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In the sixth to 12th week of pregnancy, a fetus’s bones, brain and central nervous system are forming. Buds blossom into arms and legs, and internal organs start to function. A face with eyelids, lips and other features appears.
This is also the time when a mother’s alcohol consumption poses the greatest risk of doing lifelong physical damage to her baby, according to a new study of nearly 1,000 women who drank at least once in their pregnancies.
On average, the women drank a small fraction of a drink a day. But some downed as many as 12 drinks a day—well above the amount considered safe for the women’s own health—and binged frequently.
For each drink consumed each day over the daily average in the second half of the first trimester, the women’s babies were 12% more likely to have a small head circumference, 16% more likely to have low birth weight and over 20% more likely to have a very thin upper lip or lack a vertical indentation between their noses and lips. While seemingly minor, those characteristics are typical of fetal alcohol syndrome, or FAS, and frequently presage cognitive and behavior problems later in life.
Overall, the more the women drank, the more likely their babies were to have such problems, according to the study published last week in the journal Alcoholism: Clinical and Experimental Research. Some who averaged less than one drink a day still had babies with some FAS characteristics.
“We found that there is no safe amount of alcohol to drink during pregnancy,” says lead author Haruna Sawada Feldman, a postdoctoral student at the University of California, San Diego.
A few studies have found a drink or two a week seemed to have little effect on babies. But most of those relied on mothers’ recall after giving birth, while the UC San Diego researchers interviewed subjects throughout their pregnancies.
Fetal alcohol syndrome—an array of physical and mental abnormalities including learning disabilities, language delays, poor concentration and low IQ—was first recognized in the early 1970s. Experts have never pinpointed how much alcohol it takes to cause damage, so the U.S. Surgeon General, the Centers for Disease Control and Prevention and the March of Dimes all urge women not to drink at all if they are or might become pregnant.
Some women drink anyway—in part because friends, family members and even some obstetricians say an occasional drink isn’t likely to cause harm.
“We know that alcohol crosses the placenta; we know that it’s linked to mental and physical problems; so why risk it?” says Tom Donaldson, president of the National Organization for Fetal Alcohol Syndrome, or NOFAS, a nonprofit advocacy group.
In government surveys, about 12% of pregnant women in the U.S. report drinking some alcohol in the past 30 days and about 2% report drinking five or more drinks at a time. The CDC estimates that of approximately four million U.S. infants born each year, between 1,000 and 6,000 fit the criteria for FAS. Experts think as many as 40,000 a year have some neurological or behavior issues caused by prenatal alcohol exposure, a broader, less well-defined range of conditions known as fetal alcohol spectrum disorder, or FASD.
Why alcohol seemingly affects some unborn babies but not others remains a mystery.
“There’s a huge amount that we still don’t know about this disorder,” says Kenneth Lyons Jones, one of the physicians who first recognized the danger of alcohol in pregnancy when he and a colleague noticed that eight children in a Seattle clinic all had similar facial features and developmental problems and discovered that all had been born to alcoholic mothers.
Dr. Jones, now a professor of pediatrics at UC San Diego and a co-author of the study, speculates that genetic differences may at least partly explain why some babies are more affected than others. He and other researchers are also investigating whether a mother’s health and nutrition may play a role, studying pregnant women in Ukraine where the incidence of FAS is high.
In the U.S., experts say most children who fit the criteria for FAS or FASD never get a formal diagnosis. Many of the cognitive and behavioral problems are common in the general population and some are subtle enough to go unrecognized. Mothers who drank during pregnancy are often reluctant to admit it and physicians are often loath to voice suspicions, experts say. What’s more, there are no blood tests or other biomarkers to show alcohol exposure in the womb.
But the damage can last a lifetime.
Researchers at Emory University in Atlanta have been following a group of alcohol-affected children born between 1980 and 1986 into young adulthood. (“In those days, mothers told us everything,” says Claire Coles, a professor of psychiatry at Emory and the project leader.)
Not all those whose mothers drank have suffered physical or cognitive damage. One recently graduated from Princeton University, says Dr. Coles. But many have visual and spatial difficulties and trouble encoding memories. Functional MRI studies have found that corresponding areas of their brains are abnormal. Many also have trouble with math concepts, starting around age 5. “You can get them to say that 2 plus 2 equals 4, but they don’t know what that means,” says Dr. Coles.
She and others have designed learning programs that address the specific needs FAS children have—but she stresses that it’s important to identify them early, when their brains are most adaptable. Other experts agree. The American Academy of Pediatrics plans to issue new guidelines this year urging pediatricians to look for signs of FAS and FASD in their young patients and urge parents to seek help.
Admitting that their drinking may have caused their children’s problems can be difficult for mothers, however.
“It takes a lot of courage to own this and tell people, ‘Yes, I drank while I was pregnant,'” says Kathy Mitchell, who had three children by the time she was 20 years old in the 1970s and drank wine with each pregnancy. Two of them are healthy, but one daughter, now 37, has severe FAS. Two other children died in infancy, which Ms. Mitchell also attributes to her drinking.
Now a recovering alcoholic and spokeswoman for NOFAS, Ms. Mitchell works with families who have adopted FAS children, knowingly or unknowingly, as well as birth mothers who are “stunned and remorseful and full of guilt,” she says.
“No one intentionally sets out to harm her children,” says Ms. Mitchell. “Most birth families who receive the diagnosis don’t tell anyone. But it’s not going to get prevented if we call it something else.”
Write to Melinda Beck at HealthJournal@wsj.com
Corrections & Amplifications
A caption to an image accompanying an earlier version of this article incorrectly said a fetus was shown in the seventh week of pregnancy. It was in the 17th week of pregnancy.