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U.S. Surgeon General Richard H. Carmona recently warned pregnant women and
women who may become pregnant to abstain from alcohol consumption in
order to eliminate the chance of giving birth to a baby with any of the
harmful effects of the Fetal Alcohol Spectrum Disorders (FASD). FASD is
the full spectrum of birth defects caused by prenatal alcohol exposure.
The spectrum may include mild and subtle changes, such as a slight
learning disability and/or physical abnormality, through full-blown
Fetal Alcohol Syndrome, which can include severe learning disabilities,
growth deficiencies, abnormal facial features, and central nervous
system disorders. This updates a 1981 Surgeon General's Advisory that
suggested that pregnant women limit the amount of alcohol they drink. The following is Dr. Carmona's advisory.
Thirty-two years ago, United States researchers first recognized fetal
alcohol syndrome (FAS). FAS is characterized by growth deficiencies
(or, decreased growth), abnormal facial features (specific facial
features), and central nervous system (or, brain) abnormalities. FAS
falls under the spectrum of adverse outcomes caused by prenatal alcohol
exposure called Fetal Alcohol Spectrum Disorders (FASD). The discovery
of FAS led to considerable public education and awareness initiatives
informing women to limit the amount of alcohol they consume while
pregnant. But since that time, more has been learned about the effects
of alcohol on a fetus. It is now clear that no amount of alcohol can be
considered safe.
I now wish to emphasize to prospective parents, healthcare
practitioners, and all childbearing-aged women, especially those who are
pregnant, the importance of not drinking alcohol if a woman is pregnant
or considering becoming pregnant.
Based on the current, best science available we now know the following:
- Alcohol consumed during pregnancy increases the risk of alcohol
related birth defects, including growth deficiencies, facial
abnormalities, central nervous system impairment, behavioral disorders,
and intellectual development.
- No amount of alcohol consumption can be considered safe during
pregnancy.
- Alcohol can damage a fetus at any stage of pregnancy. Damage can
occur in the earliest weeks of pregnancy, even before a woman knows that
she is pregnant.
- The cognitive deficits and behavioral problems resulting from prenatal
alcohol exposure are lifelong.
- Alcohol-related birth defects are completely preventable.
For these reasons:
1. A pregnant woman should not drink alcohol during pregnancy.
2. A pregnant woman who has already consumed alcohol during her
pregnancy should stop in order to minimize further risk.
3. A woman who is considering becoming pregnant should abstain from
alcohol.
4. Recognizing that nearly half of all births in the United States are
unplanned, women of child-bearing age should consult their physician and
take steps to reduce the possibility of prenatal alcohol exposure.
5. Health professionals should inquire routinely about alcohol
consumption by women of childbearing age, inform them of the risks of
alcohol consumption during pregnancy, and advise them not to drink>
alcoholic beverages during pregnancy.
Background
In the United States, FAS is the leading preventable birth defect with
associated mental and behavioral impairment. There are many individuals
exposed to prenatal alcohol who, while not exhibiting all of the
characteristic features of FAS, do manifest lifelong neurocognitive and
behavioral problems arising from this early alcohol exposure. In the
United States, the prevalence of FAS is between 0.5 to 2 cases per 1,000
births. It is estimated that for every child born with FAS, three
additional children are born who may not have the physical
characteristics of FAS but still experience neurobehavioral deficits
resulting from prenatal alcohol exposure that affect learning and
behavior.
The outcomes attributable to prenatal alcohol exposure for the children
of women whose alcohol consumption averages seven to 14 drinks per week
include deficits in growth, behavior, and neurocognition such as
problems in arithmetic, language and memory; visual-spatial abilities;
attention; and deficits in speed of information processing. Patterns of
exposure known to place a fetus at greatest risk include binge drinking,
defined as having five or more drinks at one time and drinking seven or
more drinks per week.
Despite public health advisories and subsequent efforts to disseminate
this information, including a Surgeon General's advisory in 1981, recent
data indicate that significant numbers of women continue to drink during
pregnancy, many in a high-risk manner that places the fetus at risk for
a broad range of problems arising from prenatal alcohol exposure
including fetal alcohol syndrome. For example, data suggest that rates
of binge drinking and drinking seven or more drinks per week among both
pregnant women and non-pregnant women of childbearing age have not
declined in recent years. Many women who know they are pregnant report
drinking at these levels.
In addition, recent analysis of obstetrical textbooks suggests that
physicians may not be receiving adequate instruction in the dangers of
prenatal alcohol exposure. The American College of Obstetricians and>
Gynecologists advises against drinking at all during pregnancy.
Nevertheless, only 24 percent of obstetrical textbooks published since
1990 recommended abstinence during pregnancy, despite 30 years of
research since the first publications proposed a link between alcohol
exposure and birth defects. Scientific evidence amassed in these
decades has fortified the rationale for the original advisory against
alcohol consumption during pregnancy. Continuing research has generated
a wealth of new knowledge on the nature of fetal alcohol-induced injury,
the underlying mechanisms of damage, concurrent risk factors, and the
clinical distinction of alcohol-related deficits from other disorders.
Alcohol-related birth defects are completely preventable. A number of
resources are available to assist healthcare and social services
professionals in advising their patients to reduce and refrain from
alcohol in pregnancy. These resources include the National Institute on
Alcohol Abuse and Alcoholism, NIH (www.niaaa.nih.gov), the Centers for
Disease Control and Prevention (www.cdc.gov/ncbddd/fas/), and the
Substance Abuse and Mental Health Services Administration
(www.fasdcenter.samhsa.gov/).
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