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Alcohol‐Related Birth Defects: Assessing the Risk a

The risk of adverse effects on the fetus of the pregnant woman who drinks has received systematic attention only in recent years.' Not surprisingly, early studies of alcoholrelated neonatal status centered on the most dramatic manifestation of the problem, the pattern termed fetal alcohol syndrome (FAS) by Jones and Smith in their seminal report.*. FAS is diagnosed in the infants of some, but not all, women who consume large quantities of alcohol during pregnancy. The diagnosis of FAS requires evidence of ( a ) growth retardation, (b) neuropsychological impairment, as mental retardation, and ( c ) the presence of craniofacial and other anomalies. Early failures to recognize FAS as a distinctive condition may have been due, in part, to the fact that growth retardation and mental retardation are not specific to FAS. Furthermore, the most important feature of FAS, mental retardation, is not readily diagnosed in the newborn, hence its association with maternal drinking has been difficult to assess. The individual anomalies are seldom all present in a given case. Considered individually, these anomalies would not be considered as major or as having any notable functional sequelae. Single specific features are not unusual; in the cohort of 359 infants in the prospective portion of this study, only 26 were without any noted anomaly. Even an infant presenting a moderate number of anomalies might not be identified in a routine examination. Nevertheless, the pattern, when seen, is clearly related to fetal alcohol exposure.