The first 10 days post ovulation the foetus is generally safe as the
placental maternal connection has not yet been established. The risk
commences once the placental blood flow commences and the foetus is connected to the mother.
As for risk obviously there is a potential for risk and a single binge has been associated with damage, however the risk is probably low if you stop drinking from now onwards and considering the point in pregnancy you drank.
If you are generally health anyway the risk is further reduced. You have every chance of having an unaffected child if you are careful from now on. The thing to do is not to worry now about something that may not happen. Good luck and I wish you a successful and health pregnancy.
Dr Raja Mukherjee
"I just found out I am pregnant. I have stopped drinking now, but I was drinking in the first few weeks of my pregnancy, before I knew I was pregnant. Could my baby have an FASD? What should I do now?"
The most important thing is that you have completely stopped drinking after learning of your pregnancy. It is never too late to stop drinking. The sooner you stop, the better the chances for your baby's health. It is not possible to know what harm might have been done already. Some women can drink heavily during pregnancy and their babies do not seem to have any problems. Others drink
less and their babies show various signs of alcohol exposure. Many body parts and organs are developing in the embryonic stage (weeks 3 to 8 of the pregnancy). This is the time when most women
do not know they are pregnant. There is no known safe amount of alcohol or safe time to drink alcohol during pregnancy. It is recommended not to drink at all if one is pregnant or planning to become pregnant. Also, if a woman is sexually active and not using an effective form of birth control, she should avoid alcohol. The best advice is to try not to be alarmed, talk to your doctor about this, and be sure to receive routine prenatal care throughout your pregnancy.
"Can a father's drinking cause FASDs?"
How alcohol affects the male sperm is currently being studied.
Whatever the effects are found to be, they are not FASDs. FASDs are caused specifically by the mother's alcohol use during pregnancy. However, the father's role is important. He can help the woman avoid drinking alcohol during pregnancy. He can encourage her abstinence from alcohol by avoiding social situations that involve drinking. He can also help her by avoiding alcohol himself.
*Source: Lupton C, Burd L, Harwood R. Cost of foetal alcohol spectrum disorders. American Journal of Medical Genetics Part C (Seminars in Medical Genetics) 2004;127C:42-50.
What is Foetal Alcohol Syndrome?
Foetal Alcohol Syndrome (FAS) is a type of neurological brain disorder that affects the baby when a mother drinks during her pregnancy. It may manifests itself as a series of physical and behavioral markers (full FAS) or just behavioral markers (Alcohol Related Neurodevelopmental Disorders (ARND) or a commonly used, non medical term, Foetal Alcohol Spectrum Disorders or FASD). Other terms for ARND and FASD are Foetal Alcohol Effects (FAE), partial FAS (pFAS), Prenatally Exposed to Alcohol (PEA), and Alcohol Related Birth Defects (ARBD).
What are the physical markers of FAS?
The Institute of Medicine has designated three main physical markers for full FAS. The first is a series of distinctive facial features such as small palprebral eye openings, a lack of a philtrum or groove beneath the nose, a thin top lip, microcephalia or a small head, exaggerated epicanthal eye folds (seen normally among Asians and some American Indians), a short snub nose with a lack of a nasal bridge, micrognathia or a small, pointy chin, large, and low, laid back ears with prominent ridges on the outside of the ear.
Other facial features are malformed or malocclused teeth, unusual amounts of hair on the face and body, strabismus or crossed eyes, myopia or shortsightedness, increased ear infections, and hearing difficulties.
Having one or two of the facial markers can be NORMAL. It is always important to consider the other two physical features (size/weight and Central Nervous System) and in particular the behavior of the individual before a child is referred to a dysmorphologist or geneticist.
Other physical features include webbed fingers, crooked little fingers, small fingernails, single creases across the palms of the hands, curvature of the back, deep dimples at the base of the spine, hands that face forward instead of toward the body, joint problems, hemangiomas (purple birth marks), heart problems, other organ problems and digestive and elimination problems.
