However, perhaps even more important are factors involving the mother – her genetic background and nutritional status to name just two. Q: Can you tell us about the new WHO study your centre is working on with the National Institute on Alcohol Abuse and Alcoholism? Dr. Michael Charness of Harvard Medical School gives just one example: “We’ve been able to show very striking effects of alcohol on the L1 cell adhesion molecule, a critical molecule for development, at concentrations of alcohol that a woman would have in her blood after just one drink.”. FASD involves a range of harmful effects that can occur when a fetus is … These estimates should not further stigmatize the mothers of children with FASD, but rather help to prioritize funding and support for these families. Absence of proof is not proof of absence. Practitioners should always inform their patients about the risks of known exposures. 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. Most babies affected by alcohol exposure have no physical birth defects. There is no safe amount or type of alcoholic beverage, and no safe time to drink alcohol during pregnancy. Myth: It is alarming and even condescending for a doctor or anyone else to advise a woman to abstain from alcohol during pregnancy. Early pregnancy is all about excitement, nerves, and lots of hormones that bring about various symptoms. Myth: My friends or family members drank a bit and their kids are fine. That means that many women don’t realize they are pregnant during the early stages and that they continue drinking … This study states, “Even low amounts of alcohol consumption during early pregnancy increased the risk of spontaneous abortion substantially.” Alcohol Research & Health , 2011. That was all there was in the curricula for medical students in the former Soviet Union. Myth: A little bit of wine helps to reduce stress and can be healthy while pregnant. An FASD is found in those whose mother drank alcohol during pregnancy. A. Foetal alcohol syndrome is a type of foetal alcohol spectrum disorder (FASD), the name for all the various problems that can affect children if their mother drinks alcohol in pregnancy. 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. Light drinking is not essential to the health or well being of a pregnant woman, so why take a chance?”. Q: How did you start researching these disorders? The human body functions the same, whether it’s a holiday or not. Not everyone who drinks while pregnant will have a child with measurable problems at birth, adolescence, or even adulthood, just like not every cigarette smoker will develop lung cancer. No safe time. If you drink heavily during pregnancy (even in the early stages before you know that you are pregnant), you increase the risk of your baby developing a range of disorders known as fetal alcohol spectrum disorders (FASD). Svetlana Popova is leading research on the epidemiology of drinking alcohol during pregnancy and its effects on the unborn child. A: Alcohol is poisonous to the developing fetus throughout the entire nine months of gestation. Which countries had the highest and lowest estimates? For decades, researchers have known that heavy drinking during pregnancy can cause birth defects. We are all responsible for the prevention of FASD: partners, families, friends and communities should all help and support women during pregnancy. More should be done to inform women about the harmful effects of drinking alcohol during pregnancy. Unfortunately, many doctors are not properly educated about the risks associated with prenatal alcohol exposure. These findings are alarming because half of the pregnancies in developed countries and over 80% in developing countries are unplanned. Q: If this is such a common condition, why is there so little awareness of it? Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. 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, … 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. 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. 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. These findings are alarming because half of the pregnancies in developed countries and over 80% in developing countries are unplanned. In many of these cases, the problems are most often not linked to the prenatal alcohol exposure, inhibiting an accurate diagnoses and delaying appropriate intervention. 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. The answer is simply, no. If a women becomes pregnant, stop drinking alcohol. 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. However, science has not demonstrated how these genetic and epigenetic (changes in how genes are expressed without altering the underlying DNA sequence) factors contribute to the vulnerability of a specific woman’s pregnancy. Recently our team identified more than 400 conditions that co-occur in individuals with FASD, spanning 18 of the 22 chapters of the, A: FAS was first described in the French medical literature by Paul Lemoine and colleagues in a 1968 study of children of alcohol-dependent parents. 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. 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. If the baby looks normal, it must be fine. No amount of alcohol use is without risk for a developing baby before birth. Fetal alcohol spectrum disorder (FASD) is a term used to describe the range of problems caused by drinking alcohol during pregnancy, including physical, mental, behavioural and learning disabilities. 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. A: We recently found that the prevalence of FASD is elevated and exceeds 1% in many countries, these data are not published yet. 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. There is also no safe time during pregnancy to drink and no safe kind of alcohol. Where appropriate, universal screening of pregnant women and women of childbearing age for alcohol use could be established. 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. Babies that survive may be left with lifelong problems. 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.  There is a wide range of effects, and most subtle behavioral and cognitive difficulties are rarely diagnosed as alcohol-related. Q: When did you first become aware of these disorders? Bulletin of the World Health Organization 2017;95:320-321. doi: http://dx.doi.org/10.2471/BLT.17.030517. Can you tell us about your study in The Lancet Global Health on the global prevalence of maternal drinking and FAS published in January? There is no cure for FASD and its effects last a lifetime. We wanted to draw the attention of health-care practitioners, health authorities and policy-makers to the problem of maternal alcohol consumption and FASD. The full impact of their alcohol exposure will not be evident until their adolescent years.”, Myth: There is no evidence of any effects from just one drink. 