Fetal alcohol spectrum disorder is an umbrella term used to describe fetal alcohol syndrome (FAS) and the less noticeable, but sometimes equally serious, fetal alcohol effects (FAE). FAS and FAE are permanent, and often devastating, birth-defect syndromes caused by maternal consumption of alcohol during pregnancy.

Drinking during pregnancy can cause mental retardation, facial deformities, stunted physical and emotional development, behavioral problems, memory deficiencies, attention deficits, impulsiveness, an inability to reason from cause to effect; a failure to comprehend the concept of time, an inability to tell reality from fantasy. Secondary disabilities develop over time because of problems fitting into the environment. Support groups estimate that 90 per cent of children with FASD have mental health issues, 61 per cent a disrupted school experience, 60 per cent trouble with the law, 50 per cent experience confinement, and 35 per cent abuse substances. [1] (http://www.juneauempire.com/stories/092004/opi_myturn.shtml)

Foetal alcohol exposure is regarded by researchers as the leading known cause of mental and physical birth defects, surpassing both spina bifida and Downs syndrome, producing more severe abnormalities than heroin, cocaine, or marijuana, and is the most common preventable cause of birth defects in the United States. [2] (http://kidshealth.org/parent/medical/brain/fas.html)

Researchers believe that the risk is highest early in the pregnancy, but there are risks throughout, because the foetus's brain develops throughout the entire pregnancy. No amount of alcohol, during any trimester, is absolutely safe.

Physical signs of FAS

Physical abnormalities are visible in children with FAS, though not in children with FAE. Generally, children with FAS have a smaller head circumference, low birth weight, they may fail to thrive, and their facial features are distinctive and diagnostically significant. The facial effects are a sign of brain damage, but damage to the brain may have occurred without the accompanying facial effects. The key facial features are:

1. Small palpebral fissure lengths (PFL). Palpebral fissures are the opening of the eyelids. These are measured from between the exocanthion and endocanthion of each eye.
2. A thin upper lip.
3. Smooth philtrum. (The philtrum is the vertical "divot" or groove between the nose and upper lip.)
4. Flattened cheekbones

"I have never seen anybody with this whole face who doesn't have some brain damage," Dr. Sterling Clarren of the University of Washington, one of the world's leading FASD researchers, told a conference in 2002. "In fact in studies, as the face is more FAS-like, the brain is more likely to be abnormal. The only face that you would want to counsel people, or predict the future about, is the full FAS face. But the risk of brain damage increases as the eyes get smaller, as the philtrum gets flatter and the lip gets thinner. The risk goes up but not the diagnosis.

"At one-month gestation, the top end of your body is a brain, and at the very front end of that early brain, there is tissue that has been brain tissue. It stops being brain and gets ready to be your face ... Your eyeball is also brain tissue. It's an extension of the second part of the brain. It started as brain and "popped out". So if you are going to look at parts of the brain from alcohol damage, or any kind of damage during pregnancy, eye malformations and midline facial malformations are going to be very actively related to the brain across syndromes, and they are, and they certainly are with FAS." [3] (http://www.come-over.to/FAS/Whitehorse/WhitehorseArticleSC1.htm)

References

"Measuring the facial phenotype of individuals with prenatal alcohol exposure: correlations with brain dysfunction" by Susan J. Astley and Clarren K. Sterling, Alcohol & Alcoholism, Vol. 36, No. 2, pp.147-159, 2001

• Fetal Alcohol Syndrome Diagnostic & Prevention Network (FAS DPN) (http://depts.washington.edu/fasdpn/)

fr:Syndrome d'alcoolisation fétale