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Alcohol consumption during pregnancy: intervention guidance for the prevention of fetal alcohol spectrum disorders

Daniela Fiorentino, Valentina Carito, Simona Solombrino, Giovanna Coriale, Maria Concetta Marcella Scamporrino, Paola Ciolli, Marisa Patrizia Messina, Marco Fiore, Mauro Ceccanti


Fetal Alcohol Spectrum Disorders (FASD) is a term used to describe the broad spectrum of pathologies and disorders caused by alcohol exposure in uterus. Since alcohol is able to directly cross the placental barrier, alcohol intake during pregnancy causes a broad range of symptoms whose severity can greatly vary in degree. It is already well established that Ethanol exhibits teratogenic effects resulting in growth delays, physical and specific facial anomalies, neurological defects including intellectual disabilities and behavioral problems. Since it is not possible yet to establish a safe threshold of consumption, the only feasible recommendation is the total abstention from alcohol during pregnancy. This work firstly presents an overview on FASD and reviews specific methodologies to overcome difficulties related to the investigation of alcohol behavior in pregnant women. Subsequently, different protocols of intervention are proposed according to different styles of alcohol consumption. The final goal is to provide clinicians with a range of methods in order to prevent damage in the newborns.


alcohol, pregnancy, fetal alcohol spectrum disorders, FASD, prevention

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Lemoine P, Harousseau H, Borteyru JP. Menuet JC. Les enfants des parents alcoholiques: anomolies observées a propos de 127 cas. Ouest Med 1968; 8: 476-82.

Jones KL, Smith DW, Ulleland CN Streissguth P. Pattern of malformation in offspring of chronic alcoholic mothers. Lancet 1973; 1: 1267-71

Jones K, Smith D. Recognition of the fetal alcohol syndrome in early infancy. Lancet 1973; 2: 999-1001.

Riley EP, Infante MA, Warren KR. Fetal alcohol spectrum disorders: An overview. Neuropsychol Rev 2011; 21: 73-80. DOI: 10.1007/s11065-011-9166-x

Lupton C, Burd L, Harwood R. Cost of fetal alcohol spectrum disorders. Am J Med Genet C Semin Med Gene 2004; 15;127C:42-50.

Popova S, Lange S, Bekmuradov D et al. J. Fetal Alcohol Spectrum Disorder prevalence estimates in correctional systems: a systematic literature review. Can J Public Health 2011; 102:336-40. PMID:22032097

Vagnarelli F, Palmi I, Garcia-Algar O, et al. A survey of Italian and Spanish neonatologists and paediatricians regarding awareness of the diagnosis of FAS and FASD and maternal ethanol use during pregnancy. BMC Pediatrics 2011;11:51.

Hoyme HE, Kalberg WO, Elliott AJ, Blankenship J, Buckley D, Marais AS, et al. Updated clinical guidelines for diagnosing Fetal Alcohol Spectrum Disorders, Pediatrics 2016;138:1-18.

Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Can Med Assoc J 2005; 172(Suppl 5):S1-S21.

Astley SJ, Clarren SK. Diagnosing the full spectrum of fetal alcohol-exposed individuals: introducing the 4-digit diagnostic code. Alcohol Alcoholism 2000;35:400-10.

Bertrand J, Floyd LL, Weber MK. Guidelines for identifying and referring persons with fetal alcohol syndrome. MMWR Recomm Rep. 2005;54(RR-11):1-14.

Mattson SN, Riley EP, Delis DC et al. Verbal learning and memory in children with fetal alcohol syndrome. Alcohol Clin Exp Res 1996;20:810-6.

Kodituwakku PW, Handmaker NS, Cutler SK et al. Specific impairments in self-regulation in children exposed to alcohol prenatally. Alcohol Clin Exp Res 1995;19:1558-64.

Olson HC, Feldman JJ, Streissguth AP et al. Neuropsychological deficits in children with fetal alcohol syndrome: Clinical findings. Alcohol Clin Exp Res 1998;22:1998-2012.

