According to Dr. Susan Astley Ph.D. and Dr. Therese Grant Ph.D., “Children exposed to and damaged by prenatal alcohol exposure look deceptively good in the preschool years. Myth: A single drink containing one ounce of alcohol during pregnancy, or occasionally during pregnancy, has been scientifically linked to affects that can be diagnosed as an FASD. It is believed that some women have a genetic predisposition that increases the vulnerability of their embryo or fetus to alcohol exposure, and other women have a genetic make-up that reduces their vulnerability for having an alcohol-effected birth. Also, some children may have subtle damage from being exposed to alcohol that is not evident until school-age or later, such as problems with learning and behavior. This can result in the loss of the pregnancy. These findings are alarming because half of the pregnancies in developed countries and over 80% in developing countries are unplanned. Q. Prenatal exposure to alcohol can damage the developing fetus and is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities. There is no known safe amount of alcohol to drink while pregnant. For example, they maintain the FASD Toolkit external icon —a comprehensive, web-based resource for management of a child with an FASD and their family. Diagnosis & Treatment.  There is a wide range of effects, and most subtle behavioral and cognitive difficulties are rarely diagnosed as alcohol-related. She is a senior scientist at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada and an associate professor at the Dalla Lana School of Public Health and Factor Inwentash Faculty of Social Work (FIFSW) at the University of Toronto. A: Alcohol consumption during pregnancy should be recognized as a serious public health problem and more effective prevention strategies targeting alcohol use before and during pregnancy are needed worldwide. Myth: A little bit of wine helps to reduce stress and can be healthy while pregnant. Thousands of papers have conclusively demonstrated that alcohol use has the potential to cause both physical and functional damage to a growing baby. There is no threshold of prenatal alcohol consumption below which the baby is not exposed. Myth: On a holiday or special occasion, it’s perfectly fine to at least have a few celebratory sips. It is true that drinking patterns associated with alcohol use disorders pose the highest risk to the unborn baby. Multidisciplinary teams of experts from different institutions around the world are collaborating on this project. The lowest prevalence was observed in the WHO Eastern Mediterranean Region, where most people – including pregnant women of course – abstain from alcohol due to religious beliefs. Children with mutations in the L1 gene have developmental disabilities and brain malformations, and, importantly, the function of the L1 molecule is also disrupted by concentrations of alcohol that a woman would have in her blood after a single drink. Evidence-based research has found that drinking even small amounts of alcohol while pregnant can increase the risk of miscarriage, stillbirth, prematurity, or sudden infant death syndrome.”. Alcohol does not lose it’s toxicity in utero because it happens to be New Year’s Eve, or because wine is consumed instead of whiskey, or because the drinker has an advanced academic degree and a high socioeconomic status. The most severe effect of prenatal alcohol exposure is fetal alcohol syndrome (FAS). Binge drinking is the direct cause of FAS or FASD. A developing baby is exposed to the same concentration of alcohol as the mother during pregnancy. “More than forty years of published research has shown alcohol to be a teratogen, a toxic substance to a developing baby, and can interfere with healthy development causing brain damage and other birth defects”, 1200 Eton Court, Third Floor, Washington, D.C. 20007, Circle of Hope: Mentoring Network for Birth Mothers, National Organization on Fetal Alcohol Syndrome, Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD), Alcoholism: Clinical and Experimental Research, The American Congress of Obstetricians and Gynecologists (ACOG). As epidemiologists we know how important it is to determine the prevalence of a disorder in order to set priorities for public health policy, funding for public health initiatives and health-care planning. Q: How common is FASD compared with other birth defects? Even with the assumption that only 1% of the Canadian population have FASD – about 355 000 people – the annual cost was estimated at 1.8 billion Canadian Dollars (US$ 1.35 billion) per year in Canada. Myth: My doctor said it’s fine to have a glass of wine or two while pregnant.  