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Welcome to the

Fetal Alcohol Spectrum Disorders 
Study Group, (FASDsg)* 

Drinking alcohol during pregnancy can lead to Fetal Alcohol Spectrum Disorders.

FASD can include significant defects in the fetal brain, cardiovascular and skeletal systems.

The life-long consequences for the child can include cognitive deficits and a variety of behavioral and social problems.

FASDSG members are researchers, clinicians and administrators with a strong professional interest in FASD


 

FASDSG:
-    Educates its members and the public.
-    Supports research into the causes and consequences of FASD.
-    Supports research into behavioral and biochemical therapies.
-    Promotes prevention of FASD and treatment for alcohol-exposed children.



While a recent meta analysis confirmed that alcohol exposure during pregnancy poses a great risk for the normal development of children (http://www.scribd.com/doc/158231079/The-Association-of-Mild-Moderate-and-Binge-Prenatal-Alcohol-Exposure-and-Child-Neuropsychological-Outcomes-A-Meta-Analysis), a soon-to-be released book, "Expecting Better: Why the Conventional Pregnancy Wisdom is Wrong—and What You Really Need to Know," by Emily Oster, advocates drinking while pregnant.

The FASDSG wants to point out that decades of studies, clinical and using animal models, have exhaustively demonstrated the deleterious effects of prenatal alcohol exposure. To deny this extensive literature can be extremely dangerous and poses a risk to children.  


A Commentary on the Book: “Expecting Better: Why the Conventional Pregnancy Wisdom is Wrong and What You Really Need to Know” by Emily Oster, Ph.D.  Associate Professor of Economics, University of Chicago.

 

Multiple health authorities, including The United States Surgeon General, the American College of Obstetricians and Gynecologists, the Canadian Society of Obstetricians and Gynecologists, and the Public Health Agency of Canada, all advise that pregnant women and women who may become pregnant should abstain from alcohol consumption.  In her recent book, Dr. Oster challenges these health authorities and this recommendation, arguing that moderate drinking during pregnancy is safe (for example, a glass of wine per day).  Although the definition of moderate drinking varies by country, consumption of 1 standard drink/day (containing approximately 0.5 fl oz of pure ethanol in the U.S.) is generally considered moderate drinking for non-pregnant women (Dufour, 1999).  Dr. Oster’s book suggests that the available scientific evidence does not support the recommendation to abstain from alcohol use during pregnancy.  This is not the case, as the current scientific evidence strongly indicates that even light drinking during pregnancy can have long-lasting negative impact on brain function in children that persists into adulthood.  Below is a summary of key scientific studies that have demonstrated significant adverse effects of alcohol at levels that can be achieved during light drinking.  We will begin with a review of studies that have been conducted with humans. 

 

  1. In a population cohort with low socio-economic status and mixed ethnicity (46% Caucasian and 54% African-American) moderate alcohol exposure during the first trimester of pregnancy was associated with significant deficits in verbal learning during adolescence (Willford et al., 2004). 
  2.  Other studies with different human populations have demonstrated a link between light drinking and behavioral and cognitive problems during childhood and/or adolescence, including alterations in working memory, attention and social interactions (Burden et al., 2005, Coles et al., 1991, O'Leary et al., 2010, Sayal et al., 2007, Sood et al., 2001). 
  3.  A recent study demonstrated that five variants of genes involved in alcohol metabolism in children and their mothers were associated with cognitive ability at 8 years of age in children born to mothers that reported drinking alcohol in moderation (1-6 drinks/week) during pregnancy. This finding indicates that certain pregnant women may be more susceptible to the effects of light drinking and that this may be related to genetic factors that regulate their ability to metabolize alcohol (Lewis et al., 2012).
  4. In a landmark longitudinal cohort study, Day and collaborators (Day et al., 2013) demonstrated that low-moderate prenatal alcohol causes significant behavioral problems (for example, attention deficits) that persist into adulthood (22 years of age).
  5. A recent brain imaging study demonstrated that low-moderate ethanol exposure during fetal development was associated with reductions in gray matter volume in several brain regions at approximately 20 years of age (Eckstrand et al., 2012).
  6.  A recent analysis of several separate studies (i.e., a meta-analysis) found a significant detrimental effect of light-moderate prenatal alcohol exposure on child behavior (Flak et al., 2013).  The problem behaviors identified in exposed children include increased need for attention, deficient interactive play skills, and behavioral modulation alterations
  7. A study with humans found that newborns of mothers that consumed light amounts of alcohol during pregnancy had a higher frequency of facial malformations and alterations in umbilical cord artery contractility (Iveli et al., 2007).

