"THE HEART OF THE MATTER"
a special program of the National Emergency Medicine Association (NEMA)
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Guest: Louise Floyd, Chief of Fetal Alcohol Syndrome prevention unit, CDC Beth Luman, statistician, CDC
Topic: Study shows more pregnant women are drinking, and drinking more
Host/ Producer: Steve Girard
NEMA: Fetal alcohol syndrome...it's a serious subject...and one theCenters for Disease Control is concerned about, perhaps to greater degree because of a new study that shows more pregnant women are drinking, and drinking more. With us today are Louise Floyd, the Chief of the CDC's fetal alcohol prevention unit, and statistician Beth Luman, of the same unit. Louise, what is fetal alcohol syndrome, and how does it affect the child?
FLOYD: Fetal alcohol syndrome is a condition that results from heavy use of alcohol during pregnancy. The syndrome consists of disorders in three different areas. The first is there are characteristic facial abnormalities that are associated with fetal alcohol syndrome, and those include: short papebral fissures...they're called, but they're short eye openings. The opening of the eye is much shorter than it should be for a newborn...for an individual. The other characteristic of the face includes a smooth philtrum. The philtrum is that ridge over your upper lip, between your nose and your upper lip, that has two little ridges there. It's a space and if you run your finger over it, you can feel it. That's normal, in most individuals to have a philtrum...there are certain characteristics that may be familial, that may affect the expression of the philtrum, however, the majority of individuals will have one. That's missing in children with fetal alcohol syndrome. The third characteristic that we look for, that's associated with FAS, is a very thin upper lip. If you look at most people's lips, you have a little cupid's bow, at the center or the midline of the lip. In fetal alcohol syndrome, that's missing and it's a very thin upper lip. Other characteristics include a flattened mid-face, around the cheekbone area, and toward the nose. Those are the facial characteristics that are affected by the early exposure, during the embryonic period. The other two areas that there are deformities in...or those are the deformities, actually...that there're disorders in are growth. Children with fetal alcohol syndrome have growth below the tenth percentile for their height and weight. That is, if it's a new born, the newborn's born weighing smaller than ...weighing less than they should for their particular age of gestation. So you would be able to see that through the lifespan, at different points. The third area is central nervous system disorders. And that can range from mental retardation to developmental problems and learning problems and behavior problems...to other types of central nervous system involvement as well. So, fetal alcohol syndrome is a condition that results from drinking during pregnancy...it includes selected abnormalities of the face that affect the eye, the mid-range area of the face, the philtrum and the upper lip...it affects the growth, the child is undergrown or growth retarded...and third, it causes central nervous system disorders, which include mental retardation and neurodevelopmental deficits.
NEMA: How do you find those at high risk....mothers-to-be and their unborn babies...and help them?
FLOYD: Well, the way we do that...the way we understand more about women who are drinking at higher levels during pregnancy, is to do surveys, and clinical studies of large representative samples of women. For example, we did a study in 1988...we had a survey that allowed us to do that. And we found in that study that women who were a little older...over 35, of lower income, who are unmarried and who smoked cigarettes...were more likely to be drinking at levels of six or more drinks a week during pregnancy. Other studies have shown women of high parity, which means they've had three or more children, are more likely to drink. Other studies have shown that women who have other psychiatric conditions, depression, certain types of anxiety disorders, are more likely to drink at these higher levels. And of course, the woman who is most at risk is the woman who's had a child that has been diagnosed with FAS, or an alcohol related disorder.
NEMA: Now, Beth Luman... you're the statistician on this study...just how bad was the news coming from the survey?
LUMAN: What we found was an increase in drinking among pregnant women from 1991 to 1995...particularly in frequent drinking, which at the heavier level...7 or more drinks per week - or at least one occasion of five or more drinks in the past month. That level of frequent drinking increased four fold...from point 8 percent in 1991, to 3 and a half percent in 1995.
NEMA: ...up to 3 and a half percent, doesn't sound like a lot...but what about in real numbers?
LUMAN: The 3 and a half percent of the pregnant women who are drinking at frequent levels...turns out to about 140 thousand pregnant women a year in this country who are drinking at those levels...and in addition, there were 16 percent who reported any drinking during pregnancy....which is quite high.
NEMA: Now, Louise...what was your department's reaction to the news?
FLOYD: We were surprised at the magnitude of the increase...the reasons for this are unclear. What we do plan to do is to pursue efforts tounderstand more about what women currently think about drinking during pregnancy, and what they're being told by their health care providers. We have surveys from 1985 and 1990 that looked at women's knowledge regarding the outcome of heavy drinking during pregnancy, and upwards of 80% percent of women in the last survey in 1990, said they believed that drinking at that level would cause adverse outcomes of pregnancy, including damage to the child, increased miscarriages, and this kind of thing. So the knowledge is there that heavy drinking during pregnancy causes problems. What may not be as clear to women is that the..while earlier studies concentrated on heavy alcohol use, and the damage cause by heavy alcohol use...of which fetal alcohol syndrome is the main one...we've learned a lot in the last 20 years. And that is that there are other effects that result from lower levels of drinking during pregnancy, or rather moderate levels of drinking that can be associated with adverse outcomes as well. And these include spontaneous abortions, more subtle kinds of neurodevelopmental problems, growth problems and selected birth defects. So, the fact that alcohol is a terratagen, which means it has the potential to cause malformations, one thing we know about terratagens is that there usually is a dose/response relationship. There's a point at which consuming, or being exposed to that substance causes abnormalities ranging from subtle to severe. So, I think women have the message that heavy drinking during pregnancy is not good, but I think they're unclear as to where to draw the line below that.
NEMA: So, do you think a zero tolerance attitude is best?
FLOYD: Well, the...certainly the official advisories from the Surgeon General and from the Secretary of Health and Human Services is if you're pregnant, or considering pregnancy, abstain from alcohol. And that certainly is the safest advice. Since we don't know...there is no established threshold...we must assume that there may be effects that we haven't yet learned to measure, that are lurking there. I think the message should be: If a woman is pregnant, and she had an occasional drink before the time she knew she was pregnant, the important thing is just to understand the importance of abstinence, from now throughout the pregnancy. But if you are in a position where you're thinking of pregnancy...then you have time to use this information that we're giving...to perspectively change your behavior before you actually become pregnant.
NEMA: Where can we get more information about fetal alcohol syndrome?
FLOYD: There are a number of places where more information can be accessed, and of course, one of those is the March of Dimes. And the March of Dimes has a telephone number, 888-663-4637. Information, general information can be obtained from the Centers for Disease Control, at 770-488-7268. And then there's also the National Institute of Alcohol Abuse and Alcoholism...that provides information on drinking, and some information on FAS, and that telephone number is 301-443-3860.
NEMA: Thanks to CDC statistician Beth Luman and Louise Floyd, chief of the CDC's fetal alcohol syndrome prevention section.
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NEMA: Thanks for joining us for today's program. If you have any comments or suggestions, contact this station. Or visit our home page at: www.nemahealth.com/ ...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I'm Steve Girard at The Heart of the Matter.
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