The effects of alcohol during pregnancy remain a massive, yet overlooked, problem. Pre-natal alcohol exposure negatively affects the development of the brain often leading to fetal alcohol spectrum disorders (FASD). The lack of awareness and limited resources invested are making FASD hard to diagnose and support. But early diagnosis and support can make a world of difference for people affected by FASD, their families, and communities at large.
Scientific studies estimate between 1% and 5% of the population is affected by FASD. However, experts estimate that the actual figures are even higher.
In a landmark 2017 study, the global prevalence of alcohol use during pregnancy was estimated to be 9.8% and the estimated prevalence of Fetal Alcohol Spectrum (FAS) in the general population was 14.6 per 10.000 people.
The researchers also estimated that one in every 67 women who consumed alcohol during pregnancy would deliver a child with FAS, which translates to about 119.000 children born with FAS in the world every year.
Apart from having difficulty with everyday life those with FASD are at greater risk to face the criminal justice system. Several small studies have estimated that between 10% to 36% of those who are incarcerated may have FASD.
Jerrod Brown, a researcher specializing in behavioral health and criminal justice at Concordia University in St. Paul, Minnesota, says he hears stories of difficulty with communication, giving false confessions, and inability to stick to probation schedules.
Foetal damage is one of the clearest examples of the second-hand harm caused by alcohol (harm to others). For example, the cost of FAS in Sweden is estimated at $1.4 billion per year. The biggest share of these costs derive from support provided by society to people living with the consequences of FAS.
A landmark report shows, for instance that the effects of prenatal alcohol exposure on foetal development are stronger than those from tobacco use, use of other psycho-active substances and exposure to other hazards such as lead and radiation.
Consequences of alcohol exposure in connection to pregnancy
- Alcohol exposure in pregnancy is the most common cause of preventable cognitive deficits among children in Sweden and globally, affecting an estimated 1% to 5% of live births each year.
- Even though the brain is the organ most severely impacted by prenatal alcohol exposure, abnormalities within the heart, kidney, liver, gastrointestinal tract, and the endocrine system can also occur.
- Possible causal mechanisms include alcohol-induced brain cell death and damage to the DNA of immature male and female reproductive cells, causing changes which can potentially last for generations.
Alcohol use in the time surrounding pregnancy
- The natural inclination is to perceive alcohol and pregnancy as a problem restricted to pregnancy, and a problem restricted to women.
- Neither is true.
- The effects of alcohol on pregnant women and their offspring are related to the alcohol use of both men and non-pregnant women in the general population.
- Over 80% of Swedish women consume alcohol during the year prior to pregnancy and 14% consume alcohol at heavy levels.
- Overall, few women reduce consumption prior to pregnancy recognition.
- Male alcohol use in the pre-conception period may adversely affect the fetus and possibly subsequent generations through genetic modification of sperm.
How alcohol affects the brain
By the 1970s researchers had identified that alcohol use during pregnancy can harm the fetus. They noticed several patterns in babies born to mothers who had severe alcohol use disorders. These babies developed facial features such as a smooth upper lip, a small head, and a flat nasal bridge. These physical features were accompanied by a variety of lifelong mental and physical challenges, such as learning disabilities, difficulty reasoning, growth deficiencies, and heart and kidney problems.
Research has since found that prenatal alcohol exposure can affect brain and body development without affecting facial features.
The term fetal alcohol spectrum disorder (FASD) defines a range of conditions from immune dysregulation to attention deficit disorders linked to prenatal exposure to alcohol. The exact symptoms differ between patients.
Alcohol affects the brain in different ways, depending on when the brain is exposed in pregnancy and how much it’s exposed, and what else is going on, like nutritional factors, genetic factors, other things about the mom and the fetus,” said Jeffrey Wozniak, a neurobehavioral development researcher at the University of Minnesota, as per National Geographic.
Jeffrey Wozniak, neurobehavioral development researcher, University of Minnesota
While the symptoms vary individually regarding the effect on the face, immune system, hormone signaling and cognition, there are several similar anatomical characteristics in the brains of those who are exposed to alcohol prenatally.
1. Smaller brain size
Wozniak says, as per National Geographic, that this finding is consistent in most research on prenatal alcohol exposure.
2. Underdeveloped corpus callosum
The corpus callosum is a thick band of neurons in the middle of the brain running from the front to the back, connecting the two hemispheres together. It coordinates between the hemispheres.
This is why many people with FASD take a longer time to process information. A study by Wozniak and his team in 2011 found that the two brain hemispheres are less coordinated among those with FASD. This leads to deficits in hand-eye coordination, verbal learning, and executive functions.
3. Significant impact on the hippocampus
Studies show that those with FASD have smaller and disorganized cells in the hippocampus. This part of the brain is related to consolidating memories. Therefore people with FASD often have memory issues.
4. Abnormalities in the prefrontal lobe
This is the part of the brain that is involved in planning and organization as well as reasoning and judgment. Research has found the system of blood vessels and veins carrying oxygenated blood around this area of the brain can be disorganized by being exposed to alcohol in utero.
This means that people with FASD have a disorganized system of getting oxygen to the prefrontal lobe. One example is that those with FASD have difficulty replenishing oxygen in areas of the brain that help people cope with frustration.
