Abstain -- Completely

"When a mother-to-be consumes alcohol, it goes directly to the fetus through her bloodstream. Alcohol is poisonous to the developing fetus and can disrupt its normal development. FASD [Fetal Alcohol Spectrum Disorder] is a serious and lifelong condition."
"Alcohol is especially dangerous for the developing brain cells; that's why people with FASD have difficulties with learning, attention, memory, reasoning, problem-solving, language and communication."
"The first step in understanding the severity and impact of FASD in any country is to determine how many people have this condition. Once this information is available, policies and programs can be planned that will benefit those living with FASD and prevent additional children from being born with these conditions."
"Public policy and clinical care for people with FASD needs to change to respond to such predictable outcomes."
Svetlana Popova, senior scientist, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto

A new study on Fetal Alcohol Spectrum Disorder whose lead author is Dr. Popova has been published in the medical journal Addiction. According to the study, close to one in ten women in any general population worldwide consume some level of alcohol during their pregnancy. The result of which is that Fetal Alcohol Spectrum Disorder is quite a bit more prevalent than has been assumed. In particular among people belonging to five vulnerable groups.

What is incontestable is the conclusion on the evidence that women who believe they can have a glass of wine during dinner throughout pregnancy are wrong. It is a myth that simply does not want to succumb to scientific evidence proving otherwise. The global study with its fluctuating prevalence rates of FASD, declares that belief to be nothing more or less than a wishful myth.

When a pregnant woman drinks any amount of alcohol during pregnancy she is flirting with genetic abnormality for her offspring. FASD is identified as a disabling condition caused by a mother's alcohol consumption during pregnancy, a kind of Russian roulette that will affect some children born to drinking mothers, and not others; afflicting some children relatively lightly and others intensely.

FASD is an affliction that is not particularly choosy; it will affect people from all racial, ethnic and sociological backgrounds indiscriminately. Data derived from 69 previously-published studies of people from 17 countries including Canada, the United States, South America, Europe, Asia and Australia, indicate prevalence rates are most particularly devastating for sub-population groups.

The five high-prevalence groups identified in the study are:

• Children in care;
• People in correctional service custody;
• People in special education services;
• People using specialized services for developmental disabilities or psychiatric care;
• Indigenous populations.

The purpose of the study's design was to assist in improved prevalence estimates and predictions hoping to to produce more useful and practical public policy and to permit for planning and budgeting of health care, community and social services response of a higher order.

Over 400 disease conditions might be associated with fetal alcohol exposure, according to Dr. Popova and her research team. Those conditions include impaired vision and hearing, heart problems, urinary and respiratory defects and problems with joints. The annual cost estimate of FASD in Canada alone has been identified at $1.8-billion.

"There is no safe amount of alcohol or safe type of alcohol or safe time to drink during pregnancy.” Getty Images

As a result of misfortune and circumstances which would be inclusive of parental alcohol or drug problems, abuse, neglect or youthful age at marriage, all circumstances associated with an increased likelihood of an unborn child exposed to alcohol, children are often placed in care, their parents unable to cope with their needs.

Lacking appropriate diagnoses and early life intervention, many children with FASD become high risk for involvement in the legal system, according to research findings. People with FASD are likelier to suffer from developmental delay, learning problems and mental-health problems. As a result they have a higher representation among special education populations.

Among Aboriginal populations the problem of high FASD prevalence has long been realized in tandem with the reality that alcohol use during pregnancy among Aboriginals in Canada is found to be roughly four times greater, in comparison to the general population.

