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The Dangers of Alcohol in Pregnancy

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It’s one thing to learn about the dangers of alcohol in pregnancy at a conference presentation. It’s another thing entirely to listen and think about my friend and the challenges she and her adopted daughter face. Every. Single. Day.

At the recent Health Journalism 2018 conference in Phoenix, pediatrician Yasmin Senturias, MD, FAAP spoke about fetal alcohol spectrum disorder (FASD), a group of conditions affecting children whose mothers drank alcohol during pregnancy. The term FASD describes a full range of diagnoses resulting from prenatal alcohol exposure. Children with FASD may have physical, neurological and neurobehavioural abnormalities. Those anomalies may affect the heart, kidneys, limbs, eyes and ears, but the biggest issue is permanent brain damage.

“Prenatal exposure to alcohol is the leading preventable cause of birth defects, intellectual disability and neurodevelopmental disorders. It is 100 percent preventable,” said Dr. Senturias. Her presentation was poignant as I thought about the years my friend has advocated tirelessly to help her daughter.

Dr. Senturias said that the problem with looking at FASD as a spectrum is that it may only be noticeable in severe cases which represent the minority. There are many more kids who are mildly to moderately affected and struggle without appropriate supports.

FASD affects from 2 to 5 per cent of American children, up to 1 in 20 children born. In Canada, a recent estimate says that up to 3 percent of Canadians or about one million people could have FASD and that this is likely a conservative estimate. Dr. Senturias said that about half of women who are of child-bearing age drink, and about half of all pregnancies are unplanned. Therefore, more children than we realize are at risk of harm.

Alcohol is a known agent that causes birth defects, called a teratogen. Dr. Senturias said, “I keep repeating: FASD is 100% preventable if no alcohol is consumed during pregnancy. There is no safe amount, no safe time, and no safe kind of alcohol during pregnancy.” If you think her position is a bit paternalistic, she clarified, “This is not about alcoholics. It’s not a judgment issue. It’s a medical issue.”

alcoholic drinks

Permanent brain damage

A baby’s brain develops during all three trimesters of pregnancy, so brain damage can occur any time alcohol is consumed. Alcohol is a small molecule that crosses the placenta to the baby. In the baby, it crosses the baby’s blood-brain barrier into the developing brain where it can cause permanent brain damage.

Brain damage from prenatal alcohol exposure can reduce the number of brain cells, cause brain cells to die, and result in slower brain processing.

Dr. Senturias refers to her patients with FASD as “ten-second people living in a three-second world.”

She outlined the areas of the brain and the functions that can be affected by prenatal alcohol exposure as follows:

  • frontal lobe – judgment, impulses, ability to plan and organize
  • hippocampus – memory
  • amygdala – emotions and emotional control
  • hypothalamus – appetite
  • cerebellum – coordination
  • basal ganglia – ability to switch to other tasks
  • corpus callosum – a thinner corpus callosum, the “information highway” between brain hemispheres, can impair learning. FASD kids with brain damage to this area may know something one day, but not the next.

Other symptoms and diagnosis difficulties

Children who are exposed to the most alcohol in utero may have notable facial abnormalities, or a lower than average height or weight. The facial anomalies include a smooth ridge between the nose and upper lip, a thin vermillion border (the line between the upper lip and skin), and small palpebral fissures (the spaces between the corners of the eye opening). Studies have found that facial abnormalities trace to alcohol exposure late in the first trimester of pregnancy.

Unfortunately, many people believe the myth that only children with these facial abnormalities have FASD. The truth is that most children with FASD do not have any visible physical abnormalities. The brain develops throughout all trimesters, so brain damage can happen at any time during a pregnancy if a mother drinks alcohol.

Diagnosis is tricky. Many mothers don’t admit to drinking alcohol during pregnancy or drank before they realized they were pregnant. Children who are adopted may have an incomplete health history. FASD shares many symptoms in common with attention deficit hyperactivity disorder (ADHD), such as executive function issues, problems staying on task, and emotional impulsivity, but medicines to treat ADHD don’t work for FASD due to brain damage. My friend notes that kids with FASD often have adverse reactions to medications. She has had her daughter try five or six different medicines so far, and nothing has worked.

Inadequate supports at school

Dr. Senturias said, “The big heartache is that too many kids with FASD are not getting support in school unless they have another diagnosis.” My friend couldn’t agree more.

Her adopted daughter was born with FASD because her biological mother drank alcohol. She has no outward physical abnormalities. However, she has neurodevelopmental delay, cognitive challenges, emotional issues, and learning disabilities. It has been an uphill battle for my friend to advocate for her daughter in school systems that seem hell-bent on not providing adequate accommodations.

The problem? There is no official way to diagnose FASD. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the authoritative handbook that healthcare professionals use to diagnose people, only recognizes fetal alcohol syndrome (FAS), the most severe form of FASD affecting a small minority of children at one end of whole FASD spectrum. A diagnosis of FAS requires the presence of three specific facial abnormalities, growth deficits and central nervous system abnormalities; or a confirmed history of prenatal alcohol exposure and central nervous system abnormalities. The rest of the children with FASD fly under the radar.

Ontario’s Education Act also doesn’t recognize FASD, so schools are not obligated to provide special education accommodations and support like they must for children with recognized diagnoses like autism. Every year, my friend tries her best to help teachers and principals understand her daughter’s diagnosis which was obtained in a private neuropsychological assessment over four years ago. Her daughter is now 13 and in Grade 7. She and all kids who were exposed to alcohol in pregnancy urgently need support to reach their full learning potential.

Last December 2017, Kingston MPP Sophie Kiwala raised Bill 191, an Education Amendment Act to promote awareness and understanding of FASD and best practices to support affected students. Bill 191 made it through first reading, but the Ontario government was prorogued in March 2018. As a result, it was recently brought back as Bill 44, Education Amendment Act (Fetal Alcohol Spectrum Disorder), 2018 and carried on first reading on April 11, 2018.

I hope that Bill 44 passes quickly, regardless of the outcome of the upcoming provincial election on June 7, 2018. My friend’s daughter, the other children living with FASD and the estimated 1 in 20 new children who will be born with FASD each year need help. The target enactment date is September 1, 2018. My fingers and toes are crossed.

Women considering getting pregnant should not drink alcohol for the duration of their pregnancy and even while breastfeeding. Their babies health depends on it.

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