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What happens if a woman drinks during pregnancy?

Drinking alcohol (beer, wine, liquor) during pregnancy exposes the fetus to alcohol. Alcohol is passed from the mother to the fetus through the placenta. High exposure to alcohol can cause Fetal Alcohol Syndrome (FAS) or Alcohol Related Birth Defects (ARBD).

Children with FAS can have:

Low birth weight

Eating and sleeping problems

Vision and hearing problems

Learning disabilities

Problems with academic achievement

Need special teachers and schools

Heavier drinking has been associated with greater disabilities (Lynch). Alcohol-affected individuals can face a lifetime of difficulties as a result of exposure.

References:

National Institute on Alcohol Abuse and Alcoholism; www.niaaa.com Lynch, M. E., Coles, C., Fernhoff, P., Schmieding, S. (2003). Longitudinal Effects of Prenatal Alcohol Exposure on Growth and Dysmorphic Features.

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What are Fetal Alcohol Syndrome (FAS) and Alcohol Related Birth Defects (ARBD), and Alcohol Related Neurodevelopmental Disorder (ARND)?

FAS or Fetal Alcohol Syndrome is a pattern of mental and physical problems that may occur in some children whose mothers consumed alcohol during pregnancy.

ARBD or Alcohol Related Birth Defects are physical anomalies that may occur in some children who have been prenatally exposed to alcohol but do not have full FAS (cite IOM – FAS)

ARND or Alcohol Related Neurodevelopmental Disorder describes problems alcohol exposed children, without full FAS, may have that relate to the central nervous system. Examples: brain size, fine motor skills, hand-eye coordination.

References:

Stratton K., Howe C., and Battaglia F., editors. (1996) Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment Report of a study by a committee of the Institute of Medicine, Division of Biobehavioral Sciences and Mental Disorders. National Academy Press.

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How common is Fetal Alcohol Syndrome?

Figures vary as to the exact number of children born with FAS. In most communities, about 0.5 to 3 children out of a 1000 are born with full FAS. But, in some communities the number is much higher. (IOM – Fetal Alcohol Syndrome). Many heavily-exposed children do not have full FAS but less severe Alcohol Related Birth Defects (ARBD) or Alcohol Related Neurodevelopmental Disorders (ARND). ARBD and ARND affect about 1 out of 100 live births or as many as 40,000 infants each year.

References:

National Organization of Fetal Alcohol Syndrome. www.nofas.org Stratton K., Howel C., and Battaglia F., editors. (1996) Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment Report of a study by a committee of the Institute of Medicine, Division of Biobehavioral Sciences and Mental Disorders. National Academy Press.

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What common problems do children with FAS have?

Failure to thrive in infancy - indicating significant growth delay

Feeding problems such as weak suck and difficulty grasping a nipple in infancy, and later decreased appetite

Sleeping problems such as trouble going to sleep and or restless sleep

Minor medical problems such as ear infections, allergies, and asthma

Delays in motor development in infancy including poor gross motor skills, delays in fine motor skills, and hand tremors

Attachment disorders which may include indiscriminate attachment or failure to attach due to environmental factors.

Specific learning disorders at school age, with better performance in reading and language, poorer ability in mathematics.

•Mild mental retardation - (IQ<70). Borderline intelligence - 70 to 85.

Alcohol exposed children may also have physical problems:

Unusual facial features (see pictures below) that include short palpebral fissures, thin upper lip, flattened philtrum, lowset ears, and flattened midface

Low birthweight and continued small size until puberty, when catch-up growth is common

Damage to the nervous system such as decreased cranial size at birth, structural brain abnormalities, and neurological hard or soft signs.

Typical Child Alcohol Affected Child

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How is Fetal Alcohol Syndrome diagnosed and treated?

FAS needs to be assessed by a team of specialists to make an accurate diagnosis and determine the best approach to treatment.

A Comprehensive Assessment Includes:

Diagnosis must be made by a Dysmorphologist

Medical status to document head circumference, height, weight, etc. as well as to address associated minor medical problems

Neurodevelopmental assessment to include IQ, achievement, visual-motor, attention, adaptive behavior, and social-emotional development

Family evaluation by social worker to assess need for community support and referrals to outside agencies

Educational assessment to insure most appropriate and least restrictive educational placement

Occupational Therapist/Physical Therapist/Speech Therapist to address commonly associated deficits in fine motor, gross motor, and expressive language development

Focused Treatment:

Identify problems based on comprehensive assessment

Recommend specific treatments to include medical, psychological, and educational interventions

Coordinate efforts to insure continuity of care as well as to maximize chances for successful outcomes

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Can Fetal Alcohol Syndrome and Alcohol Related Birth Defects be prevented?

Yes. FAS and ARBD can be prevented completely if a pregnant woman does not drink alcohol. Although about 43% of women of child-bearing age drink alcohol regularly, most quit or drink less when they become pregnant [citation - 2003 National Survey on Drug Use & Health. Research has shown that a fetus can be affected by alcohol at all stages of a pregnancy - even the earliest stages. There is no safe time to drink during a pregnancy. Women who are trying to get pregnant or having unprotected sex without contraception should refrain from using alcohol. Often pregnancies are not detected until some weeks or months after conception.

References:

2003 National Survey on Drug Use & Health, Substance Abuse and Mental Health Services Administration http://www.oas.samhsa.gov/nhsda/2k3nsduh/2k3Results.htm#ch3

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What are the long term effects of Fetal Alcohol Syndrome (FAS) and Alcohol Related Birth Defects (ARBD)?

Children born with FAS or ARBD can face the effects of alcohol for their entire lifetime. The primary disabilities, brain damage and physical deficits, caused by alcohol cannot be reversed. Without proper and timely intervention, alcohol effected children can also develop secondary disabilities.

Examples of secondary disabilities are

Mental health problems

Problems at school

Alcohol/Drug problems

Problems with employment

Independent living difficulties

While primary disabilities cannot be prevented, secondary disabilities can. Research has shown that there are certain factors which prevent alcohol effected children from developing secondary disabilities. These factors are called universal protective factors.

Some examples are

Living in a stable and nurturing home

Being properly diagnosed especially at a young age (before 6)

Never experiencing personal violence

Receiving proper disability services Having basic needs met

References:

Streissguth, A. P., Barr, H. M., Kogan, J., Bookstein, F. L. (1996). Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE)

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Why is alcohol so harmful to a developing fetus?

Alcohol is a teratogen, which is a substance that is harmful to a developing fetus. Other teratogens are: environmental toxins (like PCBs), lead, mercury, as well as a number of drugs such as thalidomide, warfarin, and antabuse [link terms to glossary] (IOM- FAS). The exact mechanism of prenatal alcohol harm is unknown at this time and more research is needed. However, research has shown that a fetus can be affected by alcohol at all stages of a pregnancy. There is no safe time to drink during a pregnancy.

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Where Can We Get More Information?

The Maternal Substance Abuse and Child Development Study is under the direction of Claire D. Coles Ph.D., with the Department of Psychiatry and Behavioral Science, Emory University School of Medicine.

For more information, please contact:

Claire D. Coles: ccoles@emory.edu

Karen K. Howell: khowell@emory.edu

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Where Can Our Child Receive Diagnostic and Clinical Services?

FAS Clinic Marcus Institute 1920 Briarcliff Road NE Atlanta, GA 30324 (404) 419-4250

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