Dispelling Myths and Developing a Framework for Reducing the Risk of Alcohol-Exposed Pregnancies

Introduction For many years, society has explored the consequences of substance abuse and remedies for this substantial health and societal problem. One of the potential consequences of substance abuse is fetal alcohol spectrum disorders (FASD). With an incidence estimated at 9.1 per 1000 live births, FASD represents the most common cause of preventable mental retardation and birth defects in North America (Barr and Streissguth 2001; Health Canada 1996; Sampson et al. 1997; Smitherman 1994). In Canada alone, the annual cost for additional resources for individuals with FASD who are under 21 years of age is estimated at approximately $344 million (Stade et al. 2006). Thus, FASD represents an important issue in North America, warranting attention and action to improve the probability that infants will be born at optimal health. FASD is a consequence of exposure to alcohol in the prenatal period. Women who consume alcohol during pregnancy, particularly those with substance abuse issues, increase the probability that they will deliver an infant with FASD. However, substance abuse is often an outcome of the interaction between preceding events, life circumstances and individual factors. If antecedent events and risk factors could be identified in childhood, adolescence, or during the childbearing years, opportunity exists to reduce the risk of substance use, substance dependence, and alcohol-exposed pregnancies. Based mainly on research around these risk factors, this paper will describe a framework for reducing the risk of alcohol-exposed pregnancies with some consideration of the broader issue of reducing the risk of alcohol dependence in general. By way of background, a brief overview of FASD will be provided before strategies to reduce the risk of alcohol-exposed pregnancies and the risk of alcohol dependence will be discussed. Fetal Alcohol Spectrum Disorder (FASD) Prenatal exposure to alcohol can result in abnormalities in facial features, deficiencies in growth and dysfunction in the central nervous system (including irreversible brain damage) leading to physical, mental, behavioural, and/or learning disabilities and individuals who require extensive support and services in the areas of health, social services, education and training, justice, addictions, and family counselling (Koren et al. 2003). Some of the primary disabilities associated with FASD involve neuropsychological impairments including deficits in executive functioning, memory, attention, visual-spatial abilities, cognitive flexibility, as well as language and motor delays (Mattson and Riley 1998; Olson et al. 1998; Rasmussen 2005). These children are at risk of lower IQ, poor academic achievement and learning problems as a consequence of structural and functional brain damage (Streissguth et al. 1994; Streissguth 1997). Due to the cognitive and social impairments of FASD, secondary disabilities are also likely to arise. Secondary disabilities include mental health problems, incarceration and retention in the justice system, confinement, inappropriate sexual behaviors, alcohol and drug abuse, and school incompletion, all of which may also reduce the likelihood of meaningful employment (Streissguth 1997; Streissguth et al. 2004). No level of alcohol consumption during pregnancy has yet been determined as safe (Fried and Watkinson 1988; Fried and Watkinson 1990; Gusella and Fried 1984; Jacobson and Jacobson 1999; Streissguth, Barr, and Sampson 1990). Current evidence suggests that heavy drinking creates the greatest risk for FASD, however, the effects of alcohol on fetal development likely depend on the interaction between a number of factors, including timing, frequency and amount of exposure to alcohol, nutritional and health status of the mother, biologic constitution of the mother and fetus, and fetal vulnerability to alcohol (Hicks 2007; Maier and West 2001). Given that no safe level of alcohol consumption during pregnancy has been determined, the current recommendation in North America is that women abstain from alcohol if they are pregnant or attempting to conceive (Alberta Medical Association 2007; American Academy of Pediatrics--Committee on Substance Abuse and Committee on Children With Disabilities 2000; Astley et al. …

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