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Alcohol - effects on unborn children

fetal; foetal; alcohol; retardation; mental; abuse; drug; pregnancy; FAS; ARND; related; neurodevelopmental; disorder; syndrome; FAE; effects; development; baby; placenta; tobacco; smoking; cigarettes;

Contents

Pregnancy and alcohol don't mix.

  • There is no safe time to drink alcohol during pregnancy and there is no safe amount of alcohol. Alcohol can harm a baby for life.
  • If you are pregnant or planning to get pregnant no alcohol is the safest choice.

Alcohol drunk by mothers during pregnancy can seriously affect the health and development of their unborn children.

  • Some of these babies will have Fetal Alcohol Syndrome (FAS).
    • They will have signs of harm when they are born including weighing less than expected at birth and having unusual facial features.
    • These babies go on to have a delay in their development and learning and behaviour problems.
  • Most babies affected by alcohol have serious lifelong disabilities without all the features of FAS.
    • These babies are said to have Fetal Alcohol Spectrum Disorders (FASD).

Fetal Alcohol Spectrum Disorder is the biggest preventable cause of birth defects and brain damage in unborn children. There is no cure for FASD.

What is fetal alcohol syndrome (FAS)?

  • Some babies with FAS are harmed by a small amount of alcohol if the mother drinks during the time that the brain is developing (between the 2nd and 8th weeks of the pregnancy). 
  • Most babies with FAS are born to mothers who abuse alcohol during the pregnancy.
    • Babies affected by FAS are smaller than expected at birth and have unusual facial features including small eye-openings, small faces and jaws and thin upper lips.
    • Some will also have heart defects, minor joint and limb abnormalities (which can cause some restriction of movements).
    • These children will usually go on to have significant developmental delay and behaviour problems.
    • Not all babies of women who abuse alcohol during pregnancy will have FAS. How these babies are protected is not yet known.

Fetal Alcohol  Spectrum Disorders (FASD)

  • Alcohol can affect physical growth and brain development throughout the whole pregnancy.
  • Not all babies exposed to alcohol before birth have the facial features of FAS, but they may have very significant developmental delay and behaviour problems.
    • These can include reduced attention, irritability, distractibility, and problems with memory, thinking and learning.
  • The babies most likely to be affected are those who are exposed to other factors which also affect growth and development including smoking, malnutrition of the mother and use of other drugs.
  • Some babies exposed to high levels of alcohol will die before they are born.

How does alcohol affect babies?

  • Alcohol in a mother's blood crosses over to the baby through the placenta so that the baby will have the same blood level of alcohol as the mother.
  • Just how alcohol causes damage to the baby is not known.

How many babies are affected by alcohol before birth?

  • The number of affected babies in Australia is not clear.
  • Using information from other countries, there may be about 30 to 40 babies born with FAS in South Australia each year although the number of babies who are recognised to have FAS is much smaller (in South Australia there are around 19,000 births each year).
  • Also up to 400 babies may be born in South Australia with alcohol caused effects on development (FASD), but not the full effects of FAS.
  • Most babies with FAS or FASD are not identified at birth, partly because many of the women who are using or abusing alcohol are not identified, so doctors do not look for the signs of FAS or other alcohol effects on babies.

What level of alcohol is safe for babies?

  • Researchers do not know how much alcohol is safe to drink when you are pregnant.
  • While most women who drink a little alcohol during pregnancy (one or less standard drinks a day) will have babies who have not been affected by alcohol, some babies have been affected by very small amounts of alcohol.
  • However women who abuse alcohol during their pregnancy are much more likely to have babies who are affected by alcohol than women who are drinking moderately.
  • As we do not know what a safe level of alcohol consumption is during pregnancy, less alcohol is better, but no alcohol is the best and safest choice.

Drinking alcohol before pregnancy is known

  • Around half of all pregnancies are not planned and women may not know they are pregnant until about the 6th week of the pregnancy or later.
  • Babies are more vulnerable to alcohol in the early weeks of pregnancy, with the highest risk being between 2 and 8 weeks.
  • If you have already had small amounts of alcohol during pregnancy the risk to your baby is low, but heavy drinking (such as binge drinking) during that time can cause problems for the baby, especially if other drugs are also used.
  • Unless a woman is abusing alcohol, exposure to alcohol is usually not thought to be a reason for terminating a pregnancy.

Stopping drinking at any stage of a pregnancy increases the chances of having a healthy baby.

