Foetal Alcohol Syndrome (FAS)

Drinking alcohol at any stage during pregnancy can cause harm to your baby and the more you drink, the greater the risk. This is why the UK Chief Medical Officers' (CMO) alcohol unit guideline advice to pregnant women is that the safest approach is to not drink alcohol at all during pregnancy. 

The more you drink when you're pregnant, the greater the risk there is to your baby’s health. Miscarriage, stillbirth, premature birth and small birth weight are all associated with a mother’s drinking during pregnancy. ⁽¹⁾

View our Alcohol and pregnancy facts page for the full details of the CMO's advice about drinking alcohol in pregnancy.

What is foetal alcohol syndrome?

A condition which is linked to drinking alcohol in pregnancy which affects the way a baby’s brain develops is called Foetal Alcohol Syndrome (FAS). The condition was first identified in America in 1973 and how serious the condition is thought be related to how much alcohol a mother drank during pregnancy.

Children with FAS have problems with their neurological development, abnormal growth, and have characteristic facial features that result from their foetal exposure to alcohol.⁽²⁾

Neurological problems are caused by damage to the central nervous system (brain and spinal cord). The problems experienced are likely to change as an infant grows up and different problems may be seen at different stages of development, from childhood, adolescence, and into adulthood.

These may include: learning disabilities, poor academic achievement, poor organisation, lack of inhibition, difficulty writing or drawing, balance problems, attention and hyperactivity problems.

Children with FAS have problems with their neurological development, abnormal growth and have characteristic facial features which result from their foetal exposure to alcohol.

The characteristic facial features can include: small and narrow eyes, a small head, a smooth area between the nose and the lips and a thin upper lip.

Children with FAS can also occasionally have additional problems such as:

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

How FAS develops during pregnancy

“When a pregnant woman drinks, the alcohol goes across the placenta to the foetus via the bloodstream,” says Dr Raja Mukherjee who works for Surrey and Borders Partnership NHS Foundation Trust. “The foetus’ liver isn’t fully formed, so it relies on the mother's liver to metabolise (break down) the alcohol. When the alcohol passes from the mother into the foetus' body it lacks oxygen and the nutrients needed for its brain and organs to grow properly. “White matter in the brain, which is responsible for speeding up the processing of information, is sensitive to alcohol,” says Dr Mukherjee. “So when a mother drinks, it affects the development of her baby’s white matter.”

Timing is another medical factor in the development of foetal alcohol syndrome. A baby’s facial features are formed during weeks six to nine of pregnancy. Professor Neil McIntosh, an Edinburgh-based neonatologist, says scientific evidence shows that mothers who drink during this three-week window are more likely to have babies with the facial deformities associated with FAS. Damage to the baby’s organs through drinking is most likely to happen in the first three months.

However, a baby's brain and spinal cord, which control most functions of our body and mind, continue to develop throughout the nine months of pregnancy. This means that damage to these vital systems may happen at any point during the pregnancy.⁽³⁾

For more information about how FAS develops in pregnancy please visit NOFAS-UK website. 

Visit NOFAS 

Foetal Alcohol Spectrum Disorder (FASD)

Since foetal alcohol syndrome (FAS) was first described in the 1970s, it has become clear that there is a spectrum of abnormalities resulting from foetal alcohol exposure, not only FAS.

Foetal Alcohol Spectrum Disorder (FASD) is the umbrella term used to describe this spectrum of abnormalities, with FAS lying at the most severely affected end of the spectrum.

FASD signs and symptoms

It is more difficult for a specialist to diagnose FASD than it is FAS. This is because children with FASD may not have facial deformities. It might not be until they start going to school and interacting with others that one or more of the following symptoms – which also affect children with foetal alcohol syndrome – show up:

• Difficulty with group social interaction
• Egocentricity
• Failure to learn from the consequences of their actions
• Hyperactivity and poor attention
• Inability to grasp instructions
• Lack of appropriate social boundaries (such as over friendliness with strangers)
• Learning difficulties
• Mixing reality and fiction
• Poor coordination.
• Problems with language
• Poor problem solving and planning
• Poor short term memory

NOFAS UK offer an overview of FASD on their website. 

Read more about FASD 

Treatment for children

GPs can refer children with FAS and FASD to community paediatricians who are likely to investigate problems further with psychologists, psychiatrists, speech and language therapists and specialists for organ defects.

Dr Mukherjee runs a clinic for adults and children over six with FAS and FASD. He diagnoses FASD by excluding similar conditions such as Attention Deficit Hyperactivity Disorder (ADHD). “Then it’s about working with the child, parents and other professionals, such as teachers, to find a management strategy for the condition,” he says. “For example, parents can learn to repeat instructions for children and use simple language and teachers should allow them more time and provide extra supervision.”

Early diagnosis is key. Research shows that people who have FAS or FASD go on to experience “secondary disabilities” – those not present at birth – which could be prevented with appropriate support. These include mental health and alcohol and drug problems. “Early diagnosis allows the stability and management that children with FAS or FASD need to be invoked earlier,” says Professor McIntosh.

Advice for mums-to-be

Because drinking during pregnancy can lead to long-term health problems like FAS, the safest approach is 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, don’t panic. Talk to your GP or midwife about any concerns you may have. Just because you may have drunk does not necessarily mean that your unborn baby has been harmed.

Want more advice on drinking while pregnant?

Taking control of your drinking

Here are three ways to keep your drinking under control if you’re pregnant or trying to have a baby.

1. Stand firm. If you’re out with friends or colleagues, you may be under pressure to drink, especially if you haven’t announced your pregnancy yet. Tell them you’re driving, on a health kick, or simply stick to soft drinks.
2. Make the switch. If you’re trying to conceive you are advised to stop drinking immediately. Alcohol-free alternatives ‘Mocktails’ can be a refreshing way to replace alcohol.
3. Get support. Ask your partner to help you by cutting down their drinking as well. If you are trying to conceive this is vital, as drinking alcohol can effect sperm count and heavy drinking can cause temporary impotence. Our Drinkaware: Track and Calculate Units app can help you stay motivated to cut back.

More information

The FASD Trust – www.fasdtrust.co.uk. The FASD Trust operates a helpline for parents and carers of children with FASD. Call 01608 811 599.
National Organisation on Foetal Alcohol Syndrome UK – www.nofas-uk.org. Or call their helpline on 020 8458 5951.