Far more children may have neurological disorders because their mothers drank alcohol while pregnant than previously thought, a new study reveals.
New data compiled by the University of California, Berkeley suggests that there may be wild regional variation, with as many as 50 out of every 1,000 children in one regional sample assessed to have some form of alcohol.
This represents a staggering increase over the previous overall estimate that about 10 in every 1,000 children in the US might be affected.
Fetal alcohol disorders are developmental delays and facial abnormalities that can affect the children of women who drank alcohol during their pregnancies.
The exact effects on their children are unpredictable and difficult to diagnose, leading to mixed guidance about drinking from the medical community.
A new JAMA study found that fetal alcohol disorders are far more common in the US than previously thought, following on a national upward trend in drinking among all women
Fetal alcohol disorders are poorly understood in part because the umbrella term describes such a wide set of conditions.
The included disorders range from mild memory and behavioral problems to the more obvious and well-known fetal alcohol syndrome (FAS), which can include similar or more severe mental and behavioral issues, as well as growth and facial abnormalities.
These features and symptoms were discovered as being consistent with alcohol exposure in 1973 when a pair of doctors in Seattle called it ‘tragic disorder.’
Children with FAS typically share in thin upper lip and flattened area above it, small chin and a flattened and shortened nose, among other abnormal features.
FAS, and to some extent, other fetal alcohol effect disorders, became part of the national conversation in the US in the 1980s and 1990s.
But since, it has become less of a ‘hot topic,’ says American College of Obstetricians and Gynecologists (ACOG) president Dr Haywood Brown.
In light of the diminishing attention being given to the disorder, ACOG, the Centers for Disease Control and Prevention and the American Academy of Pediatrics have all issued guidance warning that there is ‘no known safe amount’ or kind ‘of alcohol to drink while pregnant.’
The researchers used assessments of both intellectual abilities and the physical facial features associated with fetal alcohol syndrome to identify children likely affected by alcohol exposure
Yet the new study’s findings, published today in JAMA, suggest that more women have continued to drink during their pregnancies than expected and, as a result fetal alcohol spectrum disorders are more common than doctors expected.
The research teams, funded by the National Institute on Alcohol and Alcoholism, travelled to cities in four regions of the US: the Midwest, the Rocky Mountain region, the Pacific Southwest and the Southeast.
They assessed a total of 6,639 first-graders from schools in each area for signs of a fetal alcohol spectrum disorder.
They found that somewhere between 11.3 and 50 children out of 1,000 had been affected physically and developmentally by alcohol while they had been developing the womb.
The lowest percentage came from one of the Midwest samples, while in one group of Rocky Mountain region students, as many as 50 out of 1,000 children assessed to have been affected by alcohol during their development.
This represented a significant increase over the previous estimates, which hovered around 10 in every 1,000 children.
‘Misdiagnosis is very common, and that’s what I think this study exposed,’ says Dr Brown.
The milder, behavioral symptoms of fetal alcohol spectrum disorders are often mistaken for attention deficit disorder (ADD), Dr Brown explains.
But the higher prevalence of the set of conditions that the study revealed ‘does make the point, again, that there is probably no safe amount of alcohol’ to drink during pregnancy,’ Dr Brown says.
However ‘some have questioned that,’ in recent years Dr Brown says, publishing studies that claim to show that light drinking during pregnancy was ‘unlikely’ to harm a baby.
But the problem is that fetal alcohol effects, like most birth defects ‘are multifactorial,’ Dr Brown explains.
‘Alcohol is teratogenic, meaning it causes central nervous system, and that is well known.
‘But as is true of al teratogens, they do not affect everybody,’ he says.
How susceptible a woman’s baby will be to alcohol during her pregnancy depends, for example, on how she metabolizes alcohol.
So even though some women may drink and their baby will be unaffected, others may binge drink just once, early in her pregnancy while her baby’s face and brain are developing, then quit until delivery and still her baby will still have physical and developmental abnormalities.
Though worrying, the results of the new study were unsurprising to Dr Brown, who says that it simply follows the drinking trends among women in general.
Last year, another study, published in JAMA Psychiatry, found that the number of women drinking four or more drink in a day on a weekly basis has risen by a staggering 58 percent in recent years.
‘Logically, if you see more women drinking, more women will have been drinking when they get pregnant,’ especially those whose pregnancies are unplanned.
He adds that the general public tends to misclassify alcohol, leading to high-risk behaviors that people, including women who may be trying to conceive, pregnant, or having unprotected sex, believe are not dangerous.
‘People equate alcohol with bourbon and Scotch and they forget about beer and wine, which have alcohol in them. That’s the thing that people need to understand: alcohol is alcohol,’ Dr Brown says, ‘so put down that glass of wine.’