Fetal Alcohol Syndrome Disorder (FASD) affects an estimated 40,000 infants each year (SAMSHA, 2003). FASD is an umbrella term describing a range of characteristics that can occur in children prenatally exposed to alcohol. The characteristics may include physical,
behavioral, and/or learning disabilities that last a lifetime. According to National Organization on Fetal Alcohol Syndrome (NOFAS, 2014) FASD includes 4 distinct syndromes associated with prenatal alcohol exposure.
- Fetal Alcohol Syndrome (FAS), Partial
- Fetal Alcohol Syndrome (PFAS), Neurobehavioral Disorder
- Associated with Prenatal Alcohol Exposure (ND-PAE), and
- Alcohol Related Neurodevelopmental Disorder (ARND) are the
FASD is characterized by unique physical features and a variety of problems that can impact learning and social participation. Physical features of FASD are depicted in the figure:
Other characteristics of the syndrome may include: intellectual disabilities, learning disabilities, poor impulse control, language deficits, memory deficits, and poor social adaptability. Fetal Alcohol Syndrome is the leading cause of intellectual disabilities in children (Shapiro & Batshaw, 2013) yet it is 100% preventable. It is unclear how much alcohol is needed to affect a fetus. According to the CDC, the U.S. Surgeon General, and the American Academy of Pediatrics, there is no known safe amount of alcohol to drink while pregnant. There is also no safe time during pregnancy to drink and no safe kind of alcohol. Research indicates that even drinking small amounts of alcohol while pregnant can lead to miscarriage, stillbirth, prematurity, or sudden infant death syndrome.
If ways can be found to curb the intake of alcohol among pregnant women, a huge number of children would not have the live with the negative consequences alcohol exposure. Services and supports are needed and necessary to prevent women from drinking while pregnant. Prevention of drinking during pregnancy, especially during the critical first few months is challenging for a host of reasons. Alcohol consumption in pregnant women is not a single issue.
A study done in Washington State among women who had given birth to children with FASD provides insight into the intricacies of this issue. Intersecting social challenges include mental health disorders, physical and/or psychological abuse, and lack of education. Ninety-six percent of women who gave birth to a child with FAS had at least one mental health disorder, 95% had a history of sexual or physical abuse, 61% had less than a high school education, 25% had some college education, 77% had an unplanned pregnancy, and of that group 81% did not use birth control although most of the women ( 92%) wanted some form of birth control, and 59% had an annual gross household income of less than $10,000 (Grant, et al, 2009).
Unlike other characteristics of vulnerable populations, alcohol consumption cuts across ethnic, racial, and economic lines. Perreira and Cortes (2006) found that all segments of the population admitted to drinking alcohol while pregnant: 17% White, non-Hispanic, 9.7% Black, non-Hispanic, and 6.4% Hispanic. Almost 12 % of those who said they were born in the United States drank alcohol during pregnancy, as opposed to 8.2 percent who said they were foreign born. It is evident that this issue is persistent throughout the country and that there is not a specific demographic which can be targeted to address the problem. Additionally, as demonstrated by the findings from Washington state alcohol consumption in pregnant women may be symptomatic of much more complicated issues that have far and long reaching effects.
Deciding where to begin to address the cause of the problem is difficult and complex. Do organizations first target the poverty, the mental illness, the maltreatment, the low maternal education, the lack of access to birth control, or the lack of prenatal care? Thus far, policy has focused not on the mother but on the child, often taking the child out of the home, as is evidenced by the overwhelming number of children in the foster care system who have FAS. Children in foster care are 10-15 times more likely to be affected by prenatal alcohol exposure than other children (FASD Center for Excellence, 2007). The most notable prevention measure is the FDA regulation that all alcohol products contain a warning label that alcohol can damage a fetus. Additionally, there are some public relation campaigns and public service announcements targeting high risk populations.
By framing the use of alcohol in pregnant women as a symptom of a larger issue, the conversation regarding policy could shift away from simply putting warning labels on alcoholic beverages and taking the child out of the home to policies that address the complexity of the problem and the intersecting needs of the mother. Prevention is obviously a key component of any policy or program created to address this problem. Nurse practitioner and gynecologists/ obstetricians training should include recognition of alcohol use, anticipatory guidance on the effects of alcohol consumption while pregnant, and recognizing and supporting women with mental health concerns, domestic violence, social service needs, etc. Most importantly, treatment could be determined by recognizing that the pregnant woman who is drinking may have complex health and social service needs as opposed to a “drinking problem”. This same perspective could be used to inform decisions regarding the child after it is born. Indeed, if the child needs to be taken out of the home, efforts could be made to also treat the mother for the larger issue of her alcohol or substance abuse. Lastly, because there is such a high percentage of children with alcohol related disabilities in foster care, it is also important to train foster parents on how best to support the child. By doing this, the child and the foster family are given an opportunity to develop a close relationship and experience success for the child. Dealing with alcohol related disabilities is hard for any family and thus support and knowledge surrounding the disability is key.
FASD is 100 % preventable. However, due to a variety of reasons and the myriad of complex interrelated issues, the likelihood of eliminating developmental disabilities due to alcohol is slim. Policies can, however, begin to address the interrelated issues of the pregnant woman by viewing her alcohol consumption as a symptom and not the root issue. Additionally, foster families can be better educated about the support needed for children diagnosed with FAS. The disabilities caused by prenatal alcohol consumption are serious and need to be taken as such. The reasons and issues surrounding the pregnant woman’s drinking are also serious and need to be taken as such.
- Grant T.M., Huggins, .J.E, Sampson, .P.D, Ernst, .C.C, Barr, .H.M., Streissguth, A.P.(2009). Alcohol use before and during pregnancy in western Washington, 1989-2004: Implications for the prevention of fetal alcohol spectrum disorders. American Journal of Obstetrics and Gynecology, 200(3): 278.e:1-8
- National Organization on Fetal Alcohol Syndrome. (2014). FASD: What Everyone Should Know. Available from:http://www.nofas.org/wp-content/uploads/2014/05/Fact-sheet-what-everyone-should-know.pdf
- Substance Abuse and Mental Health Services Administration (2014). About FASD. Available from http://fasdcenter.samhsa.gov/aboutUs/aboutFASD.aspx
- Perreira, K. & Cortes, K. (2006). Race/ethnicity and nativity differences in alcohol and tobacco use during pregnancy. American Journal of Public Health, 96(9), 1629-1636. Retrieved online at http://www.ncbi.nlm.nih.gov.proxy.lib.csus.edu/pmc/articles/PMC1551957/.
- Phares, T., Morrow, B., Lansky, A., Barfield, W., Prince, C., Marchi, K., Braveman, P., William SAMSHA, 2003
- Shapiro, B. & Batshaw, M. (2013). Developmental Delay and Intellectual Disabilities. In M. L. Batshaw, N. J. Roizen, & G.R. Lotrecchiano, G.R. (Eds.), Children with disabilities. pp. 291-306. Baltimore: Paul H. Brooks Publishing Co.
— Sophie Siebach
Georgetown University College, 2015