The fetus and alcohol – A preventable tragedy

Abstract

When a pregnant woman drinks alcohol in excess of 14.8 mL per day, she places her unborn child at risk for permanent functional brain damage. If she drinks heavily, either on a regular basis or by binge drinking, the risk of pervasively affecting most of the baby’s other organs, including overall cell size and number, rises to the point that a baby can be born with a predictable and recognizable set of physical characteristics that we call fetal alcohol syndrome. The range of the physical, behavioural and intellectual handicaps that result from the toxic effects of exposing a fetus to alcohol is laid out with stark precision in the position statement by the Canadian Paediatric Society’s Indian and Inuit Health Committee (pages 161–174), “Fetal alcohol syndrome”. The Committee is quite right in drawing our attention once again to the seriousness of this problem among Canada’s First Nations and Inuit communities. Victims of fetal alcohol exposure damage are also found in Canada’s inner city communities, suburban areas and rural areas. Some of these people have parents and grandparents with the same problem. These victims are over-represented among children in care. And when they ‘graduate’ from child welfare responsibility, they often break with their foster parents or group home support systems. They hit the streets. They are the school drop-outs who can’t hold a job. They are at high risk for teenage pregnancy and AIDS. Victims of alcohol-related fetal toxic encephalopathy end up in our society’s prisons, among our homeless and in the sex trade. They are the followers who try to get along with everyone, and they will go along with anybody who shows an interest in them. They are the ones who get caught in petty crime, who enter into high risk partnerships, become unwitting victims of abuse and who use alcohol and drugs in excess as an escape from the reality of hopelessness and despair. Governments have recently become highly sensitized to this public health tragedy. They are beginning to pay serious attention to the preventive and intervention strategies laid out in the position statement. Even while education and social services budgets are being squeezed, new funding has been allocated to children who have been negatively affected by intrauterine exposure to alcohol. School officials and social services agencies have become aggressively active in trying to find out whether children with neurodevelopmental problems can be given the diagnosis of fetal alcohol syndrome or fetal alcohol exposure. Parents are becoming more willing to talk about their drinking habits if they can get help for their children by doing so. Given this element of hope for helping these children, paediatricians can be forgiven for being tempted to err on the side of making the diagnosis of fetal alcohol syndrome or fetal alcohol exposure in times of doubt. In doing so, however, paediatricians need to recognize that the diagnosis carries a life-long sentence of uncertainty. These talkative, friendly, uninhibited children aren’t slow processors who will eventually catch on. Worse, they often seem to learn quickly, but forget it within hours or days. Not only do they have a variety of learning problems, but they can’t remember what they have learned. If our current understanding is correct, many of these children will never be able to function independently in society as adults. Paediatricians must be very sensitive to the impact of this news on the parents, foster families or prospective adoptive parents. The guilt and realistic worry that accompanies this diagnosis can be devastating if the support systems are not in place to help. Paediatricians need to be sensitive and responsive to the questions of teachers and school principals in planning and delivering educational programs. We also need to be effective in our message to family physicians, social services personnel and everyone else in the community team who will be involved with these children. An exciting example of what is involved in effectively using our health care expertise in this field comes from the Department of Pediatrics, University of Manitoba, Winnipeg. The medical staff have brought their renowned experience in northern health service to bear on this challenge through the use of telemedicine. Their message is worthy of careful study, not only for the exciting potential that this technical advance offers, but also for the range of resources brought to bear on a community-based approach to this preventable tragedy.