 

Studies with laboratory animals support the findings of these human studies, demonstrating persistent effects of light-moderate alcohol exposure on the brain (Valenzuela et al., 2012).  The importance of animal studies is that other risk factors (for example, nutrition, genetics, environmental influences) are controlled for and, therefore, the effects of alcohol exposure can be quantified.

 

  1. Adult offspring of pregnant rats who consumed low levels of alcohol displayed deficits in behavioral tests of learning and memory (Savage et al., 2002, Savage et al., 2010).  Alterations in the strength of transmission of information between neurons were identified as a potential factor responsible for these deficits in learning and memory (Varaschin et al., 2010).
  2.  In addition, it was discovered that moderate alcohol exposure affects the generation of new neurons in brain regions important for learning and memory, and this could also contribute to the deficits observed in the exposed offspring (Choi et al., 2005, Uban et al., 2010, Akers et al., 2011, Roitbak et al., 2011).
  3. Exposure of pregnant macaque monkeys to moderate alcohol levels has also been shown to impair motor coordination and delayed response speed in infant offspring (reviewed in (Schneider et al., 2011)). 
  4. Long-lasting alterations in social behavior were recently demonstrated in adult offspring of rats exposed to moderate alcohol levels during pregnancy (Hamilton et al., 2010).
  5. Moderate alcohol exposure increased preference and consumption of alcohol-containing solutions in adult offspring; adult rats from the ethanol group also exhibited increased cocaine and amphetamine consumption after cocaine exposure (Barbier et al., 2009, Barbier et al., 2008).  This moderate prenatal alcohol exposure may increase the risk of developing alcoholism and other addiction-related disorders.
  6.  A study with primates showed a reduction in aversive responses to repetitive tactile stimulation in young adult monkeys exposed to low levels of alcohol throughout gestation that could result in impaired control of sensory input (Schneider et al., 2008, Schneider et al., 2011). 

 In conclusion, the collective evidence from human and animal studies strongly suggests that even light drinking during pregnancy can produce significant long-lasting alterations in the brain, adversely affecting behavior, cognition, and social skills. Given the current state of the scientific evidence, the safest course of action is to advise pregnant women and women who may become pregnant to avoid drinking alcohol, even at low levels, during any stage of pregnancy.

 

James Reynolds, Ph.D. President

C. Fernando Valenzuela, M.D., Ph.D., Vice-president

Alexandre Medina, Ph.D., Treasurer

Jeffrey Wozniak, Ph.D. Secretary

Fetal Alcohol Spectrum Disorder Study Group-Research Society on Alcoholism

 

 

References

 

Akers KG, Kushner SA, Leslie AT, Clarke L, van der Kooy D, Lerch JP, Frankland PW (2011) Fetal alcohol exposure leads to abnormal olfactory bulb development and impaired odor discrimination in adult mice. Mol Brain 4:29.

Barbier E, Houchi H, Warnault V, Pierrefiche O, Daoust M, Naassila M (2009) Effects of prenatal and postnatal maternal ethanol on offspring response to alcohol and psychostimulants in long evans rats. Neuroscience 161:427-440.

Barbier E, Pierrefiche O, Vaudry D, Vaudry H, Daoust M, Naassila M (2008) Long-term alterations in vulnerability to addiction to drugs of abuse and in brain gene expression after early life ethanol exposure. Neuropharmacology 55:1199-1211.

Burden MJ, Jacobson SW, Sokol RJ, Jacobson JL (2005) Effects of prenatal alcohol exposure on attention and working memory at 7.5 years of age. Alcohol Clin Exp Res 29:443-452.

Choi IY, Allan AM, Cunningham LA (2005) Moderate fetal alcohol exposure impairs the neurogenic response to an enriched environment in adult mice. Alcohol Clin Exp Res 29:2053-2062.

Coles CD, Brown RT, Smith IE, Platzman KA, Erickson S, Falek A (1991) Effects of prenatal alcohol exposure at school age. I. Physical and cognitive development. Neurotoxicol Teratol 13:357-367.

Day NL, Helsel A, Sonon K, Goldschmidt L (2013) The association between prenatal alcohol exposure and behavior at 22 years of age. Alcohol Clin Exp Res 37:1171-1178.

Dufour MC (1999) What is moderate drinking? Alcohol Res Health 23:5-14.

Eckstrand KL, Ding Z, Dodge NC, Cowan RL, Jacobson JL, Jacobson SW, Avison MJ (2012) Persistent dose-dependent changes in brain structure in young adults with low-to-moderate alcohol exposure in utero. Alcohol Clin Exp Res 36:1892-1902.

