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For the purposes of this review, "alcohol" is the alcohol found in alcoholic beverages, also referred to as ethanol or ethyl alcohol. Alcohol in alcoholic beverages is identified as a developmental toxicant by the California Environmental Protection Agency (Cal/EPA). A developmental toxicant is a substance that a group of expert scientists has determined can harm unborn children. Women who drink alcoholic beverages during pregnancy can give birth to children with Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE). Children with FAS may have mental retardation, behavioral problems, poor coordination, malformed hearts and brains, and distinct facial features, such as small eyes and a small upturned nose. Many of the same problems are also observed in children with FAE, but the symptoms are less severe. Woman who drink alcohol while pregnant are also more likely to have a miscarriage, a stillbirth, or a low birth weight baby. Because a safe level of alcohol intake during pregnancy cannot be determined, the March of Dimes (MOD) and the Centers for Disease Control and Prevention (CDC) recommend that pregnant women do not consume any alcohol. Women who are breastfeeding are also advised to stop drinking because small amounts of alcohol can enter the milk, and large amounts of alcohol may interfere with the release of milk from the breast. FAS is not associated with drinking by fathers, but alcohol intake can reduce sperm counts in men. In an effort to prevent FAS, organizations such as the March of Dimes and government agencies such as the Centers for Disease Control and Prevention (CDC) sponsor programs to conduct research, educate the public, and identify high risk groups which may benefit from intervention programs.

Health effects - Fetal Alcohol Syndrome, fetal Alcohol effects

The California Environmental Protection Agency (Cal/EPA) has added ethanol in alcoholic beverages to its Proposition 65 list of developmental toxicants. This means there is evidence that the alcoholic beverages can be harmful to unborn children (Cal/EPA Proposition 65 List).

According to the Centers for Disease Control and Prevention (CDC 2009), "maternal prenatal alcohol use is one of the leading preventable causes of birth defects and developmental disabilities. There is no known safe amount of alcohol to drink while pregnant nor is there a safe time during pregnancy to drink. When a pregnant woman drinks alcohol, so does her unborn baby." According to the March of Dimes, "When a pregnant woman drinks, alcohol passes swiftly through the placenta to her baby. In the unborn baby's immature body, alcohol is broken down much more slowly than in an adult's body. As a result, the alcohol level of the baby's blood can be even higher and can remain elevated longer than in the mother's blood. This sometimes causes the baby to suffer lifelong damage." The damage which occurs in children as a result of drinking during pregnancy is called Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE). FAS is the more severe defect. The March of Dimes (MOD 2002) goes on to say, "FAS occurs in about 6 percent of the babies born to women who are alcoholics or chronic alcohol abusers. These women either drink excessively throughout pregnancy or have repeated episodes of binge drinking (defined as having more than five drinks on one occasion)."

FAS babies, according to the March of Dimes (MOD 2002), "are abnormally small at birth and usually do not catch up on growth as they get older. They may have small eyes, a short or upturned nose and small, flat cheeks. Their organs, especially the heart, may not form properly. Many babies with FAS also have a brain that is small and abnormally formed, and most have some degree of mental disability. Many have poor coordination and a short attention span and exhibit behavioral problems. The effects of FAS last a lifetime. Even if not mentally retarded, adolescents and adults with FAS have varying degrees of psychological and behavioral problems and often find it difficult to hold down a job and live independently."

The March of Dimes (MOD 2002) has stated,

"As many as ten times the number of babies born with FAS are born with lesser degrees of alcohol-related damage. This condition is sometimes referred to as fetal alcohol effects (FAE) or fetal alcohol spectrum disorder (FASD). These children may have some of the physical or mental birth defects associated with FAS. The Institute of Medicine has proposed new, more specific diagnostic categories for FAE, referring to the physical birth defects (such as heart defects) as alcohol-related birth defects, and to the mental and behavioral abnormalities as alcohol-related neurodevelopmental disorders (ARND)."

According to the March of Dimes (MOD 2002), "Researchers are taking a closer look at the more subtle effects of moderate and light drinking during pregnancy. A 2001 study by researchers at Wayne State University in Detroit found that 6- and 7-year-old children of mothers who had as little as one drink a week during pregnancy were more likely than children of non-drinkers to have behavior problems, such as aggressive and delinquent behaviors. These researchers found that children whose mothers drank any alcohol during pregnancy were more than three times as likely as unexposed children to demonstrate delinquent behaviors. Researchers at the University of Washington at Seattle followed to age 14 a group of middle-class children whose mothers were "social drinkers," who drank an average of about two drinks per day. At age 7 years, when given intelligence tests, these children scored seven points lower than the average for all children in the study. At age 14, alcohol-exposed children remained more likely to have learning problems, especially with mathematics and memory, and behavioral difficulties, including attention problems. Other researchers also have reported behavioral problems in alcohol-exposed children including hyperactivity, impulsivity, poor social and communication skills and alcohol and drug use."