The second physical sign of full FAS is small size or weight, usually below the 5-10 percentile before and/or after birth. Girls may gain weight during puberty but boys often stay thin.
The third physical sign of full FAS is Central Nervous System damage. This can include behavioral problems, sensory dysfunctioning, hyper/hypo activity, learning disabilities and conscience and attachment issues.
Is FAS less serious if there are no physical markers?
It can be more serious because it is harder to diagnose and easier to apply inappropriate therapies and/or discipline. Therefore it is important to consider prenatal alcohol exposure if acceptable behavior is the primary problem.
Foetal Alcohol Spectrum Disorders (FASD) or the more medical term Alcohol Related Neurodevelopmental Disorders (ARND) is most often characterized by behavioral problems. Dr. Ann Streissguth has said that the most outstanding characteristics of FAS are bad judgment and the inability to connect an action with its consequences. But FASD has been used as an umbrella term when a child has a number of behavioral issues many of which have their own designations.
What causes FAS and FASD?
Full FAS may occur when a pregnant woman drinks 2 or more drinks a day, 14 drinks on average, per week or 4 or more drinks on any one occasion (binge drinking). The National Institute of Alcohol Abuse and Alcoholism (NIAAA) has determined that one drink a day is moderate for a woman and two drinks a day is moderate for a man.
Some researchers feel that even drinking in the months prior to conception can have a deleterious effect upon the woman’s ovum and perhaps even upon the man’s sperm. Therefore it is strongly advised that both the potential mother and father refraining from drinking for three months prior to conception. The mother should refrain from drinking after birth if she is nursing.
Other factors that influence the effect of alcohol upon the developing child are the mother’s age, how long she has been drinking, her nutritional status, and the manner in which she drinks. The older a woman is, her body becomes less efficient in metabolizing alcohol. However, if a girl starts drinking in her early teens, she is likely to have developed a higher tolerance for alcohol and thus, places her child at a greater risk for having FAS. Women who are not eating properly and who are thin are also more likely to have child who are more vulnerable to FAS. Eating meals with drinks is considered to be better than to drink without eating. Sipping a drink over an hour’s time is better than gulping down half a glass in a few minutes. Drinking a few glasses over the course of the day is considered to be less harmful than drinking the same amount in shorter time span such as the evening. I f a woman cannot quit drinking, and then cutting back is important.
Aren’t other drugs worse for the baby?
Strange as it may seem, other drugs affect the ADULT brain more than the brain of the developing foetus. This is due, in part, to the protective barrier of the placenta. The molecular structure and chemical configuration of other drugs are stopped by the placenta. The chemical configuration of alcohol resembles retinal or vitamin A and is allowed through the placenta.
Isn’t FAS a just a problem of certain minorities?
FAS has occurred across all national lines and in every known racial and cultural group.
Can the father’s drinking cause FAS?
The father’s drinking cannot cause FAS. His drinking may cause problems in attention and hyperactivity problems. The father’s drinking also influences maze solving ability in rodent studies. Paternal drinking may influence gross motor skills. Male drinking also lowers testosterone levels.
Isn’t a naturally brewed alcohol like wine or beer healthier than a hard drink?
The amount of Absolute Alcohol, that alcohol which is left when all the non-alcoholic ingredients are removed, is the same. One 12 ounce (353 ml) can if beer and one 4 ounce (117.7 ml) glass of wine contain as much Absolute Alcohol as a 2.5 ounce (73.4 ml) shot glass of whiskey. Similar bottles of wine coolers, malt liquors also contain similar amounts of Absolute Alcohol and are just as dangerous to the Foetus . Some foreign wines and beers also have greater amounts of alcohol than U.S. products.
Isn’t FAS like any other brain injury?
Most brain injuries affect certain areas of the brain. Alcohol will affect the development of every cell that is forming at the time the alcohol was being ingested. The damage is on a cellular basis not on one or two areas of the brain. Potentially, several drinks can affect every cell of the brain and body that is being formed during the time the mother is drinking.