Sokol RJ, Delaney-Black V, Nordstrom B. Fetal alcohol spectrum disorder. J Am Med Assoc 2003;290:2996-9. DOI:10.1001/jama.290.22.2996

Coriale G, Fiorentino D, Di Lauro F et al. Fetal Alcohol Spectrum Disorder (FASD): neurobehavioral profile, indications for diagnosis and treatment. Riv Psichiatr 2013;48: 359-69. DOI: 10.1708/1356.15062

Kline J, Shrout P, Stein Z et al. Drinking during pregnancy and spontaneous abortion. Lancet 1980;2(8187):176-180.

Mattson SN, Riley EP. A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcohol Clin Exp Res 1998;22:279-94.

Kodituwakku PW, Kodituwakku EL. From research to practice: An integrative framework for the development of interventions for children with fetal alcohol spectrum disorders. Neuropsychol Rev 2011;21:204-23.

Streissguth AP, Bookstein FL, Barr HM et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr 2004;25:228-38. PMID:15308923

Mead EA, Sarkar DK. Fetal alcohol spectrum disorders and their transmission though genetic and epigenetic mechanism. Front Genet 2014; 5:154. DOI: 10.3389/fgene.2014.00154

Resendiz M, Mason S, Lo CL et al. Epigenetic regulation of the neural transcriptome and alcohol interference during development. Front Genet 2014;26;5:285. DOI: 10.3389/fgene.2014.00285. eCollection 2014.

May PA, Gossage JP, Kalberg WO et al. Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Dev Disabil Res Rev 2009;15:176-92.

May PA. Researching the prevalence and characteristics of FASD in international settings. In: Riley EP, Clarren S, Weinberg J, Jonsson E eds. Fetal Alcohol Spectrum Disorder: Management and Policy Perspectives of FASD, Hoboken NJ: Wiley Blackwell, 2010: 15-25.

May PA, Hymbaugh KJ. A pilot project on fetal alcohol syndrome among American Indians. Alcohol Health Res 1982;7:3-9.

May PA, Hymbaugh KJ, aase JM et al. Epidemiology of fetal alcohol syndrome among American Indians of the Southwest. Soc Biol 1983;30:374-85.

May PA, McCloskey J, Gossage JP. Fetal alcohol syndrome among American Indians: epidemiology, issues, and research review. In: Mail PD, Heurtin-Roberts S, Martin SE, Howard J, eds. Alcohol use among American Indians and Alaska Natives: multiple perspectives on a complex problem, Vol. 13. Bethesda, MD: US Dept. of Health and Human Services. NIAAA 2002. Monograph no. 37. 321-369.

Lange S, Shield K, Rehm J et al. Prevalence of Fetal Alcohol Spectrum Disorders in child Care settings: a meta-analysis. Pediatrics 2013;132:980-95.

Ospina M, Dennett L. Systematic review on the prevalence of Fetal Alcohol Spectrum Disorders. IHE Institute of Health Economics, Alberta, Canada; April 2013.

May PA, Brooke LE, Gossage JP et al. Epidemiology of fetal alcohol syndrome in a South African Community in the Western Cape Province. Am J Public Health 2000;90:1905-12.

Viljoen DL, Gossage JP, Brooke L et al. Fetal alcohol syndrome epidemiology in a South African community: a second study of a very high prevalence area. J Stud Alcohol 2005;66:593-604.

May PA, Gossage JP, Marais AS et al. The epidemiology of fetal alcohol syndrome and partial FAS in a South African community. Drug Alcohol Depen 2007;88:259-71.

May PA, Blankenship J, Marais A-S et al. Maternal alcohol consumption producing fetal alcohol spectrum disorders (fasd): quantity, frequency, and timing of drinking. Drug Alcohol Depen 2013;133(2).

