FACT SHEET:
Fetal Alcohol Syndrome

The consumption of alcohol during pregnancy is one of the leading preventable causes of birth defects and childhood disabilities in the United States.1 The adverse effects associated with fetal alcohol syndrome (FAS) range from growth deficiency, brain structure and function anomalies, and abnormalities of the head and face.2 It is estimated that in 1992 the cost of treating FAS-affected infants, children, and adults was over $1.9 billion.3 The lifetime cost per child affected with FAS is estimated to be $1.4 million.4

FAS and Public Awareness

  • In 1981 the Surgeon General first advised that women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.

  • Public law 100-690 was implemented in 1989, requiring warning labels on all alcoholic beverages sold in the United States.

  • Since 1990 the Dietary Guidelines for Americans have stated that women who are pregnant or planning to become pregnant should not drink alcohol.

  • As of 1998, 19 states require the posting of alcohol health warning signs where alcoholic beverages are sold.

FAS Statistics

  • In 1995, four times as many pregnant women frequently consumed alcohol as in 1991.5 Researchers speculate that the increase in alcohol consumption by pregnant women may be attributed to widespread reports on the health benefits of moderate drinking.6

  • 51% of women of child-bearing age between 18-25 and 53% between 26-34, report the use of alcohol within the past month.7

  • 17% of women of child-bearing age between 18-25 and 13% between 26-34, report binge drinking (five or more drinks on one occasion) within the past month.8

  • A national survey found that more than half of women age 15-44 drank while pregnant.9

  • Of the women who reported drinking during their pregnancy, 66% reported drinking in their first trimester; 54% reported drinking in their third trimester.10

  • FAS is estimated to occur in 1 to 2 live births per every 1,000 in the United States each year.11

  • Fetal Alcohol Effects (a less severe set of alcohol-related abnormalities) is estimated to occur in 3-5 live births per every 1,000 in the United States each year.2, 11

  • According to the birth defects monitoring program, FAS rates among American Indians are 3.0 per 1000 live births compared to a rate of 0.6 per 1000 live births among Blacks and 0.1 per 1000 live births among Whites.12

  • FAS is not just a childhood disorder;13 exposure to alcohol as a fetus can cause a wide range of lifelong physical and mental disabilities.14

  • Fetal alcohol exposure may increase the risk for later alcohol, tobacco, and drug dependence in adults.15

Possible Solutions: Treatment, Education, & Higher Taxes

  • Studies have shown that FAS is completely preventable and that the consumption of alcohol can result in lifelong physical and mental impairments on the fetus. Research suggests that all pregnant women should be screened for alcohol use during prenatal visits. Women who test positive, or prove to be at-risk, should be identified early by physicians and referred for counseling and treatment.16

  • A recent survey illustrated the need for physician education on "how much" alcohol consumption is "too much" during pregnancy. 41% of physicians placed the threshold for FAS at one to three drinks per day while 38% placed the threshold at one or fewer drinks per day.17 Both opinions directly contradict the Surgeon General's advice that women not consume any alcoholic beverages during pregnancy because of the risk of birth defects.

  • Research by Abel suggests that the most effective public health strategy for reducing FAS is a combination of public health messages that target alcohol abuse, coupled with higher taxes on alcoholic beverages. Abel states that recent studies have shown that heavy drinking and binge drinking are sensitive to price changes, and that price elasticities are relatively high for heavy drinkers who are aware of the consequences of their drinking.18

  • Studies have shown that alcohol beverage warning labels have increased awareness of the risks involved with alcohol consumption during pregnancy.19 However, over time the alcohol warning labels have become commonplace, with the message often being overlooked. Changing the appearance (i.e., size, color, etc.) and rotating different warning labels on alcoholic beverage containers may help prolong awareness while eventually decreasing the number of women who expose their fetuses to alcohol.

