Want to have a drink while pregnant? Just say no
ST. LOUIS POST-DISPATCH
02/19/2007
Don't drink alcohol while you're pregnant, regardless of what you've heard, even from your doctor.
Your unborn child eats what you eat and drinks what you drink, and drinking alcohol is no less than feeding your unborn child poison, says a growing number of health care experts who believe it's time to sound an alarm.
Their message: Even small amounts of alcohol put your child at risk for a condition called fetal alcohol syndrome, or FAS. It's a devastating and expensive condition caused when pregnant women drink during pregnancy.
Researchers identified the condition more than 30 years ago. At the time, they thought fetal alcohol syndrome resulted from extreme drunkenness by the expectant mother.
The danger
Drinking while pregnant increases the chances that your child will be born with twisted or underdeveloped body parts, that he'll be slow to understand even simple tasks such as talking and eating, or that he'll have nervous system problems, even epilepsy.
"What's really disturbing is it's the one form of mental retardation birth defect that is 100 percent preventable," says Melinda M. Ohlemiller, director of prevention and advocacy for St. Louis Arc, an agency that advocates for people with birth defects.
So the fight against fetal alcohol syndrome can be won without compromise, Ohlemiller says. That's why health experts have increased their warnings about drinking while pregnant.
Even that one glass of red wine at night or a couple of beers on the weekend can have consequences for your unborn child, says Dr. Mark Mengel, professor of family and community medicine at St. Louis University School of Medicine.
The furor
By the end of the 1990s, policymakers began to change their minds about FAS. Still, U.S. Surgeon General Richard Carmona didn't issue an advisory until two years ago, shortly after the U.S. Centers for Disease Control and Prevention issued its guidelines for pregnant women.
"It is now clear that no amount of alcohol consumed during pregnancy is safe," he wrote.
The advisory included five directives:
1. A pregnant woman should not drink alcohol during pregnancy.
2. A pregnant woman who has already consumed alcohol during pregnancy should stop in order to minimize further risk.
3. A woman who is considering becoming pregnant should abstain from alcohol.
4. Recognizing that nearly half of all births in the United States are unplanned, women of childbearing age should consult their physicians and take steps to reduce their risk of prenatal alcohol exposure.
5. Health professionals should inquire routinely about alcohol consumption by women of childbearing age, inform them of the risks of alcohol consumption during pregnancy and advise them not to drink alcoholic beverages during pregnancy.
Bad information
Number 5, especially, annoys Mengel.
"There are doctors who still tell (pregnant) women it's OK to have one drink every once in a while, and that's not true," he says.
Too many physicians, nurses, social workers and others who counsel women haven't kept up with the new precautions, he says. He speaks to physician groups around the area and offers, among other things, this information:
— A pregnant woman who drinks six drinks a week has a 40 percent risk of bearing a child with fetal alcohol syndrome.
— The school of thought that the less you drink, the lower the risk, is wrong, he says. The risk varies with individuals. While anecdotally one mother may drink a lot with no problems, another can damage her baby when she drinks lightly, even a couple here and there. There's no way to tell which one you are.
— A pregnant woman can binge drink once and put her unborn child at risk. That binge can be something as innocent as a few beers at one college party.
— A woman who drinks in the third trimester of her pregnancy risks causing neurological problems for her unborn child, "because the brain and nervous system are still developing," Mengel says.
"Alcohol loves nerve tissue," Ohlemiller says.
— Even when full-scale fetal alcohol syndrome doesn't show up, a child still can suffer fetal alcohol spectrum disorder, the condition in which a child has one or a few of the less visible symptoms.
"We know clearly there's a spectrum," says Dr. Jeffrey Dicke, associate professor of obstetrics and gynecology at Washington University School of Medicine. "There are adverse effects that may not be the full-blown problem, and some may not be as severe."
Ohlemiller adds that fetal alcohol syndrome and the spectrum disorder may be responsible for many societal problems, ranging from behavioral problems in school to criminal behavior later on. "Some (early evidence) says FAS may account for 50 percent of the prison population," she says.
Detection
Researchers have yet to find a chemical or biological marker identifying fetal alcohol syndrome at birth or during pregnancy. Even when doctors use ultrasound and find a problem, it's not readily identifiable as FAS.
No test exists to identify women whose children could be prone to FAS.
Diagnosis of the disorder is a time-consuming process of connecting symptoms, much as you would a jigsaw puzzle — considering that any symptom can come from other conditions.
"That's why it's difficult to break down," says Dicke of Washington University.
A woman who binges, for example, often is doing other unhealthful things such as smoking and using recreational drugs. Any of those things can cause birth defects.
Another problem with identifying symptoms is that many mothers who drank during pregnancy may not admit or recall doing so when the child's health slides downward — which may be immediately or may take years.
A diagnosis often doesn't show up until the child is deep into elementary school. St. Louis Arc monitored one diagnosis that wasn't made until the patient was in his mid-20s.
Counterattack
St. Louis Arc, Mengel, Nurses for Newborns and other agencies are working to counteract the prevalence of fetal alcohol syndrome, as well as other prenatal care problems. They're choosing to fight with information and education.
FAS is not a product of mothers who choose to drink irresponsibly, they say. Bad information is the culprit.
This is one reason why experts don't advocate criminal charges against mothers whose children suffer from fetal alcohol syndrome.
An expectant mother innocently may not know the danger and may even have been assured by her doctor that her drinking was safe.
On the dark side, a mother who drinks incessantly and refuses to stop is an alcoholic and needs more help than a jail cell can provide, they say.
Missouri lawmakers are still learning the message, Ohlemil
ler says. Currently, liquor regulations require taverns to post signs that drinking while pregnant can cause birth defects. But that's about it so far. There's no state-supported campaign to get the word out.
Only one case in the region is pending: A 33-year-old woman who arrived drunk and in labor at St. Joseph Hospital West in St. Charles County in December was charged with manslaughter after her baby died of alcohol poisoning.
Meanwhile, across the country, women who have given birth to children who died of alcohol poisoning have faced penalties ranging from misdemeanor jail time to life in prison.
Looking good
In an experimental program with the Elaine Steven Beauty College, Nurses for Newborns began this month to train cosmetologists to discuss fetal alcohol syndrome and other health issues with their clients — young women sitting in salons and spas, talking and listening to one another. The "hey girl" conversations are ideal for spreading information, planners say.
A windfall is that the cosmetology students, who generally are in the targeted audience, learn, too, says Jean Lake, manager of the college.
"A lot of our students and the population we serve, they don't see the importance of care until the baby's there," Lake says. "We're trying to teach them that a lot of the problems they end up with can be alleviated so easily."
hjaxson@post-dispatch.com | 314-340-8234
Contributor: Peggy Seo Oba