According to research, dad’s alcohol use can harm the baby too. It has been found that dad’s sperm could be responsible for FASD, which affects one in every 100 infants. Another study showed the risk of birth defects was higher among couples with paternal alcohol consumption, after controlling for confounders. The finding suggests that future fathers should be encouraged to modify their alcohol intake before conceiving to reduce fetal risk.
Diagnosing fetal alcohol spectrum disorder (FASD)
Despite identifying common brain characteristics of FASD, doctors say brain scans cannot diagnose prenatal alcohol exposure because every case is different. Therefore, many cases of FASD go undiagnosed.
For a long time, doctors did not ask those who were pregnant or their families about their alcohol use.
However, by the early 2000s studies found that targeted therapies can help people who were prenatally exposed to alcohol. For example, offering adaptive support helped people with FASD better learn and understand math, a subject that is usually hard for people with FASD due to their issues with working memory.
Since then researchers have also found programs to help with executive function and decision making.
Early diagnosis and support can make a world of difference for those who have FASD as well as their families and the wider community. Nevertheless, there are very few diagnostic centers even in high-income countries, such as the United States (U.S.).
Since there are few diagnostic centers they only take in people they are most likely to diagnose. These are often people who are sure they have been exposed to alcohol prenatally. But it is only a fraction of the actual cases.
There are also slight changes in the diagnosis depending on how strict or relaxed certain criteria are in different clinics and states. This makes it challenging for large-scale research into FASD.
Another serious problem is that in countries like the U.S. people with FASD often do not qualify for insurance since the Centers for Disease Control and Prevention (CDC) only has consistent diagnostic criteria for fetal alcohol syndrome (FAS) and not the entire spectrum.
The way forward
There are initiatives in different parts of the world to raise awareness about and to improve the response to FASD.
Towards a National Center of Fetal Alcohol Spectrum Disorder (FASD) in Sweden
In Sweden, for example, IOGT-NTO is advocating for the creation of a National Center of Fetal Alcohol Spectrum Disorder (FASD) – based on the world class evidence their landmark report compiled.
IOGT-NTO is the largest organization promoting an alcohol-free way of life in Sweden and one of the biggest member organizations of Movendi International.
Of all the lifestyle choices we make in connection with a pregnancy, there is nothing more important to the child’s future health and development than the choices we make about alcohol,” writes Irma Kilim, Head of Drug Policy at IOGT-NTO in her editorial.
Irma Kilim, Head of Drug Policy, IOGT-NTO
Every Moment Matters campaign in Australia
Another example for the way forward is the campaign by the Foundation for Alcohol Research and Education (FARE) called Every Moment Matters – a nation-wide project supporting alcohol-free pregnancies and breastfeeding.
The project is endorsed and funded by the Australian Government Department of Health.
Almost one in three Australians aren’t aware that consuming alcohol during pregnancy can cause Fetal Alcohol Spectrum Disorder (FASD). Nearly one in four aren’t aware alcohol should be avoided altogether during pregnancy for the health of mum and baby.
Every Moment Matters aims to support Australians to stop consuming alcohol through all the moments of pregnancy, from the moment they start trying to get pregnant. It is the first phase of a broader program of work and will run from November 2021 to July 2024.
The FASD Respect Act in the U.S.
Susan Shepard Carlson, a former district court judge and first lady of Minnesota, U.S. is advocating for a bill called the FASD Respect Act. This Act aims to provide resources at the national level for screening, research, and other support services for FASD. It also aims to improve outreach and awareness on FASD and prenatal alcohol exposure.
In 1997, Carlson noticed that a lot of kids going through the court system had a profile similar to someone with FASD. She went on to convene a task force and hosted public hearings, which led to the state funding of FASD research and treatment. The court screened children suspected of having undiagnosed FASD. About 25% of the kids who were picked for screening did have FASD.
National attention to FASD goes beyond the criminal justice system. It can make a vast difference for those who have FASD and their families. Apart from getting support and treatment for the person affected, families can attend specialized training on how to communicate and better suppose their family member with FASD.
It’s really important to know that we can still have dramatic differences in the developmental outcome of these children, if we get them recognized, and get them services as early as possible,” said Julie Kable, a neurodevelopmental exposure researcher at Emory University in Georgia, as per National Geographic.
Julie Kable, neurodevelopmental exposure researcher, Emory University in Georgia
The bill for the FASD Respect Act currently has 50 sponsors in the House of Representatives. If the Act goes through it can make a long-term impact for people with FASD, their families, and the wider community, for example by preventing people with FASD from going through the criminal justice system.
For further reading
Browse through Movendi International’s resource page on FAS, FASD, and alcohol during pregnancy and breastfeeding.
Prenatal Exposure to Alcohol – a Blind Spot
Alcohol consumption during pregnancy is a risk behaviour and can cause severe damage to a foetus, even at low doses. But the problem of FASD remains underestimated despite the magnitude of harm. There are blind spots in prevention and detection, there are barriers in care and support, and there is lack of political attention. This guest expert opinion provides a compelling analysis and charts a promising way forward.
Science Digest: Estimating Community Prevalence, Child Traits, and Maternal Risk Factors of FASD
Impulse control and adaptive function were significant FASD traits. Significant maternal risk factors reported were postpartum depression, frequency of alcohol use, and recovery from alcohol use disorder. The prevalence of FASD was 7.1 %. This rate falls clearly within the prevalence range identified in eight larger samples of other communities in the Collaboration on FASD Prevalence (CoFASP) study in four regions of the United States.
Random samples can be useful for estimating the prevalence of FASD.