The fetal efects of alcohol abuse have been recognized since the 1800s. Lemoine (1968) and Jones (1973) and their coworkers are credited with describing the spectrum of alcohol-related
Teratology, Teratogens, and Fetotoxic Agents 239 fetal defects known asetal acohol syndrome (Table 12-4). For every child with the syndrome, many more are born with neurobehavioral deicits from alcohol exposure (American College of Obstetricians and Gynecologists, 2013). Fetal acohol spectrum disorder is an umbrella term that includes ive conditions attributed to prenatal alcohol damage: (1) fetal alcohol syndrome, partial fetal alcohol syndrome, (3) alcohol-related birth defects, (4) alcohol-related neurodevelopmental disorder, and neurobehavioral disorder associated with prenatal alcohol exposure (Williams, 2015). The birth prevalence of fetal alcohol syndrome is estimated to be as high as 1 percent in the United States (Centers for Disease Control, 2012; Guerri, 2009).
TABLE 12-4. Criteria for Prenatal Alcohol Exposure, Fetal Alcohol Syndrome, and Alcohol-Related Birth Defects 1.
::6 drinks per week for ::2 weeks 2.
::3 drinks per occasion for ::2 occasions 3.
Risk identiied with a validated screening questionnaire 4.
5.
Documentation of an alcohol-related legal or social 1. Dysmorphic facial features (::2 required) a.
b.
Thin vermilion border of the upper lip c.
2.
Prenatal and/or postnatal growth impairment, � 10th percentile 3.
Abnormal brain growth, morphogenesis, or physiology (::1 required) a.
b.
c.
4. Neurobehavioral impairment (deined as > 1.5 SO below mean) a.
Child <3 years: developmental delay b.
Child ::3 years: global cognitive impairment, r cognitive deicit in at least 1 neurobehavioral domain, or behavioral deicit in at least 1 domain
Cardiac: atrial or ventricular septal defect, aberrant great vessels, conotruncal heart defects
Skeletal: radioulnar synostosis, vertebral segmentation defects, joint contractures, scoliosis
Renal: aplastic or hypoplastic kidneys, dysplastic kidneys, horseshoe kidney, ureteral duplication
Eyes: strabismus, ptosis, retinal vascular abnormalities, optic nerve hypoplasia
Ears: conductive or neurosensory hearing loss
Data from Hoyme, 2016.
FIGURE 12-3 Fetal alcohol syndrome. A.At 2Y2 years. B. At 12 years. Note persistence of short palpebral fissures, epicanthal folds, flat midface, hypoplastic philtrum, and thin upper vermilion border. (Reproduced with permission from Streissguth AP, Clarren,
SK, Jones KL. Natural history of fetal alcohol syndrome: a la-year follow-up of eleven patients, Lancet. 1985 Jul 13;2(8446):85-91.)
But, studies of school children have identiied fetal alcohol spectrum disorder in 2 to 5 percent (May, 2009, 2014).
Fetal alcohol syndrome has speciic criteria (see Table 12-4). hese include central nervous system (CNS) abnormalities, preor postnatal growth impairment, and a characteristic pattern of minor facial abnormalities (Fig. 12-3). Similar criteria have been established for the other conditions that make up fetal alcohol spectrum disorder (Hoyme, 2016). Prenatal alcohol exposure criteria are also available to assist with assessment.