Exposure to alcohol in the first trimester is particularly toxic, and unfortunately this is often before many women realize they are pregnant. Alcohol consumption is almost universal in some cultures, rare in others. Though the Former Soviet Union (FSU) has a high prevalence of alcohol consumption, drinking during pregnancy is now being reported in referrals from other countries. History of drinking on the other hand is often not known or simply not documented.
While efforts are made to assess the risk factors of consumption, it must be understood, that drinking and the need to place a child for adoption are both consequences of similar demographic characteristics: poverty and social isolation.
Fetal alcohol syndrome is a complex of physical findings due to alcohol effect during the formation of the fetus. While a known history of alcohol consumption is necessary to meet the diagnostic criteria, clinicians have to recognize that piece of information is often lacking. They rely on the physical findings of history of low birth weight (not due to prematurity, microcephaly, abnormal philtrum and upper lip, small palpebral fissures, atypical ear shape and palmar crease, and neurodevelopmental abnormalities). A child born without the physical findings may just have the neurodevelopmental deficits, which may not be apparent until school age. These children used to be said to have "fetal alcohol effect." Now the condition is called "Alcohol related neurodevelopmental" effect (ARND).
Prenatal exposure to alcohol may cause deficits in physical development beyond the restricted growth of the head. There can be congenital anomalies such as abnormal teeth, heart etc., and the brain itself suffers abnormal migration of the neurons resulting in "miswiring," which can affect anything from executive function to self-modulation (the ability to control emotional responses to events) and intelligence.
Children with fetal alcohol syndrome or alcohol related neurodevelopment effects benefit from rehabilitation therapies, educational and psychological interventions. They require special family supports and the issues may be lifelong.