In the United States, approximately 80 000 women consume ethanol through all 3 trimesters of pregnancy each year. In this article, we review prevalence rates of prenatal alcohol exposure in the United States and discuss the mechanisms of prenatal alcohol exposure and placental-umbilical effects. Cigarette smoking and delayed prenatal care are often associated with prenatal alcohol exposure. In addition, increased risk for postnatal adversity is common, including maternal depression, foster care placement, and developmental delay. In part 2, we review prevalence rates and the diagnostic criteria for fetal alcohol spectrum disorder and the implications for child neurologists. We discuss management strategies and the importance of a long-term management plan and anticipatory management to prevent the development of secondary disabilities in fetal alcohol spectrum disorders. Child neurologists play a key role in diagnosis and the development of appropriate intervention programs for affected children and their families.

In part 1, we discussed the mechanism of alcohol exposure, dosimetry, and the teratogenic pathways of damage to the fetus. In part 2, we review the diagnosis of fetal alcohol spectrum disorders and the developmental implications of prenatal alcohol exposure. Fetal alcohol spectrum disorders are associated with increased rates of mental retardation, seizure disorders, brain malformations, and premature mortality. The risk of comorbid disorders is increased among this population, which enhances phenotype severity and complexity of management. Recurrence rates are high and younger siblings tend to be more severely affected. Detection of prenatal alcohol use warrants substance abuse intervention, which can avoid exposure in subsequent pregnancies. Fetal alcohol spectrum disorders are common developmental disorders with a phenotype that is influenced by both age and development and require long-term management. Child neurologists are essential in the diagnosis and management of fetal alcohol spectrum disorders.

Fetal alcohol spectrum disorders (FASD) may be common in adolescents and adults in the corrections systems. However, current prevalence estimates for FASD suggest that nearly all affected people are undiagnosed in corrections systems. In this article we provide an overview of our experience with FASD in corrections populations and present strategies for screening, assessment and intervention. We conclude with a plan to provide training to corrections staff in response to identified preferences and needs identified by Canadian and American corrections staff.