Clarren SK, Randels SP, Sanderso M et al. Screening for fetal alcohol syndrome in primary schools: a feasibility study. Teratology 2001;63:3-10.

Poitra BA, Marion S, Dionne M et al. A school-based screening program for fetal alcohol syndrome. Neurotoxicol Teratol 2003;25:725-9.

May PA, Fiorentino D, Phillip Gossage J et al. Epidemiology of FASD in a province in Italy: Prevalence and characteristics of children in a random sample of schools. Alcohol Clin Exp Res 2006;30(9):1562-75.

May PA, Fiorentino D, Coriale G et al. Prevalence of children with severe fetal alcohol spectrum disorders in communities near Rome, Italy: New estimated rates are higher than previous estimates. Int J Environ Res Public Health 2011;8:2331-51.

Petkovic G, Barisic I. Fas prevalence in a sample of urban schoolchildren in Croatia. Reprod Toxicol 2010;29(2):237-241.

Kuo HT, Wu HP, Li Q et al. In school study of prevalence of fetal alcohol spectrum disorder in east Taiwan. Alcohol Clin Exp Res 2012;36(supplS1):280.

Lee HK. Epidemiology of Fetal Alcohol Syndrome in Korea: an active case ascertainment study. Alcohol Clin Exp Res 2012;36(supplS1):212.

Petkovic G, Barisic I. Prevalence of fetal alcohol syndrome and maternal characteristics in a sample of schoolchildren from a rural province of Croatia. Int J Environ Res Public Health 2013;10:1547-61.

May PA., Keaster C, Bozeman R et al. Prevalence and characteristics of fetal alcohol syndrome and partial fetal alcohol syndrome in a Rocky Mountain Region City. Drug Alcohol Depen 2015;155:118-27.

Stratton K, Howe C, Battaglia F. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. National Academy Press: Washington, DC, USA; 1996.

Hankin JR, Sokol RJ. Identification and care of problems associated with alcohol ingestion in pregnancy. Semin Perinatol 1995;19:286-292.

NIAAA, National Institute of Alcohol Abuse and Alcoholism Council approves definition of binge drinking. 2004; NIAAA Newsletter no3 Winter.

Bonati M, Fellin G. Changes in smoking and drinking behaviour before and during pregnancy in Italian mothers: implications for public health intervention. Int J Epidemiol 1991;20:927-932.

NIAAA (National Institute on Alcohol Abuse and Alcoholism). Eighth special report to the U.S. Congress on alcohol and health from the Secretary of Health and Human Services. Washington, DC: U.S. Government Printing Office, 1993.

IOM (Institute of Medicine). Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and treatment. Washington, DC: The National Academy Press; 1996.

Plant ML, Abel EL, Guerri C. Alcohol and pregnancy. In I. Macdonald eds. Health issues related to alcohol consumption 2nd ed. Oxford, UK: Blackwell Science, 1999, 182-213.

Sood B, Delaney-Black V, Covington C et al. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect. Pediatrics 2001;108:E34.

Ceccanti M, Fiorentino F, Vitali M. Facing Fetal Alcohol Spectrum Disorders in Italy. Fetal Alcohol Forum. 2015;11:37-42. Available at

Ceccanti M, Fiorentino D, Coriale G et al. Maternal risk factors for fetal alcohol spectrum disorders in a province in Italy. Drug Alcohol Depend 2014;145:201-8.

Fiore M, Laviola G, Aloe L et al. Early exposure to ethanol but not red wine at the same alcohol concentration induces behavioral and brain neurotrophin alterations in young and adult mice. Neurotoxicology 2009;30:59-71

Fiore M, Mancinelli R, Aloe L et al. Hepatocyte growth factor, vascular endothelial growth factor, glial cell-derived neurotrophic factor and nerve growth factor are differentially affected by early chronic ethanol or red wine intake. Toxicol Lett 2009;188:208-13.