For decades, researchers have known that heavy drinking during pregnancy can cause birth defects. All women should be reminded of the risk of prenatal alcohol exposure. We are estimating the prevalence of FASD by screening children aged 7–9 years from different populations in Belarus, Canada, Moldova, Namibia, the Seychelles and Ukraine. Q: How can the global public health community use your global burden of disease study to prevent fetal alcohol disorders in their countries? No safe amount. Many have asked,” Is it completely safe for an unborn baby to be exposed to the alcohol in an occasional beer, glass of wine, or other alcoholic beverage?”, According to the CDC and the U.S. Excessive alcohol use can damage all organ systems, but it particularly affects the brain, heart, liver, pancreas and immune system. If FASD is diagnosed early, interventions may be able to lessen its impact and prevent secondary disabilities. However, the baby lacks the ability to process or metabolize the alcohol. Popova earned a PhD in medicine from the Russian Cancer Research Center of the Russian Academy of Medical Sciences in Moscow, the Russian Federation, in 1988 and a medical degree from the Turkmen State Medical Institute in Ashgabat in her native Turkmenistan in 1985. Alcohol exposure during pregnancy is also the biggest non-genetic cause of mental retardation in the U.S. And if a fetus is exposed to alcohol - especially a lot or over a long period of the pregnancy - there is a risk of fetal alcohol spectrum disorders (FASD) or, … Most babies affected by alcohol exposure have no physical birth defects. A: Alcohol is poisonous to the developing fetus throughout the entire nine months of gestation. The potential benefits of alcohol use during pregnancy to the mother are separate from the potential risk to the mother’s developing child.  The scientific and medical research is very clear: No published biomedical research has found any risk-free benefit of prenatal alcohol exposure for the embryo or fetus. Many of these conditions occur more often among people with FASD than in the general population, although a causal link has only been made with some of these conditions. Every pregnancy is different. This uncertainty is the primary reason for the recommendation of abstention from any alcohol during pregnancy as the safest course. The medical research is clear: Drinking at a level below the threshold for alcoholism still can potentially cause harm to the growing baby.  Women who do not have the disease of alcoholism could still have children with measurable effects of alcohol exposure. In 1973, fetal alcohol syndrome was first described as a specific cluster of birth defects resulting from alcohol exposure in utero. Q: Can you tell us about the new WHO study your centre is working on with the National Institute on Alcohol Abuse and Alcoholism? The absence of evidence for developmental abnormalities in babies who were exposed to small amounts of alcohol prenatally does not prove that light drinking is safe. Predominant diagnostic classifications are alcohol use disorder or alcohol dependence ().. This suggests that in some countries the prevalence of FASD may be higher than the prevalence of some common – and more generally known – birth defects such as anencephaly, Down syndrome, spina bifida and trisomy 18. Myth: You have to be an alcoholic to drink enough to cause real damage No amount of alcohol use is without risk for a developing baby before birth. Five years later, Ken Jones and David Smith published a paper in the Lancet on the association between alcohol abuse and morphological signs, and provided diagnostic criteria for this condition. This is fetal alcohol spectrum disorder (FASD). Your doctor might not be informed about the risk of prenatal alcohol exposure or could be uncomfortable talking with you about the risks to your embryo or fetus associated with prenatal alcohol use. FASD is associated with a wide range of physical, behavioural and learning problems including growth impairments, facial abnormalities, problems with brain function and developmental delays. Before our study, most governments had no idea how many pregnant women drink alcohol and how many children are born with FAS in their countries. A: Even for the health sector, FASD is a relatively new condition. No safe alcohol. A: The five countries with the highest prevalence of alcohol use during pregnancy were Ireland (about 60%), Belarus (47%), Denmark (46%), the United Kingdom of Great Britain and Northern Ireland (41%) and the Russian Federation (37%) – all of these in the WHO European Region. FASDs are 100% preventable if a woman does not drink alcohol during pregnancy. A: The Centre for Addiction and Mental Health, where I work, is a WHO collaborating centre and I started researching