A-Z Guide to Foetal Alcohol Syndrome (FAS)

About Foetal Alcohol Syndrome (FAS)

Alcohol is widely considered the most deadly substance for an unborn baby, and even more deadly than illegal drugs such as cocaine and heroin. Exposing a baby to alcohol during pregnancy can cause a condition known as Foetal Alcohol Syndrome (FAS). FAS is a broad term used to describe a triad of symptoms including central nervous system dysfunction, facial dysmorphia and stunted growth. FSA was first described in 1963 in France. The condition was official labelled as FAS in 1973.

Alcohol is known as a ‘teratogenic’ substance. This means alcohol disturbs the development of a foetus causing birth defects. Symptoms of FAS range from severe to mild. Believe it or not, FAS is the world’s number one preventable cause of mental retardation.

A baby suffering from FAS can have an abnormally small head and underdeveloped brain. In addition, a baby suffering from FAS has a brain that is far smoother when compared to a baby without FAS. This reflects the fact that alcohol kills brain cells.

A baby with FAS may also suffer from facial abnormalities such as small eyes and drooping eyelids. Furthermore, many of these babies are born with heart and lung problems.

FAS is thought to affect around 0.5-2 in 1000 babies. Since 50% of pregnancies are unplanned, it is estimated that around 37% of foetuses have been exposed to episodes of binge drinking.

Learning outcomes

In this guide, we shall cover the below key points:

  • How alcohol damages an unborn baby
  • Diagnosing FAS
  • Treating FAS
  • A discussion of current advice on the level of ‘safe’ alcohol consumption for pregnant women

How alcohol damages an unborn baby

The placenta is the organ that transports nutrients from mother to her baby. However, drugs, alcohol and toxic metabolites like acetaldehyde can also pass the placenta and make contact with the foetus. Thus, drinking alcohol whilst pregnant is the equivalent of feeding your baby alcohol.

During pregnancy, a baby’s organs are just forming, and so cannot break down drugs and alcohol. Alcohol is also a neurotoxin to a baby’s brain.

The foetal liver is incapable of detoxing ethanol due to the lack of ADH and ALDH enzymes. Thus, the foetus is exposed to alcohol and its toxic metabolites for a far greater period than the mother.

Pregnancy is broken down into three trimesters. In the first trimester, there is a rapid growth of the baby’s major organs including the heart, lungs, liver, kidneys, brain and spinal cord.

The brain and spinal cord are the first systems to begin to develop, even before the heart. Expose to alcohol and drugs can interfere with this development, damaging the baby’s ability to think and walk in later life.

Scientist believes it is during the third week of pregnancy that alcohol can inflict the most amount of damage upon the foetus. From the eighth week of pregnancy up to birth, the baby undergoes its greatest weight gain.

Exposure to alcohol during this crucial period can slow down the baby’s growth and cause mental and behavioural problems. Babies exposed to alcohol during pregnancy are often underweight and can have a smaller than normal head size.

As the baby grows older, these problems may get worse. And this includes behaviour and mental problems.

Now we list seven major ways alcohol affects a baby born with FAS:


#1. Facial dysmorphia

Dysmorphic facial features are characterised by the below features:

  • Flattened nasal bridge
  • Slanted eyes
  • Smooth elongated philtrum
  • Flattered midface
  • Small upper lip
  • Underdeveloped jaw
  • Small head (microcephaly)

#2. Physical conditions due to FAS

Common physical conditions related to FAS include liver, heart and lung problems, hypertonia (low muscle tone), short stature and Simian Crease in the palms of the hand.

#3. Central nervous system (CNS) dysfunctions caused by FAS

CNS dysfunctions due to FAS include hyperactivity, attention disorder, mental retardation, visual problems, memory difficulties and poor coordination.

#4. Diminished intelligence

People with FAS have an average IQ of between 60 and 65. Thus, many of these children require special education during their school years. Those diagnosed in early pre-school have a better chance because their education can be designed to maximise their potential.

#5. Greater chance of suffering from anxiety/depression and addiction

Around 95% of people with FAS suffer from anxiety or depression. Furthermore, FAS victims are much more likely to develop an addiction to drugs and/or alcohol.

#6. Motor functioning delays

Motor functioning delays refer to a delay in a person’s muscle reflexes.
Examples include:

  • Delay in walking
  • Balance problems
  • Difficulty coordinating hand/fingers
  • Clumsiness
  • Delay in writing

#7. Hyperactivity and concentration problems

People suffering from FAS often struggle to complete a task, or they may appear to be easily distracted. Furthermore, people with FAS may experience difficulty moving from one task to another.

Risk factors

FAS is not associate with ethnical or cultural background. In fact, FAS affects all cultures and ethnical backgrounds.
Below we list a number of environmental risk factors that increase the occurrence of FAS:

  • Low education level of the mother
  • Lower socioeconomic status
  • Prenatal exposure to other drugs such as cocaine, heroin and tobacco
  • Reduced access to prenatal and postnatal care
  • Poor nutrition
  • Where the mother is socially isolated or has a history of severe childhood sexual abuse
  • Poor developmental environment (e.g. abuse, stress, neglect)

Please note that although the above factors increase the risk of FAS, the condition has been known to affect people from all economic, education and racial backgrounds.

Physical risk factors associated with FAS include:

  • High blood-alcohol concentration
  • The timing of exposure to alcohol during pregnancy
  • The volume of alcohol consumed e.g. binge drinking
  • The frequency of alcohol consumed

Diagnosing FAS

Diagnosing FAS is problematic as there exists no test to detect the condition. Severe cases of FAS are typically diagnosed at birth. Physical characteristics synonymous with FAS may take many years to appear. These characteristics are predominantly facial abnormalities.

However, as the child reaches adolescence, these abnormalities become less obvious and harder to notice. If you suspect you or a loved one suffer from FAS, consult your GP who will refer you to a specialist. Because FAS abnormalities fade with ageing, the specialist may request you supply photographs taken of you or your loved one during childhood.

Treating FAS

Unfortunately, there exists no treatment for FAS. If you or your baby suffer from FAS, you will suffer from the condition for the rest of your life. Sufferers of FAS will typically improve their circumstances if the condition is diagnosed.

This helps the child’s school, college and university design his or her education in light of the condition. Extra help and understanding are proven to make life a lot easier for people suffering from FAS.

Early diagnosis of FAS is likely to prevent so-called ‘secondary disabilities’ such as unemployment, trouble with the law, mental health issues and inappropriate sexual behaviour. Early diagnosis will also trigger an intervention in the form of therapy and counselling for both the affected child and mother.

Is there a safe amount of alcohol I can drink when pregnant?

FAS is 100% preventable, yet it is more prevalent than ever. When you are pregnant, there is no safe amount of alcohol you may consume without putting your baby’s health at risk.

Even infants who were exposed to only a small amount of alcohol during pregnancy have been shown to have some risk of developing neurological and learning problems later on in life. So our recommendation is that there is no safe level of alcohol consumption during pregnancy.

In the United Kingdom, a foetus lacks the rights of a legal person, and there is no drive to end FAS. The Government still refuses to change its stance on the recommended amount of alcohol pregnant women are able to drink without damaging their unborn baby.

You are not legally allowed to feed alcohol to your baby, so why should you legally be allowed to drink alcohol whilst pregnant?

Currently, the NICE guidelines, the British Medical Association (BMA) guidance and a Royal College of Obstetricians and Gynaecologists (RCOG) statement advise women not to consume alcohol during the first three months of pregnancy.

However, the guidelines recommend women should drink no more than 1-2 units of alcohol no more than 1-2 time a week.

Further information