Child Development From Infancy to Adolescence. Laura E. Levine

      Facial characteristics of children with fetal alcohol syndrome. These photos show some of the facial features that are characteristic in children with fetal alcohol syndrome, including a smooth ridge between the nose and upper lip, a thin upper lip, wide-spaced eyes, underdeveloped ears, and a short nose with a flat bridge.

      Susan Astley, PhD, University of Washington

      Journey of Research: Understanding the Effects of Alcohol on a Pregnancy

      As far back as ancient Greece and Rome, people suspected that alcohol could have a negative impact on pregnancies, but concern did not appear in the medical literature until the 1700s, when a group of physicians in England described women alcoholics giving birth to children who were “weak, feeble, and distempered” (Calhoun & Warren, 2006, p. 169). In 1899, an English deputy medical examiner noted that alcoholic mothers had an increased risk of having a child who died at birth, but early observations linking alcohol and birth defects were largely ignored by the medical community until a group of French researchers published a paper in the 1960s describing some commonly occurring problems in the offspring of a group of 100 women who drank heavily during their pregnancy (Calhoun & Warren, 2006). In the 1970s, British researchers identified the anomalies seen among children born to chronic alcoholic mothers, concluded that alcohol was the cause, and coined the term fetal alcohol syndrome (Calhoun & Warren, 2006).

      As public concern began to grow, the U.S. Food and Drug Administration issued a bulletin in 1977 that discouraged “binge” or “chronic, excessive” drinking during pregnancy (Bobo, Klepinger, & Dong, 2006, p. 1062). A decade later, the federal Alcoholic Beverage Labeling Act was passed requiring alcoholic beverages to carry a warning that they should not be consumed during pregnancy because of the risk of birth defects. Several health initiatives since then have tried to inform women of this danger. In 2005, the Surgeon General updated an advisory originally issued in 1981 that suggested pregnant women “limit [emphasis added] the amount of alcohol they drink,” by saying “no amount [emphasis added] of alcohol consumption can be considered safe during a pregnancy,” and warning women that alcohol can damage the fetus at any stage in a pregnancy (U.S. Department of Health and Human Services [USDHHS], 2015a).

      How successful have our efforts been to educate women about the dangers of drinking while pregnant? A 2015 report from the CDC found that 1 in 10 pregnant women in the United States reported using any alcohol in the previous 30 days, and 3.1% reported binge drinking (Tan, Denny, Cheal, Sniezek, & Kanny, 2015). Among the binge drinkers in the study, those who were pregnant reported a higher frequency of binge drinking and consuming a greater amount of alcohol than those who were not pregnant. Although we may think that too many pregnant women in the United States continue to drink while they are pregnant, the percentages from other countries can be even higher, ranging from 20% to 80% in studies of women in Australia, Ireland, New Zealand, and the United Kingdom (O’Keeffe et al., 2015). These findings likely reflect differences in cultural attitudes toward drinking or toward reporting on alcohol consumption.

      In recent years, some studies have not found a clear relation between lower levels of drinking by pregnant women during the first trimester of pregnancy and pregnancy outcomes such as prematurity (McCarthy et al., 2013) or later child behavior (Skogerbø et al., 2013). However, even these researchers say that these studies do not lead to the conclusion that there is some safe level of alcohol consumption during pregnancy (Skogerbø et al., 2013). The CDC (2015c) and the American Academy of Pediatrics (as cited in Williams, Smith, and the Committee on Substance Abuse, 2015) continue to caution women that there is no known safe amount of alcohol to drink while pregnant. It is difficult to diagnose all the effects of alcohol on an infant’s developing brain because the effect is dose-related, meaning that the harm done is proportional to the amount consumed (May et al., 2013). Saying that we do not detect an abnormality is not the same thing as saying that there is no abnormality. Given the importance of this topic and the fact that many women do drink some alcohol while pregnant, research will continue to investigate all the consequences of alcohol consumption on prenatal development.