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# Fetal alcohol spectrum disorder

Fetal alcohol spectrum disorders are lifelong effects on the brain, growth and face after alcohol exposure before birth. They are preventable.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Frontal lobe](https://durgical.com/en/anatomy/superior-frontal-gyrus/)
- [Corpus callosum](https://durgical.com/en/anatomy/corpus-callosum/)
- [Cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/)
- [Hippocampus](https://durgical.com/en/anatomy/hippocampus/)
- [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/)
- [Maxillae](https://durgical.com/en/anatomy/maxilla/)

## Why it happens

- [Alcohol: how it injures the liver, brain, heart and fetus](https://durgical.com/en/general-pathology/alcohol-how-it-injures-the-liver-brain-heart-and-fetus/)
- [Ethanol metabolism](https://durgical.com/en/biochemistry/pathways/ethanol-metabolism/)
- [Acetaldehyde](https://durgical.com/en/biochemistry/molecules/acetaldehyde/)

## What it is

A group of lifelong conditions caused by prenatal alcohol exposure, ranging from fetal alcohol syndrome (characteristic facial features, growth deficiency and central nervous system damage) to milder forms with mainly neurodevelopmental and behavioural problems.

## Who gets it

A leading preventable cause of intellectual disability and neurodevelopmental disorders worldwide. It is underdiagnosed because most affected children lack the full facial features. Alcohol use in women of reproductive age is common in Latin America, including Colombia, and many pregnancies are unplanned, so exposure often happens before pregnancy is recognised.

## Causes

- Alcohol crossing the placenta during pregnancy; no safe amount, type or time has been identified
- Damage is greatest with heavy or binge drinking
- Facial features arise from exposure in the first trimester; the brain can be harmed throughout pregnancy

## Risk factors

- Maternal alcohol use, especially binge drinking
- Unplanned pregnancy or late recognition of pregnancy
- Previous child with a fetal alcohol spectrum disorder
- Maternal smoking, other substance use and poor nutrition
- Social adversity and limited access to prenatal care

## Pathophysiology

Ethanol and its metabolite acetaldehyde are toxic to the developing embryo: they cause death and abnormal migration of neural crest and neuronal cells, oxidative stress and disturbed growth-factor signalling. The result is smaller brain volume, structural changes such as thinning or absence of the corpus callosum and abnormalities of the frontal lobes, [cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/) and [hippocampus](https://durgical.com/en/anatomy/hippocampus/), plus the midface changes and growth restriction.

## Classification

- Fetal alcohol syndrome (FAS)
- Partial fetal alcohol syndrome
- Alcohol-related neurodevelopmental disorder (ARND)
- Alcohol-related birth defects (ARBD)
- Neurobehavioural disorder associated with prenatal alcohol exposure (ND-PAE)

## Symptoms and signs

- Facial features: smooth philtrum, thin upper lip and short palpebral fissures
- Growth deficiency before and/or after birth
- Small head (microcephaly)
- Intellectual disability or learning problems, especially in maths, memory and executive function
- Attention problems, hyperactivity and impulsivity
- Poor social judgement and difficulty understanding consequences
- Poor coordination, and in infants irritability, sleep and feeding problems

## Red flags

- Seizures or developmental regression
- Severe growth failure or feeding problems in infancy
- Signs of neglect or an unsafe home environment
- Self-harm or suicidal ideas in adolescents
- Heart murmur or other organ malformation not yet assessed

## Diagnosis

**Clinical**
A clinical diagnosis using standard criteria: the three sentinel facial features, growth deficiency, central [nervous system](https://durgical.com/en/anatomy/system/nervous-system/) abnormality (structural, neurological or functional) and, when available, confirmed prenatal alcohol exposure. FAS can be diagnosed without confirmed exposure if all features are present.

**Tests**
No laboratory test diagnoses it. Formal neuropsychological testing assesses cognition, behaviour and adaptive function. Genetic testing (chromosomal microarray) may be needed to exclude look-alike syndromes.

**Imaging**
Not required for diagnosis. Brain MRI may show a small brain, [corpus callosum](https://durgical.com/en/anatomy/corpus-callosum/) abnormalities or other changes; echocardiography, renal ultrasound and hearing and vision tests look for associated defects.

## Differential diagnosis

- Attention-deficit/hyperactivity disorder without prenatal exposure
- Genetic syndromes with similar faces, such as 22q11.2 deletion, Williams and Cornelia de Lange syndromes
- Fetal valproate or other teratogen exposure
- Maternal phenylketonuria embryopathy
- Effects of neglect or early adversity alone

## Goal of treatment

There is no cure: the aim is early identification and lifelong support of learning, behaviour, daily living skills and health, while protecting the child from a harmful environment.

## Treatment

**Rehabilitation**
Early intervention and special education: speech, occupational and physical therapy, and structured, predictable teaching suited to the child's profile.

**Medical**
Medications for associated problems, such as stimulants for attention symptoms or treatment of seizures, mood or sleep disorders.

**Conservative**
Parent training and family support; social services and protective measures when the home is unsafe.

**Follow-up**
Regular follow-up of growth, development, vision, hearing and associated malformations, with a transition plan into adulthood.

## Complications

- Lifelong intellectual and learning disabilities
- Mental health disorders: attention problems, anxiety, depression
- School failure and difficulties keeping a job or living independently
- Trouble with the law and alcohol or drug problems
- Congenital heart defects and other organ, eye or ear malformations

## Prognosis

The brain damage is permanent, but early diagnosis and a stable, supportive environment clearly improve outcomes. Many adults need some degree of ongoing support.

## Prevention

- No alcohol during pregnancy or when pregnancy is possible
- Screening and brief intervention for alcohol use in women of reproductive age and in prenatal care
- Access to contraception and treatment for alcohol use disorder

## Test yourself

Think of the answer, then tap the question to see it.

## What are the three sentinel facial features of fetal alcohol syndrome?

A smooth philtrum, a thin upper lip (vermilion border) and short palpebral fissures.

## Is there a safe amount of alcohol during pregnancy?

No; no safe amount, type or time of alcohol use in pregnancy has been established.

## Which brain structure is classically thinned or absent in fetal alcohol syndrome?

The corpus callosum; the frontal lobes, cerebellum and hippocampus are also affected.

## Is there a laboratory test that diagnoses fetal alcohol spectrum disorder?

No; it is a clinical diagnosis based on facial features, growth, central nervous system findings and exposure history.

## What is the leading preventable cause of intellectual disability?

Prenatal alcohol exposure (fetal alcohol spectrum disorders).

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/fetal-alcohol-spectrum-disorder/)

## Related conditions

- [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/)
- [Attention-deficit/hyperactivity disorder (ADHD)](https://durgical.com/en/conditions/attention-deficit-hyperactivity-disorder/)
- [Autism spectrum disorder (ASD)](https://durgical.com/en/conditions/autism-spectrum-disorder/)
- [Fetal growth restriction](https://durgical.com/en/conditions/fetal-growth-restriction/)
- [Neonatal abstinence syndrome](https://durgical.com/en/conditions/neonatal-abstinence-syndrome/)
- [Ventricular septal defect](https://durgical.com/en/conditions/ventricular-septal-defect/)
- [Child maltreatment (physical abuse, abusive head trauma, neglect)](https://durgical.com/en/conditions/child-maltreatment/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [About Fetal Alcohol Spectrum Disorders (FASDs)](https://www.cdc.gov/fasd/about/index.html) (Centers for Disease Control and Prevention (CDC), 2024).

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Source: https://durgical.com/en/conditions/fetal-alcohol-spectrum-disorder/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/fetal-alcohol-spectrum-disorder/