References
1. Centers for Disease Control and Prevention. (1995). Update: Trends in fetal alcohol syndrome--United States, 1979-1993. MMWR, 44:249-251.
2. Abel, E., and Sokol, R. (1987). Incidence of alcohol syndrome and economic impact of FAS-related anomalies. Drug and Alcohol Dependence 19:51-70.
3. Harwood, H., Fountain, D., & Livermore, G. (1998). The Economic costs of alcohol and drug abuse in the United States, 1992 (preprint copy). Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.
4. Centers for Disease Control. (1998). Preventing secondary conditions in children with fetal alcohol syndrome. World Wide Web document http://www.cdc.gov/nceh/programs/fas/factsheets/secondary/faqfas.htm (accessed on 3/17/99).
5. Hosaka, T. (1998). Mothers and the bottle. Washington Post, Health Section, Page 7, August 4.
6. Ebrahim, S. H., Luman, E. T., Floyd, R. L., Murphy, C. C., Bennett, E. M., & Boyle, C. A. (1998) Alcohol consumption by pregnant women in the United States during 1988-1995. Obstetrics & Gynecology, 92(2):187-192.
7. U.S. Department of Health and Human Services. (1998). Preliminary results from the 1997 national household survey on drug abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration.
8. U.S. Department of Health and Human Services. (1998). Preliminary results from the 1997 national household survey on drug abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration.
9. U.S. Department of Health and Human Services. (1998). Substance abuse and mental health statistics source book, 1998. Rockville, MD: Substance Abuse and Mental Health Services Administration.
10. U.S. Department of Health and Human Services. (1998). Substance abuse and mental health statistics source book, 1998. Rockville, MD: Substance Abuse and Mental Health Services Administration.
11. Abel, E. (1983). Fetal alcohol syndrome and fetal alcohol effects. New York, NY: Plenum Press.
12. Chavez, G. F., Cordero, J. F., & Becerra, J. E. (1988). Leading major congenital malformations among minority groups in the United States. Morbidity and Mortality Weekly, 37:17-24.
13. Dorris, M. (1989). The broken cord. New York, NY: Harper & Row Publishers.
14.Streissguth, A. P., Aase, J. M., Clarren, S. K., Randels, S. P., LaDue, R. A., & Smith, D. F. (1991). Fetal alcohol syndrome in adolescents and adults. Journal of the American Medical Association, 265(15):1961-1967.
15. Yates, W. R., Cadoret, R. J., Troughton, E. P. Stewart, M., & Giunta, T. S. (1998). Effect of fetal alcohol exposure on adult symptoms of nicotine, alcohol, and drug dependence. Alcoholism: Clinical and Experimental Research, 22(4):914-920.
16. Bagheri, M. M., Burd, L., Martsolf, J. T., & Klug, M. G. (1998). Fetal alcohol syndrome: Maternal and neonatal characteristics. Journal of Pediatric Medicine, 26(4):263-269.
17. Abel, E. L., & Kruger, M. (1998). What do physicians know and say about fetal alcohol syndrome: A survey of obstetricians, pediatricians, and family medicine physicians. Alcoholism: Clinical and Experimental Research, 22(9):1951-1954.
18. Abel, E. L. (1998). Prevention of alcohol abuse-related birth effects--II. Targeting and pricing. Alcohol, 33(4):417-420.
19. Greenfield, T., & Kaskutas, L. A. (1993). Early impacts of alcoholic beverage warning labels: National study findings relevant to drinking and driving behavior. Safety Science, 16:689-707.

For more information on Fetal Alcohol Syndrome contact:

The National Organization on Fetal Alcohol Syndrome (NOFAS)
http://www.nofas.org

The ARC of the United States (A National Organization on Mental Retardation)
http://www.thearc.org

The Fetal Alcohol and Drug Unit (University of Washington)
http://depts.washington.edu/fadu

The Centers for Disease Control FAS Prevention Branch
http://www.cdc.gov/ncbddd/fas

SAMHSA FASD Center for Excellence
http://fascenter.samhsa.gov