|
Fetal alcohol
syndrome (FAS) is a devastating byproduct of drinking
during pregnancy. Its impact is lifelong, but with early
intervention, FAS children can improve.
Consider the murky messages
about drinking alcohol during pregnancy cleared up:
There’s no safe time during pregnancy to drink;
no safe amount of alcohol; and no safe type of alcohol—period.
That’s the way
Dr.
Susan Adubato, clinical assistant professor of pediatrics
and psychiatry at New Jersey Medical School, explains
the current recommendations for women who are pregnant
or are planning a family. Her message might sound hard
line, but the potential consequences are lifelong and
can be severe.
When a pregnant woman
drinks, a fetus receives the alcohol by way of the mother’s
placenta, just as he or she does oxygen and nutrients.
But instead of being life-sustaining, alcohol can cause
irreversible damage by destroying the fetus’s
developing brain cells or affecting the growth of other
cells. Once the baby is born, the impact can run the
gamut from behavioral problems to mental retardation.
More than 30 years ago,
researchers identified the condition that encompasses
some of the problems alcohol-exposed fetuses can have:
Fetal Alcohol Syndrome (FAS) is characterized by a baby’s
abnormal facial features, slow growth, and impairment
to the central nervous system. FAS, which affects an
estimated 1 to 3 of every 1,000 babies born in the U.S.,
has the dubious distinction of being the leading preventable,
non-hereditary cause of mental retardation.
Dr.
Salma Ali, a neonatologist at University Hospital
and director of the state-funded Horizon Program for
substance abusing mothers, sees far too many infants
with the telltale characteristics of FAS. “A baby
exposed to alcohol while in the womb often has distinctive
facial features, including a flat, long upper lip,”
she says. “He or she is undersized, can be a fussy
eater, and has a small head circumference. When the
mom has been drinking for much or all of her pregnancy,
the baby might also show symptoms of alcohol withdrawal:
irritability, tremors, sweating, diarrhea, and a low
blood glucose level.”
During and after the
pregnancy, these women can be enrolled in the Horizon
Program for intensive outpatient alcohol and drug treatment
and rehabilitation. The Horizon Program also provides
counseling in the areas of substance abuse; HIV and
other sexually transmitted disease exposure; vocational
and life skill training; crisis intervention; parenting,
individual, couple, and family counseling; home visits;
referrals to mental health and inpatient drug rehabilitation
programs; and referrals to pediatric high risk and continuity
care clinics.
 |
 |
| Photo courtesy of
Sterling Clarren, MD |
Many children affected
by their mother’s drinking do not meet the full
criteria for FAS, but rather, have related conditions
that are part of a broader category, Fetal Alcohol Spectrum
Disorders (FASD). These conditions include Alcohol-related
Neurodevelopmental Disorder (ARND), which refers to
children with primarily intellectual and behavioral
problems, and Alcohol-related Birth Defects (ARBD),
which encompasses several physical manifestations, such
as bone and kidney problems. About 3 to 5 of every 1,000
babies born in the U.S. has FASD. According to the National
Organization on Fetal Alcohol Syndrome, there are more
new cases of FASD each year than Down syndrome, cerebral
palsy, and spina bifida combined. (See
sidebar "FAS: A Mother’s Story")
A
Lifetime Disability
Not
all children with FAS or FASD are diagnosed as infants.
In more mildly affected children, it can take time for
the neurobehavioral or intellectual differences to become
evident. “When a toddler or preschooler isn’t
meeting developmental milestones, that’s when
parents often start asking questions,” says Dr.
Barbie Bier, director of developmental pediatrics
at University Hospital. “The child might have
problems playing with other kids or difficulties with
language. Obviously, not every child with developmental
delays has FAS, but when it’s known that the mother
drank alcohol during pregnancy, we see these problems
in a different light.”
When FAS or FASD are
suspected, Dr. Bier recommends that the child undergo
comprehensive testing. In 2002, the state of New Jersey
opened six centers where a full range of diagnostic
tests and case management services are available for
FAS/FASD children. One site of the Northern New Jersey
FASD Diagnostic Center, under the direction of Dr. Adubato,
is located on the Newark campus shared by University
Hospital and New Jersey Medical School. Anyone who believes
a child should be evaluated—a physician, a parent
or a guardian, a teacher—can call the center for
more information. (See the center’s phone number
at the end of the article.) The center is staffed with
specialists from the fields of psychology, social work,
developmental pediatrics, occupational therapy, speech
and language therapy, nursing, and learning disabilities.
A complete evaluation includes assessment of a child’s
cognitive abilities, speech, gross and fine motor skills,
and psychosocial development.
The earlier a child with
FAS or any of the related conditions is diagnosed, the
sooner he or she can receive the appropriate services.
Early intervention is considered very important. And
yet, there’s no cookie-cutter approach to treatment
because the needs of one child with FAS can be dramatically
different than what another child requires. “We
see children with a range of difficulties, some who
are highly functioning and others who have a low IQ.