Flak AL, Su S, Bertrand J, Denny CH, Kesmodel US, Cogswell ME (2013) The Association of Mild, Moderate, and Binge Prenatal Alcohol Exposure and Child Neuropsychological Outcomes: A Meta-Analysis. Alcohol Clin Exp Res.

Hamilton DA, Akers KG, Rice JP, Johnson TE, Candelaria-Cook FT, Maes LI, Rosenberg M, Valenzuela CF, Savage DD (2010) Prenatal exposure to moderate levels of ethanol alters social behavior in adult rats: relationship to structural plasticity and immediate early gene expression in frontal cortex. Behav Brain Res 207:290-304.

Iveli MF, Morales S, Rebolledo A, Savietto V, Salemme S, Apezteguia M, Cecotti N, Drut R, Milesi V (2007) Effects of light ethanol consumption during pregnancy: increased frequency of minor anomalies in the newborn and altered contractility of umbilical cord artery. Pediatr Res 61:456-461.

Lewis SJ, Zuccolo L, Davey Smith G, Macleod J, Rodriguez S, Draper ES, Barrow M, Alati R, Sayal K, Ring S, Golding J, Gray R (2012) Fetal alcohol exposure and IQ at age 8: evidence from a population-based birth-cohort study. PLoS One 7:e49407.

O'Leary CM, Bower C, Zubrick SR, Geelhoed E, Kurinczuk JJ, Nassar N (2010) A new method of prenatal alcohol classification accounting for dose, pattern and timing of exposure: improving our ability to examine fetal effects from low to moderate alcohol. J Epidemiol Community Health 64:956-962.

Roitbak T, Thomas K, Martin A, Allan A, Cunningham LA (2011) Moderate fetal alcohol exposure impairs neurogenic capacity of murine neural stem cells isolated from the adult subventricular zone. Exp Neurol 229:522-525.

Savage DD, Becher M, de la Torre AJ, Sutherland RJ (2002) Dose-dependent effects of prenatal ethanol exposure on synaptic plasticity and learning in mature offspring. Alcohol Clin Exp Res 26:1752-1758.

Savage DD, Rosenberg MJ, Wolff CR, Akers KG, El-Emawy A, Staples MC, Varaschin RK, Wright CA, Seidel JL, Caldwell KK, Hamilton DA (2010) Effects of a novel cognition-enhancing agent on fetal ethanol-induced learning deficits. Alcohol Clin Exp Res 34:1793-1802.

Sayal K, Heron J, Golding J, Emond A (2007) Prenatal alcohol exposure and gender differences in childhood mental health problems: a longitudinal population-based study. Pediatrics 119:e426-434.

Schneider ML, Moore CF, Adkins MM (2011) The effects of prenatal alcohol exposure on behavior: rodent and primate studies. Neuropsychol Rev 21:186-203.

Schneider ML, Moore CF, Gajewski LL, Larson JA, Roberts AD, Converse AK, DeJesus OT (2008) Sensory processing disorder in a primate model: evidence from a longitudinal study of prenatal alcohol and prenatal stress effects. Child Dev 79:100-113.

Sood B, Delaney-Black V, Covington C, Nordstrom-Klee B, Ager J, Templin T, Janisse J, Martier S, Sokol RJ (2001) Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect. Pediatrics 108:E34.

Uban KA, Sliwowska JH, Lieblich S, Ellis LA, Yu WK, Weinberg J, Galea LA (2010) Prenatal alcohol exposure reduces the proportion of newly produced neurons and glia in the dentate gyrus of the hippocampus in female rats. Horm Behav 58:835-843.

Valenzuela CF, Morton RA, Diaz MR, Topper L (2012) Does moderate drinking harm the fetal brain? Insights from animal models. Trends Neurosci 35:284-292.

Varaschin RK, Akers KG, Rosenberg MJ, Hamilton DA, Savage DD (2010) Effects of the cognition-enhancing agent ABT-239 on fetal ethanol-induced deficits in dentate gyrus synaptic plasticity. J Pharmacol Exp Ther 334:191-198.

Willford JA, Richardson GA, Leech SL, Day NL (2004) Verbal and visuospatial learning and memory function in children with moderate prenatal alcohol exposure. Alcohol Clin Exp Res 28:497-507.

 

 


 
 

Light drinking during pregnancy will NOT make your child smarter!

