Last Call For Alcohol (One Bourbon, One Scotch, and One Damaged Kid)
According to a new study published recently in JAMA (the Journal of the American Medical Association), fetal alcohol disorders are much more common than the medical community or public previously thought: "Based on their findings, researchers estimated conservatively that fetal alcohol spectrum disorders affect 1.1 to 5% of children in the U.S., up to five times previous estimates... The disorders can cause cognitive, behavioral and physical disorders that hurt children's development and learning ability" (excerpt from a New York Times article by Pam Belluck, "Fetal alcohol disorders as common as autism, study finds" printed in The Buffalo News on Feb. 9, 21017). The main takeaway from the study is that congenital disorders caused by women drinking alcohol during pregnancy is not a single disease or condition, rather they fall along a spectrum of severity much like autism. Fetal alcohol syndrome, which is marked by both profound mental and behavioral deficiencies, and also tell-tale facial characteristics as seen in the image next to this paragraph, is the most severe and recognizable form of alcohol-related disorders, but it is not alone. As it turns out, there are much more common, milder forms of this condition that while not as pronounced or obvious physically, have subtle yet significant effects on children's mental and behavioral development.
I attended Cathedral School from kindergarten through 8th grade. During the last few years of my attendance at this Catholic school, the Cantalacian Center reached an agree-ment with the school to immerse their autistic students in the building. These students had their own classrooms, but shared the school's hallways, bathrooms and cafeteria with the regular students. Thus, I was intimately exposed to their behavior. Many of the autistic students had profound mental and behavioral problems- often slapping their heads, rocking their bodies and yelling suddenly- most had very limited vocabularies, and little to no potential for future employment. However, there was one autistic student who stood out among the rest- he was very quiet, well-behaved and extremely gifted artistically. He was a savant- lacking social and verbal skills but possessing one amazing talent (much like the title character in the movie "Rain Man"). The point is that autism is not one specific disease, but a spectrum of disorders with a wide-ranging variety of symptoms and deficiencies- from dependents with profound cognitive and behavioral disabilities that require continuous supervision and intense care, to high-functioning individuals who are employable or even supremely talented in a particular skill. What we are now learning is that alcohol disorders also fall in a wide spectrum.
Up to now the medical community has largely focused on fetal alcohol syndrome, the most severe form of alcohol-related disorders caused by heavy maternal consumption during pregnancy. What this new study indicates is that moderate or perhaps even light alcohol consumption during pregnancy may contribute to subtle mental, behavioral and learning deficiencies in affected children (along with many other drugs and chemicals both directly ingested by the mother and found in the environment). I have always been leery of the thinking, whether by physicians or women, that having a few drinks during pregnancy is perfectly fine. There is no specific threshold for how much is too much. Certainly, the more a pregnant woman drinks, the more severe the effect on the child. That much is certain because of two indisputable facts: one is that ethanol is toxic to humans and two, fetuses developing in the womb are extremely vulnerable to ethanol's harmful effects.
Ethanol at high levels causes damage to a plethora of the body's organs, from killing neurons in the brain, to enlarging and weakening the heart (alcoholic cardiomyopathy), to destroying liver cells (cirrhosis), to severely painful acute pancreatitis, and on and on. Light to moderate alcohol consumption is generally considered OK because the liver contains enzymes that break down ethanol into metabolites excreted by the kidneys in the urine. When a person drinks a lot of alcohol, in one sitting or chronically, the liver becomes overwhelmed and the finite amount of enzymes literally can't keep up with the volume of alcohol consumed. This leads to ethanol and a metabolite, acetaldehyde, to accumulate in the blood, which leads to the symptoms of intoxication, hangover and chronic damage to various organs. However, the fetal liver is very immature and lacks the enzymes to metabolize alcohol. Therefore, any ethanol drank by a pregnant woman that crosses the placenta into the fetus is going to cause some level of damage simply because the fetus lacks the ability to break down the toxin.
Furthermore, the fetal nervous system is much more vulnerable to ethanol's toxic effects than the adult human brain. During gestation, the fetus's brain, spinal cord and nerves are all undergoing rapid development and specialization into the various components of the central and peripheral nervous system. During this critical time of differentiation, the neurons and other cells and tissues are particularly sensitive to toxic effects of ethanol. The exact dose-response curve is unknown because there are so many variables, like the amount of alcohol ingested by the mother, the specific timing during pregnancy, and other genetic and environmental factors. But this much is clear to me, and the recently published research article provides strong evidence as well, that any alcohol consump-tion during pregnancy may have harmful effects on the child. Obviously, the more alcohol a woman drinks during pregnancy, the worse off the child will be, but even light ethanol consumption apparently causes some degree of mental and behavioral defects. Is there a safe level- say 1 or 2 drinks a week- that women can consume ethanol during pregnancy? I don't know and this study does not lend any evidence to that. What the study does indicate is that as many as 5% of American children- think about it, that is one out of every 20 kids in this country- are suffering from the consequences of maternal ethanol consumption during pregnancy. Combined with so many other pharmaceutical (maternal consumption of opioids, marijuana, cocaine, meth and other drugs) and socio-economic issues (poverty, lead paint, environmental pollutants, children being raised by single parents, declining moral standards etc.) it should come as no surprise why so many American kids are struggling with learning disabilities and behavioral issues.
I shall end this blog post with a strong, perhaps controversial, statement, but I think it needs to be said. Women must understand that everything they ingest, inject and inhale during pregnancy can adversely affect their developing child in the womb. I can't say (nor apparently can the most experienced physicians) with certainty that ANY alcohol consumption during pregnancy is safe. So if a pregnant woman truly values the health and potential of her unborn child, then abstain completely from drinking alcohol during pregnancy. Short-term self-gratification in the form of a glass of wine or champagne should not come at the expense of a child's mental and behavioral development, and future success as a well-adjusted, educated, productive member of society. And if that sounds sexist in any way (it's not my fault that women are the bearers of children) then perhaps all couples should make a pact- for as long as the woman is pregnant and is unable to consume alcohol, then the husband/boyfriend must also quit drinking- how about that for gender equality/fairness and maximizing the health of unborn children?
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