People in prison are one of the groups identified as being more vulnerable to Fetal Alcohol Spectrum Disorder. Getty Images

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

Preventable Prenatal Alcohol Exposure

"We are more confident now [that] Fetal Alcohol Syndrome [FASD] can happen to anyone, regardless of race, ethnicity, socioeconomic status."
"Based on the large number of children who received a comprehensive assessment for FASD, we clearly show the scope of the problem, and the need for greater awareness to prevent alcohol use during pregnancy."  
"The negative effects of alcohol consumption on the fetus likely occurred before the mothers knew they were pregnant."  
Dr. Svetlana Popova, Centre for Addiction and Mental Health

One of the risk groups is actually professional women who binge drink."
"It's easy to keep at a distance and say, 'That's not me -- it relates only to those in poverty and despair', but that's just not the case with FASD. It's an equal opportunity brain injury."
"Look at the prevalence of alcohol -- it's not just in the low income areas, alcohol is consumed by all strata of society."
"So in tackling FASD it actually means tackling the bigger problem of 'let's get together and have a drink', which is part of our culture."
Deborah Goodman, director, Child Welfare Institute, Children's Aid Society of Toronto

"I'm glad to see we're getting past the 'why should we do this research' to the 'we need to do this research' stage."
Dr. Kaitlyn McLachlan, professor, University of Guelph

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

Dr. Popova  of the Centre for Addiction and Mental Health in Toronto, estimates that public resources dedicated to Canadians with FASD, inclusive of educational, medical and legal costs represented an $1.8-billion investment of need for the 2013 year, a figure that could conceivably be reduced with the formulation of effective treatments that do not now exist in the public sphere, according to Dr. McLachlan, who studies prison populations for FASD.

A newly released report from the Centre for Addiction and Mental Health of which Dr. Popova was the lead author has steeply increased the estimate of FASD prevalence in Canada. A survey in the Greater Toronto region of 2,555 seven-to-nine-year-old children, representing one of the largest sample sizes in a Canadian study, and the first that encompasses Canada's diverse population makeup, produced the data that resulted in the survey results.

Formerly such studies on FASD focused on narrow population groups, such as children in care. Many children with FASD, points out Dr. Popova, are misdiagnosed or have never been diagnosed. Her team of researchers was comprised of leading geneticists, psychologists and pediatricians, each of whom assessed each student independently to arrive at their conclusions.Their mothers filled out questionnaires respecting alcohol consumption.



Given that it is a well-known fact that in pregnancy no amount of alcohol is considered to be safe for the developing fetus, Dr. Popova and others of her team feel the stigma of drinking through pregnancy may have resulted in some of the women failing to accurately report alcohol intake, let alone taking part in the survey to begin with. Of the 173 mothers interviewed, most said they stopped consuming alcohol once they realized they were pregnant. 

Despite which, around ten percent of the mothers with a child diagnosed with FASD responded that they had simply continued to drink through their pregnancy. Previous FASD estimates in the general population hovered around one percent.The results of this survey by Dr. Popova and her colleagues point to FASD likely being more common than the autism spectrum disorders affecting 1.5 to two percent of young Canadians.

And nor -- did the research conclude -- does the FASD risk remain confined to marginalized groups within society. According to Deborah Goodman of the Child Welfare Institute, children as young as twelve should be educated in the potential consequences of alcohol consumption. In addition, more strenuous efforts to convince adults of the harm done to children through pregnancy and exposure to alcohol should be mounted.



Dr. Popova points out that depending on factors such as the amount of alcohol a fetus is exposed to, genetic inheritance from both parents along with environmental influences, the severity of prenatal alcohol exposure can be determined. The most severe form of the disorder is fetal alcohol syndrome which can include growth deficits, coordination difficulties, visual motor complications, serious developmental delays, attention deficit and hyperactivity, while the mildest disorder on the spectrum may also cause behavioural and cognitive difficulties.

To avoid any alcohol-related neurodevelopmental disorder it is imperative that women understand that no amount of alcohol whatever should be used, even just prior to conception, let alone during the pregnancy period. Of children suspected of having FASD studied by Dr. Popova's team, 14 percent qualified. The majority of the children, representing 75 percent, reflected the milder alcohol-related neurodevelopmental disorder profile.