Snapshot A 2-year-old infant, born to a 22-year-old mother with a history of substance abuse, is brought to the pediatrician. Physical exam reveals short palpebral fissures, epicanthal folds, a thin upper lip, and developmental delay. Introduction Syndrome of physical and mental developmental delays and/or deficits that may results secondary to alcohol consumption during pregnancy Alcohol is the most common teratogen that a fetus may be exposed to in utero although more subtle symptoms occur with decreased consumption there has been no safe level of alcohol consumption established during pregnancy Most harmful during the first trimester, though there is no safe timing for alcohol consumption during pregnancy responsible for 1 in 6 cases of cerebral palsy full FAS occurs after about 4-6 drinks per day Presentation Symptoms physical and mental disability decreased muscle tone poor motor coordination classic facial deformities Physical exam short palpebral fissures epicanthal folds thin upper lip with smooth groove developmental delay microcephaly micrognathia heart murmur may be evident usually indicative of ASD/VSD Evaluation Diagnosis based primarily on clinical observations and substance abuse history of mother Blool alcohol level may be used if mother is suspected of intoxication Brain imaging CT/MRI may be helpful in identifying poor development Pregnancy ultrasound sometimes identifies restricted growth and/or classic facial anomalies of FAS Differential Other teratogen exposure; intrauterine trauma, cerebral palsy without FAS Treatment Medical management education/social support of at-risk mothers ad campaigns and public health initiatives have been designed to address these issues, however, more work is needed social support system for pregnant mother suffering from alcohol abuse is critical Prognosis, Prevention, and Complications Prognosis outcomes range widely, but most infants born with FAS show mental disability Prevention education and outreach programs to inform and prevent mothers from exposure to alcohol during pregnancy are critical for prevention Complications cardiac involvement, permanent mental and physical disability, social issues related to facial anomalies cardiac defects may include ventricular septal defect and atrial septal defect are common