Studying the history of Fetal Alcohol Syndrome

In a study published earlier this month in the Journal of the American Medical Association (JAMA), researchers found that the prevalence of fetal alcohol spectrum disorders (FASDs) may be up to five times as great as previously estimated.

FASDs include partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, and the more well-known and most severe manifestation, fetal alcohol syndrome. All can result in physical effects, such as distinct facial features and poor coordination, as well as intellectual and behavioral disabilities.

While FASDs were previously thought to affect around one percent of children, the recent study in JAMA, conducted by assessing children and interviewing parents in four areas across the United States, suggested a prevalence of somewhere between 1.1 and five percent as a conservative estimate. It also posited a figure between three and 10 percent as a weighted estimate.

Fetal alcohol syndrome, as far as developmental disorders go, has unique social and moral aspects. Organizations from the Mayo Clinic to the Centers for Disease Control and Prevention (CDC) emphasize that the condition is completely preventable, recommending that sexually active women of childbearing age, who have the possibility of getting pregnant, do not drink. 

Because there is a lack of data on the effect of low amounts of alcohol, complete abstinence is frequently recommended, summed up by the CDC’s remark, “Why take the risk?”

Given the lengthy relationship between humans and alcohol, the idea that alcohol can affect a fetus is a longstanding one, and it has always been affected by more than just contemporary biology. 

Theories have abounded since the time of Plato, with philosophers, physicians, social crusaders and the general public believing in a mix of causes and effects, influenced by everything from gender norms to race relations.

In the modern era, researchers David Smith and Kenneth Jones from Seattle are considered responsible for first formally identifying and naming fetal alcohol syndrome. 

Their initial 1973 publication in The Lancet documented eight children across three ethnic groups with similar physical features and developmental delays, who had been born to alcoholic mothers. Five years earlier, the French pediatrician Paul Lemoine had also observed abnormalities in 127 children, although his work did not receive as much exposure.

At the time, environmental dangers were fresh in the public mind, with Rachel Carson’s exposé of DDT having been published the decade before. Teratogens, or agents that can disrupt fetal development, were also of pervasive concern. This concern was caused by two recent, unrelated events that led to visible epidemics of birth defects: the thalidomide tragedy, in which thousands of women worldwide gave birth to severely deformed infants after taking a teratogenic sleeping pill, and an outbreak of rubella that had resulted in the birth of disabled children to some infected mothers.

In addition, concerns over the social impact of alcohol renewed during the Reagan administration in the 1980s, which The New York Times labeled a “temperance wave.”

Efforts to combat fetal alcohol syndrome became largely broad, with a “Just Say No” inclination. In 1977, an advisory from the National Institute on Alcohol Abuse and Alcoholism recommended fewer than two drinks a day, and in 1981 the surgeon general warned that pregnant women should avoid alcohol entirely. He even advised them to be wary of the alcoholic content of foods and drugs.

Later in the decade, legislation was passed by Congress mandating that alcoholic beverages bear a label warning pregnant women about the possibility of birth defects. 

Especially in light of the recent study suggesting that a higher than expected incidence of FASDs, new strategies are arguably needed. The study emphasized the heightened risks that come with binge drinking, a behavior which has been increasing among women, by almost 58 percent between 2002 and 2013, according to a September 2017 paper published in JAMA. 

Educational efforts that concentrate on raising awareness about binge drinking thus have the potential to not only curb the practice, which carries dangers in itself, including alcohol poisoning and accidental injury, but also to affect FASDs.

FASDs are also tied to unplanned pregnancies, which, though declining in number, still make up almost half of the pregnancies in the United States. Recommending temperance to all women who might become pregnant is unlikely to be realistically effective. Instead, initiatives to reduce the rate of unintended pregnancy would also indirectly impact the incidence of FASDs.

Currently, abstinence from alcohol is the safest measure, since so much is still not known about how alcohol affects a fetus and whether there is an allowable amount to drink. Unfortunately, raising awareness for abstinence from alcohol has not been successful. 

With the spike in attention paid to FASDs in the wake of this recent study, perhaps it is time to consider new ways to approach this old issue.