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. People with FASD – a preventable, but invisible disability - should not be forgotten by our societies. However, the baby lacks the ability to process or metabolize the alcohol. When autocomplete results are available use up and down arrows to review and enter to select. 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. Q: Why are women drinking so much alcohol today? 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. Q: How common is FASD compared with other birth defects? The effects are often invisible, leaving children and adults with fetal alcohol spectrum disorder vulnerable and misunderstood. Q: What is fetal alcohol syndrome (FAS) and how much do we know about it today? This uncertainty is the primary reason for the recommendation of abstention from any alcohol during pregnancy as the safest course. A: When I studied psychiatry as a medical student, I remember a few lines in our textbook saying that alcoholic mothers may deliver children with birth defects and other malformations. One of the most distressing disorders caused by alcohol consumption during pregnancy is Fetal Alcohol Syndrome (FAS). Diagnosis & Treatment. Why take the risk? 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: WHO initiated an International Collaborative Research Project on Child Development and Prenatal Risk factors with a focus on FASD to help gain a better understanding of the prevalence, severity and impact of FASD. Women’s alcohol consumption has been increasing in line with economic development and changing gender roles, but other factors include marketing directed towards women, increased availability and accessibility of alcoholic beverages and increased social acceptability of women drinking alcohol. In 1973, fetal alcohol syndrome was first described as a specific cluster of birth defects resulting from alcohol exposure in utero. We need an FASD surveillance system to monitor the incidence and prevalence of FASD globally. 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. 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. Fetal alcohol spectrum disorder (FASD) refers to a range of problems caused by exposure of a fetus to alcohol during pregnancy. Without knowing those genetic and nutritional factors that are critically involved with the way a woman metabolizes alcohol, it is not possible to make any generalizations about a “safe” amount of alcohol during pregnancy. Thousands of papers have conclusively demonstrated that alcohol use has the potential to cause both physical and functional damage to a growing baby. That means that many women don’t realize they are pregnant during the early stages and that they continue drinking when pregnant. 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. Women commonly cite the need to relax as one of the reasons they drink during pregnancy even if they understand the risks. We’ve made progress in understanding how alcohol damages the fetus, but this has not yet translated into better public awareness of the risks. We knew before the study that not every woman who drinks alcohol during pregnancy will deliver a child with FAS, because women drink different amounts and every mother and every fetus has a different ability to metabolize alcohol, and there are many other factors that may influence their vulnerability. Predominant diagnostic classifications are alcohol use disorder or alcohol dependence ().. We found huge costs in terms of law enforcement, the provision of social services and special education, as well as productivity losses due to morbidity and premature mortality. 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. These kinds of experiments support the view that women who are pregnant or trying to conceive would be safer to abstain from alcohol than to engage in even occasional light drinking. 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. If FASD is diagnosed early, interventions may be able to lessen its impact and prevent secondary disabilities. 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. 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. 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.”. Physicians were not trained to recognize FASD and this is still the situation in many countries today. 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. 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. Q: How can the global public health community use your global burden of disease study to prevent fetal alcohol disorders in their countries? 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. I found that this field was severely under researched and since then I have become dedicated to research in this area. The American Congress of Obstetricians and Gynecologists (ACOG) advises women to not consume any alcohol 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. Myth: My doctor said it’s fine to have a glass of wine or two while pregnant.  No safe amount. These figures are the minimum costs associated with FASD in Canada and don’t include the cost incurred to individuals themselves and their families. 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. The symptoms present in fetal alcohol syndrome (FAS) are at the most serious end of what are known as fetal alcohol spectrum disorders (FASDs). 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. Alcohol, including wine, causes more damage to the developing baby than many illicit drugs. FASDs are 100% preventable if a woman does not drink alcohol during pregnancy. Prenatal Alcohol Exposure. Symptoms include: No safe alcohol. Myth: One glass of wine is not enough for the developing baby to even be exposed to the alcohol. This research is designed to inform policies and programmes to reduce the harmful use of alcohol among women of childbearing age and to prevent alcohol consumption among pregnant women. 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: We provided data on 187 countries. The vast majority (over 85%) of children with characteristics or disabilities from prenatal alcohol exposure have no physical birth defects, only cognitive and/or behavioral consequences. 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. 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. 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. The method was presented to and discussed with researchers from around the world at the first WHO global expert Meeting on Alcohol, Health and Development in Sweden in 2009. The fact remains that alcohol is toxic to the developing baby. Overall, we found that alcohol use during pregnancy is common in many countries and that FAS is a relatively prevalent birth defect. , health authorities and policy-makers to the same concentration of alcohol use could established. 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