The Nomenclature of Prenatal Alcohol Exposure

The term “Fetal Alcohol Syndrome [FAS]” was first used in an article in the Lancet in 1973 [1]. It described infants, exposed to large amounts of alcohol prenatally, having distinct facial features, being born underweight with serious neurological deficiencies.The article did not acknowledge the effect of prenatal alcohol when the facial features were absent, i.e. FAS represented 100% of cases affected by prenatal alcohol consumption [PAE], at that time.There had been two studies in France [2], in 1960 and 1967, which described similar consequences of PAE. However, at the time these studies did not receive acknowledgement outside of France.In the French studies it was noted, with concern, that those children with the facial features represented a minority of those affected by PAE, developmentally and neurologically.After 1973 in N. America, the observations made in France were soon confirmed. The term Fetal Alcohol Effects [FAE] was given to those developmentally and neurologically affected by PAE without the facial features.As awareness of FAS and FAE increased so the percentage of those with FAS declined, out of the total number affected by PAE.In 1996 Ann P. Streissguth et.al. published a landmark longitudinal study [3]. This showed that FAS represented 38% of all those effected by PAE, in the study.Over the years the percentage of recognized cases without the facial features has increased. In 2010 a further longitudinal study [4] showed the percentage of cases with the facial features was 11%.This is attributed to the increasing awareness and diagnosis of those that do not demonstrate the facial features.

The original emphasis on the facial features of FAS, and the delay in appreciating the huge numbers affected without the facial features, has lead to misconceptions.

The facial features of FAS only occur over a few days in the first trimester at a critical time of neurological development [5]. Consequently those with FAS will tend to be more affected neurologically. Some however may have an average I.Q., with less neurological dysfunction [3].

In 1996 the Institute of Medicine, Washington, D.C. published a paper from which the following nomenclature was adopted in N. America and is now mostly used in the rest of the world [6].- FAE was dropped. FAS was maintained where all the facial features were present. Partial FAS was designated where some components of the facial anomalies were evident. Alcohol Related Neurodevelopmental Disorder [ ARND ] was designated for those without the facial features of FAS and PFAS.Alcohol Related Birth Defects [ARBD] was also designated for all the physical birth defects, other than facial, caused by PAE.

Many continued to find the above nomenclature confusing.

The confusion was alleviated to some extent with the introduction of the term Fetal Alcohol Spectrum Disorder [ FASD ], which covered all the effects of alcohol on the developing fetus.

The term FAS Spectrum Disorders was used by Professor Randi Hagerman and Dr Kieran O’Malley in September 1998 [7],

In 2000 Ann Streissguth and Dr Kieran O’Malley refined the term to Fetal Alcohol Spectrum Disorders in an article in Seminars in Neuropsychiatry [8].

The significance of the term was quickly appreciated by those most involved, namely those with FASD and the families that supported them.

It became the term of choice for the subscribers to FASLINK an internet network for FASD families; being first used by them in 2000. In 2004 the Institute of Medicine, Washington, D.C. also adopted the term [9]. In 2015 the Canadian Guidelines for the Diagnosis confirmed FASD as being the overall diagnosis; FAS and ARND being components of FASD.

References1 - Pattern Of Malformations in Offspring Of Chronic Alcoholic Mothers, Jones et.al. The Lancet: Saturday 9 June 1973. 2 - THE HISTORY OF ALCOHOLIC FETOPATHIES (1997), Paul Lemoine, MD Nantes, France. J FAS Int 2003;1:e2 April 2003 3 - Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome [FAS] and Fetal Alcohol Effects [FAE]. Final Report, August 1996., Streissguth et.al, Fetal Alcohol and Drug Unit, University of Washington, Seattle, U.S.A. 4 - A 21-Year Longitudinal Analysis of the Effects of Prenatal Alcohol Exposure on Young Adult Drinking. John S. Baer, PhD; Paul D. Sampson, PhD; Helen M. Barr, MA, MS; Paul D. Connor, PhD; Ann P. Streissguth, PhD. Arch Gen Psychiatry. 2003; 60:377-385. ABSTRACT 5 - Genesis of Alcohol-Induced Craniofacial Dysmorphism. Kathleen K. Sulik. Experimental Biology and Medicine 2005, 230:366-375. 6 - Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment (1996) Institute of Medicine, National Academy Press, Washington, D.C. 7 – Chapter of -Pharmacological treatment of alcohol-affected children and adolescents. Published by [USA] NIAAA. September 1998. 8 - Neuropsychiatric implications and long-term consequences of fetal alcohol spectrum disorders. Streissguth AP, O'Malley K 

[Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S., Review]. Semin Clin Neuropsychiatry 2000 Jul; 5(3):177-90.9 -Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Department of Health and Human Services.

Barry Stanley April, 2012 Revised 2015.