Ceccanti M, Mancinelli R, Tirassa P et al. Early exposure to ethanol or red wine and long-lasting effects in aged mice. A study on nerve growth factor, brain-derived neurotrophic factor, hepatocyte growth factor, and vascular endothelial growth factor. Neurobiol Aging 2012;33:359-67. DOI: 10.1016/j.neurobiolaging.2010.03.005Ã¥

Ceccanti M, De Nicolò S, Mancinelli R et al. NGF and BDNF long-term variations in the thyroid, testis and adrenal glands of a mouse model of fetal alcohol spectrum disorders. Ann Ist Super Sanita 2013;49:383-90. DOI: 10.4415/ANN_13_04_11

De Nicolo` S, Tarani L, Ceccanti M et al. Effects of olive polyphenols administration on nerve growth factor and brain derived neurotrophic factor in the mouse brain. Nutrition 2013;29:681-7. DOI 10.1016/j.nut.2012.11.007.

Ceccanti M, Carito V, Iannuzzi S et al. Serum BDNF and NGF Modulation by olive polyphenols in alcoholics during withdrawal. J Alcohol Drug Depend 2015;3:214. DOI:10.4172/23296488.1000214

Carito V. Ciafre S, Tarani L, Ceccanti M, Natella F, Iannitelli A, et al. TNF-alpha and IL-10 modulation induced by polyphenols extracted by olive pomace in a mouse model of paw inflammation. Ann Istit Super Sanita 2015, 51, 382-6. DOI: 10.4415/ANN_15_04_21

Carito V, Ceccanti M, Tarani L, Ferraguri G, Chaldakov GN, Fiore M. Neurotrophins' modulation by olive polyphenols. Curr Med Chem 2016, 23: 3189-3197. DOI: 10.2174/0929867323666160627104022

Carito V, Ceccanti M, Cestari V, Natella F, Bello C, Tarani L, et al. Olive polyphenols effects in a mouse model of chronic ethanol addiction. Nutrition 2017, 33: 65-9. DOI:10.1016/j.nut.2016.08.014

Jacobson JL, Jacobson SW, Sokol RJ et al. Teratogenic effects of alcohol on infant development. Alcohol Clin Exp Res 1993;17:174-183.

Abel EL, Hannigan JH. Maternal risk factors in fetal alcohol syndrome: provocative and permissive influences. Neurotoxicol Teratol 1995;17:445-62.

Ebrahim SH, Diekman ST, Floyd RL et al. Comparison of binge drinking among pregnant and nonpregnant women, United States, 1991-1995. Am J Obstet Gynecol 1999;180:1-7.

Roberts G, Nanson J. Best practices: fetal alcohol syndrome/fetal alcohol effects and the effects of other substance use during pregnancy. Canada`s Drug Strategy Division, Health Canada 2000.

Abel EL. Paternal and maternal alcohol consumption: effects on offspring in two strains of rats. Alcohol Clin Exp Res 1989;13:533-41.

Abel E. Paternal contribution to fetal alcohol syndrome. Addict Biol 2004;9:127-33.

Ceccanti M, Coccurello R, Carito V et al. Paternal alcohol exposure in mice alters brain NGF and BDNF and increases ethanol-elicited preference in male offspring. Addict Biol 2016; 21, 779-87. DOI: 10.1111/adb.12255

Popova S, Lange S Probst C, Gmel G, Rehm J Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis Lancet Glob Health. 2017;5:e290-e299

Pichini S, Marchei E, Vagnarelli F et al. Assessment of prenatal exposure to ethanol by meconium analysis: results of an Italian multicenter study. Alcohol Clin Exp Res 2012;36:417-24.

Garcia-Algar O, Kulaga V, Gareri J et al. Alarming prevalence of fetal alcohol exposure in a Mediterranean city. Ther Drug Monit 2008;30:249-54

Morrow-Tlucak M, Ernhart CB, Sokol RJ et al. Underreporting of alcohol use in pregnancy: relationship to alcohol problem history. Alcohol Clin Exp Res 1989; 13(3):399-401.

