Fetal Alcohol Disorders Up to 10 Times More Common Than Believed

[El]

Up to 10 times more children have disabilities related to fetal alcohol exposure -- drinking during pregnancy -- than previously believed, finds a new study. As many as one in 10 children in some U.S. communities may have some type of disability due to maternal drinking during pregnancy, the research suggests.

Not only does this finding reveal substantial numbers of children with potentially unrecognized disabilities who need help, but it also drives home how widespread disabilities are from drinking during pregnancy—even if it’s not heavy or binge drinking.

When most people think about drinking during pregnancy, they often think about heavy or binge drinking, which can cause fetal alcohol syndrome (FAS). FAS is a physical and developmental disability that affects growth, facial features and cognitive development and behavior. The CDC estimates that 1 in 1,000 children has FAS, though some estimates range up to 9 in 1,000.


But FAS is part of the larger, broader category of fetal alcohol spectrum disorders (FASD). FASD includes all disabilities and conditions resulting from any alcohol exposure in the womb, even if the drinking was not heavy enough and the disabilities are not severe enough for an FAS diagnosis. Until recently, low-end estimates of FASD were 1% of children, ranging up to 5%.

But the new research in JAMA suggests that 3.1% to 9.9% of children throughout the U.S. have a fetal alcohol spectrum disorder. This study looked at four regions of the U.S., but since alcohol use patterns differ across geographical areas, the prevalence of FASD will vary geographically as well.

Regardless, the overall underreporting of FASD, combined with the lack of public awareness about the spectrum of disorders, has undoubtedly fueled the misconception that very small amounts of alcohol are “safe” to drink during pregnancy.

The study, led by Phillip A. May, PhD, from the University of North Carolina at Chapel Hill, at two points in time: November 2010 and July 2016.

The researchers assessed 6,639 first graders for four contributions to FASD: 1) known prenatal exposure to alcohol, 2) difficulties in neurological or behavioral development, 3) stunted or atypical physical growth and 4) the facial features that indicate prenatal alcohol exposure. These characteristic facial features include small eye width, a smoothed area between the nose and upper lip and a thin upper lip.

The children came from one of four communities across the U.S.: a Midwest community of 172,000 people, a Rocky Mountains community of 60,000 people, a Southeast community of 206,000 people and a Pacific Northwest city of 1.4 million.

Overall, 222 children had FASD, including 27 with FAS, 104 with partial FAS and 91 with a neurodevelopmental disorder resulting from prenatal alcohol exposure. Yet only 2 of these children had previously been diagnosed with FASD. The other 220, despite having symptoms, had been missed.

The researchers made several calculations to extrapolate a range of estimates for FASD more broadly. The lowest prevalence was 3.1% in the Rocky Mountain location, and the highest was 9.9% in the Southeast location. Even the most conservative calculations suggested prevalence ranging from 1.1% to 5%. The most severe disorder, FAS, made up less than one fifth (20%) of all the FASD cases — which means the most common cases are far from the most severe.

These findings are not that different from recent global estimates that found FASD is more common than previously believed across the world. It’s still difficult to get reliable estimates, however, of differences across the world in study methods, definitions of FASD and alcohol use and norms in different countries.

But one thing is evident: many more children are affected by drinking during pregnancy than researchers previously realized.

“These prevalence estimates are consistent with mounting evidence that harmful fetal alcohol exposure is common in the United States today and highlight the public health burden due to fetal alcohol spectrum disorders,” the authors wrote. That public health burden includes at least $4 billion a year only for those with FAS—excluding the much larger population of people with FASD.

Even though the findings cannot be generalized to all communities in the U.S., and there is potential for some over-diagnosis, these results are probably more accurate than past U.S. estimates, the authors wrote. They also note that data have shown an increase in women’s alcohol use from 2001 until 2013.

According to a JAMA commentary on the study, the methods used in this study are the most reliable for estimating FASD prevalence.

“The high prevalence of fetal alcohol spectrum disorders in the United States suggests better education of girls and women of childbearing age about the detrimental consequences of alcohol use during pregnancy on the fetus is needed,” wrote the editorial authors. “As suggested by the American Academy of Pediatrics, the message about alcohol use during pregnancy to the public should be clear and consistent: there is no safe amount, time, or type of alcohol to drink during pregnancy or when trying to get pregnant.”

Evidence shows that drinking any amount of alcohol during pregnancy carries risks—despite a strong national narrative of denial that just a few drinks here and there carries insignificant risk. Epidemiological studies suggesting no effects have substantial limitations and flaws, including an inability to detect the effects with the tools and methods used and assessing children before more evident issues appear. Many problems caused by alcohol exposure in the womb don’t show up until children are in the mid or late teens.

