Fetal Alcohol Spectrum Disorder : Preventable

"Because of its social acceptance, we have lost sight of the fact that continued high rates of problematic alcohol consumption are [sic] leading to a wide-range of harms."
Dr. Theresa Tam, Chief Public Health Officer, Canada

"Too many physicians in this country still advise women that it's okay to drink a little bit during pregnancy."
"But what does it mean to drink a little bit? Or is that just an enabling statement that says, 'Oh I really don't have to change my lifestyle because I'm pregnant'."
Dr. Kwadwo Oheme Asante

Originally from Ghana, Dr. Asante came to Canada on a student visa to study science at the University of British Columbia. Following medical school in the 1970s he set up practise as a pediatrician in a large area of northwestern British Columbia and the Yukon, the only pediatric specialist in the region. His intention was to remain in the vast area long enough to pay off his medical training debt.

Soon he began seeing patients that he hardly expected to be confronted with; babies with small heads, thin upper lips, flat cheekbones. These were children missing critical developmental milestones and who would never 'catch up' to what other, normal children were achieving in their development, physical and mental. His initial thoughts were that these were children symptomatic of a chromosomal or metabolic disorder. Nothing existed in the medical literature to describe his cases.

A colleague in 1973 alerted him to a new paper published in the influential journal the Lancet produced by two pediatricians at the University of Washington, describing children exposed to alcohol in utero -- exhibiting symptoms that Dr. Asante recognized immediately. This was an era when doctors might prescribe alcohol for morning sickness, when hospitals made use of ethanol drips in the prevention of early labour. When beer was considered a nutritional drink for expectant mothers.



The medical community viewed this new information with shock since the uterus had been regarded as a protective barrier, impenetrable by harmful agents, a trust that was only shaken in the early 1960s with the advent of the anti-nausea drug prescribed for pregnant women called thalidomide which went on to produce grossly malformed limbs in babies whose mothers trustingly used the drug.

Dr. Asante set out with a team of doctors across the country for the purpose of ensuring that doctors and their patients, policymakers and the press became alerted to the risks of Fetal Alcohol Spectrum Disorder (FASD). Later studies definitively proved alcohol to pass from mother to foetus through the bloodstream, with the potential to deleteriously impact development of the central nervous system as well as sensory and immune systems, among others.

The first large-scale study on FASD surveyed over 2,500 seven- to nine-year-olds in the Greater Toronto Area was released last year, its conclusion suggesting that up to three percent of the general population could be victims of the disorder. FASD could turn out to affect greater numbers in the Canadian population than does autism and cerebral palsy together. This, at a time when social culture has changed, when more women drink, more frequently than ever.



The most recent national survey out of the Society of Obstetricians and Gynecologists of Canada estimates that 61 percent of women between ages fifteen and fifty have reported an unplanned pregnancy at a time when social drinking has been recognized as a symbol of female empowerment. A symbol that does not hesitate to lapse during pregnancy, as far as some women are concerned, resentful of being reminded that their social habit may harm their foetus.

A fifth of respondents to a survey of Canadian physicians on an online medical community, Figure 1, suggests that physicians may themselves be aiding in the normalizing of this reaction by women to alcohol consumption during pregnancy, by informing their patients that the occasional drink during pregnancy is safe. This, in startling contrast to the official position of Health Canada.

It has been well understood for close to a half century that drinking during pregnancy is harmful. Given the current social climate, it is little wonder that eradication of FASD has failed. Some children diagnosed with FASD resulting from their pregnant mothers imbibing alcohol are born with visible physical features typifying their condition, while others suffer with impaired motor and sensory control.

Embryonic stem cells exposed to low levels of alcohol "led to the abnormal development of parts of the brain responsible for executive function -- critical for self-control, organizational skills and goal attainment" according to a 2010 study out of the Emory School of Medicine in Atlanta. Drinking appears to be most detrimental during the first three to eight weeks of gestation when cells are dividing to form the baby's organs.



And during the third trimester, alcohol consumption is similarly detrimental, at a time that the brain undergoes rapid development, and when specific organ functions are being determined. Research such as this with their definitive conclusions along with the dedicated work of campaigners like Dr. Asante have led most bars and liquor stores in Canada to post prominent signs outlining the risks of drinking during pregnancy.

In the United States, warning labels are mandatory by law to be placed on alcoholic beverages, informing and reminding women of the harms that drinking results in during pregnancy. Not all children of the estimated 10 percent of Canadian mothers who flaunt this cautionary advice are born with FASD. Many risk factors for the disorder -- genetics, maternal nutrition, exposure to other toxins, poverty and trauma -- also exist, but their influence is not settled.

Just exactly how much alcohol may cause FASD, or the type of alcohol -- 13 percent alcohol red wine as opposed to 70-proof tequila may make a difference in the threat, is also unclear. Leading, according to James Reynolds, professor of biomedical and molecular science at Queen's University to an impression that only "problem" drinking places a foetus at risk.

One Figure 1 user posted the statement that "I've known fellow medical professionals who are open about their own consumption during pregnancy".

A new report found up to three per cent of Canadians could have fetal alcohol spectrum disorder.   Ian Kucerak/Edmonton Sun