Fetal Alcohol Syndrome

What is fetal alcohol syndrome (FAS)? Can a single drink cause FAS? Can pregnant women safely drink in moderation? Who is at greatest risk of giving birth to a child with fetal alcohol syndrome? How we can reduce FAS?

What is Fetal Alcohol Syndrome?

Fetal alcohol syndrome (FAS) is a serious health problem that tragically affects its victims and their families, but that is completely preventable. Causing a child to suffer from fetal alcohol syndrome is really nothing short of child abuse and it lasts for life. Babies born with FAS tend to weigh less and be shorter than normal. They usually suffer from:

Victims of fetal alcohol syndrome often experience mental health problems, disrupted school experience, inappropriate sexual behavior, trouble with the law, alcohol and drug problems, difficulty caring for themselves and their children, and homelessness. 2

Should Pregnant Women Drink At All? The Research Evidence

Is there a safe or acceptable level of alcohol consumption for pregnant women?

A large study examined 400,000 women in the U.S., all of whom had consumed alcohol during pregnancy. Not a single case of fetal alcohol syndrome occurred and no adverse effects on children were found when consumption was under 8.5 drinks per week. 3

A review of research studies found that fetal alcohol syndrome only occurs among alcoholics. The evidence is clear that there is no apparent risk to a child when the pregnant woman consumes no more than one drink per day. 4

"One drink can hurt your foetus," a mass media campaign in the province of Quebec, was dropped after a number of women who had consumed a single drink while pregnant, often before realizing they were expectant, began demanding abortions.

Source: Dr. Hubert Sacy, presentation at the Gode Alkoholdninger meetings, Kobenhavn, Denmark, April, 2001.

A study of moderate drinking during pregnancy found no negative effects. The researchers suggested that one drink per day provides a significant margin of safety, although they did not encourage drinking during pregnancy. 5

A study of pregnancies in eight European countries found that consuming no more than one drink per day did not appear to have any effect on fetal growth. A follow-up of children at 18 months of age found that those from women who drank during pregnancy, even two drinks per day, scored higher in several areas of development. 6

An analysis of seven major medical research studies involving over 130,000 pregnancies suggests that consuming two to 14 drinks per week does not increase the risk of giving birth to a child with either malformations or fetal alcohol syndrome. 7

Negative effects appear to be related to relatively higher levels of consumption per occasion, and hence, to higher blood alcohol content levels. Thus, it appears to be very important never to consume more than one drink in any one day while pregnant. 8

The guidelines of the Royal College of Obstetricians and Gynaecologists recommend that "women should be careful about alcohol consumption in pregnancy" 9 and recommends as acceptable two drinks a couple of times each week. 10 These conclusions appear consistent with the research findings of the Institute of Medicine of the National Academy of Sciences, a major science body in the U.S. 11

Similarly, the American College of Obstetricians and Gynecologists concluded that "there is no evidence that an occasional drink is harmful. Women who drink heavily throughout pregnancy may have smaller babies with physical and mental handicaps, but women who drink moderately may have babies with no more problems than those women who drink rarely or not at all." 12

This group of medical specialists pointed out that "It's hard to determine the amount and timing of alcohol consumption that puts the fetus at risk. One study shows that women who drank only occasionally and moderately (described in this particular study as between 1 and 45 drinks spaced out over a month) had babies with no more problems than those women who drank rarely or not at all. There were no differences either in size or number of babies' handicaps between the women who drank moderately and those who abstained or drank likely." 13

The Harvard Women's Health Watch advises pregnant women that "having more than one alcoholic drink per day puts the fetus at risk for various defects and disabilities." 14 Thus, it suggests that expectant women should limit themselves to one drink per day. The health publication emphasizes that one drink is 12 ounces of beer, five ounces of wine, or 1.5 ounces of spirits or liquor.

