Latest research published in the December 2008 issue of Indian Pediatrics deals with foetal alcohol spectrum disorders, or FASD. This is a disorder commonly found among women who consume alcohol during pregnancy, which affects their offspring in terms of growth retardation, intellectual dysfunction, and behavioural problems.

Alcohol is found to be neuro-toxic to the brain during the development stage of the foetus. Behavioural problems in children with FASD start at an early age and progress to adulthood. Recent research has established that even though fewer women drink alcohol than men, the bio-medical and other consequences of women’s alcohol use may be greater than that of men for the same amount of alcohol consumed. In general population studies throughout the world, as compared to women, men are more frequent drinkers, consume more alcohol, and cause more problems by doing so.

However, in the US, approximately 60% of adult women drink alcohol, at least occasionally. The rates of drinking and heavy drinking tend to be highest among young women, and decline steadily with age. In the United States, Britain, and Canada, 20%-32% of pregnant women drink, and in some European countries the rate is higher, exceeding 50%.

In a study in the Western Cape Province of South Africa, 34% of urban women and 46%-51% of rural women drank during pregnancy. Their drinking pattern was characterized by heavy binge drinking on weekends, with no reduction of use during pregnancy.

Maternal drinking during pregnancy varies among and within populations throughout the world. Both animal and human studies have reported that binge drinking is more harmful to the developing brain than the regular pattern. According to the “Gender, Alcohol and Culture: an International Study” (GENACIS) in India, 5.8% of all female respondents reported drinking alcohol at least once in the last 12 months.

In India, alcohol use is more prevalent in tribal women, tea plantation workers, and women of lower socio-economic status, commercial sex workers and to a limited rich upper crust, and is not favoured by women from the middle or upper socio-economic classes. In these high-risk groups, the prevalence is around 28-48%.

In England in the 1700s, several physician groups described children of alcoholics as “weak, feeble, and distempered,” and “born weak and silly… shrivelled and old.” The first good description on the adverse effects of alcohol at birth was by Sullivan in 1899, where he described the offspring of alcoholic women imprisoned in England. He concluded that these women produced children characterized by a pattern of birth defects of increasing severity and higher rates of miscarriage; there was a tendency for healthier infants to be born when gestation occurred in prison (thus indicating abstinence as prevention). These children were not productive members of society as they aged, and male alcoholism was not a factor in producing the abnormalities.

In 1968, Lemoine of France reintroduced the apparently ignored, unrecognized, or misunderstood concept of adverse outcomes resulting from foetal alcohol exposure. He studied more than 100 children of women who drank heavily and documented many of the physical and behavioural patterns among those children, but did not present any definitive diagnostic criteria for diagnosing FASD. Later, in 1973, Jones, Smith, and colleagues were the first to describe in detail the consistent pattern of malformations among children of mothers with significant pre-natal alcohol intake and to provide diagnostic criteria for the condition they termed FASD.
 

Apart from neurological problems like lower IQ, achievement deficits, learning problems, deficits in memory, attention, visual-spatial abilities, declarative learning, processing speed as well as language and motor delays, babies suffering from FASD may also have Cardiac defects like Atrial septal defects, aberrant great vessels, ventricular septal defects, tetralogy of Fallot; Renal defects like Aplastic kidneys, dysplastic kidneys, ureteral duplications, hypoplastic kidneys, hydronephrosis, horseshoe kidneys; Ocular defects like Strabismus, refractive problems and hearing loss.

Why is this condition important?

FASD is the one of the preventable causes of intellectual dysfunction and behavioural problems. Alcohol prevalence is an increasing trend among women. Most women who come to doctors will not spontaneously reveal their history of alcohol consumption. Hence efforts should be made to elicit substance use history in women, especially in those who are in the reproductive age and mothers of children who have intellectual and behavioural problems.

As there is no known safe amount of alcohol consumption during pregnancy, the AAP (American Academy of Pediatrics) recommends abstinence from alcohol for women who are pregnant, or who are planning a pregnancy.

Renuka Chaudhary, well-known politician, is giving the completely opposite message. She wants to open the doors of pubs in the name of freedom and rights for women. Will she like to have our future generation suffer from low IQ and mental retardation? The general public can see how politicians harm us for political scores.
 

The author is Senior Resident, Deptt. of Paediatrics, St. Stephen Hospital, Delhi