Ideally, this study is a wake-up call in recognizing how common disabilities are from drinking during pregnancy—and that the only way to eliminate these risks completely is to eliminate alcohol completely during pregnancy and while attempting to conceive.

Not even a tiny bit surprising to me.

[El]

Also, got to this article from that one, and thought it was a pretty good exploration of what this means for women:

Backlash Over CDC Paternalism Overshadows Real Risks Of Drinking In Pregnancy
     

Tara Haelle , CONTRIBUTOR
I offer straight talk on science, medicine, health and vaccines. 
Opinions expressed by Forbes Contributors are their own.
Feminists--including myself--have been in an uproar this week over the tone-deaf and paternalistic decree from the CDC that women of childbearing age shouldn't drink alcohol if they're not on birth control. After all, the CDC reasons, they might get pregnant and not realize it and keep drinking, thereby harming their baby. I agree with much of the excellent commentary pointing out how sexist, condescending and demeaning the CDC’s statement was. (“The language insinuates that your womb is a Schrodinger's box” was a personal favorite.)

I was angry at the patriarchal tone, the exclusion of lesbians’ existence, the lack of acknowledgement regarding contraception access difficulties or the option of termination, the possibility that some women might actually be abstinent, the absence of any mention of sexual partners who contribute sperm and the overall implication that women exist only as potential baby-carrying vessels, not as individuals.

But as angry as I am that my national public health agency devalues my existence as an autonomous human being, I’m actually angrier about what their failure to effectively communicate has wrought with its (deserved) backlash. Because the CDC completely bungled their messaging, people are disregarding the actually important information the agency was trying to convey about alcohol and pregnancy. Everyone is talking about how much they screwed up—not enough people are talking about the very large and serious public health problem behind their statements. Our country, like so many others, is in denial about a lot of the ways alcohol is harmful, including during pregnancy—yes, even a tiny bit. The CDC just gave people a reason to continue that denial.

In the midst of much of the criticism, I’ve seen far too many comments in the media coverage about how the research shows “a glass now and then” can’t hurt, or that “very light drinking shows no effects” on children. As I’ve written before, that’s not the case. I’ve also seen a lot of false equivalence: people think, “They also say caffeine should be avoided. And sushi. And lunchmeat. And soft cheese. I’m not a damn saint!” And they figure if the risk is kind of low-ish with those substances, then so it must be with alcohol.


The problem is that the risks associated with alcohol are different from those other “risks,” some of which (e.g., caffeine) don't exist at all. The risk of listeria from soft cheese is vanishingly small (and you can get it from just about any food), and it's a binary situation: you get listeria, or you don't. With alcohol, there is no question of harm. Alcohol is a toxin that directly damages cells. Harm occurs. The question is the scale and the effect (and whether it’s detectable), and that part of the message was not communicated at all.


Just about everyone has heard about the dangers of heavy or even moderate drinking during pregnancy. Fewer are aware that even light or occasional drinking can cause harm as well--even if it's not detectable. photo by Dani Simmonds

Should a woman who is pregnant--or a woman who might become pregnant--drink a glass of wine or two? That is not my decision to make, nor is it the CDC's. It’s also not my place to tell a woman what she should do, nor is it the CDC's. But it is important for that woman to know what risks she is taking, whether currently pregnant or having unprotected sex, and it is absolutely the role of the CDC to clearly and transparently explain those risks--and they failed.

Alcohol starts affecting a developing embryo by the third week after fertilization. From then on, alcohol crosses the placenta. Every. Single. Time. What it does once it gets there depends on what's going on at that precise moment. But the idea that it does nothing is a misconception not supported by the evidence base.

I read dozens and dozens of studies in full for the alcohol and pregnancy section of the book I coauthored with Emily Willingham. I began that research thinking a glass here or there was no big deal. I had even had a few glasses of wine or beer sparingly in my second pregnancy and stood by my decision. Heck, I had a half a shot of whisky at the start of my son’s second trimester—it was a free sample and I wanted a taste. I was therefore stunned when I really dug deep into the research: Several dozens of hours reading epidemiological studies, basic science studies, animal studies, in vitro studies, ultrasound studies, developmental studies and various commentaries and editorials on the relative merits and limitations of all these.

To my own surprise, I changed my mind. Once I had a better understanding about what alcohol is at a chemical level, how it works, how it differs from many other substances, how it interacts with cells, how it circulates and how underreported fetal alcohol spectrum disorders—separate from the more serious fetal alcohol syndrome—are, and how poorly these conditions are screened for, detected, diagnosed and managed, I did a complete 180 on this question.

