Alcohol-Related Birth Defects-The Past, Present, and Future
Warren, Kenneth R., Foudin, Laurie L., Alcohol Research
In 1994 Alcohol Health & Research World (now titled Alcohol Research & Health) last devoted a full issue to the topic of fetal alcohol syndrome (FAS) and other alcohol-related birth defects (ARBD). This introductory article provides readers with information on how the field has advanced since then. In addition to tracing the development of the terminology used in the field, it describes the difficulties involved in determining the true prevalence of FAS and ARBD; the mechanisms that may play a role in alcohol-derived fetal injuries; approaches to preventing drinking during pregnancy; and strategies for assisting people who have been born with FAS and ARBD. KEY woRDS: Fetal alcohol effects; fetal alcohol syndrome; birth defects; alcohol-related neurodevelopmental disorder; diagnostic criteria; risk factors; AODR (alcohol- or other drug-related) biological markers; targeted prevention; warning label
In 1994 Alcohol Health & Research World (now titled Alcohol Research & Health) last devoted a full issue to the topic of fetal alcohol syndrome (FAS) and other alcohol-related birth defects (ARBD) (see Volume 18, Number 1, 1994). Selected by the National Association of Government Communicators as first prize in the technical publications category, that issue of the journal provided an excellent overview of the existing knowledge on alcohol-- derived prenatal injury and still remains a valuable resource for readers. Since the publication of that issue, however, research in the ARBD field has advanced significantly This current issue of Alcohol Research & Health presents a selection of these new, important findings.
In the interval between the two publications on ARBD, the United States Congress directed the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to prepare a comprehensive report on FAS. In response, NIAAA commissioned the Institute of Medicine (IOM) of the National Academy of Sciences to conduct a study. The resulting seminal report, Fetal Alcohol Syndrome: Diagnosis, Epidemiology Prevention, and Treatment (Stratton et al. 1996a), critically reviewed the major scientific issues in fetal alcohol research. Among its many recommendations, the IOM Committee proposed a revision of the terminology used regarding manifestations of alcohol-- derived prenatal injury, particularly because the terminology is very much interwoven with the clinical and scientific issues related to the diagnosis of FAS and other alcohol-related prenatal effects. The new terminology was designed to better meet the needs of various constituencies, including policymakers, scientists, clinicians, and other health care providers who deal with these issues.
The term "fetal alcohol syndrome" was introduced in 1973 by Jones and Smith (1973), whose original diagnostic criteria have changed very little even after being reconsidered by other groups, such as the Fetal Alcohol Study Group of the Research Society on Alcoholism (Rosett 1980; Sokol and Clarren 1989). However, after the FAS diagnostic criteria were introduced, it became clear that there were people who likely had been adversely affected by prenatal alcohol exposure but who did not completely fulfill the criteria for a diagnosis of FAS. One term that had been introduced to include such cases was "fetal alcohol effects" (FAE) (Clarren and Smith 1978). But, unlike the term "FAS," not all clinicians and researchers used the term "FAE" uniformly. Consequently, the IOM addressed this confusion by introducing more refined definitions, which have helped to provide consistency in the terminology used to describe the problems caused by prenatal alcohol exposure. For this reason, it is worthwhile to review the diagnostic criteria in the IOM report in some detail.
The IOM developed five diagnostic categories (see textbox). The first two pertain to FAS itself The other categories address various aspects of the spectrum of alcohol-related disorders. Researchers previously had disagreed whether an FAS diagnosis could be made without evidence of maternal alcohol use. …