Alcohol is a teratogen (toxin). Teratogens are known to cause abnormalities and birth defects following exposure during pregnancy. Alcohol affects the normal development of a fetus, including the brain and other organs.

A baby’s brain develops throughout the nine months of pregnancy and therefore can be impacted at any stage during pregnancy. When alcohol crosses the placenta, the unborn baby is exposed to the same blood alcohol level as the mother, because the liver of the developing baby is not fully formed until late in pregnancy.

This means the baby has the same (or possibly even higher) blood alcohol content as the mother, and it remains at that level for longer.

In many branches of medicine, health professionals and researchers can conduct clinical trials to understand what causes a disease or condition, however it would be unethical to do clinical trials involving pregnant women to determine whether consuming any amount of alcohol is safe for the unborn baby.

Although we know that alcohol at any point during pregnancy can cause FASD, the risk of harm is different for everyone and impossible to predict. Risk factors include:

Prenatal alcohol exposure

• Dose (how much)
• Timing (when during the pregnancy)
• Frequency (how often)

Maternal

• Genetics e.g for metabolising alcohol
• Age
• General health, medical conditions, liver function
• Body composition (percentage of fat, muscle,
  water, bone)
• Other drug use

All of the above can influence blood alcohol levels and hence the risk of harm to the baby.

Thus, to prevent harm from alcohol to an unborn child, the Australian guidelines to reduce health risks from drinking alcohol state:

A. To prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol.

B. For women who are breastfeeding, not drinking alcohol is safest for their baby.

*We know that women drink alcohol whilst pregnant for a number of reasons and roughly 50% of pregnancies in Australia are unplanned. As a result, many women consume alcohol before knowing they are pregnant. If you are concerned that you have consumed alcohol whilst pregnant, free, confidential and judgement-free support is available by contacting the helpline at NOFASD Australia. 

Based on Australian studies, approximately half of all women will consume alcohol during pregnancy, however, the majority will stop drinking once they know they are pregnant.

Some women are at higher risk of continuing to drink alcohol during pregnancy due to:

• Disadvantage
• Alcohol dependency
• Historic trauma
• Mental Health problems

All women need support from partners, friends, family and health professionals to try to abstain from alcohol. Some women, including those with alcohol dependency, will need additional help from experienced drug and alcohol professionals to assist them to safely stop drinking alcohol during pregnancy.

FASD occurs in all parts of Australian society where alcohol is consumed.

Worldwide, WHO data suggests that around 1% of the population is estimated to have FASD.

In countries similar to Australia, such as the US and Canada, the estimated prevalence of FASD is 2-4%, or about one child in every classroom.

Certain groups have documented higher rates of FASD including people living in out of home care and institutions, justice settings, and some Indigenous Communities.

FASD has been shown to be more prevalent than other neurodevelopmental disorders such as Autism.

Babies and young children with FASD may have:

• Small head circumference (lower than the 3rd percentile)
• Dysmorphic (abnormal) facial features
• Birth defects
• Prematurity
• Low birth weight

Behaviours might include:

• Poor sucking reflexes
• Poor sleep patterns
• Irritability or drowsiness
• Strong startle reflex
• Sensory problems (sound, light, touch, smell)

If you are concerned that your baby has FASD, the first step is to reach out to your GP. NOFASD Australia also offer a free and confidential helpline which operates every day of the year, providing guidance and judgement-free support for families looking for support around the assessment and diagnosis of FASD.

Children with FASD may display:

• Delayed development
• Social, learning and behavioural problems
• Short attention span and/or hyperactivity
• Cognitive problems, including a low IQ (although intellectual disability is not common)
• Poor language and communication skills
• Poor memory
• Difficulty organising and scheduling
• Problems with mood, attachment or mental health
• Poor social skills
• Poor emotional regulation
• Impaired judgment and impulsive behaviour
• Difficulty with life skills
• Sleep disorder
• Sensory problems – noise, lighting, pain, cold
• Difficulty with reading, writing and maths

Adolescents may also encounter difficulties with education, sexuality and substance use. Some may come into contact with the justice system. Many will need support to live and work independently.

If you are concerned that your child has FASD, the first step is to reach out to your GP. NOFASD Australia also offer a free and confidential helpline which operates every day of the year, providing guidance and judgement-free support for families looking for support around the assessment and diagnosis of FASD.

Early diagnosis of FASD in childhood enables early interventions to promote optimal neurodevelopment. A circle of collaboration between health professionals, the family, school and service providers ensures the best opportunities for people with FASD.