FASD in 2009, when WHO asked our team to collaborate on developing a method that could be used to estimate the prevalence of FAS and FASD in all countries. There is also no known safe time during pregnancy or safe type of alcohol.” The American Academy of Pediatrics also advises against drinking during pregnancy, “There is no safe amount of alcohol when a woman is pregnant. Q: If this is such a common condition, why is there so little awareness of it? FASD is preventable. Babies that survive may be left with lifelong problems. A: We recently found that the prevalence of FASD is elevated and exceeds 1% in many countries, these data are not published yet. It is important for pregnant women to be reminded that proper nutrition, good general health, and early and regular prenatal doctor visits might help reduce the effects of light drinking during pregnancy.  The Institute of Medicine says, “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” No type of alcohol or illicit drugs consumed during pregnancy are completely without risk. If a woman is informed of the risk and decides to drink, that is her decision–NOFAS is opposed to any rules, regulations, or statutes that seek to punish or sanction women for drinking alcohol during pregnancy. An FASD is found in those whose mother drank alcohol during pregnancy. Clinical studies do not have the power to detect small effects of alcohol on brain development, and even significant effects might be missed if the wrong test is used or if testing is conducted at the wrong developmental period. Now, countries can use these data to help children with FAS and to prevent future cases. When a mother-to-be consumes alcohol, it goes directly to the fetus through her blood stream. It was then refined with technical input from the National Institute on Alcohol Abuse and Alcoholism in the USA and discussed at a WHO planning meeting of principal investigators from more than 15 countries, organized alongside the first European conference on FASD in the Netherlands in 2010. Unfortunately, many doctors are not properly educated about the risks associated with prenatal alcohol exposure. Fetal Alcohol Spectrum Disorder (FASD) is the term used to describe the lifelong physical and/or neurodevelopmental impairments that can result from fetal alcohol exposure. That means that many women don’t realize they are pregnant during the early stages and that they continue drinking when pregnant. Drinking alcohol in pregnancy can cause birth defects and long-term health problems for babies and children. There is no cure for FASD and its effects last a lifetime. The answer is simply, no. A: Men still drink more alcohol than women, but the epidemiology of alcohol use appears to be changing and the gap between male and female patterns of alcohol use is closing, especially at younger ages. They said that before, when they told their governments that FASD is a serious disabling, prevalent and costly condition, government officials dismissed them and some didn’t even believe that FASD existed. She received her master’s degree in public health from the School of Public Health, University at Albany, United States of America (USA) in 2000. A developing baby is exposed to the same concentration of alcohol as the mother during pregnancy. These children may be born with fetal alcohol spectrum disorder (FASD), which is an umbrella term that covers all alcohol-related diagnoses, of which fetal alcohol syndrome (FAS) is the most severe and visibly identifiable form. Women commonly cite the need to relax as one of the reasons they drink during pregnancy even if they understand the risks. If the baby looks normal, it must be fine. Pregnant women should not drink alcohol to eliminate the chance of giving birth to a baby with fetal alcohol spectrum disorder (FASD). I found that this field was severely under researched and since then I have become dedicated to research in this area. Myth: One glass of wine is not enough for the developing baby to even be exposed to the alcohol. These children have subtle behavioral and learning problems that are often undiagnosed or misdiagnosed as Autism, Attention Deficit Disorder, or another developmental disaiblity instead of one of the Fetal Alcohol Spectrum Disorders. A: While we were working on the Global FASD prevalence project, the Public Health Agency of Canada asked our team to estimate the economic cost of FASD in Canada. Alcoholism is not a recognized diagnostic entity. AAP works to develop and implement educational and capacity-building resources for the prevention, early identification, and care of children with FASDs and their families. Can you tell us about your study in The Lancet Global Health on the global prevalence of maternal drinking and FAS published in January? These children may be born with fetal alcohol spectrum disorder (FASD), which is an umbrella term that covers all alcohol-related diagnoses, of which fetal alcohol syndrome (FAS) is the most severe and visibly identifiable form. While only abstention from alcohol during pregnancy completely eliminates any risk to the embryo or fetus, there is no published research of a diagnosis of an FASD from prenatal exposure to an ounce of alcohol.  