A baby is born into the world taking that first breath. But soon after, it is discovered the baby is small and not eating well. On his second day of life, he develops seizures and is transferred to the neonatal intensive care unit (NICU). While trying to determine the cause of his seizures, his mother admits to heavily drinking alcohol while she was pregnant.
This scenario is not uncommon for babies born to mothers who drank heavily during pregnancy. They tend to be premature and need critical care with specialized staff in the NICU. However, most of the lifelong effects of fetal alcohol spectrum disorder (FASD) are detected as that baby grows up.
“Most infants born to mothers who consumed alcohol during their pregnancies will not be identified during the first few days of life. The adverse effects of prenatal alcohol exposure may be subtle or overlooked in the newborn period, especially those involving the central nervous system, which may not emerge until a child fails to meet developmental milestones or has difficulty at school,” said
Eustratia Hubbard, MD, pediatrician at UC San Diego Health.
FASD is an umbrella term describing the range of effects that can occur in a child whose mother drank alcohol during pregnancy. Some of the features include a small head, below average weight and height, difficulty with learning and behavioral problems.
“Unlike many other syndromes we may diagnose in infants and children, FASD is completely preventable by avoiding all alcohol in any amount during the entire pregnancy. When a pregnant woman drinks alcohol, so does her developing baby,” said Hubbard. “Any amount of alcohol, even the alcohol in one glass of wine, passes through the placenta from the mother to the growing baby and can have effects on their brain and other organs.”
The CDC reports one in 10 pregnant women in the United States drinks alcohol, defined as at least one drink of any alcoholic beverage in the past 30 days, and one in five pregnant women reports binge drinking.
“A pattern of binge drinking during pregnancy is thought to present the highest risk for FASD,” said Hubbard. “Heavy drinking during pregnancy can also increase the risk of prenatal issues, such as miscarriage, stillbirth and prematurity.”
Among the pregnant women in the CDC report, the highest prevalence of any alcohol use was among those who were:
- 35 to 44-years-old
- College graduates
- Not married
At the first prenatal care visit, health care providers ask mothers about their alcohol intake and counsel them to abstain from alcohol during the pregnancy. However, women may drink alcohol before they realize they are pregnant, during a critical period of fetal organ development.
“Signs warning about the dangers of alcohol consumption during pregnancy are posted in areas where liquor is sold and labels with the same information are on alcohol containers. Yet, many women are unaware that any amount of alcohol and any type, even beer from the local brewery, can cause harm,” said Hubbard.
A recent study by researchers at the University of California San Diego School of Medicine found the prevalence of FASD is much higher than previously thought.
The findings show a significant number of children across four regions in the United States were determined to have FASD. More than 6,000 first-graders in the Pacific Southwest, Midwest, Rocky Mountain and Southeast regions of the U.S. were evaluated in the study. Researchers found that 1 to 5 percent of the children were determined to have FASD.
“Our results suggest that the rate of FASD in children in the United States is as high or higher than autism spectrum disorders (ASD),” said Christina Chambers, PhD, MPH, co-principal investigator of the study, professor of pediatrics at UC San Diego School of Medicine and co-director of the UC San Diego Center for Better Beginnings.
The frequency of FASD in the study ranged from approximately 11 to 50 children per 1,000 per region, with the lowest estimate in one Midwestern region sample, and the highest in one Rocky Mountain region sample. Previous data suggests the estimated frequency in the U.S. is 10 per 1,000 children. The Centers for Disease Control (CDC) estimates the frequency of ASD at 14.6 per 1,000 8-year-olds.
Of the 222 children diagnosed with FASD in the study, only two had been previously diagnosed, although many parents and guardians were aware of the children’s learning and behavioral challenges.
“Our findings suggest that FASD is a critical health problem that often goes undiagnosed and misdiagnosed,” said Chambers. “Prenatal alcohol exposure is the leading preventable cause of birth defects and neurological abnormalities in the United States. It can cause a range of developmental, cognitive and behavioral problems, which may be recognized at any time during childhood and can last a lifetime.”
Chambers adds that her team’s findings from the four regions may not represent the nation overall, but the goal is that the estimates will contribute to strategies that will expand screening, prevention and treatment options for FASD.
“It is imperative that we find a solution to this global health problem,” said Chambers. “Women need to know that we have not been able to demonstrate a safe level of alcohol to drink while pregnant, so the best approach to prevention is to avoid alcohol in pregnancy.”
“I see first-hand what the consequences of drinking during pregnancy can do,” said Hubbard. “It is time to educate and raise awareness of FASD so babies are born healthy with the best start at life.”
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