Alcohol's Effects on Health

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Understanding Fetal Alcohol Spectrum Disorders

Image of whiteboard. Fetal alcohol spectrum disorders (FASD) affect 1% to 5% of U.S. children in the first grade. Source: May PA, Chambers CD, Kalberg WO, et al. JAMA, 2018

What Are Fetal Alcohol Spectrum Disorders?

The term fetal alcohol spectrum disorders (FASD) refers to the wide range of physical, behavioral, and cognitive impairments that occur due to alcohol exposure before birth (also known as prenatal alcohol exposure). These impairments may appear at any time during childhood and last a lifetime. An estimated 1% to 5% of U.S. first graders have FASD, according to a National Institute on Alcohol Abuse and Alcoholism (NIAAA)-supported study published in the Journal of the American Medical Association.1

What Causes Fetal Alcohol Spectrum Disorders and How Are They Prevented?

Alcohol exposure during pregnancy can result in FASD by interfering with development of the baby’s brain and other critical organs and physiological functions. This can lead to deficits after birth and beyond.2,3 Alcohol can disrupt development at any stage, even before a woman knows that she is pregnant.

Research shows that binge drinking and heavy drinking during pregnancy put a developing baby at the greatest risk for severe problems.4 However, even lesser amounts can cause harm.5,6 In fact, there is no known safe amount of alcohol consumption during pregnancy. 

What Are the Types of Fetal Alcohol Spectrum Disorders?

The term fetal alcohol spectrum disorders (FASD) refers to a range of physical, cognitive, and behavioral abnormalities caused by prenatal alcohol exposure. Depending on the features identified, the disorders categorized as FASD15,16 include:

  • Fetal alcohol syndrome
  • Partial fetal alcohol syndrome
  • Alcohol-related neurodevelopmental disorder
  • Alcohol-related birth defects
  • Neurobehavioral disorder associated with prenatal alcohol exposure

Prenatal alcohol exposure and central nervous system (CNS) involvement are factors common to the disorders encompassing FASD. Evidence of CNS involvement can be structural (e.g., small brain size, alterations in specific brain regions) or functional (e.g., cognitive and behavioral deficits, motor and coordination problems). For fetal alcohol syndrome—which is also characterized by growth deficiencies, distinct facial features, and other physical factors in addition to CNS involvement—confirmation of prenatal alcohol exposure is not required.

If an individual was not exposed to alcohol before birth, they will not get FASD. Given that approximately half of all pregnancies in the United States are not planned, the U.S. Surgeon General recommends that women who are pregnant, might be pregnant, or are thinking about getting pregnant should not drink alcohol at all.7

Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental disorders in the United States. Women who need help to stop drinking alcohol can talk to their health care provider about treatment options. There are a variety of treatments available for pregnant women, including behavioral treatment and mutual-support groups. Visit the NIAAA Alcohol Treatment Navigator® to learn more about evidence-based treatments for alcohol-related problems. 

How Common Is Alcohol Use During Pregnancy in the United States?

A study17 that analyzed 2015–2018 data from the National Survey on Drug Use and Health reports that:

  • About 1 in 10 (9.8%) pregnant women report current alcohol use.
  • About 1 in 22 (4.5%) pregnant women report binge drinking.
  • Alcohol use is highest among women who are in the first trimester of pregnancy, with about 1 in 5 (19.6%) reporting current alcohol use and 1 in 10 (10.5%) reporting binge drinking.
  • About 40% of pregnant women who report current drinking also report current use of one or more other substances—most commonly tobacco and marijuana.

What Are the Symptoms of Fetal Alcohol Spectrum Disorders?

Individuals with FASD experience day-to-day challenges, which may include cognitive and behavioral impairments as well as secondary disabilities including medical, educational, mental health, and social challenges, throughout their life. They are also subject to stigmatization for their disorder. People with FASD may have difficulty in the following areas:8,9,10

  • Learning and memory
  • Understanding and following directions
  • Switching attention between tasks
  • Controlling emotions and impulsivity
  • Communicating and developing social skills
  • Experiencing depression and anxiety
  • Performing daily life skills, including feeding, bathing, counting money, telling time, and minding personal safety

How Are Fetal Alcohol Spectrum Disorders Diagnosed?

Early identification of FASD is critical for the well-being of individuals affected by prenatal alcohol exposure and their families. Early identification can maximize help in the treatment of FASD and in building supportive networks with other individuals and families impacted by FASD. Unfortunately, FASD is often undiagnosed or misdiagnosed. This may be due, in part, to a lack of information about prenatal alcohol exposure or difficulty in distinguishing FASD from other developmental disorders that might have similar cognitive or behavioral symptoms.

The American Academy of Pediatrics (AAP) stresses the importance of universal screening for prenatal alcohol exposure for all children.11 A diagnosis of FASD can include evidence of CNS problems (see “What Are the Types of FASD?” box), physical abnormalities (e.g., growth deficits, specific facial anomalies), health concerns, and documented prenatal alcohol exposure. The AAP recommends initial assessment and diagnosis by the child’s pediatrician.12 Referrals for additional evaluation and treatment can be made to other clinicians and health care professionals or, when available, to a specialized multidisciplinary team for a comprehensive evaluation and care.

What Are the Interventions or Treatments for Fetal Alcohol Spectrum Disorders?

