Academic journal article Alcohol Research

Fetal Alcohol Spectrum Disorders: Research Challenges and Opportunities

Academic journal article Alcohol Research

Fetal Alcohol Spectrum Disorders: Research Challenges and Opportunities

Article excerpt

The adverse effects of prenatal alcohol consumption have long been known; however, a formal description and clinical diagnosis of these effects was not introduced until 1973. Since then, the distinction of the wide range of effects that can be induced by prenatal alcohol exposure, and, consequently, the terminology to describe these effects has continued to evolve. Although much progress has been made in understanding the consequences of prenatal alcohol exposure, challenges still remain in properly identifying all affected individuals as well as their individual patterns of alcohol-induced deficits. Also, as the large numbers of women who continue to drink during pregnancy indicate, prevention efforts still require further refinement to enhance their effectiveness. In addition, the mechanisms underlying alcohol-induced damage have not yet been fully elucidated; as knowledge of the mechanisms underlying alcohol-induced deficits continues to grow, the possibility of minimizing potential harm by intervening during prenatal alcohol exposure is enhanced. Finally, researchers are exploring additional ways to improve or fully restore behavioral and cognitive functions disrupted by prenatal alcohol exposure by treating the individuals with fetal alcohol spectrum disorders, thereby reducing the heavy burden for affected individuals and their families. KEY WORDS: Fetal alcohol spectrum disorders; fetal alcohol syndrome; fetal alcohol effects; maternal alcohol consumption; prenatal alcohol exposure; pregnancy; alcohol related birth defects; developmental disorders; diagnosis; research; alcoholrelated neurodevelopmental disorder

Although the effects of alcohol consumption on pregnancy outcomes have been observed throughout history, alcohol's ability to interfere with embryonic and fetal development (i.e., teratogenicity) was not recognized until the latter half of the 20th century. Alcohol now is recognized as the leading preventable cause of birth defects and developmental disorders in the United States (Bailey and Sokol 2008). The severity of birth defects resulting from exposure of the developing embryo or fetus to alcohol is determined by multiple factors, including genetic background, timing and level of alcohol exposure, and nutritional status (Guerri et al. 2009; Warren and Li 2005). The most serious adverse consequence of prenatal alcohol exposure is fetal alcohol syndrome (FAS), which has an estimated prevalence that ranges from 0.5 to 7.0 cases per 1,000 births in the United States (May and Gossage 2001; May et al. 2009). Moreover, many children who have been exposed to large amounts of alcohol prenatally may exhibit alcoholrelated brain and behavioral abnormalities but are not diagnosed with FAS because they do not show the abnormal facial features. This range of deficits now is referred to as fetal alcohol spectrum disorders (FASD) and is estimated to occur in 1 percent of births (Sampson et al. 1997), although some have suggested that the rate is much higher (May et al. 2009). The disabilities associated with FASD can persist throughout life and place heavy emotional and financial burdens on individuals, families, and society.

This is the third issue of Alcohol Research & Health and its predecessor, Alcohol Health & Research World, to address the problems resulting from prenatal alcohol exposure (National Institute on Alcohol Abuse and Alcoholism [NIAAA] 1994, 2001), and it is clear that although significant progress has been made, many challenges remain. For example, researchers have made progress both in understanding the mechanisms of how alcohol damages the fetus, including epigenetic influences, and in the potential prevention of such damage through the development of pharmacotherapeutic interventions. Nevertheless, too many pregnant women continue to drink and too many nonpregnant women in their childbearing years drink in risky patterns that place themselves and their potential progeny at high risk for negative health outcomes, making prevention and intervention strategies a high priority. …

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