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Perspectives in Disease Prevention and Health Promotion Fetal Alcohol Syndrome: Public Awareness Week

Clinical studies have shown that heavy use of alcohol by pregnant women may result in a pattern of severe and irreversible abnormalities in their offspring called the fetal alcohol syndrome (FAS). Children with FAS may show a wide range of disabilities. The most consistent features include prenatal and postnatal growth deficiency in terms of decreased weight, height, and head circumference; impairment in intellectual and motor functioning; and a characteristic pattern of cranio-facial abnormalities.

The number of children in the United States with FAS is not known. Its reported prevalence at birth varies widely, depending on the location and population under study. The overall prevalence appears to be in the range of 1-2 per 1,000 births based both on American studies (1-3) and European studies (4,5). As might be expected, estimates of FAS prevalence among babies born to women identified as problem drinkers or alcohol abusers are higher, ranging from 23 to 29 per 1,000 (1-3).

Based on current estimates, FAS in the United States is a leading known cause of mental retardation and birth defects. The birth prevalence of FAS is similar to that of two other major birth defects

  • Down syndrome (1/1,000 live births) and neural tube defects (anencephaly and spina bifida) (1/1,000 births). In addition to FAS, other birth effects, including low birthweight, irritability during the newborn period, and various complications of pregnancy, may be associated with maternal alcohol use during pregnancy.

FAS is potentially preventable. A survey of 4,405 married mothers who delivered babies in 1980 found that 30% of women who drank before pregnancy stopped drinking during pregnancy (6). Some pregnant women spontaneously reduce their alcohol consumption for physiological reasons (7). It is also likely that pregnant women will reduce or cease their alcohol intake if they are made aware of the deleterious effects of alcohol on their babies. Evidence indicates that women who reduce or eliminate alcohol consumption before, and possibly even during, pregnancy may increase their chances of delivering infants of normal birthweight (8). The effects of mild to moderate alcohol consumption are uncertain; also uncertain are the critical periods during pregnancy--from conception to delivery--when the fetus is at risk.

In recognition of the potential for serious consequences of fetal exposure to alcohol and in the interest of increasing both public and professional awareness of the preventability of these consequences, the President has proclaimed the week of January 15-21, 1984, "National Fetal Alcohol Syndrome Awareness Week." Obstetricians and other health providers involved in the care of pregnant women are in a key position to intervene to prevent FAS. However, efforts to increase awareness of FAS and its preventability must be directed at the general public and at all health professionals. Reported by D Spiegler, MA, H Malin, MA, C Kaelber, MD, Div of Biometry and Epidemiology, K Warren, PhD, Div of Extramural Research, National Institute on Alcohol Abuse and Alcoholism.

References

  1. Hanson JW, Streissguth AP, Smith DW. The effects of moderate alcohol consumption during pregnancy on fetal growth and morphogenesis. J Pediatr, 1978;92:457-60.

  2. Rosett HL, Weiner L, Lee A, Zuckerman B, Dooling E, Oppenheimer E. Patterns of alcohol consumption and fetal development. Obstet Gynecol, 1983;61:539-46.

  3. Sokol RJ, Miller SI, Reed G. Alcohol abuse during pregnancy: an epidemiologic study. Alcoholism, 1980;4:135-45.

  4. Olegard R, Sabel KG, Arronson M, et al. Effects on the child of alcohol abuse during pregnancy. Acta Paediatr Scand (Suppl), 1979;275:112-21.

  5. Dehaene P, Samaille-Villette C, Samaille P, et al. Le syndrome d'alcoolisme foetal dans le nord de la France. Rev Alcoolisme, 1977;23:145-8.

  6. Prager K, Malin H, Spiegler D, Richards L, Placek P. Smoking and drinking behavior before and during pregnancy of mothers of liveborn infants. Health, United States, 1983, National Center for Health Statistics (in press).

  7. Little RE, Schultz FA, Mandell W. Drinking during pregnancy. J Stud Alcohol, 1976;37:375-9.

  8. Alcohol and the fetus--is zero the only option? (editorial). Lancet 1983;I:682-3.



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