A baby with FAS; his lifetime medical and welfare costs are calculated at $5 million. [1]

Fetal alcohol spectrum disorder (FASD) describes a spectrum of permanent and often devastating birth-defect syndromes caused by maternal consumption of alcohol during pregnancy. The main effect of fetal alcohol exposure is brain damage, which can be caused during any trimester, because the fetus's brain continues to develop throughout the entire pregnancy. The brain damage is often accompanied by, and reflected in, distinctive facial stigmata, as seen in the photograph on the right. Image File history File links FASbaby. ... Image File history File links FASbaby. ... Medicine is the branch of health science and the sector of public life concerned with maintaining human health or restoring it through the treatment of disease and injury. ... Welfare has four main meanings. ... A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ... Look up mother in Wiktionary, the free dictionary. ... In general usage, alcohol (from Arabic al-kukhūl الكحول = the spirit, the chemical.) refers almost always to ethanol, also known as grain alcohol, and often to any beverage that contains ethanol (see alcoholic beverage). ... Pregnancy Pregnancy is the carrying of one or more embryos or fetuses by female mammals, including humans, inside their bodies. ... The human gestation period of approximately 40 weeks between the time of the last menstrual cycle and delivery is traditionally divided into three periods of three months, or trimesters. ... Comparative brain sizes In animals, the brain, or encephalon (Greek for in the head), acts as the control center of the central nervous system. ... Stigmata (plural of stigma) are wounds that were, according to the Holy Bible, inflicted on Jesus during his crucifixion. ...

There are a number of subtypes, including full-blown fetal alcohol syndrome (FAS), and the less noticeable, but sometimes equally serious, possible fetal alcohol effects (PFAE). The latter is also known as prenatal exposure to alcohol (PEA) or alcohol-related neurodevelopmental disorder (ARND). [4]

Features of FASD may include facial deformities, stunted physical and emotional development, memory and attention deficits, a tendency to impulsive behavior, inability to reason from cause to effect, a failure to comprehend the concept of time, difficulty telling fantasy from reality, inability to control sexual impulses, and an apparent lack of remorse. Secondary disabilities such as mental illness and drug addiction are also likely to develop. Unlike the primary disabilities, these do not reflect the central nervous system damage, but instead develop because the child has difficulty adapting to his environment. The face of Leonardo da Vincis Mona Lisa, one of the most recognized faces in the world The face is the front part of the human head from forehead to chin including the head, hair, forehead, eyebrow, eyes, nose, cheek, mouth, lips, teeth, skin, and chin. ... Emotion in its most general definition is a neural impulse that moves an organism to action, originating automatic reaction behavior which has been adapted through evolution as a survival need. ... Memory is the ability of the brain to store, retain, and subsequently recall information. ... A watch Attempting to understand time has long been a prime occupation for philosophers, scientists and artists. ... People feel remorse when reflecting on their actions that they believe are wrong. ... Listen to this article · (info) This audio file was created from an article revision dated 2005-08-20, and does not reflect subsequent edits to the article. ... Addiction is a compulsion to repeat a behaviour regardless of its consequences. ... A diagram showing the CNS: 1. ...

Fetal alcohol exposure is regarded by researchers as the leading known cause of mental retardation in the Western world (Abel and Sokel 1987), surpassing both spina bifida and Down syndrome. In the United States alone, it is estimated that, every year, one in 750 babies born suffers from FAS, and 40,000 from PFAE. [5] Fetus at eight weeks Foetus redirects here. ... Mental retardation (also called mental handicap and, as defined by the UK Mental Health Act 1983, mental impairment and severe mental impairment) is a term for a pattern of persistently slow learning of basic motor and language skills (milestones) during childhood, and a significantly below-normal global intellectual capacity as...

Naming of the syndrome

Fetal alcohol syndrome was named in 1973 by two dysmorphologists, Kenneth Lyons Jones and David W. Smith of the University of Washington Medical School in Seattle. They identified a pattern of "craniofacial, limb, and cardiovascular defects associated with prenatal onset growth deficiency and developmental delay" in eight unrelated children, of three ethnic groups, born to mothers who were alcoholics (Jones et al 1973, p. 1267). The pattern of malformations indicated that the damage was prenatal. News of the discovery was "shocking, and met at first with disbelief" (Streissguth in Streissguth and Kanter 2002, p xi). The University of Washington, founded in 1861, is a major public research university in the Seattle metropolitan area. ... City nickname Emerald City City bird Great Blue Heron City flower Dahlia City mottos The City of Flowers The City of Goodwill City song Seattle, the Peerless City Mayor Greg Nickels County King County Area   - Total   - Land   - Water   - % water 369. ... This article needs cleanup. ...

