- Dosage (blood alcohol level)

- Pattern of drinking

- Timing during gestation

- Advanced age

- Genetic sensitivity

- Maternal metabolism ( chronic use of alcohol)

- Nutrition / Parity

- Active teratogenic metabolites

- Synergy with other agents (environment)

- mental health issues

(identical twins both affected, fraternal twins not necessarily both affected)

Alcohol passes freely from the mother to the fetus through the placenta

fetal liver cannot metabolize alcohol efficiently

blood alcohol levels are equivalent between the woman and fetus within one hour

alcohol levels are lower in amniotic fluid but persist for longer

First trimester

- cell damage

- brain damage

- substantial structural changes

Second trimester

- poor nutrition can retard the growth of tissue and organs

- risk of miscarriage

Third trimester

- lower birth weight/overall amount of growth

-increases likelihood of early labor and delivery

-mental retardation

Growth restriction: babies are born smaller than anticipated for the gestational age at birth, usually remain so throughout life

Central Nervous System: any or all of the following conditions present - mental retardation, developmental delays, short attention span, impulsivity, perceptual problems, hyperactivity, poor coordination and learning disabilities

Facial anomalies: babies have the following distinctive facial features:

- small widely spaced eyes

-short upturned nose

-smooth philtrum

-abnormally thin upper lip and small flat cheeks