There is no doubt that even one drink—even a half drink—circulates throughout the entire body and reaches the embryo (or, later, fetus). There is no doubt that alcohol damages developing cells. So the question isn’t about exposure but about damage. The more relevant questions are: “Which cells?" and “How bad is the damage?" And there is no way for current technology to answer that at any given moment.

Most certainly, one drink may have so little effect, if any at all, that's it's irrelevant. Or not. It's not the precautionary principle if we have solid evidence of harm that occurs at a cellular level. And we do. In educated, upper-income women with good nutrition, that effect will likely be offset so much that any manifestation would be subclinical—not detectable with current tests—and the parents may very well be fine with that possibility. That’s also why those who have already drunk before they knew they were pregnant should not be shamed. (Paying attention, CDC?) Whatever damage has potentially occurred is likely small enough not to be noticed unless the person was regularly binging.

If a person knowingly chooses to drink while pregnant and accept the risk, that is her decision—I do not in any way judge someone who drinks during pregnancy. Rather, I empathize with her. Being pregnant was no picnic for me, and goodness knows I really felt I needed that glass of wine a couple times. I do, however, believe that people have a right to be fully informed about the science. I wasn’t at that time. Others aren’t either right now, in part, because of paternalistic, oversimplifying, sexist messages like that of the CDC’s.

Instead of clearly EXPLAINING what is scientifically understood about the risk and what the effects are from even small amount of alcohol, the agency issues a blanket statement for “all women” (lesbians don’t matter, apparently) that talks down to women, exonerates men and leaves everyone with just as little information as they had before. Simply stating “There is no known safe amount of alcohol--even beer or wine--that is safe for a woman to drink at any stage of pregnancy,” and asking, “Why take the chance?” does not actually tell people anything.

Scientists have known for three decades that alcohol disrupts the structure of cell membranes. Even a tiny amount of it. They know it damages stem cells. Does that matter to a developing embryo? Well, that depends. Precisely which organ is in the midst of forming at that exact moment when a pregnant woman downs…a half shot of whisky, for example? We don’t know. Twin studies have found that one twin may be much more affected by a mother’s alcohol consumption than the other. Did one buffer the other? Have a genetic mutation that protected them? Simply hang out in a luckier part of the womb? What effect alcohol might have at any given moment will vary from woman to woman, embryo to embryo, drinking episode/instance to drinking episode/instance. And it’s fully within a woman’s right to take that risk once she is aware of that.

An estimated 40,000 children are born each year with FASDs and related alcohol effects. It’s possible to look at one study here and one study there and find ways to justify that a little bit of drinking won't cause harm, but a close examination of all the evidence together leaves little doubt about even small amounts of alcohol. Most of the studies looking at “light drinking” have not used sophisticated enough tests to detect what effects might be there. Most lesser effects, such as attention and focus problems, difficulty in decision-making and mood problems, do not show up until adolescence, and very few studies have tracked children that far. When including all FASDs and other non-FASD conditions, 1% of all live births in the U.S. are affected by alcohol, and that is an underestimate precisely because of what cannot be detected in healthier, wealthier women. Alcohol exposure during pregnancy is the leading cause of intellectual disability (formerly called "mental retardation") in the U.S.

Yes, consumption of alcohol in those precious few weeks (or months) before a woman knows she is pregnant almost certainly has adverse effects on her child that are preventable. Yes, this is a major health issue, it's not adequately addressed, and the CDC is the appropriate agency to address it. And they completely and totally screwed it up. They bungled it to such a degree that they very well might cause harm by obfuscating just what the risks are with their paternalistic decrees. Women are not children who need admonishment about not touching the stove. They need information—clearly communicated information without euphemisms or tsk-tsks, delivered in a reasonable tone that respects them as adults capable of making their own decisions.

[Yuri Bezmenov]

Also, got to this article from that one, and thought it was a pretty good exploration of what this means for wamyn:

Backlash Over CDC Paternalism Overshadows Real Risks Of Drinking In Pregnancy

   

                        

Fucking sociopathic feminazi bullshit!!

"So what if I drink like a fish when I'm pregnant, it's MYYYY body and it's MYYYY choice!!"

Any woman who believes that needs their ovaries ripped out.

[renaeden]

My mum drank after she had the four of us.

[El]

Also, got to this article from that one, and thought it was a pretty good exploration of what this means for wamyn:

Backlash Over CDC Paternalism Overshadows Real Risks Of Drinking In Pregnancy

   

                        

Fucking sociopathic feminazi bullshit!!

