Researchers are developing new drugs that aim to lessen or even reverse the effects of fetal alcohol syndrome, but some scientists are skeptical about the claims, and worry that more medication could detract from prevention efforts.
It’s estimated that at least one per cent of the population suffers from fetal alcohol spectrum disorder (FASD) — permanent brain damage from prenatal alcohol exposure — although many experts consider this a low estimate. (Canada’s first population-based prevalence study is set to be published early next year.) Children with FASD often have a range of disabilities, including learning and behavioural problems. While there are different ways of managing symptoms — no single treatment exists for the debilitating disorder.
But researchers are working on it. A study published in November found lithium could treat sleep disruption and memory loss in mice, both common symptoms associated with FASD. And earlier this year, researchers found that giving baby rats exposed to alcohol in utero a combination of two drugs reversed their memory and learning deficits. Researchers hope to eventually develop medications that women could take during their pregnancy, or give to their newborn child, to lessen or even reverse the impacts alcohol had on the developing fetus.
Not everyone thinks this is a good thing.
Dr. James Reynolds, a professor of biomedical and molecular sciences at Queen’s University who researches FASD, said that while drug research is important, there’s concern that it could downplay prevention efforts.
“(Drug development) shouldn’t distract in any way from efforts in prevention,” he said. “There is no substitute for prevention because we know that drugs are rarely curative.”
But Dr. Eva Redei thinks science is coming close to a breakthrough. The FASD researcher at Northwestern University in Illinois said the need to advance drugs to treat and ideally reverse the disorder is absolutely essential.
“This isn’t a replacement for prevention but unfortunately prevention doesn’t work because despite all of the efforts people will continue to drink during pregnancy,” she said. “I am confident that in a few years there will definitely be a treatment.”
Her team is waiting on funding to start a clinical trial to test two drugs they believe could reverse the effects of FASD after birth.
Redei said the idea isn’t to encourage people to drink during pregnancy and think they can reverse it with a simple pill. Instead, the real intention is to help women who suffer from addiction or who drink in their first trimester before knowing they’re pregnant.
While Reynolds agreed that prevention will probably never be 100 per cent effective, he hesitated at the idea of a drug that will reverse FASD. He cautioned that scientists still don’t understand exactly what alcohol does to a developing child.
“I am personally quite skeptical that we’ll find one mechanism that alcohol targets to affect the developing brain, so the idea of a drug that targets one key process doesn’t seem realistic,” he said. “It might be beneficial to individuals with FASD if there was a drug to allow them to have better cognitive function, but it’s unlikely it would ever restore them to quote unquote normal function.”
Another issue is that most children with FASD are already on several medications.
Reynolds said people with FASD are one of the most “highly over-medicated groups,” and said other forms of treatment with proven benefits (such as exercise and physical therapy) are just as important. He believes many families would welcome non-pharmacological treatments.
“Even with the best guidance you don’t know how your child is going to respond to medication so you’re really playing trial and error which, as a parent, is extremely difficult,” she said. “Our kids are on medication because we feel they need to be, but (my husband and I) struggle with this decision all the time and constantly question ourselves.”
Moisan said the topic of medication is passionately debated within the FASD community.
“Medication is part of the picture but I don’t see something being developed that will actually reverse FASD,” she said. “I don’t know any parent where drugs is the only strategy they’re employing.”
Whether medication would be accessible to those in need is also an issue. There’s a culture of “blame and shame” when it comes to FASD, which could prevent women from asking their physician for medication. Women suffering from addiction might not even have access to a doctor.
For Moisan, prevention is still a huge piece of the puzzle, but she believes the tone around it needs to change. Her sons’ biological mother grew up in foster care and has a history of addiction and trauma. Moisan thinks it’s wrong to say she made a choice to drink.
“I think our prevention efforts really focus on telling women they shouldn’t have a drink if they’re pregnant or trying to get pregnant, but that’s only half the piece,” she said. “Talking about FASD as entirely preventable drastically oversimplifies it and doesn’t get to the deeper issues. We can’t frame this as just a choice.”
Reynolds cautions that parents shouldn’t have false hope about a pill that could reverse the effects of FASD. But he says drug studies are still important because they give us more insight into a complex disorder.
“(These drug studies) give us more clues about why and how alcohol damages the developing brain, and any information that helps us better understand this is valuable in and of itself.”