I recently discovered that I am pregnant. Unfortunately, this was not the news I wanted to hear. I had one glass of wine, not knowing that I was pregnant at the time. I am worried that I may have damaged my baby. How concerned should I be?
When it comes to the question “What does alcohol do to a fetus?”, even the brightest and most fanatical doctors have to admit that they simply do not know if there is a safe level of alcohol consumption during pregnancy. More and more studies confirm that no amount of alcohol is safe. A recent study in the June issue of Alcoholism: Clinical and Experimental Research showed that just one drink a day is associated with a 2-point drop in overall IQ by the time the child is 10 years of age (One drink refers to 355 ml of beer or 118 ml of wine).
Canadian survey data suggest that the number of women who report drinking during pregnancy has decreased. According to the National Longitudinal Survey of Children and Youth (NLSCY), from 1994 to 1995, 17-25% of women drank alcohol at some point during their pregnancy, and 7-9% of women drank alcohol throughout their pregnancy. The data from 1998 to 1999 show these percentages dropped to 14.4 % and 4.9%, respectively.
One of the dilemmas faced by women of childbearing age is that, in many instances, they do not know they are pregnant when alcohol is consumed early in the pregnancy. In fact, in the USA 45% of pregnancies are unplanned. There is also no end to the debate on the usefulness of warning labels on alcoholic beverages regarding the dangers of alcohol to a fetus. At this point, the best advice is to abstain 100% from any alcohol while expecting a baby, and to use contraception if one wants to drink alcohol while fertile.
Historically, there are references made to the adverse effects of alcohol on the fetus. Aristotle and other Greek philosophers made such references. There is also biblical reference found in the Book of Judges (13:4-7) about the importance of not drinking any alcohol during pregnancy. During the 1700s in England, records show that physicians described children of alcoholics as "born weak and silly". Some also suggested that the incidence of miscarriages was higher in mothers who drank alcohol while pregnant.
The discovery of Fetal Alcohol Syndrome (FAS) is a relatively recent event. In 1968, Dr. Paul Lemoine - the French pediatrician responsible for first identifying FAS - and his colleagues described adverse outcomes resulting from fetal alcohol exposure. Subsequently, many publications have detailed a consistent pattern of damage to babies exposed to alcohol in utero. What is less consistent is agreement on the best way of diagnosing the problem.
There is no controversy regarding full-blown FAS, which is found at the worst end of the spectrum. These babies usually exhibit classical features such as poor growth both before and after birth, significant developmental and behavioral abnormalities, and facial abnormalities, which include short spacing of the eye fissures (known as palpebral fissures), a smooth thin upper lip, and an abnormally shaped ear referred to as a "railroad track" ear. In addition, there may be involvement of the heart, kidneys, skeleton, and a number of other malformations.
The problem is that it is not common to see full-blown FAS. Instead, there is a wide spectrum of abnormalities referred to as Fetal Alcohol Spectrum Disorder (FASD). Given it is so difficult to be definitive when diagnosing FASD, a number of Canadian and American experts have tried to bring every clinician onto the same page. So far, this effort has met with mixed results.
In 1996 in the USA, the Institute of Medicine (www.iom.edu) published its version of the best way to diagnose FASD. Another diagnostic strategy called the 4-Digit Diagnostic Code was designed by the Washington State FAS Diagnostic & Prevention Network. The latter uses 4 features ranked in terms of strength of evidence: growth deficiencies, facial abnormalities, damage to the central nervous system, and gestational exposure to alcohol.
In Canada, the Canadian Medical Association published the first Canadian guidelines for the diagnosis of FAS and its related disabilities (found in a supplement to the CMAJ, March 1, 2005). The work was done by a subcommittee of the Public Health Agency of Canada's National Advisory Committee on Fetal Alcohol Spectrum Disorders. In this publication - detailed enough to be of use in courts of law - experts have completely dissected each and every previous diagnostic tool. The committee also mentions emerging issues such as screening meconium and other fluids related to pregnancy for evidence of alcohol or metabolites of alcohol. However, there may be ethical issues regarding informed consent when it comes to using biological markers in the efforts to prove alcohol use during pregnancy.
The financial cost of FASD to society is no small matter. In the USA, it is estimated that the annual cost has reached $4 billion. Similar figures in Canada are difficult to obtain given variances from region to region and within populations. For instance, the prevalence among First Nation communities in Manitoba is 55 -110 per 1000 live births; among native children in the Yukon is 46 per 1000 births; and in Northern British Columbia is 25 per 1000 births. Moreover, many populations with significantly higher incidence of FASD are typically found in remote regions where resources are often limited and difficult to coordinate.
The Canadian Pediatric Society provides more information on this completely preventable condition on its web site for parents (www.caringforkids.cps.ca). In Calgary, the Medigene FAS Diagnostic Clinic offers further help (Please contact Suzanne Johnson at 403- 571-0450).
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