Dr. Paul Lemoine of Nantes, France had already published a study in a French medical journal in 1968 about children with distinctive features whose mothers were alcoholics (Lemoine et al in Streissguth and Kanter 2002, pp. 15 and 25). The Washington and Nantes findings were confirmed by a research group in Gothenburg, Sweden in 1979 (Olegard et al 1979). City motto: Favet Neptunus eunti. ... Gothenburg (Swedish: ▶ (help· info)) ) is a city and municipality on the west-coast of Sweden, in the County of Västra Götaland. ...

Researchers in France, Sweden, and the United States were struck by how similar these children looked, though they were not related, and how they behaved in the same unfocused and hyperactive manner (ibid).

Within four years of the Washington discovery, animal studies, including non-human primate studies carried out at the University of Washington Primate Center by Dr Sterling Clarren, had confirmed that alcohol was a teratogen. By 1978, 245 cases of FAS had been reported by medical researchers, and the syndrome began to be described as the most frequent known cause of mental retardation. Families 15, See classification A primate is any member of the biological order Primates, the group that contains all lemurs, monkeys, apes, and humans. ... Dr. Sterling Clarren Sterling K. Clarren is one of the worlds leading researchers into fetal alcohol spectrum disorder (FASD), an umbrella term emcompassing fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). ... Teratogenesis is a medical term from the Greek, literally meaning monster-making. ...

Brain damage and facial defects

A newborn baby with FAS. The photograph is from the clinic of Dr. Jon Aase, University of New Mexico. [2]

A thin upper lip and a smooth philtrum are signs of FAS

The image on the left shows the brain of a six-week-old; on the right, the brain of a baby the same age with FAS. [3] The photograph is from the clinic of Dr. Sterling Clarren of the University of Washington, Seattle.

Craniofacial abnormalities are visible in children with FAS, though not in children with FAE. Generally, children with FAS have a smaller head circumference and low birth weight, and they may fail to thrive. Their facial features are distinctive and diagnostically significant, in that they are a sign of brain damage, although there may be brain damage without the visible facial effects. Image File history File links NewbornFAS.jpg Newborn baby with FAS from the clinic of Dr. Jon Aase, specialist in FASD, taken from [1] Dr. Aase has been e-mailed to request a free licence. ... Image File history File links NewbornFAS.jpg Newborn baby with FAS from the clinic of Dr. Jon Aase, specialist in FASD, taken from [1] Dr. Aase has been e-mailed to request a free licence. ... This work is copyrighted. ... This work is copyrighted. ... A human face, with the philtrum in the yellow box. ... Image File history File links FASbrains2. ... Image File history File links FASbrains2. ... Dr. Sterling Clarren Sterling K. Clarren is one of the worlds leading researchers into fetal alcohol spectrum disorder (FASD), an umbrella term emcompassing fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). ... Failure to thrive is a medical term which denotes poor weight gain and physical growth failure over an extended period of time in infancy. ... Brain damage or brain injury is the destruction or degeneration of brain cells. ...

Common findings are mild to moderate microcephaly; small palpebral fissure lengths (palpebral fissures are the opening of the eyelids, measured from between the exocanthion and endocanthion of each eye); a thin upper lip; smooth philtrum (the vertical "divot" or groove between the nose and upper lip); flattened cheekbones; and a short nose. [6] An eyelid is a thin membrane of skin with the purpose of covering and protecting an eye. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... A womans lips with various kinds of lipstick applied. ... The zygomatic bone (also known as the zygoma; Os Zygomaticum; Malar Bone) is a paired bone of the human skull. ...

Dr. Sterling Clarren, one of the world's leading FASD researchers, of the University of Washington's Fetal Alcohol and Drug Unit, told a conference in 2002. The University of Washington, founded in 1861, is a major public research university in the Seattle metropolitan area. ...

