Foetal Alcohol Syndrome

The more alcohol a woman drink when she’s pregnant, the greater the risk she is taking with her baby’s health. Miscarriage, stillbirth, premature birth and small birth weight are all associated with a mother’s drinking alcohol during pregnancy.

Foetal Alcohol Syndrome (FAS)  affects the way a baby’s brain develops. First discovered by two doctors in the US in 1973, the seriousness of  the condition depends on how much alcohol a mother drank during pregnancy. The World Health Organisation quotes a 2005 US study which estimated that one in every 1,000 children are born with FAS (2).

What is foetal alcohol syndrome?



Children with FAS have distinct facial features including: small and narrow eyes, a small head, a smooth area between the nose and the lips and a thin upper lip. They also show the following symptoms:

  • Hearing and ear problems
  • Mouth, teeth and facial problems
  • Weak immune system
  • Epilepsy
  • Liver damage
  • Kidney and heart defects
  • Cerebral palsy and other muscular problems
  • Height and weight issues
  • Hormonal disorders

How FAS develops during pregnancy

When a pregnant woman drinks, the alcohol goes across the placenta to the foetus via the bloodstream The foetus’ liver isn’t fully formed, so it cannot metabolise the alcohol quickly enough.  At this stage, the baby has a high blood alcohol concentration. It therefore lacks oxygen and the nutrients needed for its brain and organs to grow properly. White matter in the brain, which is responsible for speeding up the processing of information, is sensitive to alcohol so when a mother drinks, it affects the development of her baby’s white matter.”

Timing is another medical factor in the development of foetal alcohol syndrome. A baby’s facial features are formed during weeks six to nine of pregnancy. Scientific evidence shows that mothers who drink during this three-week window are more likely to have babies with the facial deformities associated with FAS. Damage to the baby’s organs through drinking is most likely to happen in the first three months.


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FASD signs and symptoms

Foetal Alcohol Spectrum Disorder (FASD) is the umbrella term used to describe the conditions that occur in people who have been diagnosed with some, but not all, of the symptoms of foetal alcohol syndrome. Like FAS, FASD is caused by a mother’s drinking during pregnancy, and it affects the way a baby develops physically and mentally. There are no accurate records of the incidence of FASD in Western countries, but experts estimate that it may be as high as one child in 100 is born with FASD (

It is more difficult for a specialist to diagnose FASD than it is FAS. This is because children with FASD may not have facial deformities. It might not be until they start going to school and interacting with others that the following symptoms – which also affect children with foetal alcohol syndrome – show up:

  • Learning difficulties
  • Problems with language
  • Lack of appropriate social boundaries (such as over friendliness with strangers)
  • Poor short term memory
  • Inability to grasp instructions
  • Failure to learn from the consequences of their actions
  • Egocentricity
  • Mixing reality and fiction
  • Difficulty with group social interaction
  • Poor problem solving and planning
  • Hyperactivity and poor attention
  • Poor coordination.

Treatment for children

GPs can refer children with FAS and FASD to community paediatricians who are likely to investigate problems further with psychologists, psychiatrists, speech and language therapists and specialists for organ defects.

Dr Mukherjee runs a clinic for children and adults over six with FAS and FASD. He diagnoses FASD by excluding similar conditions such as Attention Deficit Hyperactivity Disorder (ADHD). “Then it’s about working with the child, parents and other professionals, such as teachers, to find a management strategy for the condition,” he says. “For example, parents can learn to repeat instructions for children and use simple language and teachers should allow them more time and provide extra supervision.”

Early diagnosis is key. Research shows that people who have FAS or FASD go on to experience “secondary disabilities” – those not present at birth – which could be prevented with appropriate support. These include mental health and alcohol and drug problems. “Early diagnosis allows the stability and management that children with FAS or FASD need to be invoked earlier,” says Professor McIntosh.

Advice for mums-to-be

We don’t know how much alcohol is safe to drink in pregnancy. It depends on various factors such as how fast a mum-to-be absorbs alcohol, her physical health, diet and what medication she is on. It’s why the government advises pregnant women and those trying to conceive to avoid alcohol altogether.

