Perspectives in Disease Prevention and Health Promotion
Fetal Alcohol Syndrome: Public Awareness Week
Clinical studies have shown that heavy use of alcohol by
pregnant
women may result in a pattern of severe and irreversible
abnormalities
in their offspring called the fetal alcohol syndrome (FAS).
Children
with FAS may show a wide range of disabilities. The most
consistent
features include prenatal and postnatal growth deficiency in terms
of
decreased weight, height, and head circumference; impairment in
intellectual and motor functioning; and a characteristic pattern of
cranio-facial abnormalities.
The number of children in the United States with FAS is not
known. Its reported prevalence at birth varies widely, depending
on
the location and population under study. The overall prevalence
appears to be in the range of 1-2 per 1,000 births based both on
American studies (1-3) and European studies (4,5). As might be
expected, estimates of FAS prevalence among babies born to women
identified as problem drinkers or alcohol abusers are higher,
ranging
from 23 to 29 per 1,000 (1-3).
Based on current estimates, FAS in the United States is a
leading
known cause of mental retardation and birth defects. The birth
prevalence of FAS is similar to that of two other major birth
defects
Down syndrome (1/1,000 live births) and neural tube defects
(anencephaly and spina bifida) (1/1,000 births). In addition to
FAS,
other birth effects, including low birthweight, irritability during
the newborn period, and various complications of pregnancy, may be
associated with maternal alcohol use during pregnancy.
FAS is potentially preventable. A survey of 4,405 married
mothers
who delivered babies in 1980 found that 30% of women who drank
before
pregnancy stopped drinking during pregnancy (6). Some pregnant
women
spontaneously reduce their alcohol consumption for physiological
reasons (7). It is also likely that pregnant women will reduce or
cease their alcohol intake if they are made aware of the
deleterious
effects of alcohol on their babies. Evidence indicates that women
who
reduce or eliminate alcohol consumption before, and possibly even
during, pregnancy may increase their chances of delivering infants
of
normal birthweight (8). The effects of mild to moderate alcohol
consumption are uncertain; also uncertain are the critical periods
during pregnancy--from conception to delivery--when the fetus is at
risk.
In recognition of the potential for serious consequences of
fetal
exposure to alcohol and in the interest of increasing both public
and
professional awareness of the preventability of these consequences,
the President has proclaimed the week of January 15-21, 1984,
"National Fetal Alcohol Syndrome Awareness Week." Obstetricians
and
other health providers involved in the care of pregnant women are
in a
key position to intervene to prevent FAS. However, efforts to
increase awareness of FAS and its preventability must be directed
at
the general public and at all health professionals.
Reported by D Spiegler, MA, H Malin, MA, C Kaelber, MD, Div of
Biometry and Epidemiology, K Warren, PhD, Div of Extramural
Research,
National Institute on Alcohol Abuse and Alcoholism.
References
Hanson JW, Streissguth AP, Smith DW. The effects of moderate
alcohol consumption during pregnancy on fetal growth and
morphogenesis. J Pediatr, 1978;92:457-60.
Rosett HL, Weiner L, Lee A, Zuckerman B, Dooling E, Oppenheimer
E. Patterns of alcohol consumption and fetal development.
Obstet
Gynecol, 1983;61:539-46.
Sokol RJ, Miller SI, Reed G. Alcohol abuse during pregnancy:
an
epidemiologic study. Alcoholism, 1980;4:135-45.
Olegard R, Sabel KG, Arronson M, et al. Effects on the child
of
alcohol abuse during pregnancy. Acta Paediatr Scand (Suppl),
1979;275:112-21.
Dehaene P, Samaille-Villette C, Samaille P, et al. Le syndrome
d'alcoolisme foetal dans le nord de la France. Rev Alcoolisme,
1977;23:145-8.
Prager K, Malin H, Spiegler D, Richards L, Placek P. Smoking
and
drinking behavior before and during pregnancy of mothers of
liveborn infants. Health, United States, 1983, National Center
for Health Statistics (in press).
Little RE, Schultz FA, Mandell W. Drinking during pregnancy.
J
Stud Alcohol, 1976;37:375-9.
Alcohol and the fetus--is zero the only option? (editorial).
Lancet 1983;I:682-3.
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