"So what if I drink like a fish when I'm pregnant, it's MYYYY body and it's MYYYY choice!!"

Any woman who believes that needs their ovaries ripped out.

...did you actually read the article, or just flip out over the headline?

[Icequeen]

My mum drank after she had the four of us.

That's how it worked here. 

They need to do some more research on effects at conception and put some stern warnings out there for the guys too. A generation of kids where probably conceived after the husband came home drunk...but not too drunk to get it up.

Doctors need to stop denying effective birth control methods to women that WANT to remain childless, or decide they only want one child. Women are still treated in many places as if they don't really know WHAT they want in life.

That doesn't even go into how many women are denied effective birth control because of some potential health risk.

"I'm sorry...I can't prescribe birth control for you due to your blood test results." ..."but if you don't choose to be celibate or rely on less effective methods...whatever you do don't go out and drink until you hit menopause."

...and if you did and it happened..."shame on you...you should have known better."

[Calandale]

Kids these days are just getting drunk earlier!

[Yuri Bezmenov]

Also, got to this article from that one, and thought it was a pretty good exploration of what this means for wamyn:

Backlash Over CDC Paternalism Overshadows Real Risks Of Drinking In Pregnancy

   

                        

Fucking sociopathic feminazi bullshit!!

"So what if I drink like a fish when I'm pregnant, it's MYYYY body and it's MYYYY choice!!"

Any woman who believes that needs their ovaries ripped out.

...did you actually read the article, or just flip out over the headline?

Yes I read it, which is why I find it so revolting.

This author thinks that wamyn's butthurt fee fee's are more important than the well being of their children.

She, along with any other wamyn who believes this tripe, shouldn't be allowed within a country mile of any actual children as they will always place their own interests above that of the innocent.

What a fucking callous selfish entitled adult child this person is.

[mdagli1]

Good. If the baby doesn't like being born retarded, then maybe it should of protect itself from being fucked to begin with. The best that we can hope for is that they are aborted before they fall out from behind the meat curtain.

[Icequeen]

This author thinks that wamyn's butthurt fee fee's are more important than the well being of their children.

She, along with any other wamyn who believes this tripe, shouldn't be allowed within a country mile of any actual children as they will always place their own interests above that of the innocent.

What a fucking callous selfish entitled adult child this person is.

I didn't see that.

I saw a woman who believed the facts should be stated, and that we, as thinking, educated human beings with a brain should be capable of making the proper decision.

She AGREED with the research, just not how it was presented.

This:

Women are not children who need admonishment about not touching the stove. They need information—clearly communicated information without euphemisms or tsk-tsks, delivered in a reasonable tone that respects them as adults capable of making their own decisions.

[Yuri Bezmenov]

I saw a woman who believed the facts should be stated, and that we, as thinking, educated human beings with a brain should be capable of making the proper decision.

Not exactly, she said that the women themselves should make the decisions which is bullshit.

A woman who makes the "decision" to drink while she's pregnant is guilty of child abuse and should be put in jail (and kept sober) until she goes into labor.

She AGREED with the research, just not how it was presented.

This:

Women are not children who need admonishment about not touching the stove. They need information—clearly communicated information without euphemisms or tsk-tsks, delivered in a reasonable tone that respects them as adults capable of making their own decisions.

Jesustaptancing Christ!! someone call the Waaaaaaaambulance already.

Teh wamyn got her fee fees hurted in teh butt, oooooooh noooooees!!!!!!

[El]

I saw a woman who believed the facts should be stated, and that we, as thinking, educated human beings with a brain should be capable of making the proper decision.

Not exactly, she said that the women themselves should make the decisions which is bullshit.

A woman who makes the "decision" to drink while she's pregnant is guilty of child abuse and should be put in jail (and kept sober) until she goes into labor.

oh boy

[Jack]

In some states it's illegal. Though in New York it's illegal to refuse to sell alcohol to a pregnant woman.

[Icequeen]

I saw a woman who believed the facts should be stated, and that we, as thinking, educated human beings with a brain should be capable of making the proper decision.

Not exactly, she said that the women themselves should make the decisions which is bullshit.

A woman who makes the "decision" to drink while she's pregnant is guilty of child abuse and should be put in jail (and kept sober) until she goes into labor.

oh boy

Yeah, I'm done here. 

[mdagli1]

I agree with pisshead, lets abuse the mother for abusing thier unborn kid. Punch her in the head till she is in a coma, that should stop them from making stupid choices. Alternatively, aim your foot at her stomach and kill the foetus outright because you can't be done for murder for ending something that hasn't even been born yet.