If you didn’t know you were pregnant and you have been drinking above the government’s lower risk guidelines, don’t panic. Talk to your doctor or midwife about any concerns you may have. Just because you may have drunk does not mean you have necessarily done damage. If you drink a lot of alcohol  and are pregnant and find it hard to stop, talk to your doctor about getting help.

“If you drink a low amount when you are pregnant your baby has a low risk of developing FAS or FASD,” says Dr Mykherjee. “If you drink heavily you have a high risk. If you don’t drink, there’s no risk at all.”



Causes of learning disabilities and their impact on health

The World Health Organization (WHO) has defined learning disabilities as a state of arrested or incomplete development of mind. Somebody with a general learning disability is said to have a significant impairment of intellectual, adaptive and social functioning. A learning disability is not acquired in adulthood and is evident from childhood.

The term general learning disability has now been recommended in the UK to replace terms such as mental handicap or mental retardation. A child with a general learning disability or intellectual impairment finds it more difficult to learn, understand and do things compared with other children of the same age. The degree of disability can vary greatly, being classified as mild, moderate, severe or profound.

General learning disability is different from from specific learning difficulty such as dyslexia which means that the person has one difficulty such as in reading, writing but has no problem with learning in other areas.  It is characterised by generally poor performance in tasks such as learning, short-term memory and problem solving.

People with intellectual disabilities have an increased prevalence of health problems and their health needs are often unrecognised and unmet. For example, anxiety disorders are the most prevalent of the major mental illnesses and are present in 15–20% of the population but for people with intellectual disability, the prevalence of anxiety disorders has been shown to be much higher, particularly for hose with a mild to moderate intellectual disability. This is likely to be because they are aware that they are functioning less well than other people and because they find it significantly harder than others to cope with the demands of everyday life Anxiety disorders in people with intellectual disability can often be overlooked. Communication difficulties may make it harder for the person to describe their feelings and fears. Their difficulties may result in aggressive or destructive behaviour when they find situations difficult to cope with or are trying to avoid something which they find stressful

Although life expectancy is increasing, with people with mild learning disabilities approaching that of the general population, the mortality rates among people with moderate to severe learning disabilities are three times higher than in the general population, possibly due either to the impact of the cause of the disability, complex additional physical difficulties or because of less effective health care than the general population. The median age at death for people with learning disabilities is about 25 years younger than for those who do not have learning disabilities.

A classification of mild, moderate, severe and profound has been used to describe the degree of learning disability. However, this classification is in many ways inappropriate because each person with general learning disability must be assessed and treated as an individual. A person’s degree of intellectual impairment provides very little information about a person’s social, educational and personal needs, and the kind of help and support

About 2% of the population is estimated to have an intellectual impairment. It has been estimated that 1,191,000 people had learning disabilities in England in 2011, including: 286,000 children (180,000 boys, 106,000 girls) aged 0-17. As all children are assessed and monitored in infancy and all children attend school, it is likely that all or almost all of these children are receiving services to support them and their families

However of the 905,000 adults aged 18+ (530,000 men and 375,000 women), estimated to have an intellectual impairment only 189,000 (21%) are known to learning disabilities services. This means that the vast majority of adults with an intellectual impairment are not receiving services which would provide support for them and their families

The population for people with learning disabilities shows a sharp reduction in prevalence rates after age 49 due to reduced life expectancy. A sharp increase in prevalence for those under 20 may reflect increased survival rates among more severely disabled children.

The number of people with intellectual disabilities increased by 53% over the 35-year period from 1960 to 1995 as a result of improvements in socio-economic conditions, medical  care  and access to services for children

The causes of intellectual impairment include:

Genetic disorders such as Down’s syndrome, fragile X syndrome, Klinefelter’s syndrome and Turner syndrome

Metabolic disorders such as Tay-Sachs disease, Gaucher’s disease, Niemann-Pick disease) and Hurler’s syndrome.

Nutritional deficiency such as iodine deficiency.

Damage caused before the child is born by infections such as rubella; or by drugs or alcohol.

Damage caused during labour by prolonged labour, trauma, and deprivation of oxygen

Accidental or non-accidental injury, severe infections, poisoning or malnutrition   in infancy or childhood

For many people with an intellectual impairment there is no known cause