Can’t cells damaged by alcohol be re-trained?
Re-training implies that a damaged cell was once normal and can “learn’ again. A new cell damaged by alcohol has never learned how to be normal in the first place so it does not readily “learn” what is normal except by repetitive training over a very long period of time.
Does that mean that children who have FAS(D) will not improve with age?
The children may often improve with age but it is going to be at a far slower rate than the average child. A good rule of thumb…take the child’s chronological age and divide by two, you will them arrive at his/her true mental age. If you are expecting a 12 year old to behave like a 12 year old, you are doomed to disappointment. But if you understand that he/she is functioning at a 6year old level, then you will be more successful in dealing with them. Some things, such as bad judgment and the inability to connect actions with consequences, may never change.
Aren’t many doctors still recommending things like a glass of wine to relax before birth and beer to bring down the milk during nursing?
Yes, many doctors are still making these recommendations. Most of these doctors finished their training in the 1960s, 70s and 80s long before the information about FAS became more internationally recognized. Although there have been several hundred papers written about the behaviors of children of alcoholics, the first paper to make a direct connection between maternal drinking and behavioral problems was written in 1968 by Dr. Paul Lemoine. However, it was not until 1973, that a team of physicians at the University of Washington gave the connection a name and that was Foetal Alcohol Syndrome. Even some 11 years after that, many medical textbooks were still not including FAS and if they did, the major problem mentioned was mental retardation.
Isn’t FAS the leading known cause of mental retardation?
Yes, FAS is the leading known cause of mental retardation. However, the majority of children do not have severe mental retardation and many have superior intelligence. The average IQ of these children is 70+ but it can range from 40 to over 130. Again, it is not the mental capacity that makes these children stand out, it is their bad judgment and inability to connect an action with its consequences and other forms of behavior that do not fit into society.
The American Association of Mental Retardation uses a scale that is less dependent on IQ and relies more heavily on ancillary services needed for activities of actual living.
Is there a cure for FAS(D)?
There are a number of therapies that have helped to some degree but nothing has been found to “cure” or completely alleviate the symptoms of FAS(D). Each cell that was damaged while the mother drank would have to be “fixed”.
The 1996 Final Report on the Occurrence of Secondary Disabilities in Clients with Foetal Alcohol Syndrome and Foetal Alcohol Effects has determined that early diagnosis (before the age of 6) and early intervention can do much to alleviate the problems caused by FAS(D). <http://depts.washington.ed/fadu>
How many babies are born with full FAS? How many are born with FASD?
In the United States, one of the most conservative estimates is 9.7 per 10,000 live births. It is also estimated that nearly one baby in 100 is born with some form of Alcohol Related Neurodevelopmental Disorder (ARND or FASD).
How can we estimate how many children are born in our country with FAS(D)?
Because most of the research on this is done in the United States, you might examine some comparable statistics. Statistics on female consumption of alcohol and numbers of female deaths related to alcohol and similar figures for the U.S. can be compared in the World Health Organization www.who.int (WHO) Global Report on Alcohol (2001 and 2004) to determine the level of female drinking in another country. However, the more economically depressed countries also have a higher rate of home brewed alcohol that cannot be included in the WHO Global Report because of reporting and documentation problems.
The researcher must also be aware that total consumption is based on tax receipts but that deaths due to alcohol are often not reported because of the diseases that the alcohol caused such as cancer and heart failure are named first as the cause of death.
Will the diagnosis of Foetal Alcohol Syndrome brand the child for life?
Without a diagnosis, the child with FAS(D) is often called lazy, unmotivated, a troublemaker, the class clown, a drifter, stupid, and much worse. It is important to get a diagnosis so that he/she can get appropriate services when they are young. It is important to know that FAS is not the child. The child may have FAS but it is not the complete determinant of the child’s personality.
