Stricter Thinking on Alcohol During Pregnancy
By MELINDA BECK
Melinda Beck on Lunch Break looks at the
latest in warnings for pregnant women on drinking
alcohol during their pregnancies.
In the sixth to 12th week of pregnancy, a fetus’s
bones, brain and central nervous system are
forming. Buds blossom into arms and legs, and
internal organs start to function. A face with
eyelids, lips and other features appears.
This is also the time when a mother’s alcohol
consumption poses the greatest risk of doing
lifelong physical damage to her baby, according
to a new study of nearly 1,000 women who drank at
least once in their pregnancies.
On average, the women drank a small fraction of a
drink a day. But some downed as many as 12 drinks
a day?well above the amount considered safe for
the women’s own health?and binged frequently.
For each drink consumed each day over the daily
average in the second half of the first
trimester, the women’s babies were 12% more
likely to have a small head circumference, 16%
more likely to have low birth weight and over 20%
more likely to have a very thin upper lip or lack
a vertical indentation between their noses and
lips. While seemingly minor, those
characteristics are typical of fetal alcohol
syndrome, or FAS, and frequently presage
cognitive and behavior problems later in life.
A fetus in the seventh week of
pregnancy, above, is in the range of greatest risk from a mother’s drinking
Overall, the more the women drank, the more
likely their babies were to have such problems,
according to the study published last week in the
journal Alcoholism: Clinical and Experimental
Research. Some who averaged less than one drink a
day still had babies with some FAS characteristics.
“We found that there is no safe amount of alcohol
to drink during pregnancy,” says lead author
Haruna Sawada Feldman, a postdoctoral student at the University of . California, San Diego.
A few studies have found a drink or two a week
seemed to have little effect on babies. But most
of those relied on mothers’ recall after giving
birth, while the UC San Diego researchers
interviewed subjects throughout their pregnancies.
Fetal alcohol syndrome?an array of physical and
mental abnormalities including learning
disabilities, language delays, poor concentration
and low IQ?was first recognized in the early
1970s. Experts have never pinpointed how much
alcohol it takes to cause damage, so the U.S.
Surgeon General, the Centers for Disease Control
and Prevention and the March of Dimes all urge
women not to drink at all if they are or might become pregnant.
Some women drink anyway?in part because friends,
family members and even some obstetricians say an
occasional drink isn’t likely to cause harm.
“We know that alcohol crosses the placenta; we
know that it’s linked to mental and physical
problems; so why risk it?” says Tom Donaldson,
president of the National Organization for Fetal
Alcohol Syndrome, or NOFAS, a nonprofit advocacy group.
In government surveys, about 12% of pregnant
women in the U.S. report drinking some alcohol in
the past 30 days and about 2% report drinking
five or more drinks at a time. The CDC estimates
that of approximately four million U.S. infants
born each year, between 1,000 and 6,000 fit the
criteria for FAS. Experts think as many as 40,000
a year have some neurological or behavior issues
caused by prenatal alcohol exposure, a broader,
less well-defined range of conditions known as
fetal alcohol spectrum disorder, or FASD.
Why alcohol seemingly affects some unborn babies
but not others remains a mystery.
“There’s a huge amount that we still don’t know
about this disorder,” says Kenneth Lyons Jones,
one of the physicians who first recognized the
danger of alcohol in pregnancy when he and a
colleague noticed that eight children in a
Seattle clinic all had similar facial features
and developmental problems and discovered that
all had been born to alcoholic mothers.
Dr. Jones, now a professor of pediatrics at UC
San Diego and a co-author of the study,
speculates that genetic differences may at least
partly explain why some babies are more affected
than others. He and other researchers are also
investigating whether a mother’s health and
nutrition may play a role, studying pregnant
women in Ukraine where the incidence of FAS is high.
In the U.S., experts say most children who fit
the criteria for FAS or FASD never get a formal
diagnosis. Many of the cognitive and behavioral
problems are common in the general population and
some are subtle enough to go unrecognized.
Mothers who drank during pregnancy are often
reluctant to admit it and physicians are often
loath to voice suspicions, experts say. What’s
more, there are no blood tests or other
biomarkers to show alcohol exposure in the womb.
But the damage can last a lifetime.
Researchers at Emory University in Atlanta have
been following a group of alcohol-affected
children born between 1980 and 1986 into young
adulthood. (“In those days, mothers told us
everything,” says Claire Coles, a professor of
psychiatry at Emory and the project leader.)
Not all those whose mothers drank have suffered
physical or cognitive damage. One recently
graduated from Princeton University, says Dr.
Coles. But many have visual and spatial
difficulties and trouble encoding memories.
Functional MRI studies have found that
corresponding areas of their brains are abnormal.
Many also have trouble with math concepts,
starting around age 5. “You can get them to say
that 2 plus 2 equals 4, but they don’t know what that means,” says Dr. Coles.
She and others have designed learning programs
that address the specific needs FAS children
have?but she stresses that it’s important to
identify them early, when their brains are most
adaptable. Other experts agree. The American
Academy of Pediatrics plans to issue new
guidelines this year urging pediatricians to look
for signs of FAS and FASD in their young patients
and urge parents to seek help.
Admitting that their drinking may have caused
their children’s problems can be difficult for mothers, however.
“It takes a lot of courage to own this and tell
people, ‘Yes, I drank while I was pregnant,'”
says Kathy Mitchell, who had three children by
the time she was 20 years old in the 1970s and
drank wine with each pregnancy. Two of them are
healthy, but one daughter, now 37, has severe
FAS. Two other children died in infancy, which
Ms. Mitchell also attributes to her drinking.
Now a recovering alcoholic and spokeswoman for
NOFAS, Ms. Mitchell works with families who have
adopted FAS children, knowingly or unknowingly,
as well as birth mothers who are “stunned and
remorseful and full of guilt,” she says.
“No one intentionally sets out to harm her
children,” says Ms. Mitchell. “Most birth
families who receive the diagnosis don’t tell
anyone. But it’s not going to get prevented if we call it something else.”
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