Fetal alcohol syndrome

Alcohol is a physical and behavioural teratogen. Fetal alcohol syndrome (FAS) is a common yet under-recognized condition resulting from maternal consumption of alcohol during pregnancy. While preventable, FAS is also disabling. Although FAS is found in all socioeconomic groups in Canada, it has been observed at high prevalence in select First Nations and Inuit communities in Canada. This statement addresses FAS prevention, diagnosis, early identification and management for health care professionals. Prevention of FAS must occur at two levels. Primary prevention involves eliminating FAS through classroom or community education, and encouraging women to avoid consuming alcohol before conception and throughout pregnancy. Secondary prevention involves identifying women who are drinking while pregnant and reducing their consumption. This statement describes a variety of screening strategies including ToleranceAnnoyance, Cut Down, Eye Opener (T-ACE). Medical practitioners should recommend abstinence starting with the first prenatal visit. Prompt referral for alcohol treatment is recommended for pregnant individuals who are unable to stop drinking alcohol. This statement describes the diagnosis of FAS, partial or atypical FAS, alcohol-related birth defects and alcoholrelated neurodevelopmental disorder. With a history of in-utero alcohol exposure, a diagnosis of FAS should be considered with current or previous growth deficiency, select facial abnormalities involving the upper lip and eyes, and neurodevelopmental abnormalities. These features are best quantified with the use of a four-digit diagnostic method. Strategies for early identification of possible alcohol-related abnormalities are outlined. Intervention focuses on optimizing development, managing behavioural difficulties and providing appropriate school programming. Of prime importance is earliest possible childhood intervention to prevent secondary disabilities that may result from delay while awaiting a definitive diagnosis of FAS.