We are alarmed by a rash of recent newspaper reports suggesting that light drinking during pregnancy may be beneficial for your unborn child. These misleading and irresponsible reports followed a recently published study by Kelly and colleagues suggesting that 3-year-old children whose mothers drank “lightly” during pregnancy were not at risk for certain behavioral problems. The erroneous interpretation by the lay press about some “beneficial” effects of drinking during pregnancy was NOT part of the study’s findings. Indeed, the comments by the press also run counter to research studies indicating that low levels of alcohol can damage a fetus.

The results from the study by Kelly and colleagues must be interpreted with extreme caution for reasons that were overlooked in subsequent news reports. First, the “light drinkers” in this study were more socially and economically advantaged compared to both the heavier drinkers and the women who did not drink during pregnancy. Higher socio-economic status is generally associated with better nutrition, prenatal care and postnatal care-giving environments. The study’s authors suggested that any apparent differences in child development between the light drinkers and abstainers may be due to social factors, not drinking.

Second, the study focused only on children up to three years of age. Generally, the adverse effects of light drinking during pregnancy are subtle and may go undetected in young children. However, other group studies of more moderate or “social” drinking levels during pregnancy have shown an adverse impact on multiple aspects of development through adolescence and young adulthood, even when important environmental factors are taken into account.

Third, “light drinking” was defined in the study as anyone who had “no more than one or two drinks a week or no more than two drinks on an occasion.” This broad categorization includes patterns of drinking that have been shown to affect fetal brain development in laboratory research studies. Public health policymakers, health care providers, and the public all want to understand the dangers of alcohol consumption during pregnancy. Studies of pregnant women may not provide clear answers. But carefully controlled laboratory research studies clearly show that the blood alcohol
levels that occur with “light drinking” can interfere with biological processes that are critical for proper development of the fetal brain. Repeated consumption of this amount of alcohol during pregnancy has also been shown to cause functional brain damage and behavioral problems.

It is an inconvenient fact of life that alcohol is a “teratogen,” that is, a chemical that can cause physical or functional birth defects. Prenatal exposure to alcohol is widely accepted to be a risk factor in child development, which may be associated with other prenatal or environmental risk factors. Other risk factors include smoking, stress, poor nutrition and diseases affecting a mother’s health, such as diabetes, obesity and high blood pressure. As risk factors accumulate, developmental outcomes are usually less positive.

The consensus recommendation of the hundreds of scientists and clinical investigators, who study Fetal Alcohol Spectrum Disorders, along with public health officials around the world, is very clear - a woman should abstain from drinking during pregnancy as part of an overall program of good prenatal care that includes good nutrition, adequate exercise, sufficient rest, and proper prenatal health care.

Clinical Research References:

Baer JS, Sampson PD, Barr HM, Connor PD, Streissguth AP (2003) A 21-year longitudinal analysis of the effects of prenatal alcohol exposure on young adult drinking. Arch Gen Psychiatry. 60:377-385.

Connor, PD, Sampson PD, Streissguth AP, Bookstein FL, Barr HM (2006) Effects of prenatal alcohol exposure on fine motor coordination and balance: A study of two adult samples. Neuropsychologia 44:744-751.

Day NL, Leech SL, Richardson GA, Cornelius MD, Robles N, Larkby C (2002) Prenatal alcohol exposure predicts continued deficits in offspring size at 14 years of age. Alcohol Clin Exp Res 26:1584-1591.

Jacobson JL, Jacobson SW, Sokol RJ, Ager JW (1998) Relation of maternal age and pattern of pregnancy drinking to functionally significant cognitive deficit in infancy. Alcohol Clin Exp Res 22:345-351.

Jacobson SW, Chido LM, Sokol RJ, Jacobson JL (2002) Validity of maternal report of prenatal alcohol, cocaine and smoking in relation to neurobehavioral outcome. Pediatrics 109:815-825.

Olson HC, Streissguth AP, Sampson PD, Barr HM, Bookstein FL (1997) Association of prenatal alcohol exposure with behavioral and learning problems in early adolescence. J Amer Acad Child Adol Psychiatry. 36:1187-1194.

Willford J, Leech S, Day N (2006) Moderate prenatal alcohol exposure and cognitive status of children at age 10. Alcohol Clin Exp Res. 30:1051-1059

Laboratory Research References:

Bearer CF, Swick AR, O'Riordan MA, Cheng G (1999) Ethanol inhibits L1-mediated neurite outgrowth in postnatal rat cerebellar granule cells. J Biol Chem 274:13264-13270.

