Epidemiological appraisal of the literature on the fetal alcohol syndrome in humans.

An evaluation of the evidence regarding the association between heavy maternal alcohol intake during pregnancy and the occurrence in offspring of that cluster of abnormalities called the Fetal Alcohol Syndrome is undertaken from an epidemiological perspective. Areas of concern in assessing the literature include the objectivity with which the maternal drinking history was obtained, the nature, systematic or not, of examination of offspring, the presence or absence of a comparison group, the control for potentially confounding factors and, perhaps most important of all, whether or not the identification of a case was made blind to knowledge of the maternal drinking history. While well-documented evidence that can implicate a hypothesized teratogen is difficult to obtain, the data available concerning the effects of in utero exposure to high doses of alcohol must be carefully and thoughtfully scrutinized so that valid inferences may be drawn. In this review particular attention is focused on the nature of the association between in utero alcohol exposure and mental retardation, certainly the most devastating of the FAS features.