A lack of early diagnosis and tailored support may lead to later challenges for people living with FASD and their families, including challenging behaviours, learning difficulties, early school disengagement, drug and alcohol use, poor mental health, unemployment, and engagement with the justice system (as victims and offenders).

Read more about why a diagnosis for FASD is important.

Diagnostic assessment for FASD can be conducted with people of all ages. However, the diagnosis can be difficult to make in young children who cannot complete formal assessments.

Diagnostic assessment is most commonly conducted with primary school aged children and teenagers. There are limited services for the diagnosis and support of adults with FASD.

Ideally a child should have a diagnostic assessment as early as possible.

Read more about the Assessment and Diagnosis of FASD.

A diagnosis of FASD requires a multidisciplinary assessment, however individual clinicians can all play their part in contributing towards a diagnosis.

A FASD diagnosis requires confirmation of prenatal alcohol exposure and severe impairment in at least three domains of neurodevelopmental function (e.g attention, cognition, language).

All children should be assessed for physical features including the facial features typical of FASD (‘sentinel facial features’), microcephaly (small head), birth defects and impaired vision, hearing, or growth.

To have your child assessed for FASD you should start by making an appointment with you General Practitioner (GP) who may refer you to a paediatrician or allied health professional for further assessment.

Adults should also see their GP who may refer them to a psychologist, physician or psychiatrist.

Find FASD-informed clinicians across Australia through the FASD Hub Australia Service Directory.

In 1973, Fetal Alcohol Syndrome (FAS) was described in children with characteristic facial features, developmental problems, birth defects and poor growth who were born to mothers who consumed large amounts of alcohol.

By 2000 it was recognised that prenatal alcohol exposure may result in brain injury causing neurodevelopmental problems in the absence of facial and other physical features, and the term Fetal Alcohol Spectrum Disorder (FASD) was coined.

Although birth defects and facial features result from prenatal alcohol exposure in the first trimester (12 weeks of pregnancy) the brain continues to grow and develop throughout pregnancy and may be harmed by prenatal alcohol exposure at any time in the pregnancy.

Over the years, a number of different terms have been used to describe severe harms from prenatal alcohol exposure. These include:

• Fetal Alcohol Syndrome
• Partial Fetal Alcohol Syndrome
• Alcohol-Related Neurodevelopmental Disorder
• Alcohol-Related Birth Defects

In the Australian Guide to the diagnosis of FASD, updated in 2020, the term FASD is used as a diagnostic term incorporating two sub-categories:

• FASD with three sentinel facial features
• FASD with less than three sentinel facial features

All people with FASD have strengths and although FASD cannot be cured, with the right support, people with FASD can be helped to achieve their potential and live happy and healthy lives.

Australian research shows that only a fifth of people with FASD have the three distinctive facial features (known as ‘sentinel facial features’), thus FASD is often referred to as an ‘invisible’ disability.

The sentinel facial features are:

• Short palprebal fissures (eye openings)
• Thin upper lip
• Flat or indistinct philtrum (the area between the nose and upper lip)

Others will have major or minor congenital anomalies (birth defects) which may affect their appearance.

Many people with FASD have difficulty with their cognitive (‘thinking’) skills, however most will not have an intellectual disability.

Intellectual Disability is defined as an IQ score of less than 70 in association with severe impairment of adaptive function (self care and living skills, social skills, social communication).

Many people with FASD have difficulties in their day to day lives despite having a normal IQ. Their challenges will vary depending on how prenatal alcohol exposure has injured their brain.

People with FASD may have a range of health problems associated with prenatal alcohol exposure. These might include:

• Problems with hearing and vision
• Musculoskeletal problems
• Congenital heart defects
• Cleft lip and palate
• Sleep disorder

FASD may co-occur with other diagnoses, including:

• Intellectual Disability
• Conduct Disorder
• Attention Deficit Hyperactivity Disorder
• Autism Spectrum Disorder
• Specific learning disorders
• Mental health problems (eg anxiety and depression)

These may be a direct result of prenatal alcohol exposure but may also have a genetic component, or be secondary to the challenges faced by people with FASD.

NOFASD Australia are the peak body working with families and people with FASD in Australia, providing:

• Support for individuals/parents/caregivers/families before, during and after a diagnostic assessment.
• Free online and telephone support via a helpline.
• ‘Families Linking with Families’ support group program, which brings together families who are caring for a child or young person with FASD
• Resources for individuals, parents/caregivers and families.
• Education and training workshops for a wide range of audiences across Australia.