: September 18, 2024
: Families & Caregivers, Minority Health, Prevention, Substance Use, Treatment
: Berlina Wallace-Berube, MACP, MEd, LPC, NCC, Senior Public Health Advisor, Center for Substance Abuse Treatment

September is Fetal Alcohol Spectrum Disorders (FASDs) Awareness Month, a meaningful time to raise awareness of FASD prevention and celebrate the strengths, skills, and successes of those living with FASDs. Did you know that approximately one in 20 school-aged children in the United States (or 5%) may have FASDs? FASDs refer to a range of disorders caused by alcohol exposure during pregnancy that entail physical, cognitive, or behavioral issues in the affected individuals. Fetal Alcohol Syndrome (FAS) is the most severe manifestation of FASDs, marked by distinct facial features, growth deficiencies, and central nervous system problems.

People with FAS can have problems with learning, memory, attention span, communication, vision, hearing, or a combination of these problems. While FAS is the most recognizable, it represents only one part of the broader spectrum of disorders. Understanding FASDs is crucial for expecting parents and the community. It not only raises awareness about the potential risks associated with alcohol consumption during pregnancy but also promotes healthier choices that can lead to better outcomes for future generations.

The primary cause of FASDs is the consumption of alcohol by a pregnant person. There is no known safe amount of alcohol use during pregnancy, and even small amounts can pose risks. Alcohol passes easily from a pregnant person’s bloodstream to their developing baby’s bloodstream.

Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental abnormalities in the United States. The severity of FASDs can vary based on several factors, including the timing of alcohol exposure, the amount consumed, and the frequency of consumption. Each pregnancy is unique, and the effects of alcohol exposure can differ greatly from one individual to another.

FASDs can lead to a range of cognitive impairments, including learning disabilities, attention deficits, and difficulties with impulse control. Common physical characteristics of individuals with FAS include distinct facial features (such as a smooth philtrum and thin upper lip), growth deficiencies, and other anatomical anomalies.

Behavioral issues, such as hyperactivity and social challenges, are also common. Individuals with FASDs are also at increased risk for experiencing mental health and substance use conditions. It's important to note that symptoms can vary widely from person to person and are experienced throughout the lifespan, making early diagnosis and individualized support essential for improving outcomes.

The safest approach to ensure a healthy pregnancy is to stop using alcohol before getting pregnant. Alcohol consumption during pregnancy can disrupt the baby’s brain development, leading to lifelong implications for cognitive function, behavior, and physical health. Understanding these effects is essential for prevention and support.

Only individuals exposed to alcohol before birth may develop FASD. Given that approximately half of all pregnancies in the United States are not planned, the U.S. Surgeon General recommends that people who are pregnant, might be pregnant, or are planning a pregnancy not drink alcohol at all.

Stigma prevents pregnant people from seeking support for alcohol use and can also deter them from pursuing a diagnosis of FASD for their children. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Screening, Brief Intervention, and Referral to Treatment (SBIRT) program provides ways to ask pregnant people about alcohol use in a manner that encourages honesty, reduces stigma, and helps them get the support they need.

It is never too late to stop alcohol use during pregnancy. Because brain growth takes place throughout pregnancy, stopping alcohol use at any stage will improve the baby's health and well-being. Alcohol use disorder (AUD) is a medical condition that happens when drinking alcohol causes serious problems. The two types of evidence-based treatment for AUD are behavioral therapies and medications. Medications for Alcohol Use Disorder (MAUD) have been proven to be highly effective in helping people with AUD stop alcohol use and maintain abstinence.

Early detection of FASDs is critical for providing appropriate interventions and support, which can significantly improve the quality of life for affected individuals. Diagnosing FASDs involves a comprehensive evaluation, including a detailed medical history, physical examination, and neurodevelopmental assessments. It often requires a multidisciplinary approach to ensure accurate diagnosis and support.

While there is no cure for FASDs, early intervention and comprehensive treatment planning can significantly improve the quality of life for those impacted by symptoms of FASDs. Treatment typically involves a combination of medical care, behavioral therapy, educational support, and family assistance.

And while there is no medication to treat FASD itself, medications can be prescribed to manage symptoms such as hyperactivity, anxiety, depression, or seizures. Although medication use may be unavoidable in many children with FASDs, it is important to exercise prudence when prescribing. Medications should not be a sole substitute for nonpharmacologic interventions such as parent education, parent-child interaction therapy, self-regulatory supports, school interventions, developmental therapies, social skill interventions, and community supports. Treatment services for people with FASDs are most effective when they are strengths-based and address a person’s specific impairments and needs.

People living with FASDs can thrive and live successful, self-directed lives with planned and appropriate support from their families, friends, community and health care systems. However, discriminatory practices lead to FASD disparate outcomes. Bias can affect how FAS is documented in medical records, leading to discrepancies across populations. For instance, a study found that FAS was reported more frequently at a large, inner-city hospital serving underserved populations, whereas it was underreported at a large, suburban hospital.

Although reports indicate that individuals from underserved, historically marginalized, and under-resourced populations experience higher rates of FASDs, Black, Indigenous, and People of Color (BIPOC) women and individuals from economically disadvantaged backgrounds are less likely than White women to receive adequate prenatal care and services for their children.

FASDs and disabilities are interconnected in many areas of life for individuals who had prenatal substance exposure. Acknowledging and addressing these intersections is crucial for advancing behavioral health equity and enhancing the overall health and well-being of those living with FASDs.

FASDs are complex conditions that require our collective attention and compassion. We can make a significant difference by spreading awareness, advocating for prevention, and supporting individuals and families affected by FASDs. Every step toward education and understanding is a step toward a healthier future. Let’s commit to a world where every child has the chance to reach their full potential, free from the preventable impact of prenatal alcohol exposure.

The U.S. Department of Health and Human Services offers a wealth of resources for parents, caregivers, and families:

If you are concerned about FASDs, ask your health care provider to refer you to a specialist who knows about FASDs. To find health care providers, referrals to resources and services, or receive one-on-one peer support, visit FASD United’s Family Navigator program. If your child is younger than three years old, you can contact your state or territory’s early intervention program. FASD United also has a searchable Resource Directory that helps you to find resources in your area. Together, we can create a brighter tomorrow.