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Understanding Risks and Effects on a Developing Baby

A developing baby is exposed to the same concentration of alcohol as the mother during pregnancy. Baby’s brain, body and organs are developing throughout pregnancy—and especially in first weeks following conception. Alcohol exposure is unsafe for developing babies at every stage of pregnancy.

Of all the substances of abuse—including cocaine, methamphetamine, heroin and marijuana—alcohol produces by far the most serious neurobehavioral effects in a developing baby. ¹ 

Alcohol in Pregnancy

Prenatal exposure to alcohol can cause damage to a developing baby at any time.  Alcohol crosses the placenta within minutes, resulting in similar blood concentration in the baby as is present in the mother. As a teratogen—an agent that causes birth defects—alcohol is a toxic substance to a developing baby, and can cause:

• Premature and still birth
• Growth problems before and after birth (including being born small in both height and weight for their age, as well as having small heads).
• Physical birth defects
• Sudden Infant Death Syndrome (SIDS)
• Intellectual and behavioral problems

Exposure

The effects of alcohol on a developing baby primarily depend on the following:

• Quantity: How many drinks a woman consumes per occasion, such as binge drinking
• Frequency: How often a pregnant woman drinks
• Timing: What part or parts of the baby are developing at the time of the exposure

Other factors can also play a role in how prenatal alcohol exposure affects children. This includes:

• Poor maternal nutrition
• How quickly alcohol is metabolized in the mother
• Maternal age

Environmental Factors

Research demonstrates that children can be more affected by prenatal alcohol exposure if their mothers experience adverse-living conditions and high levels of stress. These may include: social isolation, living in circumstances where excessive drinking is common and accepted, and living in a community where resources for prenatal care are limited.

Genetics

The extent of alcohol’s effect on a developing baby may also depend on the mother’s genetic make-up, her child’s genetic make-up, and changes in gene activity caused by prenatal alcohol exposure.

The Fetal Alcohol Spectrum

Alcohol consumption during pregnancy can cause a group of conditions called Fetal Alcohol Spectrum Disorders (FASD). FASD is an umbrella term to characterize the full range of damage from prenatal alcohol exposure, varying from mild to severe, and encompasses a broad array of physical, intellectual, learning, and behavioral disabilities. These conditions are lifelong and irreversible.

There is clear and compelling evidence that prenatal alcohol exposure negatively affects cognitive ability and behavior. Those affected by an FASD often have problems with learning and remembering; understanding and following directions; shifting their attention; and controlling their emotions. They may struggle with communication, socializing with others, and performing daily life skills like telling time, managing their money and being aware of dangers to personal safety. These problems may emerge early in life and continue to significantly impair an individuals’ functioning in a number of domains throughout the lifespan. While identified problems may be primarily attributed to brain damage due to alcohol exposure, the conditions can become apparent or exacerbated with interactional and environmental factors.

The Spectrum of FASD

The four categories of the FASD spectrum are Fetal Alcohol Syndrome (FAS), Partial FAS (pFAS), Alcohol Related Neurodevelopmental Disorder (ARND), and Alcohol-related Birth Defects (ARBD). Confirmation of prenatal alcohol exposure is required to determine all types of FASD, except for the most severe (FAS), which is determined by observable measurements taken by a trained pediatric specialist.

Fetal Alcohol Syndrome (FAS)

Fetal Alcohol Syndrome (FAS) is at the most severe end of the FASD range and is the most well-known FASD diagnosis. FAS was first described in medical literature by our Center’s own Dr. Jones in 1973. The prevalence of FAS is estimated to be 1 to 3 per 1,000 live births; this is roughly equivalent to the prevalence of Down Syndrome. A diagnosis of FAS requires the following:

• growth deficiency, as defined by height and/or weight being under the 10th percentile.
• a cluster of three specific facial malformations: small eyes, a thin upper lip, and a smooth philtrum (the area between the nose and the top of the upper lip).
• severe brain abnormalities; that is, either the physical size of the brain is small (a condition called microcephaly), there are abnormalities in specific structures of the brain, or there is evidence of neurological, intellectual and/or functional deficits.
• prenatal alcohol exposure (either confirmed or unknown).

Individuals with full FAS represent only a small portion of the FASD spectrum (that is, they are just “the tip of the iceberg”) and are generally recognized early due to the facial features and the severity of the symptoms. However, the majority of individuals affected by prenatal alcohol exposure do not meet all the above criteria. For example, they may have none of the physical features but still have cognitive and/or behavior deficits as a result of alcohol exposure. Terms given to these conditions include:

Partial FAS (pFAS)

Partial FAS (pFAS) is a diagnostic classification that includes some, but not all, of the physical characteristics of FAS but where there is evidence of severe brain abnormalities.