Other problems can occur if women drink while pregnant. According to the March of Dimes (MOD 2002), "Consuming alcohol during pregnancy increases the risk of miscarriage, low birth weight and stillbirth. Heavy drinkers are two to four times more likely to have a miscarriage between the fourth and sixth months of pregnancy than are nondrinkers. A recent Danish study found that women who drank five or more drinks a week were three times more likely to have a stillborn baby than women who had fewer than one drink a week."

Questions about safe Alcohol levels during pregnancy

The March of Dimes (MOD 2002) recommends that no alcohol be consumed during pregnancy. They have stated, "No level of drinking has been proven safe. The full pattern of FAS usually occurs in offspring of chronic alcohol abusers, most often in women who drink four to five or more drinks daily. However, it has occurred in women who drink less. Alcohol-related behavioral disorders (ARBD) and alcohol-related neurodevelopmental disorders (ARND) can occur in babies of women who drink moderately or lightly during pregnancy."

Women who drink occasionally before realizing they were pregnant often worry that their unborn child could be harmed. According the March of Dimes, "It is unlikely that the occasional drink a woman takes before she realizes she is pregnant will harm her baby. The baby's brain and other organs begin developing around the third week of pregnancy, however, and are vulnerable to damage in these early weeks. Because no amount of alcohol is proven safe, a woman should stop drinking immediately if she even suspects she could be pregnant, and she should abstain from all alcohol if attempting to become pregnant."

Alcohol while breast feeding

The March of Dimes (MOD 2002) has reported, "Small amounts of alcohol do get into breast milk and are passed on to the baby. One study found that the breastfed babies of women who had one or more drinks a day were a little slower in acquiring motor skills (such as crawling and walking) than babies who had not been exposed to alcohol. Large amounts of alcohol also may interfere with ejection of milk from the breast. For these reasons, the March of Dimes recommends that women abstain from alcohol while they are nursing."

Alcohol intake by fathers

According to the March of Dimes (MOD 2002), "To date, there is no proof that heavy drinking by the father can cause FAS. There is, however, increasing evidence that heavy alcohol use by the male can lower the level of the male hormone testosterone, leading to low sperm counts and, occasionally, to infertility. Men who stop drinking during their partner's pregnancy also help the partner avoid alcohol."

Alcohol abuse programs

Some women may find it hard to stop drinking alcohol. The March of Dimes (MOD 2002) recommends contacting the following places if help is needed to stop drinking:

Alcoholics Anonymous (AA)
Local chapters are listed in the white pages of local phone books.

1-800-ALCOHOL (1-800-252-6465)
A national help and referral line for people affected by alcohol and drug abuse.

The National Council on Alcoholism
1-800-NCA-CALL (1-800-622-2255)

Fetal Alcohol Syndrome prevention programs

The March of Dimes (MOD 2002) has stated, "FAS is one of the most common known causes of mental retardation, and the only cause that is entirely preventable." Therefore, agencies such as the March of Dimes, as well as the Centers for Disease Control and Prevention (CDC 2005) are sponsoring programs to help prevent FAS. The March of Dimes (MOD 2002) has described their programs to prevent FAS:

"March of Dimes-supported researchers are investigating the influence of alcohol on pregnancy. One current grantee is exploring the role of a gene in causing craniofacial and brain defects in FAS, with the ultimate goal of developing treatment to prevent these defects in babies of mothers who continue to drink during pregnancy. The March of Dimes also works to prevent FAS and FAE by educating the general public, teenagers, adults of childbearing age and expectant mothers about the dangers of alcohol and other drugs to unborn children. Because there currently is no way to predict which babies will be damaged by alcohol, the safest course is not to drink at all during pregnancy and to avoid heavy drinking during the childbearing years (because at least 50 percent of pregnancies are unplanned). All women who drink should stop as soon as they think they are pregnant. Heavy drinkers should avoid pregnancy until they believe they can abstain from alcohol throughout pregnancy. The March of Dimes has also developed tools for health care providers to aid in the screening and diagnosis of affected children."

Organizations to contact for additional information

National Organization on Fetal Alcohol Syndrome
900 17th Street NW, Suite 910
Washington, DC 20006
Phone: (202) 785-4585, +1(800)66NOFAS
FAX: (202)466-6456

To find a list of diagnostic and treatment centers and support groups near you, go to the NOFAS home page, click on "Resources", and then click on "National and State Resource Directory".

March of Dimes Resource Center
Toll-free: 888-MODIMES
TTY: 914-997-4764
Fax: 914-997-4763

Fetal Alcohol Syndrome Prevention Section
Division of Birth Defects and Developmental Disabilities
National Center for Environmental Health, MS F-15
Centers for Disease Control and Prevention
4770 Buford Highway NE
Atlanta, GA 30341-3724
Telephone: (770) 488-7370
FAX: (770) 488-7361

The American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
847/434-8000 (Fax)

SAMHSA Fetal Alcohol Spectrum Disorders Center for Excellence
2101 Gaither Road, Suite 600
Rockville, MD 20850
Phone: 1-866-STOPFAS(786-7327)

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