There is even little evidence that occasional binge drinking during pregnancy seriously harms the fetus, according to an analysis of medical research published during the 35 year period between 1970 and 2005 involving over 3,500 articles. Binge drinking was defined as consuming five or more alcoholic drinks per occasion.

There was little evidence that binge drinking caused miscarriage, stillbirths, abnormal birthweight, or birth defects such as fetal alcohol syndrome (FAS). However, there was some suggestion that it might impair normal neurodevelopment, although the effects were generally quite small, reported the researchers. 15

There is even evidence that light drinking during pregnancy may be beneficial to children. A study of 12,495 three-year-old children found that those born to mothers who drank light amounts of alcohol (beer, wine or spirits) during pregnancy had fewer conduct, emotional and peer problems than did those born to abstaining mothers or those who drank heavily while pregnant.

The research used a nationally representative sample of infants born in the United Kingdom and utilized the U.K. Millennium Cohort Study, a project following the health of children born between 2000 and 2002 in England, Northern Ireland, Scotland and Wales.

Boys born to light drinkers had 40% fewer conduct problems, were 30% less likely to suffer hyperactivity, and received higher scores on tests of vocabulary and of ability to identify colors, shapes, letters and numbers than did those born to abstainers.

Girls born to light drinkers were 30 percent less likely to have emotional symptoms and peer problems compared with those born to abstainers during pregnancy.

Children born to heavy drinkers (two percent of the total mothers) were more likely to exhibit problems.

Lead researcher Dr. Yvonne Kelly said the study raises questions as to "whether the current push for policy to recommend complete abstinence during pregnancy is merited." 16

Confusion

The National Institute for Health and Clinical Excellence (NICE), which issues health guidelines in the UK, concluded that it is safe for expectant mothers to consume a small drink of alcohol each day. 17

Two weeks later, Britain's Department of Health changed its advice from recommending no more than two small drinks per day to recommending that pregnant women not drink any alcoholic beverage. 18

Then the Royal College of Obstetricians and Gynaecologists reported that light alcohol consumption during pregnancy might affect the long-term health of child 19 but restated its recommendation that two drinks twice a week is an acceptable level of alcohol consumption during pregnancy. 20 This was followed by a new British Medical Association Report that pregnant women should abstain from drinking alcohol. 21

The British Medical Journal has added to the confusion. In it, an employee of the British Medical Association warns of "possible risks" to the foetus (or fetus). She concluded that because of the uncertainty and confusion surrounding the question, women should simply be told to avoid alcohol entirely. 22

In the same issue of the journal, a leading medical authority insisted that "there is no evidence that alcohol in moderation causes harm to unborn babies." 23

The Australian Alcohol Guidelines state that consuming fewer than seven drinks per week, with no more than two drinks on any one day, is a safe level for drinking during pregnancy. The Guidelines have been endorsed by the Ministerial Council on Drug Strategy, which is Australia's highest decision-making body for alcohol and drug policy. 24

Reflecting their basis in scientific evidence rather than in speculation or ideology, most medical school textbooks on obstetrics condone drinking at some level by pregnant women. About one-third do not address the question. A minority of the textbooks go beyond the scientific medical evidence to recommend zero alcohol consumption during pregnancy. 25

What's a Pregnant Woman to Do?

Several important points are worth noting:

The Problem

There is no scientific support for the type of widespread hysteria that permeates public discussion on fetal alcohol syndrome. 26 Many people falsely believe that even a single drink during pregnancy can cause FAS. If this were true, the majority of the populations of dozens of countries around the world would suffer the effects of FAS!

Some pregnant women have actually become frantic upon realizing they had inadvertently eaten salad that had wine vinegar dressing, fearing their children would be born suffering from fetal alcohol syndrome. 27 Of course, wine vinegar, being vinegar, contains no alcohol.