It’s a misconception that all children with FAS
are mentally retarded, although some are,” says
Dr. Bier.
Some of the children’s
problems are behavioral in nature, such as difficulty
in regulating their moods. They are happy one minute
and upset the next. Others struggle with language and
concrete thinking. “It’s not uncommon for
a child with FAS to have difficulty with the idioms
and sayings easily understood by others,” notes
Dr. Adubato. “One young woman with FAS was told,
‘Don’t come home after dark,’ so she
stayed out on the porch all night.”
A
Drink is a Drink
FAS and FASD are completely
preventable, but the keys to prevention begin with education
and communication. Even women with the best of intentions
for a healthy pregnancy can be confused by long-held
beliefs. One common misconception is that beer and wine
coolers are not “real alcohol.” Says neonatologist
Dr. Ali, “When I take a birth history, I ask the
mother if she drank alcohol while she was pregnant.
Often, the answer is no. ‘Not even beer?’
‘Oh, well, yes, I drank some beer.’ Many
women believe that only hard liquor can harm the baby,
and it’s simply not the case.”
Years ago, doctors would
tell their patients that an occasional drink was ok
during pregnancy. While it’s true that the less
a woman drinks, there’s less potential for harm,
any damage that occurs lasts a lifetime. A recent study
indicated that even two drinks during the first trimester
can damage the fetus’s brain cells.
On the other end of the
drinking spectrum, there’s the binge drinker and
a person who has alcoholism. Binge drinking has increased
in popularity in the United States, particularly among
young people, and that troubles those who work in the
FAS field. “There’s a correlation between
binge drinking and children who are the most severely
affected by FAS,” says Dr. Adubato. Heavy drinking,
defined as seven or more drinks in a week, also increases
that possibility; add to the equation that alcoholics
are more likely to engage in other risky behaviors—illegal
drug use and smoking—that can harm the fetus.
Certainly, not all children
with FAS or FASD are born to moms with drinking problems.
About half of all pregnancies in the U.S. are unplanned,
meaning that many women drink alcohol when they are
unaware they are expecting. Unfortunately, there’s
no way to turn back the clock, but the experts’
advice to pregnant women who’ve drank alcohol
is to abstain from any more for the remainder of the
nine months. “Our education efforts need to start
early, even among teenagers,” says Dr. Ali. “But
if a woman doesn’t get the message before she
becomes pregnant, the next best thing is that she stops
drinking right away.”
No
Safe Amount
The
medical community’s position on pregnant women
and alcohol has changed over time. In 1981, the U.S.
Surgeon General recommended that pregnant women limit
the amount of alcoholic drinks they consumed. As researchers
have brought new findings to light, there’s been
a growing consensus among healthcare professionals that
no amount of alcohol is a safe for a fetus at any stage
of development. This February, the current U.S. Surgeon
General issued a new advisory urging pregnant women
to abstain from alcohol. “I now wish to emphasize
to prospective parents, healthcare practitioners, and
all childbearing-aged women, especially those who are
pregnant, the importance of not drinking alcohol,”
said U.S. Surgeon General Richard H. Carmona.
To reach women with this
message, it’s essential to reach the obstetricians,
nurse midwives, family practitioners, and any other
healthcare worker in a position to counsel women of
childbearing age. Although professional organizations
such as the American College of Obstetricians and Gynecologists
embrace a “no drink” policy, according to
Surgeon General Carmona, only 24 percent of obstetrical
textbooks published since 1990 recommend abstinence
from alcohol during pregnancy.
Recognizing the need
to close this gap, the Centers for Disease Control provided
funding for FAS education programs. Dr. Michael Brimacomb,
associate professor of preventive medicine at New Jersey
Medical School, is the director of the New Jersey Regional
FAS Education & Training Center, which through presentations
at medical societies, continuing education classes and
hospital grand rounds, explains the latest in research
and ways healthcare professionals can communicate the
alcohol abstinence message to women. Dr. Adubato and
Dr. Bier are involved with this program, which also
has a curriculum development component.
The
Outlook
There
aren’t many happy FAS or FASD stories to tell.
And yet, there are glimmers of hope, both with prevention
efforts gaining momentum and with the prospects for
affected children.
FAS has lifelong ramifications, but the outlook for
some people with the condition is better than it was
20 years ago. “Early intervention and support
services are making an important difference. Children
with FAS and FASD can often go to school with their
peers, and in New Jersey, they must be placed in the
least restrictive environment,” says Dr. Bier.
“As they grow up, some adults have jobs and are
able to live independently. When that happens, it is
very rewarding.”
To contact
the Northern New Jersey FASD Diagnostic Center, please
call (973) 972-8930. To contact the Horizon Program
for Drug and Alcohol Exposed Pregnant Mothers and Infants,
please call (973) 972-4184.
|
|
