Fetal Alcohol Spectrum Disorder (FASD)

Drinking alcohol at any stage during pregnancy can cause harm to your baby and the more you drink, the greater the risk.^2,3,4   

Miscarriage, stillbirth, premature birth, and small birth weight are all associated with alcohol-exposed pregnancies (although they can be due to other reasons too).^5,6 Fetal Alcohol Spectrum Disorder is caused by drinking alcohol while pregnant and affects the development of a baby’s brain and body. FASD is a spectrum and can be very severe. Each person with FASD is affected differently. It is a lifelong neurodevelopmental condition with lifelong cognitive, emotional, and behavioural challenges.⁷

FASD is completely avoidable if you do not drink alcohol while you're pregnant. The risk of FASD is higher the more you drink. There is no known safe level of alcohol consumption during pregnancy.⁸ That’s why the advice for pregnant women in the UK Chief Medical Officers' (CMOs) low risk drinking guidelines is that the safest approach is to not drink alcohol at all throughout pregnancy.

Read our alcohol and pregnancy page for the full details of the CMOs’ advice about why you shouldn’t drink alcohol during pregnancy.

What is Fetal Alcohol Spectrum Disorder?

One possible outcome of drinking during pregnancy is the risk of the baby developing Fetal Alcohol Spectrum Disorder (FASD).⁹

FASD is a life-long condition that can affect a child’s brain development, behaviour and growth.¹⁰ It’s caused by a developing unborn baby (fetus) being exposed to alcohol in the womb.

The severity of the problems caused by FASD is wide-ranging, but there is no such thing as ‘mild’ FASD.¹¹ No two children with FASD are exactly alike, either cognitively or physically,¹² but they all face serious, life-long implications for their health and wellbeing.

FASD can cause problems with:¹³

• Movement, balance, vision, and hearing
• Learning, such as problems with thinking, concentration, and memory
• Managing emotions and developing social skills
• Hyperactivity and impulse control
• Communication, such as problems with speech
• Joints, muscles, bones, and organs such as the kidneys and heart

These can create great difficulties for individuals in their childhood that persist throughout life, with a greater likelihood of facing problems at school, trouble with the law, substance misuse problems, and risky or inappropriate sexual behaviours.¹⁴

In a minority of cases (fewer than one in 10)¹⁵ FASD may be associated with characteristic facial features too – small and narrow eyes, a small head, a smooth area between the nose and the lips, and a thin upper lip.¹⁶

Among those children affected, in addition to the problems listed above, they may have additional serious problems including:^17,18,19

• Epilepsy
• Hearing and ear problems
• Height and weight issues
• Hormonal disorders
• Liver damage
• Mouth, teeth, and facial problems
• Weak immune system

How FASD is diagnosed

If you’re worried about your child’s development, you should speak to your GP or health visitor. They will need to know whether your child was exposed to alcohol while you were pregnant and can refer you to a specialist for more help and support if they think FASD is a possibility.²⁰

To diagnose FASD, as well as considering any exposure to alcohol before the child was born, the specialist will check if they have physical signs of FASD, like the facial features mentioned above. According to SIGN 156 (clinical guidelines developed by the Scottish Intercollegiate Guidelines Network), a diagnosis/descriptor of FASD is made only when there is evidence of pervasive and long-standing brain dysfunction, which is defined by severe impairment in three or more of the following neurodevelopmental areas of assessment:^21,22

• Motor skills
• Cognition
• Memory
• Neuroanatomy/neurophysiology
• Academic achievement
• Language
• Attention
• Executive function, including impulse control and hyperactivity
• Affect regulation
• Adaptive behaviour, social skills, or social communication

Your specialist will also consider whether these symptoms could be caused by anything else – like another health condition or genetic reason. They might also decide they need to monitor your child’s development to see whether any problems are temporary or get worse as they get older.^23,24

The earlier a diagnosis of FASD can be made, the sooner support can be provided for the person affected and their family.

The terminology doctors use when talking about FASD has changed in the UK in recent years. The new diagnostic terms are:²⁵

• Fetal Alcohol Spectrum Disorder with sentinel facial features: formerly Fetal Alcohol Syndrome)
• Fetal Alcohol Spectrum Disorder without sentinel facial features: formerly Partial Fetal Alcohol Syndrome (PFAS), Alcohol-Related Neurodevelopmental Disorder (ARND), Alcohol-Related Birth Defects (ARBD), or Neurodevelopmental Disorder-Prenatal Alcohol Exposure (NDPAE)

How Fetal Alcohol Spectrum Disorder develops during pregnancy

Alcohol can cause harm to a developing baby at any point during pregnancy.^26,27

When a pregnant woman drinks, the alcohol goes through the placenta to the fetus via the bloodstream. Alcohol is a type of substance known as a ‘teratogen’ – something that has been proven to adversely affect the way a fetus develops²⁸ (other examples of teratogens are sodium valproate (an epilepsy drug), thalidomide and cocaine).

Alcohol has a number of harmful effects on a developing fetus including destroying brain cells²⁹ and damaging developing organs.^30,31

Treatment for children

There is specialist support available for children with FASD but there is no specific treatment and any damage to the child’s brain and body can’t be reversed.³² To prevent your child from developing FASD, if you are trying to conceive or are pregnant it is safest not to drink alcohol at all.

GPs can refer children with FASD to community paediatricians. They will work with psychologists, psychiatrists, speech and language therapists, and occupational therapists and other specialists, to determine the best course of action.

Early diagnosis is key. Research shows that many people who have FASD go on to experience preventable associated difficulties (conditions that weren’t present at birth) such as mental health issues and problems with substance dependency, which could be avoided with early support.^33,34

Advice for mums-to-be

Because drinking during pregnancy can lead to the long-term health problems of FASD, the UK Chief Medical Officers advise that it’s safest not to drink alcohol at all if you are trying to conceive or are pregnant.

If you didn’t know you were pregnant and you drank alcohol during early pregnancy, talk to your GP or midwife about any concerns you have. You may have drunk alcohol, but that doesn’t necessarily mean your unborn baby has been harmed.

UK low risk drinking guidelines

More information

The National Organisation for FASD website provides information and resources for parents, maternity teams, people with FASD and a range of professionals. Or call their helpline on 020 8458 5951 for support or information.

FASD Network UK is an organisation that specialises in providing information, support, and training on FASD. Visit the FASD Network website here.