Fetal Alcohol Spectrum Disorders

Abstract

Fetal alcohol spectrum disorders (FASDs) describe a range of effects that can occur in children whose mothers drank alcohol during pregnancy. These effects can include lifelong behavioral and learning problems and, in some cases, physical problems. Fetal alcohol syndrome (FAS) is a condition associated with the most severe physical and functional impairments. While FAS and the corresponding abnormal facial features, growth, and central nervous system problems are best known, clinicians should recognize that FASDs refer to the entire spectrum of problems, from mild to the most severe FAS impairments. FASD, risky drinking, and alcohol use in pregnancy are timely topics for social work focus, as growing rates of heavy alcohol use and binge drinking among women present serious health consequences. In the United States, up to one in twenty US school children are living with FASD. Moreover, negative outcomes from alcohol use during pregnancy and FASD occur in every social, economic, and demographic group, among social drinkers as well as heavier drinkers. Social workers across practice settings can support positive health and social outcomes by learning more about FASD, participating in screening, assessment, and referrals; providing FASD-informed services; and advocating for individuals and families living with FASD. Two behaviors must occur simultaneously to put any woman at risk of an alcohol-exposed pregnancy (AEP): (a) drinking alcohol, and (2) not using contraception effectively or at all. Nearly half of all pregnancies in the United States are unintended, and over half of US women (53.6 percent) of reproductive age report using alcohol, with up to 29 percent of women aged 21 to 24 reporting binge drinking. Among pregnant women, 1 in 10 report drinking alcohol during pregnancy. When alcohol use and pregnancy occur together, a woman may have a child with FASD. Therefore, when considering how to prevent an AEP and a possible FASD, a discussion with a woman who is drinking alcohol must include whether she is using contraception effectively. Social workers can put prevention into practice by screening clients for risky alcohol use (alcohol screening and brief intervention), talking to women about their drinking and contraception, and providing counseling and referral when needed. The key message is simple: No amount of alcohol is known to be safe during pregnancy. Despite the prevalence of FASD and the lifelong problems it can cause for individuals and families, the literature on FASD is relatively sparse compared to other areas of study. However, a body of literature on prevention, screening, referral, and treatment for women who are at risk for alcohol-exposed pregnancies and some excellent resources for working with individuals and families with FASD, along with a number of excellent online resources, is growing.