Alcohol (wine, beer, or liquor) is the leading known preventable cause of developmental and physical birth defects in the United States.

When a woman drinks alcohol during pregnancy, she risks giving birth to a child who will pay the price — in mental and physical deficiencies — for his or her entire life.

Yet many pregnant women do drink alcohol. It's estimated that each year in the United States, 1 in every 750 infants is born with a pattern of physical, developmental, and functional problems referred to as fetal alcohol syndrome (FAS), while another 40,000 are born with fetal alcohol effects (FAE).

Signs and Symptoms

If you adopted a child or consumed alcohol during pregnancy and are concerned that your child may have FAS, watch for characteristics of the syndrome, which include:

• low birth weight
• small head circumference
• failure to thrive
• developmental delay
• organ dysfunction
• facial abnormalities, including smaller eye openings, flattened cheekbones, and indistinct philtrum (an underdeveloped groove between the nose and the upper lip)
• epilepsy
• poor coordination/fine motor skills
• poor socialization skills, such as difficulty building and maintaining friendships and relating to groups
• lack of imagination or curiosity
• learning difficulties, including poor memory, inability to understand concepts such as time and money, poor language comprehension, poor problem-solving skills
• behavioral problems, including hyperactivity, inability to concentrate, social withdrawal, stubbornness, impulsiveness, and anxiety

Children with FAE display the same symptoms, but to a lesser degree.

Diagnosis and Long-Term Effects

Problems associated with FAS tend to intensify as children move into adulthood. These can include developmental health problems, troubles with the law, and the inability to live independently.

Kids with FAE are frequently undiagnosed. This also applies to those with alcohol-related neurodevelopmental disorder (ARND), a recently recognized category of prenatal damage that refers to children who exhibit only the behavioral and emotional problems of FAS/FAE without any signs of developmental delay or physical growth deficiencies.

Often, in kids with FAE or ARND, the behavior can appear as mere belligerence or stubbornness. They may score well on intelligence tests, but their behavioral deficits often interfere with their ability to succeed. Extensive education and training for the parents, health care professionals, and teachers who care for these kids are essential.

How Much Alcohol Is Too Much?

It's clear that abusing alcohol during pregnancy is dangerous, but what about the occasional drink? How much alcohol constitutes too much during pregnancy?

No evidence exists that can determine exactly how much alcohol ingestion will produce birth defects. Individual women process alcohol differently. Other factors vary the results, too, such as the age of the mother, the timing and regularity of the alcohol ingestion, and whether the mother has eaten any food while drinking.

Although full-blown FAS is the result of chronic alcohol use during pregnancy, FAE and ARND may occur with only occasional or binge drinking.

Because alcohol easily passes the placental barrier and the fetus is less equipped to eliminate alcohol than its mother, the fetus tends to receive a high concentration of alcohol, which lingers longer than it would in the mother's system.

Mothers who drink during the first trimester of pregnancy have kids with the most severe problems because that is when the brain is developing. The connections in the baby's brain don't get made properly when alcohol is present. Of course, in the early months, many women don't even know they're pregnant.

It's important for women who are thinking about becoming pregnant to adopt healthy behaviors before they get pregnant.

Women who abstain from alcohol in early pregnancy may feel comfortable drinking in the final months. But some of the most complex developmental stages in the brain occur in the second and third trimesters, a time when the nervous system can be greatly affected by alcohol. Even moderate alcohol intake, and especially periodic binge drinking, can seriously damage a developing nervous system.

Prevention Is the Key

FAS can be completely prevented by not drinking any alcohol during pregnancy.

Reviewed by: Louis E. Bartoshesky, MD, MPH
Date reviewed: November 2011
Originally reviewed by: Linda Nicholson, MS, MC