Alcohol and the pregnant woman

Fetal Alcohol Syndrome (FAS), Down's syndrome, and spina bifida are the three most common problems leading to mental retardation in newborns. Fetal Alcohol Syndrome is the direct result of alcohol in the mother's blood transferring to the blood of the unborn child. Each year some 3,000 to 5,000 babies born in the United States have FAS—and this is probably a low estimate because many of the symptoms of FAS are not apparent at birth or in the early months of child hood. ¹

FAS is a group of defects and symptoms exhibited in varying degrees in the children of drinking mothers. Some babies and young children are diagnosed quickly and easily as having FAS. The symptoms of others are barely perceivable at birth. Only as the child goes through some of the developmental stages and fails to keep up with the accepted norm is the syndrome diagnosed.

Yet FAS is preventable. Women who do not drink do not produce children with FAS. But pregnant women who take alcohol into their systems in any form are giving alcohol directly to their unborn babies. And the concentration of alcohol in the baby's blood is double that in the mother's blood. Alcohol is metabolized through the liver; the fetus, however, must release that alcohol back into the mother's circulatory system for elimination from its body.

At birth the average American infant weighs 7.2 pounds, with only 7 percent weighing less than 5.5 pounds. ² In contrast, the average FAS infant weighs less than 4.5 pounds, and 75 percent of these infants weigh less than 5.5 pounds (2,500 grams). ³ This low birth weight is a good predictor of increased sickness and mortality.

FAS is characterized by several birth defects, including irreversible mental retardation, delayed development or motor retardation, and distortion of physical features. There may be problems in any one of the body's major organ systems. Frequently the baby has a small head and distinctive facial features: a flat profile, small eyes, short nose, ears set low, and sometimes other deformities. The IQ of an FAS child averages between 65 and 70. The child may manifest hyperactivity, learning disabilities, and motor disturbances that may include fine and gross motor activity.

FAS has been divided into three classifications: true FAS children, those manifesting all symptoms; moderate FAS children, those showing some functional impairment and physical signs; and mild FAS children, those with only from one to a few minor signs.

Researchers are still debating the mechanism by which alcohol affects the infant. But we know quite a bit about the effects of alcohol. Evidence shows that alcohol inhibits cell multiplication, which is vital to the developing embryo or fetus. In addition alcohol, even in low doses, may cause a decrease in oxygen delivery to the fetus by causing constriction of the umbilical artery. Unlike the moderate constriction that occurs with low doses, high doses bring severe prolonged constriction or even complete collapse of the blood vessels in the umbilical cord. This then leads to fetal oxygen deficiency. ⁴, ⁵

A recent Swedish study reported that children of alcoholic women showed an IQ score 15 to 19 points below that of a control group of normal children. One half of the children of alcoholic women showed signs of FAS and had lower IQ scores than those who did not show signs of FAS. Sixty percent showed signs of hyperactivity, distractibility, and short attention span, and one-third showed signs of low perseverance. ⁶

At what stage of her pregnancy, then, should a woman stop drinking? How much alcohol is safe during pregnancy? Studies indicate that even when a woman isn't drinking enough to be considered an alcoholic, her drinking has a negative effect on her baby. Researchers have been unable to show how much, if any, alcohol can be consumed without harming the unborn. If a woman wants assurance that no harm will come to the unborn, she should stop drinking before she becomes pregnant. In terms of deformities, the greatest harm occurs during the early weeks of pregnancy, the very time when the woman may not know that she is pregnant.

In July 1981 the United States surgeon general mailed a bulletin to more than 1 million physicians and health professionals in the United States. It said, "The surgeon general advises women who are pregnant (or considering pregnancy) not to drink alcoholic beverages and to beware of the alcoholic content of food and drugs." ⁷ "Even if she does not bear a child with full FAS, a woman who drinks heavily is more likely to bear a child with one or more of the birth defects included in the syndrome. [Small head size,] which is associated with mental impairment, is one of the most common of these defects." ⁸

Two years after the surgeon general's recommendation, the American Medical Association's Council on Scientific Affairs also came out against the use of alcohol during pregnancy. Their statement presented clear evidence tying heavy alcohol consumption with Fetal Alcohol Syndrome.

Though the evidence was still not clear as to the effect of less-than-heavy drinking on fetal outcome, the AM A recommended that "physicians should be explicit in reinforcing the concept that, with several aspects of the issue still in doubt, the safest course is abstinence." ⁹

Babies born to a mother with alcohol in her system at birth go through withdrawal symptoms. Children of alcoholic mothers may be born alcoholics. The day they take their first alcoholic drink, they may exhibit every symptom and have all the problems of an alcoholic. This first drink may come any time in life. These children do not develop alcoholism over a period of time. They are alcoholics from the very first drink.

To prevent FAS, women must refrain from alcohol use immediately prior to and during pregnancy. Getting them to abstain during these times means we must teach them values before they make the decision to imbibe alcohol. They learn these values from parents, from society (including school and church), and from immediate peers.

Our efforts at prevention should focus on assisting the community to control alcohol and alcoholism effectively. The church in its preventive measures needs to consider both the smaller community of its own members and the larger community that surrounds it. The church's role includes both ministry and mission. Ministry means tenderly sup porting those in the church and those who come to the church for help. Mission includes the church's outreach to let people know that the church has a ministry to offer. The church must confront individuals with the facts and then comfort them as it helps them change their lifestyles. The church can then present natural remedies as alter natives.

Education for both parents and children should be given early. Two types of parent and teacher groups are needed: information groups involving the total community, and "squeal" groups consisting of parents and teachers who encourage one another to speak up when they have concerns about local drug and alcohol use. As parents listen to the squealing of others, they can lovingly confront their children with their behavior. This will make them better chaperons for children's parties and better observers of children's behavior.

The church should support Alcoholics Anonymous and its related bodies (Al-Anon, Alateen, etc.), and encourage members to use these groups. It can also provide further support for its members through small groups within the church. And to have a broader impact in the community the church can get involved with action groups, such as SADD, MADD, and Straight, that are campaigning against alcohol and drugs.

Parents should be role models of nonalcoholic behavior not only to their children but to the community. Since 10 percent of social drinkers become alcoholics, we must not consider social drinking acceptable. Yet we must help the drinker feel accepted and assist him or her to a healthful lifestyle that excludes alcohol.