not typically present with any observable physical signs which means it is more difficult to diagnose and therefore also means we have little idea about how many individuals in our communities are affected. Estimates for ARND in the general population are potentially 10 times higher than FAS and estimates range from 1:100 live births to perhaps 2-5% of the general population. Philip May and colleagues have recently reported:
Regarding all levels of FASD, we estimate that the current prevalence of FASD in populations of younger school children may be as high as 2–5% in the US and some Western European countries.
How Much is a Risk?
Researchers do not yet know how much alcohol, if any, is safe to drink during pregnancy and there is also no safe time for consuming alcohol. What they do know is the risk of damage increases the more you drink and that binge drinking is especially harmful.
Every individual who is has an FASD will have some level of brain impairment and the extent of damage caused to the developing brain is dependent on (1) the dose – the amount consumed to which the unborn child is exposed; and (2) the timing – the stage of pregnancy. There are other environmental factors currently being researched which may have an additional effect including stress; nutrition; and other drug use however, no other drug has been found to have the detrimental effect on healthy fetal development that alcohol has.
FASD & Primary Disabilities
|Compromised executive functioning||
|Difficulties with abstract concepts||
|Inability to generalise information||
|Poor communication skills||
|Slow cognitive pace||
|Slow auditory pace||
|Sensory systems dysfunction||
FASD & Secondary Behaviours
“Whilst the primary disabilities are defined as “functional deficits that reflect the CNS…[central nervous system]…dysfunctions inherent in the…[fetal alcohol exposure]…diagnosis”, secondary behaviours (or conditions) are those “that arise after birth and presumably could be ameliorated through better understanding and appropriate interventions.”
Secondary behaviours for those living with an FASD arise from a lack of appropropriate intervention in response to the primary disabilities an individual with an FASD is born with. These behaviours can develop over time as “defensive behaviours.”
The ‘invisibility’ of FASD means individuals will adapt their behaviours in line with not being able to meet the normal expectations expected of them. These same behaviours are used to ‘label’ and define the individual for example, as defiant, wilful and/or disruptive and can simply be explained as normal protective reactions to frustration and continued failure. Defensive behaviours can be helpful ‘clues’ for identifying points for intervention and can be addressed when the environment is adjusted to suit each individual.
Common secondary conditions include:
- Inappropriate humour
- Pseudo-sophistication – the individual is able to echo words or phrases, manners and dress in order to ‘pass’ as competent beyond their actual ability. Often this is to the detriment of the individual
- Fatigued, irritable, resistant and/or argumentative
- Anxious, fearful and/or chronically overwhelmed
- Frustrated, angry, aggressive and/or destructive
- Has a poor self-concept which is often masked by unrealistic goals or self-aggrandisement
- Isolated, few friends and probably bullied
- Family or school problems including fighting, suspension/s or expulsion
- May run away, have other forms of avoidance
- Trouble with the law
- Problematic alcohol and other drug use
- Depression, self-destructive and/or suicidal behaviours
 May, P et al, 2009 Wiley-Liss, Inc. Dev Disabil Res Rev 2009;15:176–192.
 Streissguth A. & Kanter, J., (2002) The Challenge of Fetal Alcohol Syndrome: Overcoming secondary disabilities. University of Washington Press: Seattle.
- An introduction to FASD presentation – download the presentation.
- Living with FASD – A guide for careers and parents – download a copy.
- NOFASARD March 2011 Newsletter – NOFASARD is the peak national non-government organisation representing the interests of parents, carers and others interested in or affected by FASD. Visit the NOFASARD Newsletters here.
- The DEN offers a education and training service for parents and care givers as well as the health works etc. Visit the Alcohol and Pregnancy service page for further information.