benefit from What is fetal alcohol syndrome? Fetal alcohol spectrum disorders (FASDs) are a group of potentially disabling congenital conditions that occur due to alcohol consumption by the mother during pregnancy, with fetal alcohol syndrome or FAS being the most severe among them [1] . Problems and complications associated with it include mental retardation, physical and facial deformities and learning difficulties [2] . What are the causes and risk factors of fetal alcohol syndrome? Drinking alcohol during pregnancy is the principal cause responsible for this disorder in newborn infants. No safe amount of alcohol to drink during pregnancy has been determined. So, it is advisable to avoid drinking altogether to eliminate any risk [3] . However, researchers show that binge drinking is likely to result in more serious problems compared to drinking a glass of wine now and then [4] . FAS mainly affects the facial features, bones, heart and central nervous system. So, it is believed that drinking during the first trimester may affect the fetus most as these organs and body parts develop in the initial three months. But, drinking during any trimester is harmful for the baby [5] . How does alcohol affect the fetus? When you drink alcohol during pregnancy, it reaches the developing fetus, crossing the placenta through your bloodstream [4] . The fetus cannot metabolize the alcohol as fast as you can. As a result, the blood alcohol concentration in the baby becomes higher than that in your body, causing developmental problems [6] . Alcohol also prevents ample amount of oxygen and necessary nutrients from reaching the baby s developing organs and tissues, such as heart and brain. Is fetal alcohol syndrome genetic? According to a research performed on primates, newborns carrying a specific gene variant are believed to be more likely to develop the symptoms of FAS [7] . What are the signs and symptoms of fetal alcohol syndrome? Being one of the most common causes of congenital mental retardation [14] , it is also characterized by a wide range of physical, mental and behavioral symptoms. Fetal Alcohol Syndrome Facial Features Short palpebral fissures (narrow eye opening) Wide-set eyes having large epicanthal folds [4] Small upper jaw Amblyopia (lazy eye) [8] Thin vermillion border (Thin and smooth upper lip) Smooth philtrum (absence of groove between the nose and upper lip) [9] Flat cheeks Short, upturned nose Small teeth [10] Other Physical Characteristics Small head (large head circumference may be present) [11] Excessive hair growth [12] Unusual railroad track shaped ears [13] Under-grown nails Decreased muscle tone [4] Underdeveloped genitalia Limbs, joints and finger deformities [14] Low birth weight Below-average height [15] Small toe-nails and fingernails Abnormal hand and foot creases Caved-in chest wall Limited range of movement of fingers and elbows Mental, Behavioral and Internal Effects Small, underdeveloped brain (microcephaly) Heart defects, heart murmur and large vessel abnormalities [12] Diaphragmatic or umbilical hernia [10] Kidney defects [16] Learning disorders and short attention span Articulation problems due to poor tongue control [17] Poor memory [18] Poor hand-eye coordination [19] Developmental delay [14] Mental retardation Irritability in infants and hyperactivity in older children (attention deficit hyperactivity disorder or ADHD) [20] Poor impulse control Extreme anxiety and nervousness Short attention span Poor social skills [13] Vision and hearing problems Increased risks of epilepsy [21] Other organ dysfunction [19] Long Term Effects of Fetal Alcohol Syndrome in Adults Problems associated with FAS tend to worsen as an affected individual reaches adulthood. Long term effects may include problems associated with growth retardation and intellectual development, inability to live alone, difficulty in abiding by the law [19] and increased risk of being suicidal [22] . Fetal Alcohol Syndrome Prevention It is easily preventable by avoiding drinking alcohol while pregnant. It is recommended to give up drinking as soon as you plan to have a baby to eliminate any risks. Women with drinking problems should consult a health care practitioner regarding the best ways to refrain from alcohol throughout pregnancy [23] . How is fetal alcohol syndrome diagnosed? It is not possible to confirm the diagnosis of FAS before birth [24] . But, tests and exams performed for fetal health assessment (e.g. pregnancy ultrasound) often enables doctors to suspect the condition. Women unable to give up alcohol during pregnancy should consult their doctor to help detect the problems as soon as possible [5] . Brain imaging exams (MRI, CT scan) as well as tests for determining the blood alcohol levels in the mother help to evaluate the chances of FAS for the unborn baby. Diagnosis after birth includes a thorough physical examination to look for characteristic symptoms such as heart murmur and other cardiac defects [25] . A child may have to remain under observation for weeks, months and even years after birth as the doctor assesses the following: Growth rate [26] Language development Facial features [24] Vision and hearing as the child grows up Bone growth Coordination Head size The facial and other physical signs present in babies born with FAS help with the detection at the early stage. However, it is possible for a healthy baby to have a few facial characteristics that resemble those described in FAS patients [14] . So, proper assessment by an expert physician is essential for confirming the diagnosis. Fetal Alcohol Syndrome Differential Diagnosis Genetic testing may be necessary to rule out any hereditary condition with similar symptoms [24] . Autism (May coexist with FAS) [30] Down syndrome Williams syndrome Noonan s syndrome Dubowitz syndrome Possible environmental causes (abuse, neglect etc.) responsible for the CNS abnormalities should also be considered in the differential diagnosis [30] . It also includes ruling out other FASDs such as ARND (alcohol-related neurodevelopmental disorder) and ARBD (alcohol-related birth defects) that often leads to similar physical symptoms. Fetal Alcohol Syndrome Treatment and Management Despite being an incurable disorder, the quality of life of the patients may be improved by proper management that generally continues throughout their lives [5] . Children with FAS should be provided with a stable routine to follow at home as they are often highly sensitive to disorders and disruptions in their daily routine. Being exposed to abuse and violence at home increases their chances of developing problems with substance abuse and violence as adults [5] . A regular routine with simple rules and rewards for proper behaviour help these children to lead as normal a life as possible. The following measures can also help with the management: Consulting the doctor regarding the usefulness of the FDA (The U.S. Food and Drug Administration) designated drugs for managing the symptoms of alcohol withdrawal in newborn babies [12] Working with a speech therapist from a young age Providing the child with proper therapy to help him cope with the birth defects and function within the limitations of the condition Occupational therapy for enabling the patient maintain proper self-esteem, learn to make the right decisions and develop tolerable interpersonal skills to allow him lead a relatively normal social life [27] Providing special education to help the child cope with learning difficulties Fetal Alcohol Syndrome Prevalence Facts Its exact prevalence is still not known. But according to statistics, the overall incidence is estimated to be 0.97 in every 1000 live births and 43 in every 1000 births among babies born to heavy drinkers. Although FAS is seen among all races, babies having a Native American origin are found to be more susceptible to the condition. In Canada, it has a higher prevalence among Inuit communities and certain First Nations [27] . Fetal Alcohol Syndrome Support Group The Arc 1825 K Street NW, Suite 1200 Washington, DC 20006 Phone: 800-433-5255 / 202-534-3700 Fax: 202-534-3731 Email: [email protected] Website: http://www.thearc.org/page.aspx?pid=2530 ICD-9 and ICD-10 Codes The ICD-9 code used for indicating FAS is 760.71 [28] while its ICD-10 code is Q86.0 [29] . 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