September 9th is International FASDay and I bet that you have never heard of it. In 1999, a group of parents in Canada some US cities decided that on the ninth month on the ninth day at 9:09 am it would be a good time to call some attention to Fetal Alcohol Spectrum Disorders and fact that it is 100% preventable during the nine months of pregnancy. Since that time, FASDay has come to be recognized all over the world and is celebrated by the ringing of church bells, federal, state, and local proclamations, alcohol-free drink competitions at bars, meetings on capitol steps (even in Sacramento), and other fun and informative activities. Culver City even proclaimed FASDay in 2008. And yet, this may be the first time that you have heard of it.
Fetal Alcohol Spectrum Disorders (FASD) occurs when a pregnant woman drinks alcohol: beer, wine, champagne, hard liquor, etc. It can happen even if you only have one drink. Alcohol is a small molecule that can pass the placenta unmodified and whatever attribute of the fetus that may be developing that day may be affected (a teratogen). You may think that it is rare, but the Centers for Disease Control (CDC) notes that 1 in 1000 live births results in full Fetal Alcohol Syndrome (FAS) and that 1 in 100 live births is alcohol affected in some way. Alcohol exposure is the number one cause of mental retardation and birth defects in the US, higher than autism, spina bifida, and Down’s syndrome. And yet, it is the one cause of birth defects that is 100% preventable.
“So why have I not heard of it?” you may ask. Sometimes FASD is misdiagnosed as ADHD, autism, Oppositional Defiant Disorder, bi-polar disorder, Sensory Integration Disorders, or other learning disabilities. There is no single community that is specifically affected; it can happen in poor families or affluent families, it affects all women who drink alcohol when they are pregnant. But unlike most birth defects, this is caused by something that is legal, readily available, and socially acceptable, and it can do life-long damage, even in very limited exposures. Until recently, OB/GYNs were not trained to even ask if mothers were drinking. Locally, UCLA started training their medical and nursing students in the 2000’s to use a screening process when patients first go to the doctor or public health nurse, to inform patients of the risks of alcohol during pregnancy and to identify babies at birth, if possible.
The U.S. Surgeon General states that there is no safe amount of alcohol during pregnancy. None. “But I read a book or a study that says that light drinking is ok,” you might say. The headlines for some studies might make it appear that light or moderate drinking is OK. But if you read the studies or the follow-up from the medical community, you will find that what the study measures is not a core hallmark of FASD. Balance, for instance, and is not always an indicator of the Central Nervous System (CNS) damage that will appear in school-age children and yet that was a measurement used to indicate that low to moderate alcohol consumption was OK.. One study measured the calmness in 2-year-olds who were exposed to alcohol prenatally. The parents of some children with autism will tell you that this is just before the time that they start to notice the symptoms. This is not a reliable indication that alcohol is safe.
Some studies are funded by the alcohol industry. The American Academy of Pediatrics states very clearly that no amount of alcohol is safe. Most studies that follow children through school show that 80% of these kids have trouble in school, substance abuse issues, or trouble with the law, because of poor impulse control and decision-making.
The President of the American Congress of Obstetricians and Gynecologists, Jeanne A. Conry, MD, PhD, said in her blog of August 15, 2013 “Ob-gyns understand there’s often conflicting data and that the changes we suggest during pregnancy can sometimes be overwhelming: nine months can seem like an eternity when you have to give up your favorite things. Sometimes we even look back and realize our advice missed the mark. I remember a time when bed rest was prescribed for many patients with preterm labor, which we now realize accomplished little. But as doctors, we’re continuously learning. Advising patients to avoid things that we KNOW can cause harm is a good practice. Why take the risk of drinking alcohol when you know it could cause a problem? Given the risks, most patients don’t want to use their own child as a test subject. “
This is what we know: (from the Surgeon General’s 2005 Advisory of Alcohol Use in Pregnancy)
Based on the current, best science available we now know the following:
* Alcohol consumed during pregnancy increases the risk of alcohol related birth defects, including growth deficiencies, facial abnormalities, central nervous system impairment, behavioral disorders, and impaired intellectual development.
* No amount of alcohol consumption can be considered safe during pregnancy.
* Alcohol can damage a fetus at any stage of pregnancy. Damage can occur in the earliest weeks of pregnancy, even before a woman knows that she is pregnant.
* The cognitive deficits and behavioral problems resulting from prenatal alcohol exposure are life-long.
* Alcohol-related birth defects are completely preventable.
For these reasons:
1. A pregnant woman should not drink alcohol during pregnancy.
2. A pregnant woman who has already consumed alcohol during her pregnancy should stop in order to minimize further risk.
3. A woman who is considering becoming pregnant should abstain from alcohol.
4. Recognizing that nearly half of all births in the United States are unplanned, women of child-bearing age should consult their physician and take steps to reduce the possibility of prenatal alcohol exposure.
5. Health professionals should inquire routinely about alcohol consumption by women of childbearing age, inform them of the risks of alcohol consumption during pregnancy, and advise them not to drink alcoholic beverages during pregnancy.
What if you drank before you knew you were pregnant or you had a few glasses of wine, because you thought it was safe? Should you be worried? If you are pregnant now, stop drinking. If you need help doing that, please seek help (see the NOFAS link below for a caring resource.) Children with FASD are loving, creative, and many have very high IQ’s and with the proper supports, they can be quite successful, especially with early intervention. Let your healthcare provider know that you have this concern.
In 2008, in California, 365,000 children and adults were identified as having FASD. 15 babies a day, approximately 5,510 babies year, were diagnosed with full FAS. Perhaps, to celebrate FASDay on September 9th you can learn more at the following sites:
About FASDay: http://fasday.com/
The basic facts about FASD: http://www.cdc.gov/ncbddd/fasd/index.html, or http://fasdcenter.samhsa.gov/
Local training for medical professionals: http://www.semel.ucla.edu/fas/center
Gentle and caring help for women who are drinking and pregnant or have given birth to a child with FASD: http://www.nofas.org/
Substance Abuse/Mental Heath treatment locator: http://findtreatment.samhsa.gov/