Most family Doctors and peadiatricians are not knowledgeable enough to diagnose FAS(D). It is suggested that the child be seen by a dysmorphologist, a geneticist or a neuropsychologist.
What learning disabilities are associated with FAS(D)?
The Foetal Alcohol Behavioral Scale developed by Dr. Ann Streissguth <depts..washington.edu/fadu> says that the following problems are either learning disabilities or make learning difficult. She mentions poor attention (may or may not be ADD), overreaction, self-centeredness, over stimulation, fidgety, talkative, demands attention, conversation out of context, messy, chats with no content, talks too fast, can’t play team sports, cannot perform sequential instructions, unusual topics of conversation, inappropriate behavior, repeats often, sensitive to noises, and may have a loud, unusual voice. FAS families have mentioned problems with short term memory loss, intermittent long term memory problems, perserveration, speech an language problems, receptive language disorder, disorderly conduct, fine motor skills, trouble learning new motor skills and sensory issues with lights, touch and smell. Problems with math are considered to be a primary symptom of FAS(D).
What life problems can be expected when a child has FAS(D)?
According to the 1996 Final Report on Secondary Disabilities in Clients with Foetal Alcohol Syndrome and Foetal Alcohol Effects, 473 clients were examined and have experienced the following problems:
178 clients (almost 38%) were diagnosed with full FAS and had an average IQ of 79.
(In all evaluations, a score of 100 is considered to be normal)
Average Reading score was 78; Average Spelling score was 75; Average Math score was 70; Average Adaptive Behavior Score was 61.
295 clients (over 62%) were diagnosed as having Foetal Alcohol Effects, most commonly called FAE and medically referred to as Alcohol Related Neurological Disorders and had an average IQ of 90.
Average Reading score was 84; Average Spelling score was 81; Average Math score was 76; Average Adaptive Behavior score was 67.
Of these clients, 415 were selected for a life history questionnaire and these were the results: Mental Health Problems were by far the most prevalent secondary disability experienced over the entire age sample (90%). (Ages 3-51 years).
The following results were found for those age 12 and older:
*Disrupted school experience (defined as having been suspended or expelled from school or having dropped out of school) was experienced by 60% of the clients.
*Trouble with the law (defined as ever having been in trouble with authorities, charged or convicted of a crime) was experienced by 60% of the clients.
*Confinement (including inpatient treatment for mental health problems or alcohol/drug problems, or ever having been incarcerated for a crime) was experienced by almost 50% of the clients.
90 clients age 21 and older were selected for questions about self-sufficiency or independent living skills.
80% of the clients, age 21 and older, were not self sufficient in the areas of *Getting Dressed
*Using Public Transportation
*Personal Hygiene
*Staying Out of Trouble
*Structuring Leisure Time
*Cooking Meals
*Grocery Shopping
*Interpersonal Relationships
*Getting Medical Care
*Getting Social Services
*Making Decisions
*Managing Money
80% of the 90 adults age 21 and over were still having employment problems that dealt with
*Lying
*Problems with Supervisor
*Anger Management
*Unreliability
*Social Problems
*Poor Judgment
*Poor Task Comprehension
*Easy Frustration
***Clients with FAE or Alcohol Related Neurological Disorders have a higher rate of ALL secondary disabilities except for mental health problems.***
What is the lifetime cost of FAS(D)?
A 2004 FASD Center for Excellence study estimated the lifetime cost to be $2.9 million dollars per individual. However, this does not include visual disabilities, physical or occupational therapy, cardiac, digestive, reproductive or psychiatric problems.
It also fails to include the lost opportunity costs of caregivers and individuals providing special services and time to the child/adult with FAS(D). It is estimated that this can push the overall costs as high as $5 million per person.
Other indirect costs include the time of family and friends who often help
with the care of the child/adult when the parents cannot. And finally, we may never know the lost opportunity cost of what this person could have contributed to society had they not had the debilitating effects of FAS(D).