In reality there is absolutely no evidence that light drinking, even on a daily basis, leads to fetal alcohol syndrome. Actually, most women who are light or moderate drinkers choose not to drink during pregnancy. The real problem is found among frequent heavy drinkers, who most often are alcoholics consuming heavily on a daily basis throughout their pregnancies. 28

Additionally, those who give birth to FAS children characteristically smoke, use illegal drugs, are frequently malnourished, and rarely receive adequate medical care during pregnancy. And drinking during pregnancy has not declined among such women over time. Because of their addiction, these women are virtually immune to our current educational approach. This may also be because so many of these women are poorly educated and often lead marginal lives. 29

This is the target group to which our efforts and resources need to be directed in a massive drive to get these women the necessary help and treatment. It will not be cheap or easy, but it is essential if we seriously want to reduce the incidence of fetal alcohol syndrome.

We need to abandon scare tactics for real solutions

This site does not provide medical advice. Consult a physician for information on alcohol and other health issues.

References

  • 1. Stratton, K., Howe, C., and Battaglia, F. (Eds). Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC; National Academy Press, 1996.
  • 2. Streissguth, A., and Kanter, J. (Eds.) The Challenge of Fetal Alcohol Syndrome. Seattle: University of Washington, 1997.
  • 3. Wilkie, S. Global overview of drinking recommendations and guidelines. AIM Digest (Supplement), June, 1997, 2-4, p. 4.
  • 4. Abel, E. "Moderate" drinking during pregnancy: cause for concern? Clinica Chimica Acta, 1996, 246, 149-154.
  • 5. Forrest, F., and du Florey, C. Reported social alcohol consumption during pregnancy and infants' development at 18 months. British Medical Journal, 1991, 303, 22-26.
  • 6. du Florey, D., et al. A European concerted action: maternal alcohol consumption and its relation to the outcome of pregnancy and development at 18 months. International Journal of Epidemiology, 1992, 21 (Supplement #1).
  • 7. Polygenis, D., et al. Moderate alcohol consumption during pregnancy and the incidence of fetal malformations: a meta-analysis. Neurotoxicol Teralol., 1998, 20, 61-67.
  • 8. Streissguth, A. P., et al. Prenatal alcohol and offspring development: the first fourteen years. Drug and Alcohol Dependence, 1994, 36(2), 89-99; Goodlett, C. R., and Peterson, S. D. Sex differences in vulnerability to developmental spatial learning deficits induced by limited binge alcohol exposure in neonatal rats. Neurobiological Learning and Memory, 1995, 64(3), 265-275; Day, N. L. The effects of prenatal exposure to alcohol. Alcohol Health and Research World, 1992, 16(2), 328-244.
  • 9. Wilkie, S. Global overview of drinking recommendations and guidelines. AIM Digest (Supplement), June, 1997, 2-4, p. 4.
  • 10. Royal College of Obstetricians and Gynaecologists. Royal College of Obstetricians and Gynaecologists statement on the BMA report on fetal alcohol spectrum disorder. Royal College of Obstetricians and Gynaecologists website, June 4, 2007.
  • 11. Stratton, K., Howe, C., and Battaglia, F. (Eds.) Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press, 1996.
  • 12. The American College of Obstetricians and Gynecologists. Alcohol and Your Unborn Baby. Washington, DC: American College of Obstetricians and Gynecologists, 1987.
  • 13. The American College of Obstetricians and Gynecologists. Alcohol and Your Unborn Baby. Washington, DC: American College of Obstetricians and Gynecologists, 1987.
  • 14. Pauker, S. P. By The Way Doctor. Harvard Women's Health Watch, June 2002, p. 7. Dr. Pauket is a member of the Harvard Women's Health Watch Advisory Board.
  • 15. Henderson, J., Ulrik, K., and Gray, R. Systematic review of the fetal effects of prenatal binge-drinking. Journal of Epidemiology and Community Health, 2007, 61, 1069-1073.
  • 16. Yvonne Kelly, Amanda Sacker, Ron Gray, John Kelly, Dieter Wolke, and Maria A Quigley. Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age? International Journal of Epidemiology, Advance Access published on October 30, 2008; doi:10.1093/ije/dyn230
