Any Amount of Alcohol Is Harmful to the Unborn Child
6 January 2004
Q. I have been married for several years. My husband and I
enjoy a glass of wine at meal times, and we also drink fairly
regularly with our friends. I am thinking of starting a family.
When I talked to my younger sister who is a nurse, she told me that
I should stop drinking; otherwise the alcohol can hurt our baby.
I don't drink and drive, but I am just not sure that I should stop
drinking completely in order to have a baby. Is my sister just
trying to scare me?
A.
I am going to disappoint you here. Your sister is absolutely
right. Alcohol can harm your baby, and you should stop drinking
before conceiving your first child. I am really glad that you ask
this question before you get pregnant. Let me explain to you in
more detail here.
Alcohol has been part of many cultures since early civilization.
It is served at weddings, births, and many other celebrations around
the world. Drinking to excess and alcoholism has been well recognized
not only in North America, but around the globe. With the advent
of automobiles, drinking and driving has cost the lives of many
young people, leading to the birth of organizations like MADD
(Mothers Against Drunk Driving). Alcoholism leads to spouse and
child abuse, family disruption, as well as premature death from
cirrhosis of the liver and other complications.
The effect of alcohol on the foetus was not well recognized until
the last few decades. The first case reports of children born with
severe medical problems directly linked to alcohol were published
in 1968 and 1973. These children have a number of facial features
that are very characteristic, including shortened eye-opening (the
distance between inner and outer corners of the eyes), droopy
eyelids, flattened mid-face, upturned nose, smooth philtrum (the
part between the nose and upper lip), as well as a thin upper lip.
These features are most obvious when the children are still very
young. The doctors called it foetal alcohol syndrome (FAS).
These children have the most severe form of disease. Their mothers
have well-documented drinking problem before and during pregnancy.
In addition to their facial features, many of them also have other
abnormalities, including low birth weight, poor weight gain after
birth in spite of adequate nutrition, congenital heart disease,
cleft lip or cleft palate, hearing loss, as well as abnormal kidneys
and limbs.
The most troubling problem in FAS is development of the brain, or
more accurately the lack of development of the brain. Many of
these children are born with a small head. As they develop, they
are found to have significant delay in their developmental milestones
as well poor co-ordination and fine motor function. When tested,
many children have under-development of multiple areas of their
brain which at least partially explain some of the deficits that
were noticed on examination.
Worst of all, when these children had their intelligence tested,
their IQ (Intelligence Quotient, a measure of intelligence compared
with the general population) ranged from 16 to 105, with an average
of 66. The average IQ of a large population (like all Canadians)
is 100. If an individual's IQ is below 70, he is regarded as
mentally retarded. Therefore, the great majority of children with
FAS suffer from severe mental retardation as a result of exposure
to alcohol during pregnancy.
As expected, children with FAS have all sorts of learning difficulty
in school. They have trouble learning language skills, grasping
concepts, and understanding mathematics. Most of them also have
difficulty paying attention and controlling their impulse, and have
been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
I should caution here that most children with ADHD do not have
foetal alcohol syndrome. FAS is just one of the causes of ADHD.
In addition to difficulty learning academic subjects, these children
also have great deal of difficulty understanding social interactions.
Therefore, they often misbehave because they misunderstood the
social context. Their social intelligence is often far worse than
their IQ. They have temper tantrums, mood swings, frustration and
anger. Their social problems often make it difficult, if not
impossible, for them to live and function independently without
special assistance and support from the society.
We still do not completely understand how alcohol affects the
foetus. Alcohol is readily absorbed from the stomach of women into
the blood. Recent research suggested that women have lower levels
of the enzyme alcohol dehydrogenase which breaks down alcohol in
the liver. As a result, women may have higher blood level of
alcohol than men after drinking the same amount of alcohol.
Furthermore, alcohol passes readily through the placenta to the
foetus.
Scientific research in mice found that exposure of foetus to alcohol
during the first trimester (the beginning 1/3 of pregnancy) is the
major cause of congenital abnormalities in children with FAS. This
is the period of time when major organs are formed and developed.
Alcohol and its by-products are harmful to developing cells. As
a result, there is damage and death to the cells that shape the
face, leading to the typical facial features of FAS. This also
explains other congenital abnormalities found in children with FAS.
As the pregnancy progresses, continual exposure to alcohol reduces
the growth and development of most organ systems in the foetus,
resulting in stunted growth and low birth weight. Unfortunately,
this problem does not end at birth; many children with FAS are
unable to catch up in their growth later on in life even when they
are given adequate amount of nutrition. The loss of foetal cells
has permanently reduced their body's potential to grow normally.
Part of the growth failure in children with FAS is due to a lack
of essential nutrients from the mother. Women who drink alcohol
may consume less of nutritious food, and alcohol can also stimulate
the body to eliminate essential nutrients rapidly, therefore
depriving the growing foetus of nutrients that are necessary for
its growth and development.
The part of the body that suffers the most is probably the brain.
Alcohol not only causes death of young brain cells, it also affects
the development of synapses which are connections between brain
cells, as well as chemicals called neurotransmitters which help
brain cells communicate with each other. The end result is a
smaller brain, with reduced cognitive ability (lower IQ), poor
attention and impulse control (ADHD), and marked delay in motor
and social development.
The detrimental effect of alcohol to the developing brain is not
limited to binge drinking where alcohol level is markedly increased
for a period of time. Even lower levels of alcohol are harmful to
the developing brain. Since the discovery of FAS, many more children
have been identified to have suffered from the effects of alcohol
while in the mothers' wombs without the obvious facial features.
Many of these children have 'alcohol-related neurodevelopmental
disorder' (also called ARND): reduced IQ, delay in motor or social
development, as well as learning difficulties. Other children have
'alcohol-related birth defects' (ARBD) like the ones I have listed
above.
In this day and age, many adults are trying very hard to improve
their health and watch what they eat. Some refuse to buy
genetically-modified foods in case there are long-term side effects
that scientists haven't discovered as yet. When they decide to
have children, they expect them to be perfectly healthy. However,
there is one piece of medical information that is very clear:
alcohol is harmful to the foetus, and there is no safe level of
drinking during pregnancy. Yet, every year, thousands of babies
are born with FAS and other alcohol-related conditions.
If you are planning to get pregnant, I would suggest that both of
you should review your drinking habit. It is very difficult for
you to change while your husband continues to drink. Both of you
need to make a conscious decision to stop drinking completely before
conception because, as I have mentioned earlier, the greatest damage
to the foetus is likely in the first trimester, often before a
woman is even aware that she is pregnant. This won't be an easy
task, but if you want a healthy baby with the best potential in
life, you have to stop drinking.
In addition to drinking, cigarette smoke, either directly from the
mother, or passively from people around her, can be harmful to the
foetus. This discussion is far too broad and beyond the scope of
this column. If you are smoking, consider quitting that also, or
at least reduce the number of cigarettes that you smoke. If your
family members smoke, ask them to go outside and not to smoke in
the car.
If you are one that loves to eat fruits and vegetables, I don't
have to say much more. Folic acid is very important for the
development of the foetus. There is plenty of folic acid in fruits
and vegetables. Eat sensibly and avoid things that can be harmful
to your baby, and most likely you will have a perfectly healthy
one.
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