F A S
(Published in the February 2010 edition of The East Bay Psychiatric Newsletter)
There is a substance that is legally sold in super markets that most adults ingest regularly, but is extraordinarily toxic to fetuses. Avoiding it during pregnancy is the only known preventable cause of mental retardation. 60% of victims to this toxin eventually wind up incarcerated due to severe behavioral problems. Two children out of every thousand babies born in the United States are afflicted with the teratogenic effects of this substance.
There has been extensive research documenting the nature of the brain damage that is caused by this substance. Some of these effects are well known to many people. But the best that the United States has been able to do to educate the general public about this is to require the following cautionary message in small print on the back label of products that contain this substance: “According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.”
Fetal alcohol syndrome (FAS) is devastating to the individual afflicted, their family, and the nation at large, yet the birth rate of children with FAS continues to be significant. There is no established safe amount of alcohol that can be drunk during pregnancy. FAS is permanent and irreversible. It impairs a child’s lifetime ability to function mentally, socially, and physically. It affects reasoning, judgment and self-control and can result in crime, delinquency and other anti-social behavior.
Alcohol is responsible for an enormous amount of public health problems in this country. While it is one thing for an adult to willfully impact his or her own health by drinking to excess, it is quite another to voluntarily damage one’s unborn child with use of this substance during pregnancy.
Once a pregnant woman has a binge or two of heavy drinking it may be too late to protect her fetus from the permanent toxic effects characteristic of FAS. Toward that end, as psychiatrists, the least we can do is assertively communicate to our female patients with a history of alcohol abuse who become pregnant, that they should immediately become engaged in substance abuse treatment to help them avoid using alcohol during their pregnancy. AA sponsors and lay counselors are another group that need to be alert to, and forceful about, proper education of FAS.
Substance abuse disorders are characterized by relapses. Anticipating the possibility of a relapse during pregnancy, and proactively establishing treatment before a potential relapse occurs, is simply good medical practice. Adult and adolescent psychiatrists should be clear with their patients about the risks that exist and provide them with appropriate information about treatment. Pediatricians’ ability to identify and diagnose FAS in the newborn is all well and good, but the horse is already out of the barn at that point, so the first line of defense needs to be preemptive medical treatment by the professionals who are seeing the individual with a history of alcohol abuse when she gets pregnant.