FAS and FASD in Aboriginal communities

  • In many Aboriginal communities including in Australia and Canada fewer young women drink alcohol than in non-Aboriginal communities, but some young women drink a lot of alcohol and they have a higher risk of having babies with FAS or FASD.
  • This was not recognised until recently by the communities, but it is now being seen as a very significant problem for the communities.
  • Through family networks, communities are now able to identify women who are at high risk, and are working to reduce this risk.

How to know if a baby has been affected by alcohol

  • Babies with fetal alcohol syndrome may be identified around birth if it is known that the mother has abused alcohol during the pregnancy because they may be small and have the facial features of FAS.
  • Other babies with FAS or with FASD may not be picked up until they are older when their behaviour has become a problem or they are having learning problems such as delay in starting to talk or difficulties at school. This will only happen if the health professionals ask about alcohol use during pregnancy and mothers take the risk of talking about alcohol use.
  • Alcohol effects should be considered whenever a child is being assessed for difficult behaviour or developmental delay.

Secondary effects of alcohol related developmental disorders

Secondary effects are ones that are not present at birth but occur later and may be preventable if the condition is better understood and if there is more support for children, adults and their families.

  • Mental health problems - Studies have shown that there is an increased risk of many types of mental health problems including ADD (Attention Deficit Disorder), ADHD (Attention Deficit Disorder with Hyperactivity), conduct disorder, alcohol or drug dependence, depression and psychotic episodes.
  • Conduct problems in school - Children with FAS and FASD are more likely than other children to be suspended, expelled or drop out early from school. They can have difficulty getting on with other children and with teachers.
  • Trouble with the law  young people with FAS or FASD are more likely to commit crime and to be imprisoned. They may have difficulty controlling anger and frustration and may be violent.
  • Alcohol and drug dependence - Many people with FAS or FASD have problems with alcohol and drugs.
  • Independent living - Adults with FAS or FASD may have trouble keeping a job or living independently.

Protective factors for children with FAS or FASD

  • Early diagnosis - Identifying these children early can mean that they get more support for their learning, and their behaviour difficulties are better understood and managed.
  • Involvement in special education - Identification can enable development of a curriculum that is suited to the individual child.
  • Support for the family - A large number of children with FAS or FASD end up in alternative care (eg with foster families) sometimes because the parents also have FAS or FASD. Support early, and community involvement, can enable the child to live within the family or extended family (this can be particularly successful in Aboriginal communities).
  • Absence of violence - Children with FAS or FASD who are brought up in a family where they do not experience violence are less likely to use violence when they are angry or frustrated.

Protecting babies from FAS or FASD

  • Many women who become pregnant do not know of the serious effects that alcohol can have on an unborn baby, so increasing knowledge in the community is important.
  • No alcohol during pregnancy is the best protection for babies. This will also make it easier to not smoke during pregnancy, as drinking alcohol makes it harder to resist smoking.
  • If you want any further information about smoking see the topics 'Cigarettes and smoking' and 'Passive smoking' (Parenting and Child Health site).

What to do for your child

If your child might have alcohol effects on development there is no 'test' that can be done to show that behaviour or learning problems are due to alcohol.

Careful watching of progress with development and behaviour, with support when needed, can help prevent or reduce many of the secondary effects.

Resources

References

Centers for Disease Control and Prevention (US). 'Fetal Alcohol Spectrum Disorders':
http://www.cdc.gov/ncbddd/fas/default.htm

Centers for Disease Control and Prevention 'Guidelines for indentifing and referring persons with Fetal Alcohol Syndrome'
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5411a1.htm

Canadian Centre on Substance Abuse:
http://www.ccsa.ca

SAMHSA Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence Web site.
http://www.fascenter.samhsa.gov

Loock C, Conry J, Cook JL, Chudley AE, Rosales T: 'Identifying fetal alcohol spectrum disorder in primary care' Canadian Medical Association Journal March 1, 2005
http://www.cmaj.ca/cgi/content/full/172/5/628

National Drug Strategy website (Australia):
http://www.nationaldrugstrategy.gov.au

National Health and Medical Research Council 'Australian Alcohol Guidelines to reduce health risks from drinking alcohol 2009 
http://www.nhmrc.gov.au/publications/synopses/ds10syn.htm

University of Washington - Fetal Alcohol and Drug Unit:
http://depts.washington.edu/fadu/

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Youth Healthline on 1300 13 17 19 (local call cost from anywhere in South Australia).
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