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Research Summary

Risk Factors for Fetal Alcohol Syndrome

Identifying maternal risk factors associated with fetal alcohol syndrome (FAS) can help inform prevention efforts. Using a population-based sample in the Western Cape Province of South Africa (an area with extremely high FAS rates), researchers compared mothers of first graders born with FAS (cases; n=53) with mothers of first graders without FAS (controls; n=116).

  • Cases were significantly more likely than controls to live in a rural area during their index pregnancy, work on a farm, have a greater number of children, and have a lower income and educational attainment. They were significantly less likely to be married while pregnant and to participate in religious activities.
  • Cases drank for more years (13 versus 4) and had greater current use (13 versus 1 drink per week; binge drinking* among 70% versus 6%).
  • During pregnancy, over 85% of cases consumed the same or more than their current levels. Over 84% of controls drank less than their current levels.
  • Immediate family members of cases drank significantly more than did the immediate family of controls (e.g., 63 drinks per month for fathers of cases versus 32 drinks for fathers of controls).
  • Cases were also more likely to have smoked during pregnancy (e.g., 76% versus 27% during the third trimester).


This study confirms that the range of maternal risk factors associated with FAS is broad. Clearly, maternal alcohol consumption is the key risk factor for FAS; how other factors increase risk is less clear. Nonetheless, clinicians should consider and address all of these factors during prenatal assessments.

Joseph Conigliaro, MD, MPH
*>=3 drinks on >=1 days in the past week


May PA, Gossage P, Brooke LE, et al. Maternal risk factors for fetal alcohol syndrome in the Western Cape Province of South Africa: a population-based study. Am J Public Health. 2005;95(7):1190-1199.