Although the incidence of FAS has been difficult to determine with precision, reasonable estimates range from 0.97 to 1.9/1000 live births (Alcohol and Health 9, 1997). Moreover, most experts agree that the incidence of partial presentations of FAS, including neurobehavioral anomalies, is much higher. Given the impact that FAS and partial presentations of FAS have on the individual and society, it is imperative to maintain a strong research program in these areas.

Based upon the report of the Extramural Science Advisory Subcommittee on FAS, there are two major conceptual areas of research that warrant increased emphasis. Both of these areas require continued development of quantitative, objective methods of classifying the entire spectrum of possible consequences of alcohol consumption during pregnancy.

The causal agent of FAS and partial presentations of FAS is alcohol consumption during pregnancy. Even though FAS is a theoretically preventable condition, diagnosis at the above rates indicates that a significant number of women who are pregnant continue to consume alcoholic beverages in amounts that adversely affect their child. Universal or primary prevention approaches, including the labeling of alcoholic beverages (Hankin et al., 1996), have not been successful in those pregnant women most likely to give birth to an affected child, i.e., those who are heavy drinkers with long drinking careers (Serdula et al., 1992; Smith et al., 1987).

There is an existing literature on intervention and prevention of excessive consumption of alcoholic beverages in women that could be utilized in developing effective prevention initiatives for identified high-risk populations for FAS and related partial presentations. FAS has been reported to be more prevalent in Native Americans, African Americans, lower socioeconomic classes, and women who have already given birth to a child diagnosed with FAS. Consequently, within these and other high-risk populations, successful prevention or reduction of alcohol consumption would be expected to significantly decrease the incidence of FAS.

The development of valid markers and biomarkers for identifying women at high risk for having a child with alcohol-related effects is important. In particular, the determination of biomarkers for alcohol consumption during pregnancy would facilitate identification of high-risk pregnancies.

Active surveillance, case-ascertainment techniques in well-defined small communities would enable accurate estimates of FAS in those communities. Moreover, these approaches could also provide an opportunity to test the utility of employing such proxy measures as intelligence, growth parameters, and facial anomalies to estimate FAS prevalence. Thus, small selected communities could be optimum settings for prevention/intervention studies.

Specific areas of emphasis are:

1. Research on the prevention or reduction of alcohol consumption in identified high-risk populations for FAS and related partial presentations should be instituted. Related areas include (a) identifying biomarkers of alcohol consumption in pregnant women and/or developing techniques to measure blood alcohol concentrations over extended periods of time and (b) identifying factors (e.g., genetic, nutrition, use of other drugs, drug-alcohol interactions) that increase the likelihood of a woman having a child with FAS or its partial presentations.
2. Accurate estimates of FAS and partial FAS are required for this prevention research. Active surveillance, case-ascertainment procedures in well-defined, small communities result in state-of-the-art diagnosis and permit assessment of the utility of proxy measures. Development of valid and cost-effective proxy measures would enable accurate estimates of rates of FAS in the general population.

Given the devastating impact of CNS dysfunction following prenatal alcohol exposure, intervention efforts for newborns and infants who are diagnosed with FAS or partial presentations of FAS should be directly primarily at the resulting neurocognitive and behavioral impairments. Intervention may be possible because the CNS effects of prenatal alcohol exposure appear to be more significant later in development, reflecting the (1) time course of cognitive and motor development; (2) cumulative effects of the interaction of alcohol=s teratogenic effects and disruptive and impoverished environments; and/or (3) varying types of neurological damage associated with prenatal alcohol exposure (Coles and Platzman, 1992; Streissguth et al., 1993). Unfortunately, there have been few well-designed developmental studies of FAS with respect to intervention.

Animal and human studies suggest that prenatal alcohol exposure can alter the structure and function of specific areas of the brain (Mattson et al., 1992). Furthermore, widespread observations indicate that the psychosocial environments of many individuals with FAS are inadequate, impoverished, and perhaps dysfunctional, with consequent adverse effects on cognitive processes independently or interactively with changes in brain (Nadel, 1985). Individual or environmental characteristics that protect the individual or mitigate undesirable cognitive and behavioral outcomes in FAS-related presentations have not been well studied. Beneficial effects of protective and intervention factors, especially education, physical and occupational therapy, behavioral/environmental interventions, and others demonstrated to be of importance from studies of other developmental disabilities, need to be determined using random assignment and appropriate controls.

Research with animal models of FAS offers the ability to identify potential behavioral, environmental, and pharmacological interventions for children with FAS. For example, animal models could be useful in determining the effects of pharmacological interventions and in demonstrating that complex motor training helps negate alcohol-related deficits in fine motor and muscular coordination (Klistova et al., 1997). Pharmacological interventions in children have not received sufficient attention and should be studied in and of themselves, as well as in combination with behavioral, educational, and other interventions. These studies should use random assignment and appropriate controls.

Specific areas of emphasis are:

1. Basic and clinical studies directed at assessing various intervention strategies (behavioral, pharmacological, combinations of the two) are warranted.
2. Basic and clinical studies designed to assess individual and/or environmental characteristics that mitigate or exacerbate the effects of prenatal alcohol exposure need to be conducted.

Based upon the reports submitted to the Extramural Science Advisory Subcommittee on FAS, the following other areas of research also warrant special emphasis.

1. Identification of characteristics that could help define FAS or partial presentations of FAS early in life, particularly in the newborn or infancy period, is an important area of research. This will necessitate studies on the effects of timing, dose, and the pattern of exposure on physical, physiological, neurochemical, and behavioral characteristics.
2. The latest technology needs to be utilized in hypothesis-driven research to determine which brain structures and functions are compromised by prenatal alcohol exposure. This research could lead to the development of proxy indicators of CNS abnormalities.
3. Research into the mechanisms of FAS must continue and importantly keep pace with recent advances in molecular, cellular and developmental biology as well as genetics. This work will aid in developing intervention strategies.

Up to Table of Contents

Alcohol and Health 9, 1997.

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Hankin JR, et al: Heeding the alcoholic beverage warning label during pregnancy: Multiparae versus nulliparae. J Stud Alcohol 57:171-177, 1996.

Klinstova AY, et al: Therapeutic motor training increases parallel fiber synapse number per Purkinje neuron in cerebellar cortex of rats given postnatal binge alcohol exposure: Preliminary report. Alcohol:Clin Exp Res 21:1257-1263, 1997.

Mattson SN, et al: Fetal alcohol syndrome: A case report of neuropsychological, MRI, and EEG assessment of two children. Alcohol:Clin Exp Res 16:1001-1003, 1992.

Nadel M: Offspring with fetal alcohol effects: Identification and intervention. Alcohol Treat Quart 2:105-116, 1985.

Serdula M, et al: Trends in alcohol consumption by pregnant women: 1985-1988. JAMA 265:876-879, 1991.

Smith IF, et al: Identifying high-risk pregnant drinkers: Biological and behavioral correlates of continuous heavy drinking during pregnancy. J Stud Alcohol 48:304-309, 1987.

Streissguth AP, et al: The Enduring Effects of Prenatal Alcohol Exposure on Child Development: Birth Through Seven Years, a Partial Least Squares Solution. University of Michigan Press Ann Arbor, MI, 1993.

Posted: June 1998

Updated: October 2000