Fetal Alcohol Syndrome

Oct 12, 2010

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

A very long time ago when I was a teenager, I taught my girlfriend to drive. She was only fifteen at the time and didnt have a drivers license. She was a city girl and had never driven any motorized vehicle before. We were in a very small town with very little traffic, no traffic lights and only a few stop signs. Although not legal, I thought it was very safe. She felt the thrill of driving and I felt like a big man for being able to teach her something. Months later, when she was back at home in BC, she decided to drive again. She still didnt have a drivers license, but that didnt stop her from taking out the family car and promptly getting it stuck in a snow bank. Looking back, showing her how to drive was very dangerous and very irresponsible. When she decided to take that drive in the family car, she could have been hurt, or she could have hurt someone else. I made a poor choice when I showed her how to drive.

There was a study released in the October 2010 Journal of Epidemiology and Community Health about Light Drinking in pregnacy. The British study seemed to indicate that women who drank only 1-2 drinks per week during pregnancy would not harm their babies. The study even said that at age 5, the children of the light drinkers scored better than the children of the abstainers on some tests.

It has been well established that heavy drinking by mothers during pregnancy is bad for their babies. The earliest reference I found was Jones et al who published Pattern of malformation in offspring of chronic alcoholic mothers in the Lancet in 1973. This form of alcohol induced damage of a baby is called Fetal Alcohol Syndrome (FAS). To confirm the diagnosis of FAS, the doctor must confirm alcohol was drunk during the pregnancy, the child isnt growing as fast as expected, the child has certain facial features and the childs central nervous system isnt working as well as expected. The estimate is that 1-2 out of every 1000 live births in the US has fetal alcohol syndrome. Fetal alcohol spectrum disorder (FASD) is more broadly defined and does not require the facial features of FAS or the slower growth. FASD does require that alcohol was drunk during pregnancy and there has to be central nervous system impairment. It is estimated that 1 in 100 live births in the Unites States has FASD.

Alcohol seems to effect how cells form in the fetus. Alcohol seems to be especially hard on nerve cells when they are forming. I found this interesting because this means that even if a woman drinks late in her pregnancy it can still be bad for the fetus. Late in the pregnancy is when the baby is building a brain, so alcohol late in the pregnancy can effect brain development. Which area of the fetus is damaged by alcohol varies by how much alcohol is consumed, the time in the pregnancy it is consumed, patient genetics and probably other factors we arent aware of yet.

What challenges might a child face if they have FAS or FASD? When the Centers for Disease Control in the US looked at the statistics, they found some disturbing numbers. About 1 in 4 adults with FASD have made suicide attempts, almost half have been incarcerated at least once, and over 80% of adults with FASD are not be able to live independently. It doesnt seem to matter if the people with FASD had physical abnormalities or not.

So what about the British Study looking at Light Drinking and Pregnancy? It is still controversial. Some commentators have pointed out the light drinkers made more money than other people in the study. Many other studies have linked higher income with higher IQ in children. Did the light drinkers have children with higher IQs and skew the results? Will the public just hear Light Drinkers and not the definition of 1-2 drinks per week? Will women who think Light Drinking is 2-3 drinks per day harm their children? It doesnt have to be that complicated. The question about whether to drink while pregnant is just another question about what drugs are safe during pregnancy.

Questions about what medications are safe to take during pregnancy come up at the pharmacy at least once a week. I usually can find the answers in our one trusty pregnancy and lactation reference book. When I cant, I have a secret weapon. I go to www.motherisk.ca. Motherisk is a program run by the University of Torontos Sick Kids Hospital. You should go to their website. It has excellent resources for health care professionals and mothers about many, many questions around pregnancy. Those resources include an excellent section on alcohol during pregnancy and even a toll free number for mothers to call with questions. I really liked an interview I heard with the Director of the Motherisk Program, Gideon Koren about the British Study on Light Drinking and pregnancy. His take home message was it was unlikely that drinking 1-2 glasses of wine per week would make a woman significantly happier than abstaining for nine months. However, there was still a chance that drinking 1-2 glasses of wine per week could hurt the fetus. The risk benefit analysis definitely still said abstaining was better.

When I taught my girlfriend without a drivers license to drive, that was irresponsible. Although no one was hurt, someone could have been. I made a bad choice. Both FAS and FASD are 100% preventable. If you dont drink during pregnancy and you wont have a child with FAS or FASD. I think the right choice is still not to drink during pregnancy.

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