Alcohol is an inextricable and largely inescapable part of American culture. We see sexy beer commercials on television, hear humorous spots for alcoholic beverages on the radio, and see arty liquor ads in magazines. The promotion of alcohol is all around us and has been a part of life for thousands of years. We entertain and relax by drinking, use alcohol to enhance conviviality and set the mood for romance. Many women drink socially for a number of reasons. But one thing is certain: when a woman is pregnant, drinking is one of the most potentially harmful things she can do.

The reason? Fetal Alcohol Syndrome (FAS). Doctors tell us that FAS is one of the leading causes of birth defects and developmental disabilities in the United States.

According to the National Pregnancy and Health Survey sponsored by the National Institute of Drug Abuse (NIDA), National Institutes of Health, an estimated 4 million women gave birth in the United States in 1992, and of these women, nearly 19 percent used alcohol. This is probably a conservative estimate. There apparently is an increasing frequency of the FAS problem in the U.S. The Centers for Disease Control and Prevention, Atlanta, tell us this may reflect a true increase in the number of infants with FAS, or an increase in the awareness and diagnosis of FAS in newborns by physicians.

What causes FAS?

FAS results from the toxic effect of alcohol and its byproducts on the developing brain. The alcohol enters the baby's bloodstream through the placenta. Doctors aren't sure when alcohol becomes a danger. However, they do know that women who usually drink two or more drinks a day or binge have the greatest danger of delivering babies with FAS. The equivalent of one to two ounces of straight alcohol a day is enough to cause real damage. Although the fetus may be in greatest danger early in a woman's pregnancy, studies have found that mothers who drink only during the later part of their pregnancies have more premature and small babies than women who abstain. Pregnant women are on safest ground when they avoid alcohol completely.

Donna Nimec, M.D., coordinator of the Kids in Need program, Denver, Colorado and the Colorado Fetal Alcohol and Substance Abuse Coalition, says that every FAS child is different. Diagnosis is difficult, but it always involves the following three physical characteristics:

1. Growth retardation
   • children are born small and generally stay small.
2. Facial Defects
   • Small head - known as microcephaly
   • Small eyes, these may look wide set.
   • Mid-face defects --flattening of the cheekbones, lack of definition between the nose and lip,pugnose, small chin, extra skin in the middle part of eye.
3. Some central nervous system defects
   • Attention problems
   • Seizures
   • Learning disabilities
   • Hearing problems

Children with FAS may suffer from mental retardation, poor muscle coordination, chronic middle ear infections, and dental and vision problems. Dr. Nimec emphasizes that diagnosis is made on the basis of physical characteristics, because behavioral defects can be so varied and diagnosis made on the basis of behavior can be very subjective.

Is any amount of alcohol safe?

Most likely one drink a week will not harm the fetus, but because alcohol affects different women in different degrees, even light drinking may be harmful.

"FAS is the single greatest cause of mental retardation in the U.S. today," said Douglas A. Millligan, M.D., a maternal-fetal medicine specialist at the University of Kentucky. "Approximately 67% of women in the U.S. drink at some time during pregnancy and there is no accepted safe level of drinking. The signs of FAS are more common in heavy drinkers, but most of the studies define heavy drinking as two drinks a day. Even a single binge in pregnancy has been associated with learning disabilities."

Doctors have also found that moderate drinking can lead to an increased chance of spontaneous abortion. The American Academy of Pediatrics (AAP) recommends that a woman not drink while she is pregnant. This is the only sure way of preventing FAS.

Getting help for a drinking problem is essential

Dr. Nimec says that women are more highly motivated to seek treatment for drinking problems during pregnancy. Most women really care about their babies and may put more effort into abstaining to have a healthy child. Dr. Nimec also observes that women may need special treatment focusing on female issues. While alcohol and drug treatment programs for men are in plentiful supply nationwide, such programs specifically for women are hard to find, and this problem should be corrected, according to Dr. Nimec.

Pregnant women should remember that alcohol consumption is only one factor affecting the health of her baby. Care should begin even before pregnancy. When a woman is planning to have a baby, she should quit smoking and drinking, and eliminate drug use -- unless advised to the contrary by her physician. In addition, 0.4mg daily intake of folic acid before conception and during pregnancy can decrease the incidence of open neural tube defects, such as spina bifida, a heart-breaking birth defect affecting approximately one in every 1,000 babies born in the United States. Unfortunately, many women do not seek care until the pregnancy is well underway.

If you are actively trying to conceive or if you think there's even a chance you may be pregnant, developing an ongoing relationship with a primary care physician or obstetrician/gynecologist is very important to the well-being of both you and your unborn child. The AAP encourages physicians to increase their awareness of alcohol exposure during pregnancy to help identify, and possibly prevent, birth defects. Taking strict precautions while pregnant is the least a woman can do for her baby.

For more information on Fetal Alcohol Syndrome or to learn more about what can be done to increase your chances of having a healthy baby, contact:

Kids in Need Program

The Children's Hospital, Denver, Colorado USA
(303) 861-6630

Kathy Akerlund
Special Connections
Colorado Department of Public Health and Environment

4300 Cherry Creek Drive South
Denver, CO 80222 USA
(303) 692-2952

The American College of Obstetricians and Gynecologists
(ACOG)

Office of Public Information
409 12th Street, S.W.
Washington, D.C. 20024-2188 USA
Phone: (202) 484-3321
FAX: (202) 479-6826

Public Health Service
Office of Disease Prevention and Health Promotion

Room 2132
330 C Street, S.W.
Washington, DC 20201 USA
Phone: (202) 205-9370

The American Academy of Pediatrics

P.O. Box 927
Elk Grove Village, IL 60009-0927 USA
Phone: (708) 228-5005
FAX: (708) 228-5097

The American Academy of Family Physicians

8880 Ward Parkway
Kansas City, Missouri 64114-2797 USA
Phone: (816) 333-9700
FAX: 816-822-0580

American Public Health Association

1015 Fifteenth Street, NW
Washington, DC 20005 USA
Phone: (202) 789-5600
FAX: (202) 789-5681

American Medical Women's Association

801 N. Fairfax Street, Suite 400
Alexandria, VA 22314 USA
(703) 838-0500

March of Dimes Birth Defects Foundation

1275 Mamaroneck Avenue
White Plains, NY 10605 USA
(914) 997-4600

Joel R. Cooper
The Medical Reporter
Medical/Healthcare Writing, Reporting, Editing
Medical/Healthcare Information Service/Clearinghouse
jcooper@medreport.com
jcooper@usa.net
(303) 337-6299, phone
(303) 337-9201, fax
P.O. Box 370314
Denver, Colorado 80237 USA