I have never seen anybody with this whole face who doesn't have some brain damage. 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. Brain damage or brain injury is the destruction or degeneration of brain cells. ... Comparative brain sizes In animals, the brain, or encephalon (Greek for in the head), acts as the control center of the central nervous system. ... A human face, with the philtrum in the yellow box. ...

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 certainly are with FAS. [7] Gestation is the carrying of an embryo or fetus inside a female viviparous animal. ... Wikipedia does not yet have an article with this exact name. ...

As of 2002, there were 25 reports of autopsies on babies known to have been suffering from FASD. The first was in 1973 on a baby who died shortly after birth (Smith and Jones 1973). The examination revealed extensive brain damage, including microcephaly, migration anomalies, callosal dysgenesis, and a massive neuroglial, leptomeningeal heterotopia covering the left hemisphere (Mattson and Riley in Streissguth and Kantor, 2002, p. 10). An autopsy, also known as a post-mortem examination or an obduction, is a medical procedure that consists of a thorough examination of a corpse to determine the cause and manner of a persons death and to evaluate any disease or injury that may be present. ...

Sterling Clarren described a second baby born in 1977, whose mother was a binge drinker. The baby died ten days after birth. The autopsy showed severe hydrocephalus, abnormal neuronal migration, and a small corpus callosum (which connects the two hemispheres) and cerebellum (ibid). Grays FIG. 733– Corpus callosum from above. ... Figure 1a: A human brain, with the cerebellum in purple. ...

Since then, FASD has also been linked to brainstem and cerebellar changes, agenesis of the corpus callosum and anterior commissure, migration errors, absent olfactory bulbs, meningomyelocele, and porencephaly (ibid, p. 11). The brain stem is the stalk of the brain below the cerebral hemispheres. ... The olfactory bulb (1) is relatively large in the rabbit brain The olfactory bulb is a part of the brain that is a distinct outgrowth from the forebrain of mammals. ...

Diagnostic criteria

Although clinicians agree on the definition of full-blown fetal alcohol syndrome, there is no agreement on the clinical criteria or names for lesser forms of it. This has led to some confusion for clinicians and patients. The following definitions are used in the clinic of Dr. Sterling Clarren (Clarren in Streissguth and Kanter 2002, p. 46):

• FAS with a confirmed history of fetal alcohol exposure

The definition of FAS is much the same as when the syndrome was first named. Diagnostic criteria include growth deficiency, the characteristic set of facial anomalies described above, and evidence of organic brain damage including structural, neurological, or functional stigmata.

• FAS without a confirmed history of fetal alcohol exposure

Clarren writes that he has never seen a patient with the same findings as above who has confirmed negative for prenatal alcohol exposure. However, his clinic does see patients who fit the diagnosis for whom no early history is available. Prenatal exposure is therefore not regarded as part of the diagnostic criteria, but will tend only to confirm it.

• Atypical FAS or Possible FAS (PFAS)

These patients have almost all the findings, and a confirmed history of alcohol exposure, but may lack growth deficiency or the full facial stigmata.

• Fetal alcohol effect (FAE), possible fetal alcohol effect (PFAE)

This term was used in research studies to describe humans and animals in whom teratogenic effects were seen after confirmed fetal alcohol exposure, but without obvious physical anomalies (Clarren and Smith 1978). Because alcohol could not be regarded with certainty as the only cause of the effects, the term "possible fetal alcohol effects" was proposed for clinical use. This term has fallen out of favor with clinicians because it was being regarded by the public as a final diagnosis rather than a tentative one, and because it seemed to overstate the relationship between the possible cause and the perceived effects.

• Alcohol-related birth defect

This was proposed as an alternative to FAE and PFAE, but it has fallen out of favor, according to Clarren.

• Alcohol-related neurodevelopmental disorder

This was suggested by Stratton, Howe, and Battaglia in 1996 to replace FAE and PFAE, but Clarren regards the term as begging the question regarding the extent to which alcohol may have played a role, when the damage in some patients is minimal and hard to evaluate in terms of causation.

When the brain damage occurs

During the first trimester, according to Dr. Sterling Clarren and Dr. Ann Streissguth, both of the University of Washington, alcohol interferes with the migration and organization of brain cells (Journal of Pediatrics, 92(1):64-67). Brain cells are made up mostly of nerds and glial cells. ...