There are various approaches that may help reduce the symptoms of FASD and lessen the impact on affected individuals and their families. These include education and behavioral interventions for individuals with FASD and their caretakers as well as medications, social support, case management, and other services for children and adults with FASD.13,14 New interventions are currently being developed and evaluated. These treatments include:

  • Prenatal nutritional supplements for pregnant women and postnatal supplements for their children
  • Learning and behavioral interventions aimed at improving cognition, daily life skills, and impulsive behavior
  • School-based approaches focused on specialized teaching strategies and computer-based games
  • Mobile health apps and other interventions that support families and caregivers to assist them in caring for children with FASD

For more information about alcohol and pregnancy, how to stop drinking, and alcohol treatment options, please visit the NIAAA website at niaaa.nih.gov

1 May PA, Chambers CD, Kalberg WO, Zellner J, Feldman H, Buckley D, Kopald D, Hasken JM, Xu R, Honerkamp-Smith G, Taras H, Manning MA, Robinson LK, Adam MP, Abdul-Rahman O, Vaux K, Jewett T, Elliott AJ, Kable JA, Akshoomoff N, et al. Prevalence of fetal alcohol spectrum disorders in 4 US communities. JAMA. 2018;319(5):474–82. PubMed PMID: 29411031

2 Williams JF, Smith VC, Committee on Substance Abuse. Fetal alcohol spectrum disorders. Pediatrics. 2015 Nov 1;136(5):e1395–e1406. PubMed PMID: 26482673

3 Wozniak JR, Riley EP, Charness ME. Clinical presentation, diagnosis, and management of fetal alcohol spectrum disorder. Lancet Neurol. 2019;18(8):760–70. PubMed PMID: 31160204

4 Maier SE, West JR. Drinking patterns and alcohol-related birth defects. Alcohol Res Health. 2001;25(3):168–74. PubMed PMID: 11810954

5 Sundermann AC, Zhao S, Young CL, Lam L, Johns SH, Velez Edwards, DR, Harmann KE. Alcohol use in pregnancy and miscarriage: a systematic review and meta-analysis. Alcohol Clin Exp Res. 2019;43(8):1606–16. PubMed PMID: 31194258

6 Lees B, Mewton L, Jacobus J, Valadez EA, Stapinski LA, Teesson M, Tapert SF, Squeglia LM. Association of prenatal alcohol exposure with psychological, behavioral, and neurodevelopmental outcomes in children from the adolescent brain cognitive development study. Am J Psychiatry. 2020;177(11):1060–72. PubMed PMID: 32972200

7 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention [Internet]. Advisory on alcohol use in pregnancy from the U.S. Surgeon General. 2005 [cited 2023 Jul 27]. Available from: https://www.cdc.gov/ncbddd/fasd/documents/sg-advisory-508.pdf

8 Mattson SN, Bernes, GA, Doyle LR. Fetal alcohol spectrum disorders: a review of the neurobehavioral deficits associated with prenatal alcohol exposure. Alcohol Clin Exp Res. 2019;43(6):1046–62. PubMed PMID: 30964197

9 McLachlan K, Flannigan K, Temple V, Unsworth K, Cook JL. Difficulties in daily living experienced by adolescents, transition-aged youth, and adults with fetal alcohol spectrum disorder. Alcohol Clin Exp Res. 2020;44(8):1609–24. PubMed PMID: 32472600

10 O’Connor MJ. Mental health outcomes associated with prenatal alcohol exposure: genetic and environmental factors. Current Developmental Disorders Reports. 2014;1(3):181–8.

11 American Academy of Pediatrics [Internet]. Screening for prenatal alcohol exposure [updated 2021 Nov 29; cited 2023 May 22]. Available from: https://www.aap.org/en/patient-care/fetal-alcohol-spectrum-disorders/screening-for-prenatal-alcohol-exposure

12 American Academy of Pediatrics [Internet]. Common diagnostic approaches in fetal alcohol spectrum disorder [updated 2021 Nov 29; cited 2023 May 22]. Available from: https://www.aap.org/en/patient-care/fetal-alcohol-spectrum-disorders/common-diagnostic-approaches-in-fetal-alcohol-spectrum-disorder

13 Reid N, Dawe S, Shelton D, Harnett P, Warner J, Armstrong E, LeGros K, O’Callaghan F. Systematic review of fetal alcohol spectrum disorder interventions across the life span. Alcohol Clin Exp Res. 2015;39(12):2283–95. PubMed PMID: 26578111

14 Petrenko CL, Alto ME. Interventions in fetal alcohol spectrum disorders: an international perspective. Eur J Med Genet. 2017;60(1):79–91. PubMed PMID: 27742482

15 Stratton K, Howe C, Battaglia F, editors. Fetal alcohol syndrome: diagnosis, epidemiology, prevention, and treatment. Washington, DC: Institute of Medicine, The National Academies Press; 1996. Executive Summary; p. 4-5.

16 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Association; 2013, p. 86, 708–801.

17 England LJ, Bennett C, Denny CH, Honein MA, Gilboa SM, Kim SY, Guy GP, Tran EL, Rose CE, Bohm MK, Boyle CA. Alcohol use and co-use of other substances among pregnant females aged 12–44 years — United States, 2015–2018. MMWR Morb Mortal Wkly Rep. 2020;69(31):1009–14. PubMed PMID: 32759915

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