So you’re craving a glass of Pinot with dinner, you’re in your third trimester and you’ve heard all about how women in France sip wine throughout their pregnancies. How much harm could it do, right? Actually, if you listen to the research, quite a bit. Not only are the effects of prenatal alcohol lifelong, they can be hard to predict. Just because your friend had a glass of wine and her baby was fine doesn’t mean that yours will be, too. In fact, her child may be yet to show the signs.
Brian Philcox and Bonnie Buxton’s adopted daughter, Colette, started out as a spunky but happy kid. But after starting school, she started showing signs of behavioural issues. By the time she was 10, she was skipping school, and by her teens, she was doing drugs. Within a few years, she was living on the streets. The behaviour was confusing and heartbreaking for her parents who had always provided a stable home, but when Buxton saw a program about Fetal Alcohol Spectrum Disorder (FASD) on TV, it all made sense. She recognized many of the physical and behavioural attributes in her daughter and after an encounter with Colette’s birth father’s family, her suspicions were confirmed: Colette’s mother had been a heavy drinker and drank throughout her pregnancy.
But not many moms understand or are willing to talk about the effect their drinking has had on their kids. Many of the problems remain untold. That’s why we went to some of Canada’s leading FASD doctors and researchers to get the facts. Here’s everything you need to know, from how to diagnose FASD in your child, to what to do when the pregnancy test comes back positive days after a wine-filled night.
What is FASD? Fetal Alcohol Spectrum Disorder occurs when alcohol is consumed by a mother during pregnancy and causes brain damage in the infant that leads to physical defects and neurobehavioural issues. Of every 1,000 babies born in Canada, it’s estimated that nine have FASD. The Public Health Agency of Canada calls it the leading cause of preventable developmental disability.
How does alcohol affect the brain? Alcohol is a toxic substance that easily passes across the placenta from a mother to a fetus, says Svetlana Popova, a senior scientist at the Centre for Addiction and Mental Health’s Institute for Mental Health Policy research. That toxic substance can disrupt all aspects of development—particularly in the brain. And as James Reynolds, professor in the department of biomedical and molecular sciences in the Centre for Neuroscience Studies at Queen’s University, explains, there are countless opportunities for error as an embryo goes from one cell to many. “We have all of these key processes that are going on throughout development. Alcohol can impair every one of them,” he says. “When there are multiple incidences of alcohol exposure, more and more of the processes can be disrupted.” And unlike some substances, such as nicotine, which reacts with specific receptors in our body, alcohol can impact all kinds of biochemical processes and pathways.
How much alcohol does it take? There is no safe amount of alcohol that can be consumed during any stage of pregnancy. Whether you are in your first trimester or third, you need to avoid it. There are simply so many variables. Jocelyn Cook is a scientific director for Society of Obstetricians and Gynaecologists of Canada and has worked with the Canada FASD Research Network, and as she explains it, if two women were to drink the same amount during pregnancy, one might have a child who is unaffected and another might have a child who experiences lifelong disability with FASD. But because we don’t know how each fetus will react beforehand, we need to avoid alcohol entirely. Though it’s frustrating to avoid alcohol for more than nine months—or longer if you’re trying to get pregnant for a long time—you’ll be saving yourself and your child a lifetime of difficulty.
If you’ve heard that European women sip alcohol without any problems, Cook argues that they are beginning to change their ways. “In Europe, they’re a little bit farther behind in terms of the research and data but they are getting there and realizing that alcohol during pregnancy is an issue,” she says. And, though any alcohol consumption is dangerous, binge drinking and chronic drinking are the worst. Cook says that the amount of alcohol, the duration of the drinking and the frequency all play into the likelihood of a baby to develop FASD. “It’s all about when you get that blood alcohol level in the mom’s body up,” she says.
What if you drink before you realize you’re pregnant? Because many pregnancies are unplanned, Murray Trusler, a retired assistant professor of family medicine at Queen’s University and father to a son with FASD, recommends that any women who are having unprotected sex should be abstaining from alcohol. “There is no morning-after pill for alcohol,” says Trusler.
If you find out you’re pregnant and you know you’ve had a drink or two over the past few weeks, talk to your health care provider about the risks and your concerns. Cook recommends trying your best from that point on to have the healthiest pregnancy possible. Lifestyle factors, such as having poor eating habits, being stressed and smoking can all increase the risk of having a child with FASD.
What are the signs of FASD? There are three main physical symptoms commonly associated with FASD: small eye openings, a thin upper lip and a flat philtrum (that groove between your nose and your mouth). But, Cook says, many kids who have FASD may not exhibit all—or any—of these signs. It’s the behavioural issues that can be more telling in making a diagnosis. Trusler explains that most of the brain injuries involved in FASD show up as problems in adaptive behaviour, language, attention, reasoning and memory. Kids may have difficulty focusing in a typical classroom setting or may seem to lie or change their story because they don’t recall what happened. They may also have trouble understanding the consequences of their actions, which can end up getting them into trouble.
How and when can it be diagnosed? Right now, there is no way to test a baby in utero for FASD, and diagnosis can take many years as the signs begin to emerge. Like Colette, many children will begin to show signs of FASD around the time they enter school. Popova says the average age of diagnosis ranges from three to 10 years, though some people are not diagnosed until adulthood. To get a diagnosis, you need to be referred to an FASD diagnostic clinic—there are at least 86 in Canada. At a clinic, a child will likely be examined by a paediatrician, and be seen by a psychologist, and possibly even a psychiatrist, occupational therapist or speech and language pathologist. Since all of this can take time, there tends to be waiting lists for the clinics, and even recognizing the signs necessary to get a child into the clinic can be a challenge. Reynolds says that many kids are misdiagnosed with ADHD or autism because the effects of these disorders often overlap. Others who are correctly diagnosed with FASD will go on to receive another diagnosis. “We recently identified more than 400 disease conditions that co-occur in individuals with FASD,” says Popova, explaining that this can be due to the many language, auditory, visual, mental and behavioural impairments.
In the future, there is hope that diagnosis of FASD could be more efficient. A researcher from UBC found a genetic difference among kids with FASD, which could help with earlier diagnosis, and Reynolds is studying eye movement as a way to assess brain function and potentially diagnose conditions like FASD.
How can you talk to your child about the diagnosis? If your child is diagnosed with FASD, it’s important to help him understand it. “You need to get the message to the child that they’re not dumb—they just need help with various things,” says Trusler, who has been through the experience with his own adopted son. “Once the child understands the nature of the problem, and that it isn’t their fault, that takes a huge weight off their shoulders.” Trusler also recommends talking to the school about the possibility of offering extra supports, such as oral tests instead of written ones, or other adaptations that can help your child learn.
What treatment options are available? Though there is no medical treatment available for kids with FASD—the brain damage is permanent—there are people there to help. At a diagnostic clinic, families will often be set up with social workers who can help them navigate the supports they need to help make life easier for them and their child. Depending on the child’s impairments, different social programs or services may be available to help.
How long do the effects of FASD last? Unfortunately, the damage associated with FASD never goes away. Though many individuals will learn how to manage the condition and be successful in life, not everyone is so lucky. Later in life, the brain damage associated with FASD can lead to academic failure, substance abuse, mental health problems and conflicts with the law. And individuals with FASD can often have trouble managing money or keeping a job. And because they are predisposed to having problems with drugs or alcohol, they’re also more likely to have their own kids with FASD.
What else should parents know? Trusler warns that alcohol is not the only substance that parents-to-be need to worry about.Marijuana can have similar effects, though there has been less research on prenatal marijuana use. If you’re not sure about the implications of any substance you’re taking, talk to your doctor.