Allen JP, Columbus M. Assessing Alcohol Problems: A Guide for Clinicians and Researchers. National Institute on Alcohol Abuse and Alcoholism Treatment Handbook Series 4. NIH Pub. No. 95-3745. Bethesda, MD: the Institute, 1995.

Sobell LC, Sobell MB. Timeline follow-back: A technique for assessing self-reported alcohol consumption. In R.Z. Litten & J. Allen (Eds.), Measuring alcohol consumption: Psychosocial and biological methods. New Jersey: Humana Press, 1992; 41-72.

Bloomfield K, Hope A, Kraus L. Alcohol survey measures for Europe: A literature review. Drug- educ prev polic 2013;20:348-60.

King AC. Enhancing the self-report of alcohol consumption in the community: two questionnaire formats. Am J Public Health 1994;84:294-6.

Kerr WC, Stockwell T. Understanding standard drinks and drinking guidelines. Drug Alcohol Rev 2012;31:200-5.

Chang G. Alcohol-screening instruments for pregnant women. Alcohol Res Health 2001;25:204-9.

Burns E, Gray R, Smith LA. Brief screening questionnaires to identify problem drinking during pregnancy: a systematic review. Addiction 2010;105(4):601-614.

Chan AW, Pristach EA, Welte JW et al. Use of the TWEAK test in screening for alcoholism/heavy drinking in three populations. Alcohol Clin Exp Res 1993;17:1188-92.

Bush K, Kivlahan DR, McDonell MB et al. The AUDIT alcohol consumption questions (AUDIT- C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med 1998;158:1789-95.

Sokol RJ, Martier SS, Ager JW. The T-ACE questions: practical prenatal detection of risk-drinking. Am J Obstet Gynecol 1989;160:863-8.

Saunders JB, Aasland OG, Babor TF et al. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with armful alcohol consumption - II. Addiction 1993;88:791-803.

Selzer ML, Vinokur A, Van Rooijen L. A self-administered Short Michigan Alcoholism Screening Test (SMAST). J Stud Alcohol 1975;36:117-26.

Ferraguti G, Ciolli P, Carito V, Battaglese G, Mancinelli R, Ciafre' S, Tirassa P, Ciccarelli R, Cipriani A, Fiore M, Ceccanti M. Ethylglucuronide in the urine as a marker of alcohol consumption during pregnancy: comparison with four alcohol screening questionnaires. Toxicol Lett 2017, 275, 49-56. DOI: 10.1016/j.toxlet.2017.04.016

Lange S, Shield K, Koren G et al. A comparison of the prevalence of prenatal alcohol exposure obtained via maternal self-reports versus meconium testing: a systematic literature review and meta-analysis. BMC Pregnancy Childbirth 2014;14:127.

Kulaga V, Shor S, Koren G. Correlation between drugs of abuse and alcohol by hair analysis: par ents at risk for having children with fetal alcohol spectrum disorder. Alcohol 2010; 44:615-21.

Datta S, Turner D, Singh R et al. Fetal alcohol syndrome (FAS) in C57BL/6 mice detected through proteomics screening of the amniotic fluid. Birth Defects Res A Clin Mol Teratol 2008;82:177-86.

Floyd RL, Ebrahim S, Tsai J et al. Strategies to reduce alcohol-exposed pregnancies. Matern Child Health J 2006;10(5 Suppl):S149-151.

Floyd RL, Jack BW, Cefalo R. et al. The clinical content of preconception care: alcohol, tobacco and illicit drug exposures. Am J Obstet Gynecol 199:S333-S339, 2008

WHO Guidelines for the identification and management of substance use and substance use disorders in pregnancy. Geneva: World Health Organization; 2014 (, accessed 9 July 2016)

Schölin L. Prevention of harm caused by alcohol exposure in pregnancy. Rapid review and case studies from Member States, WHO, 2016.

