More U.S. Children Than Previously Thought May be Suffering From Fetal Alcohol Syndrome

A program in Waco, Tex., teaches the effects of alcohol on pregnancy.
Brandon Thibodeaux for The New York Times

More American children than previously thought may be suffering from neurological damage because their mothers drank alcohol during pregnancy, according to a new study.

The study, published Tuesday in the journal JAMA, estimates that fetal alcohol syndrome and other alcohol-related disorders among American children are at least as common as autism. The disorders can cause cognitive, behavioral and physical problems that hurt children’s development and learning ability.

The researchers evaluated about 3,000 children in schools in four communities across the United States and interviewed many of their mothers. Based on their findings, they estimated conservatively that fetal alcohol spectrum disorders affect 1.1 to 5 percent of children in the country, up to five times previous estimates. About 1.5 percent of children are currently diagnosed with autism.

“This is an equally common, or more common, disorder and one that’s completely preventable and one that we are missing,” said Christina Chambers, one of the study authors and a professor of pediatrics at the University of California, San Diego. “If it truly is affecting a substantial proportion of the population, then we can do something about it. We can provide better services for those kids, and we can do a better job of preventing the disorders to begin with.”

The range of fetal alcohol spectrum disorders (also called FASDs) can cause cognitive, behavioral and physical difficulties. The most severe is fetal alcohol syndrome, in which children have smaller-than-typical heads and bodies, as well as eyes unusually short in width, thin upper lips, and smoother-than-usual skin between the nose and mouth, Dr. Chambers said. A moderate form is partial fetal alcohol syndrome. Less severe is alcohol-related neurodevelopmental disorder, in which children have neurological but not physical characteristics and it is known that their mothers drank during pregnancy.

Dr. Chambers said the researchers were in the process of analyzing the mothers’ answers to questions to see if they can identify relationships between the timing and amount of drinking during pregnancy and the type and severity of children’s impairment.

It has been unclear how common these disorders are because the facial features are subtle, and some effects, like problems paying attention or recognizing the consequences of behavior, can apply to other diagnoses. Also, the degree and area of a child’s brain damage appears to vary depending on when and how much during pregnancy the mother drank, as well as genetics, so symptoms can vary, too.

Then there is the stigma that often makes mothers reluctant to acknowledge alcohol consumption.

“When you identify a kid with FASD, you’ve just identified a mom who drank during pregnancy and harmed her child,” said Susan Astley, director of the Fetal Alcohol Syndrome Diagnostic and Prevention Network at the University of Washington, who was not involved in the study.

While Dr. Astley, a longtime expert in the field, said she admired the researchers’ hard work, she said the reliability of the study’s numbers was hampered by several factors. For example, only 60 percent of eligible families in the schools allowed their children to be evaluated and more than a third of those children’s mothers declined to answer questions about drinking during pregnancy.

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SOURCE: New York Times, Pam Belluck