Farr KL, Montano CY, Paxton LL, Savage DD (1988a) Prenatal ethanol exposure decreases hippocampal [3H]-glutamate binding in 45-day-old rats. Alcohol 5:125-133.
12/2/2008

Farr KL, Montano CY, Paxton LL, Savage DD (1988b) Prenatal ethanol exposure decreases hippocampal [3H]-vinylidene kainic acid binding in 45-day-old rats. Neurotoxicol. Teratol. 10:563-568.

Galindo R, Zamudio PA, Valenzuela CF (2005) Alcohol is a potent stimulant of immature neuronal networks: implications for fetal alcohol spectrum disorder. J Neurochem. 94:1500-1511

Lochry EA, Riley EP (1980) Retention of passive avoidance and T-maze escape in rats exposed to alcohol prenatally. Neurobehav. Toxicol. Teratol. 2:107-115.

Queen SA, Sanchez CF, Lopez SR, Paxton LL, Savage DD (1993) Dose and age dependent effects of prenatal ethanol exposure on hippocampal metabotropic-glutamate receptor-stimulated phosphoinositide hydrolysis. Alcohol Clin Exp Res. 17:887-893.

Ramanathan R, Wilkemeyer MF, Mittal B, Perides G, Charness ME (1996) Ethanol inhibits cell-cell adhesion mediated by human L1. J Cell Biol 133:381-390.

Savage DD, Montano CY, Otero MA, Paxton LL (1991) Prenatal ethanol exposure decreases hippocampal NMDA-sensitive [3H]-glutamate binding site density in 45-day-old rat. Alcohol 8:193-201.

Savage DD, Becher M, de la Torre AJ, Sutherland RJ (2002) Dose-dependent effects of prenatal ethanol exposure on synaptic plasticity and learning in mature offspring. Alcohol Clin Exp Res 26:1752-1758.

Schneider ML, Moore CF, Kraemer GW (2001) Moderate alcohol during pregnancy: learning and behavior in adolescent rhesus monkeys. Alcohol Clin Exp Res. 25:1383-1392.

Swartzwelder HS, Farr KL, Wilson WA, Savage DD (1988) Prenatal exposure to ethanol decreases physiological plasticity in the hippocampus of the adult rat. Alcohol 5:121-124.

Vaglenova J, Petkov VV (1998) Fetal alcohol effects in rats exposed pre- and postnatally to a low dose of ethanol. Alcohol Clin Exp Res. 22:697-703.

Governmental and Organizational Recommendations:

U.S. Department of Health and Human Services (DHHS)

U.S. Surgeon General Advisory (February 21, 2005) on Alcohol Use in Pregnancy “Urges Women Who Are Pregnant or Who May Become Pregnant to Abstain from Alcohol”
http://www.lhvpn.net/hhspress.html

The National Academy of Sciences, The Institute of Medicine
Stratton K, Howe C, Battaglia F, editors. 1996. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention and Treatment. National Academy Press, Washington, D.C.

U.S. National Institutes of Health (NIH), National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Alert, No. 50 (December 2000) “Fetal Alcohol Syndrome and the Brain”

U.S. National Institutes of Health (NIH), National Institute on Alcohol Abuse and Alcoholism (NIAAA) “When You Are Pregnant … Drinking Can Hurt Your Baby”
http://pubs.niaaa.nih.gov/publications/DrinkingPregnancy_HTML/pregnancy.htm
12/2/2008 page 4

U.S. National Institutes of Health (NIH), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Interagency Coordinating Committee on Fetal Alcohol Syndrome
http://www.niaaa.nih.gov/AboutNIAAA/Interagency/default.htm

U.S. Centers for Disease Control (CDC) National Center on Birth Defects & Developmental Disabilities http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5114a2.htm

State of California Department of Health Services, Maternal, Child and Adolescent Health Branch and The University of California San Francisco
“Alcohol Use During Pregnancy”
http://www.cdph.ca.gov/data/surveys/Documents/MO-AlcoholFactSheet2005.pdf

Australian & New Zealand Journal of Obstetrics and Gynaecology [2008] 48(3):236-239. Elliott EJ, Bower C. Alcohol and Pregnancy: The Pivotal Role of the Obstetrician. "New draft alcohol guidelines for Australia state that, for pregnant women and women planning pregnancy, ‘no drinking is the safest option’."

World Health Organization (WHO)

Europe: http://www.euro.who.int/mentalhealth/Policies/20070921_4
Americas: http://www.paho.org/English/DD/PIN/ePersp001_news03.htm
Africa: http://www.afro.who.int/rc57/documents/AFR-RC57-
14_Harmful_use_of_Alcohol_in_the_WHO_African_Reg_final.pdf



 

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