Chang G. Screening for alcohol and drug use during pregnancy. Obstet Gyn Clin N Am 2014;41:205-12.

Higgins PG, Clough DH, Frank B et al. Changes in health behaviors made by pregnant substance users. Int J Addict 1995;30:1323-1333.

Handmaker NS, Miller WR, Manicke M. Finding of a pilot study of motivational interviewing with pregnant drinkers. J Stud Alcohol 1999; 60:285-287.

Chang G, McNamara TK, Orav EJ, Koby D, Lavigne A, Ludman B et al. Brief intervention for prenatal alcohol use: a randomized trial. Obstet Gynecol. 2005;105 (5 Pt 1):991-8.

Tzilos GK, Sokol RJ, Ondersma SJ. A randomized phase I trial of a brief computer-delivered intervention for alcohol use during pregnancy. J Womens Health. 2011;20:1517-24.

Osterman RL, Carle AC, Ammerman RT, Gates D. Single-session motivational intervention to decrease alcohol use during pregnancy. J Subst Abuse Treat.2014;47:10-9.

Floyd RL, Sobell M, Velasquez MM et al. Preventing alcohol-exposed pregnancies: a randomized controlled trial. Am J Prev Med 2007;32:1-10.

Chang G, McNamara TK, Orav EJ et al. Brief intervention for prenatal alcohol use: a randomized trial. Obstet Gynecol 2005;105(5 Pt 1):991-998.

O`Connor MJ, Whaley SE. Brief intervention for alcohol use by pregnant women. Am J Public Health 2007;97:252-8.

Miller WR, Sanchez VC. Motivating young adults for treatment and lifestyle change. In: Howard, G., ed. Issues in Alcohol Use and Misuse in Young Adults. Notre Dame: University of Notre Dame Press, 1994; 55-81.

Abel EL. Fetal alcohol syndrome in families. Neurotoxicol Teratol 1988;10:1-2.

Burd L, Martsolf JT, Klug MG et al. Diagnosis of FAS: a comparison of the Fetal Alcohol Syndrome Diagnostic Checklist and the Institute of Medicine Criteria for Fetal Alcohol Syndrome. Neurotoxicol Teratol 2003;25:719-24.

Coriale G, Fiorentino D, Di Lauro F, Marchitelli R, Scalese B, Fiore M, et al. Fetal Alcohol Spectrum Disorder (FASD): neurobehavioral profile, indications for diagnosis and treatment. Riv Psichiatr. 2013;48:359-69. DOI: 10.1708/1356.15062.

Young JK, Giesbrecht HE, Eskin MN et al. Nutrition implications for Fetal Alcohol Spectrum Disorder. Adv Nutr 2014;5:675-92. DOI: 10.3945/an.113.004846

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About The Authors

Daniela Fiorentino
`Sapienza` Università di Roma, Italy

Centro di Riferimento Alcologico della Regione Lazio

Valentina Carito
Istituto di Biologia Cellulare e Neurobiologia, IBCN-CNR, Roma, Italy

Simona Solombrino
`Sapienza` Università di Roma, Italy

Centro di Riferimento Alcologico della Regione Lazio

Giovanna Coriale
`Sapienza` Università di Roma, Italy

Centro di Riferimento Alcologico della Regione Lazio

Maria Concetta Marcella Scamporrino
`Sapienza` Università di Roma, Italy

Centro di Riferimento Alcologico della Regione Lazio

Paola Ciolli
`Sapienza` Università di Roma, Italy

Dipartimento di Scienze Ginecologico-Ostetriche

Marisa Patrizia Messina
`Sapienza` Università di Roma, Italy

Dipartimento di Scienze Ginecologico-Ostetriche

Marco Fiore
Istituto di Biologia Cellulare e Neurobiologia, IBCN-CNR, Roma, Italy

Mauro Ceccanti
`Sapienza` Università di Roma, Italy

Centro di Riferimento Alcologico della Regione Lazio

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