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Fetal Alcohol Spectrum Disorder

When a pregnant woman drinks alcohol, there is a chance that her baby will be born with a lifelong disability called Fetal Alcohol Spectrum Disorder (FASD).

One way of preventing Fetal Alcohol Spectrum Disorder is to spread the word that a healthy pregnancy doesn’t include alcohol. A healthy pregnancy includes: regular visits with a healthcare provider, healthy eating, taking prenatal vitamins, exercising, and avoiding stress.

There is a lot of confusing information about pregnancy and alcohol and people aren’t sure what to do. Research shows that:
  • alcohol is a dangerous drug and can do more harm to developing babies than many other drugs
  • any type of alcohol (wine, beer, cooler, hard liquor) can harm the baby
  • there is no known safe amount to drink
  • alcohol can cross the placenta and reach the developing baby
  • when the mother drinks, she and her baby have the same blood alcohol content
  • because the baby’s liver is still growing, it takes a long time to get rid of alcohol giving it more time to damage baby’s developing cells
  • the damage to the cells can cause a physical and brain-based disability that cannot be cured

Half of pregnancies are not planned which means many women are drinking before they know they are pregnant. Most women do stop drinking as soon as they find out. If they were drinking, they may worry about how alcohol has affected their baby. No one can say, for certain, if damage has been done. Every baby develops differently and can be affected differently. Stopping alcohol and talking with a healthcare provider can help. Each day without alcohol is good for the developing baby.

What is Fetal Alcohol Spectrum Disorder?

What is Fetal Alcohol Spectrum Disorder?

FASD is a spectrum (range) of disabilities that can be caused by a mother drinking while pregnant.

What are the diagnoses in FASD?

In Canada, there are new guidelines for diagnosing FASD. Making a diagnosis of FASD requires a multidisciplinary team (Paediatrician or Doctor with expertise in diagnosis, Occupational Therapist, Speech-Language Pathologist, and Psychologist) and could also include information from family, social work, justice, education, and others as needed.

Diagnosis is a process, not a stand-alone test, and is complex. Diagnosis includes gathering information about prenatal alcohol exposure, physical features affected by alcohol, and areas of the brain and central nervous system that have been harmed.

As of 2016, there are two new diagnostic categories:

  • FASD with sentinel facial features
  • FASD without sentinel facial features

A new term is at risk for neurodevelopmental disorder and FASD associated with prenatal alcohol exposure. This designation is given if an individual is referred to a team for diagnosis and there is confirmed prenatal alcohol exposure, a clinical concern about development, and three distinct facial features but the person does not show impairment in at least three areas of the brain.

In Saskatchewan, diagnosis is done in Prince Albert, Regina, Saskatoon, and Onion Lake. Find more information about diagnostic teams at www.saskatchewan.ca.

A diagnosis can be important for the person and the family. Diagnosis is important to help put the right supports in place for children, youth, adults, and their families. Putting the right supports in place can prevent “secondary disabilities” such as problems with friends, school, mental health, and substance use.

The new guidelines include other recommendations to support prevention of FASD:

  • Counselling women and their partners about stopping drinking alcohol during pregnancy or when planning a pregnancy
  • Screening all pregnant women and new mothers for alcohol use

How Common is FASD?

Most websites will say that FASD occurs in 1 in 100 live births. In 2009, Dr. Philip May, an expert on FASD, concluded that rates of FASD in the general population were higher than previously thought. He estimated the rate could be as high as 2 to 5 in 100 live births.

Why is FASD called an invisible disability?

Often there are no obvious physical signs of the brain damage caused by alcohol. The effects of the damage to the brain can be seen through things such as behaviour and learning difficulties. This is why FASD is often called an invisible disability. This makes it different from many other disabilities. For example, a person who is unable to walk may use a wheelchair. A person who is hearing impaired may use a hearing aid. Someone who is visually impaired may use a cane or service animal.

The invisibility of this disability can make it more difficult for people with FASD. Other people may decide that a person’s behaviours or difficulties are because of choice, and not because of disability.

Is FASD 100% Preventable?

FASD Preventable

Is FASD 100% preventable?

In an ideal world, FASD would be totally preventable. If a mother does not drink while pregnant, her baby will not have FASD.

People do not live in an ideal world. There are many reasons a woman may drink while pregnant. They include:
  • She may drink before she knows she is pregnant. 50% of pregnancies are unplanned. (Singh, S., Sedgh, G., Hussain, R. (2010).
  • She may be dealing with addiction issues.
  • She may have been told a glass of wine or other alcoholic drink is fine while pregnant.
  • Her partner or friends may make it difficult to stop drinking.

Saying that FASD is 100% preventable can lead to judgement of a woman or add to the guilt she may already be feeling. It is best to avoid stating it is 100% preventable and make sure that people understand why women may drink while they are pregnant.

What Contains Alcohol?

What contains alcohol?

Alcohol is found in:
  • Wine and Champagne
  • Beer and Ciders
  • Coolers
  • Spirits (vodka, rum, brandy, tequila)
  • Liqueurs
  • Some cough syrups, hand sanitizers, mouthwashes, and cleaners

How and Why is a Baby Affected by Alcohol?

How is a baby affected by alcohol?

The developing baby is connected to the mother by an umbilical cord to the placenta. There is a protective membrane (thin layer of tissue) between the umbilical cord and the placenta that prevents the mixing of their blood. This common blood supply is in place (at about 7-10 days). Anything that goes into the mother’s bloodstream will be passed on to the fetus through a large vein in the umbilical cord. This includes nourishment such as food, water, and oxygen. It also includes other things such as caffeine, alcohol and medication. It also allows the waste products from the fetus to pass back to the mother’s bloodstream through two arteries (also in the umbilical cord). The developing baby’s system breaks down alcohol much more slowly than the mother’s. This makes the baby’s alcohol level higher and the effect lasts longer.

PregantDrinkingImage

Why is a baby affected by alcohol?

Alcohol is a teratogen (poison) that interferes with the normal development of the developing baby (fetus) causing cells to die or mutate. Teratogens can cross through the placenta. Other teratogens include:

  • Radiation exposure from x-rays and uranium.
  • Infections such as German Measles (Rubella), and Herpes Simplex virus.
  • Chemicals such as mercury and lead.
  • Drugs such as thalidomide, valproic acid (an anticonvulsant drug), and alcohol.
The impact that alcohol has on the fetus is not the same for all people. It is influenced by factors such as:
  • Timing
  • Amount
  • Pattern of drinking
  • Nutrition
  • Genetics

3-151: Pregnancy And Alcohol Brochure
You can download or order the Pregnancy & Alcohol: A Doctor’s Advice Brochure here.

What Damage Can Alcohol Do?

What damage can alcohol do?

Alcohol affects the central nervous system (brain and spinal cord) of a developing baby. It can cause a wide range of disabilities. These can range from mild to severe, and can result in a unique mix of effects which are present at birth (primary disabilities). Areas that can be affected include:

  • Learning
  • Memory
  • Attention
  • Problem solving
  • Social interactions
  • Mental health
The effects of alcohol exposure are unique to the individual. Each person will have different strengths and struggles throughout life.

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