It is possible that a drink could have a subtle harmful effect, but it has not been scientifically shown that such an effect would reach the criteria necessary for a diagnosis under the FASD umbrella. Bulletin of the World Health Organization 2017;95:320-321. doi: http://dx.doi.org/10.2471/BLT.17.030517. An FASD can include physical, behavioral, and learning problems. It is important for physicians to advise women of the risks of alcohol use during pregnancy, be nonjudgmental, and provide guidance for an appropriate intervention, if necessary. A: We estimated that one out of 67 women who consume alcohol during pregnancy will deliver a child with FAS, which translates to about 119 000 such children born globally every year. Most countries did not have prevalence data at a population level for alcohol use during pregnancy or FAS, so this study was urgently needed. Practitioners should always inform their patients about the risks of known exposures. A person with FASD can get help with their learning and behaviour to maximise their independence and achievements. Consuming alcohol during pregnancy can severely harm a developing fetus and may have lasting health and developmental consequences known as Fetal Alcohol Spectrum Disorders (FASDs). A: Alcohol is poisonous to the developing fetus throughout the entire nine months of gestation. FASD involves a range of harmful effects that can occur when a fetus is … Q. More practically, it is impossible to assure a mother that a child’s light prenatal alcohol exposure did not result in a small drop in the IQ of her child. Early treatment can improve development. Fetal alcohol spectrum disorder (FASD) refers to a range of problems caused by exposure of a fetus to alcohol during pregnancy. What may be” safe” for one woman may be “devastating” for another woman’s unborn baby.”, Dr. Michael Charness – Harvard Medical School, © National Organization on Fetal Alcohol Syndrome 2020. Pregnant women are advised not to drink any alcohol during pregnancy. Recently our team identified more than 400 conditions that co-occur in individuals with FASD, spanning 18 of the 22 chapters of the International statistical classification of diseases and related health problems. The fact remains that alcohol is toxic to the developing baby. When a mother-to-be consumes alcohol, it goes directly to the fetus through her blood stream. People with FASD – a preventable, but invisible disability - should not be forgotten by our societies. We wanted to draw the attention of health-care practitioners, health authorities and policy-makers to the problem of maternal alcohol consumption and FASD. There is no safe amount or type of alcoholic beverage, and no safe time to drink alcohol during pregnancy. This study states, “Even low amounts of alcohol consumption during early pregnancy increased the risk of spontaneous abortion substantially.” Alcohol Research & Health , 2011. The effects are often invisible, leaving children and adults with fetal alcohol spectrum disorder vulnerable and misunderstood. Alcohol abuse encompasses a spectrum of unhealthy alcohol drinking behaviors, ranging from binge drinking to alcohol dependence, in extreme cases resulting in health problems for individuals and large scale social problems such as alcohol-related crimes.. Alcohol abuse was a psychiatric diagnosis in the DSM-IV, and has been merged with alcohol dependence into alcohol use disorder in the DSM-5. In the United States 50% of pregnancies are unplanned, so it is possible that the first time a woman is told that alcohol can harm her pregnancy is after she is already pregnant and has been drinking. These findings are alarming because half of the pregnancies in developed countries and over 80% in developing countries are unplanned. When you drink alcohol, so does your baby. Symptoms include: National Organization on Fetal Alcohol Syndrome - (800) 66-NOFAS, The Leading Resource of the Fetal Alcohol Spectrum Disorders Community, “When talking about the prenatal effects of alcohol we usually think exclusively about the dose, the strength, and the timing of alcohol exposure. High-Risk pregnancy situation system to monitor the incidence and prevalence of FASD globally else to advise a to. 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