  • 17. Yee, Linda. New Study Says Some Alcohol OK for Pregnant Women. HealthWatch website, November 15, 2007.
  • 18. Cockcroft, Linda. Pregnant women told to keep off alcohol. Telegraph Media, October 26, 2007.
  • 19. Rose, David. Pregnant women told glass of wine a day is fine -- and too dangerous. The Times (UK), October 11, 2007.
  • 20. Rose, David. Pregnant women told glass of wine a day is fine -- and too dangerous. The Times (UK), October 11, 2007.
  • 21. Pregnancy and Alcohol - How Much is Safe? Medical News Today website, October 27, 2007.
  • 22. Nathanson, Vivienne. Is it all right for women to drink small amounts of alcohol in pregnancy? No. British Medical Journal, 2007, 335, 857.
  • 23. O'Brien, Pat. Is it all right for women to drink small amounts of alcohol in pregnancy? Yes. British Medical Journal, 2007, 335, 856.
  • 24. Australian Government: National Drug Strategy. Ministerial Council on Drug Strategy, May 15, 2006 (http://www.nationaldrugstrategy.gov.au/councils/communique_150506.htm); Australian Medical Association. Drug and Alcohol Addiction Treatment Should Take Front Seat, Australian Medical Association. AMA press release, May 19, 2006.
  • 25. Loop, K. Q., and Nettleman, M. D. Obstetrical textbooks: Recommendations about drinking during pregnancy. American Journal of Preventive Medicine, 2002, 23(2), 136-138.
  • 26. It has been pointed out that "Given its emotive nature, the issue of risk to pregnancy has frequently been overstated. For example, US publicity material in the 1980s and early 1990s frequently quoted Clarren, a worker at the Seattle Institute of Dysmorphology, as having stated that alcohol was the third most important cause of infant handicaps. However, Clarren was referring to handicaps with known causes, which are only about 10 per cent of the total. Such problem inflation is fanned by press reports of cases of severe alcohol damage, and although scientists may dismiss isolated reports, they assume great importance in the minds of the public and consequently in the minds of policy-makers."
  • 27. The past is illuminating; "In the US no public warnings were issued until 1977. Women were then warned against consuming more than six drinks a day. At the same time, moves to display compulsory public health warnings about the dangers of alcohol to the foetus were rejected. In 1980 a national workshop was held and the following year the American Surgeon General issued a warning to pregnant women against consuming alcohol, even in food. In spite of protests, this warning was widely publicised and increased research funding for nationally co-ordinated projects on the topic provided. In New York and many other parts of the country, bars, restaurants and liquor stores are required to display a sign stating that drinking can cause birth defects. Since 1989, every container of alcoholic beverage sold in the US has had to carry a label which gives a warning that women should not drink alcohol during pregnancy because of the risks of birth defects."
  • 28. And the pressure continues: "Since the late 1980s the issue has become of increasing concern to the US legal system. Cases of physicians facing damage suits for failing to advise that alcohol could affect the foetus have been reported. Since 1987 mothers who use alcohol...during pregnancy have become subject to increasing legal controls, compulsory treatment and may even face imprisonment. If their child shows positive signs of damage they may also face charges of child abuse." (Waterson, J. Women and Alcohol in Social Context: Mother's Ruin Revisited. Hampshire, England: Palgrave, 2000, pp. 167-168. Note: internal references deleted.)
  • 29. Barr, Andrew. Drink: A Social History of America. New York: Carroll & Graf, 1999, p. 159.
  • 30. Stratton, K., Howe, C., and Battaglia, F. (Eds.) Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press, 1996.
  • 31. Stratton, K., Howe, C., and Battaglia, F. (Eds.) Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press, 1996.

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