Most of the clinical features of FAS (the facial and other visible deformities) are believed to be caused mainly during the 10th and 20th week (Early Human Development; 1983 Jul Vol. 8(2) 99-111).

During the third trimester, damage can be caused to the hippocampus, which plays a role in memory, learning, and emotion, leading to difficulty encoding visual and auditory information (Neurotoxicology and Teratology, 13:357-367, 1991). [8] The location of the hippocampus in the human brain. ...

Other physical effects

• Growth — Pre- and postnatal onset growth retardation.
• Performance — The I.Q. may be in the region of 63, though this depends on the severity of the condition. Poor eye-hand coordination. Fine motor dysfunction manifested by a weak grasp.
• Skeletal — Joint anomalies including abnormal position and function, altered palmar crease patterns. Small distal phalanges and small fifth fingernails.
• Cardiac — A heart murmur that frequently disappears by one year of age. Ventricular septal defect most commonly seen, followed by an atrial septal defect.
• Occasional abnormalities — Ptosis of the eyelid. Microophthalmia, cleft lip with or without a cleft palate, webbed neck, short neck, Tetralogy of Fallot, coarctation of the aorta, Spina bifida, and hydrocephalus.

IQ tests are designed to give approximately normally distributed results, which causes a bell curve graph of IQ score frequency. ... The phalanges in a human hand The name Phalanges is commonly given to the bones that form fingers and toes. ... Echocardiographic image of a large ventricular septal defect. ... Atrial septal defects (ASD) are a group of congenital heart diseases that involve the interatrial septum of the heart. ... Ptosis is the paralysis of the muscles of the eyelid. ... In medicine, the tetralogy of Fallot (described by Etienne Fallot, 1850 - 1911, Marseille) is a significant and complex congenital heart defect. ... Aortic coarctation is narrowing of the aorta in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. ...

Prevention

Alcohol is a teratogen, and the only certain way to prevent FASD is to avoid drinking alcohol during pregnancy. In the United States, the Surgeon General recommended in 1981 that women not drink while pregant or while planning a pregnancy, the latter to avoid damage in the earliest stages of a pregnancy while the woman may not be aware that she has conceived. Congress passed legislation in 1989 that requires warning labels be placed on all alcoholic beverage containers. Teratogenesis is a medical term from the Greek, literally meaning monster-making. ... A spermatozoon fertilising an ovum Fertilization (also known as conception, fecundation and syngamy) is fusion of gametes to form a new organism. ...

References

• Astley, S.J. and Clarren, S.K. "Measuring the facial phenotype of individuals with prenatal alcohol exposure: correlations with brain dysfunction", Alcohol & Alcoholism, Vol. 36, No. 2, pp.147-159, 2001
• Clarren, S.K. (1979). "Central nervous system malformations in two offspring of alcoholic women". Birth Defects, 13, 151-153.
• Olegard, R., Sabel, K.G., Aronsson, M. Sandin, B., Johannsson, P.R., Carlsson, C., Kyllerman, M., Iversen, K. & Hrbek, A. (1979). "Effects on the child of alcohol abuse during pregnancy". Acta Paediatrica Scandinavica, 275, 112-121
• Streissguth, A. and Kanter, J. The Challenge in Fetal Alcohol Syndrome: Overcoming Secondary Disabilities. First published in 1997; this edition 2002. ISBN 0295976500
• Fetal Alcohol Syndrome Diagnostic & Prevention Network (FAS DPN)
• Photographs from the clinic of Dr. Jon Aase showing facial abnormalities, University of New Mexico
• Well.com FAS Fact Sheet
• FAQ on FAS from National Organization on Fetal Alcohol Syndrome
• Dr Sterling Clarren's keynote address on FASD, Prairie Northern Conference on Fetal Alcohol Syndrome, Yukon 2002
• FASD in CanadaLakeland Centre for FASD, Alberta Canada
• "Whose baby is this?" FAS Community Resource Center

Further reading

• "Fetal Alcohol Syndrome: Everything you need to know about Fetal Alcohol Spectrum Disorders", a website sponsored by the FAS Community Resource Center, retrieved January 21, 2006
• "Fetal Alcohol Syndrome" website run by David J. Hanson of the State University of New York