Alcohol Related Neurodevelopmental Disorder (ARND)

Alcohol Related Neurodevelopmental Disorder (ARND) requires evidence of both prenatal alcohol exposure and problems with neurocognitive development, adaptive function and/or behavior regulation, which can range from mild to severe. However, the physical characteristics (like the facial features and growth issues) are most often not seen in ARND.

Alcohol Related Birth Defects (ARBD)

Alcohol primarily affects the brain, but it can affect other organ systems as well. Those with ARBD may have problems with the heart, kidneys, bones, hearing, and/or vision. A diagnosis of Alcohol-Related Birth Defects (ARBD) requires evidence of both prenatal alcohol exposure and brain abnormalities, which may be structural or functional.

Recent Diagnostic Development in the Field of Mental Health: Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE)

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE) is a new psychiatric diagnosis being considered that is included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the handbook used by healthcare professionals to diagnose mental disorders. ND-PAE requires evidence of both prenatal alcohol exposure and impairments in the following three areas: cognition, self-regulation, and adaptive functioning. This new diagnosis will improve understanding of the multifaceted cognitive and behavioral deficits seen in some people exposed to alcohol prenatally, and facilitate diagnosis and treatment of these individuals.

Institute of Fetal Alcohol Spectrum Disorders Discovery

Paving the Way to a Better Tomorrow for FASD-Affected Families

Children, adults, and families who live with disabilities related to prenatal alcohol exposure face extraordinary challenges on a daily basis. The work of clinicians and researchers to understand and improve outcomes for these families is the focus of the Institute of Fetal Alcohol Spectrum Disorder Discovery at the Center for Better Beginnings. We have pioneered medical, educational, social, and scientific initiatives, all in pursuit of improving the quality of life for those affected and reducing the public health burden resulting from an FASD.

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¹ Institute of Medicine Report on Fetal Alcohol Syndrome Diagnosis, Epidemiology, Prevention and Treatment, 1996

A Program Integrating Research, Education & Screening Services

The Center for Better Beginnings is home to an integrative program to provide education, screening, and research on Fetal Alcohol Spectrum Disorders (FASD), and to provide support to families affected by these conditions.

Led by Dr. Kenneth Lyons Jones, the physician who co-identified fetal alcohol syndrome in 1973, and Andrea Torzon, our Institute for Fetal Alcohol Spectrum Disorders Discovery (IFASDD) is the nation’s leading epicenter for work to prevent alcohol-exposed pregnancies and to assist those who are affected. As a multidisciplinary center, IFASSD brings together medical physicians, researchers, parent advocates and educators as a think-tank for this under-recognized disorder.

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Screening Services

Research & Discovery

Alcohol Free Pregnancies

Our Vision

Advocacy

Outreach

Screening Services

Detecting Alcohol-based Birth Defects

IFASDD provides screening services to at-risk children who may have been impacted by prenatal alcohol exposure. FASD screenings are provided to children receiving services from Kidstart (an early intervention program run by Rady Children’s Hospital-San Diego), as well as youth involved with the juvenile justice system. Children who screen positive are then referred to Dr. Jones at UC San Diego Health Pediatrics in Kearny Mesa or Dr. Miguel del Campo at Rady Children’s Hosptial FASD Clinic for a comprehensive diagnostic evaluation.

Research & Discovery

Broadening the Scope of Understanding

The multidisciplinary nature of IFASDD makes innovative research possible. A few examples of projects include:

• A study to determine the national prevalence of FASD in the United States.
• An intervention study evaluating whether choline (a nutritional supplement) can reduce the severity of cognitive deficits associated with FASD.
• Testing an intervention to reduce alcohol exposure among American Indian/Alaska Native people of reproductive age.
• An ongoing 15+ year study in Ukraine that has examined several different questions about how we can better identify and prevent FASD.
• A study examining if alcohol exposure can be identified in discarded baby teeth

Read more about our pioneering efforts to understand the impact and scope of problems associated with prenatal alcohol exposure.

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Promoting Alcohol-Free Pregnancies

To Prevent Prenatal Alcohol Exposure

Drinking alcohol during pregnancy causes serious damage to a developing baby’s brain; in fact, it causes more damage than cocaine, heroin, and marijuana combined. Prenatal alcohol exposure is the nation’s leading cause of preventable birth defects. FASD is the range of neurological disorders associated with prenatal alcohol exposure and includes physical birth defects as well as difficulties with learning and behavior. There is no cure for FASD, only support services for children affected by the condition and their families. However, FASD is 100% preventable by not drinking alcohol during pregnancy.

Our Vision

Preventing FASD and Helping People Living with an FASD

Imagine a world where everyone knows the dangers of prenatal alcohol exposure — together, we can do this!

Our Goal
Reduce the number of children born with FASD.

Our Objectives
To accomplish this goal, the following will be required:

• Community advocacy
  • Educational seminars, on-demand webinars, and workshops
  • School education
• • Research & clinical practice
  • Multicenter research sites
  • Integrated programming
• Clinical and Support Services for affected children and families

Community advocacy is critical in raising awareness about FASD and the fact that it is 100% preventable. We want to make sure that those who are pregnant, planning a pregnancy, or at risk for unplanned pregnancy fully understand the lifelong damage that alcohol use can cause a developing baby. We also want to make sure that shame and judgment of mothers who have children with FASD is eliminated. Children who are affected by prenatal alcohol exposure must get the support they need at home and in school. Finally, researchers need funding to support their work with families and children affected by FASD to develop effective prevention strategies and intervention tools.

Educational workshops, on-demand webinars, and seminars to train health and social service professionals and the general public on FASD are essential to support our community. Trainings for medical providers, educators, social workers, criminal justice workers, caregivers, and others in the health and human services sector are needed to allow for a better understanding of the physical, behavioral, and cognitive challenges faced by people with an FASD and to help eliminate alcohol exposure during pregnancy.

Schools need to be able to educate students about the increasing number of public health issues for which they are at risk. The risks of alcohol consumption during pregnancy need to be taught during health classes in an understandable and effective way when it is developmentally appropriate to do so.

Research is critical to ensure there are effective programs to prevent prenatal alcohol exposure as well as evidence-based interventions and treatments for children diagnosed with FASD. By supporting research centers, we can share best practices in prevention, intervention, and treatment of FASD.

Research centers need to become integrated with clinical practice and support services. Dr. Ken Jones leads research and clinical services at UC San Diego in the field of preventable birth defects. In 1973, Dr. Jones and his mentor were the first physicians to describe Fetal Alcohol Syndrome in the U.S. Since that time, Dr. Jones has been a health provider, researcher, and an advocate for families affected by FASD. As his integrative program, the Institute for Fetal Alcohol Spectrum Disorders Discovery (IFASDD) illustrates, families benefit the most when clinical practice and research inform one other.

Clinical and support services for affected children and families are critical for those impacted by FASD. It is incredibly difficult for children living with FASD to get the necessary medical, behavioral, and educational services they need, in part because medical professionals are not adequately trained on FASD. The development of a universal coding system to classify FASD is an urgent need, as is better curricula and continuing education programs for medical, allied health professional, and mental health providers. Similarly, those in the fields of childhood education, special education, and juvenile justice need to be trained on how FASD may impact the children with whom they interact.

Together we can jump start immediate action. Share in our vision of all children being born FASD-free. Contact us to get involved or donate today!

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Community Outreach & Advocacy

Increasing Public Awareness of FASD

Many people are unaware of how damaging alcohol can be for a developing baby. No amount or type of alcohol has been found to be safe in pregnancy. Drinking only non-alcoholic beverages both while trying to get pregnant and for all nine months of pregnancy is the only way to prevent FASD.

Alcohol is what medical professionals call a “teratogen”, or an agent that can disrupt the development of the embryo or fetus and can cause birth defects. Alcohol crosses the placenta and easily enters a developing baby’s bloodstream. Alcohol causes the most damage to the developing brain, but it can also affect other critical organs, structures, and systems in the body. Alcohol at any time during pregnancy can result in a wide range of physical, intellectual, and learning disabilities known as Fetal Alcohol Spectrum Disorders (FASD).

The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention agree that prenatal alcohol exposure can lead to miscarriage, stillbirth, premature labor, birth defects, and FASD. They all recommend that alcohol be avoided during pregnancy.

FASD is preventable. Be #FASDInformed. Let’s act now!

Professional Workshops

Supporting Our Communities to Prevent FASD

We offer trainings about FASD to a range of audiences in the San Diego region, including physicians, nurses, social workers, psychologists, attorneys, probation officers, students, and educators. Topics include an overview of FASD, its clinical presentation, the neurobehavioral aspects and effects of prenatal alcohol exposure on a child’s behavior and educational functioning, and a summary of current research, interventions, and parent perspectives. Our in-service workshops are specifically tailored to professionals working with communities affected by FASD. If you are interested in scheduling a FASD workshop, let us know by filling out our Workshop Request Form.

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