Dr David Bratt
Fetal Alcohol Spectrum Disorder, or FASD, is a scary name that is not well known in T&T. But is it alarming enough to make Trinidadians drink less?
FASD is a diverse group of conditions that occur in persons exposed to alcohol during their mother’s pregnancy. Alcohol is harmful to a developing fetus and causes a wide range of permanent damage. There is no ‘safe’ amount to drink while pregnant. Even small amounts, a single drink or less, may lead to serious problems.
There also isn’t a ‘safe’ time to drink. Alcohol is harmful throughout the whole pregnancy. Any amount of alcohol consumed at any point during pregnancy can cause irreversible damage, leading to fetal alcohol spectrum disorders.
In general, drinking alcohol in the first trimester damages the developing fetus and results in facial and brain anomalies. Once the baby is developed, alcohol consumption in the second three months of pregnancy increases the likelihood of miscarriage. In the third trimester, high levels of alcohol consumption are associated with prematurity, low birth weight, length and microcephaly (small head) with decreased brain volume. Besides affecting the fetus, alcohol can cause spontaneous abortions, preterm delivery, placental insufficiency and stillbirth.
Really nasty stuff.
A major problem is that a woman may be pregnant but not know it and consume alcohol. The 2024 PAHO Trinidad and Tobago STEPS survey, done on just over 4,000 adults, showed that 20 per cent of our women never drink, 43 per cent had had a drink in the past month and 10%, one in ten, had “engaged in heavy episodic drinking,” six or more drinks on any occasion, in the 30 days before the survey.
Most women stop drinking alcohol once they know they are pregnant. But around 10% of women continue drinking. Combine this with the fact that, in the first month of pregnancy, most women do not know they are pregnant and may continue their usual drinking habits. This damaging exposure to the fetus is unintentional but happens. The only safe thing for women who are trying to become pregnant or are in the child-bearing age is not to drink alcohol.
That is not easy in an alcohol fuelled culture and there are certain times of the year, Christmas and Carnival for example, when it’s very difficult to say no to a drink … “one drink, dass all, dah eh go harm yuh!” Probably won’t but it could harm a two-week-old developing fetus.
Exposure to alcohol during pregnancy is the main preventable cause of birth defects and neurodevelopmental problems. It’s highly misdiagnosed and underdiagnosed, and it certainly is in T&T. In 2017, a global study of 76 countries determined that at least 1% of children in these countries had FASD and that one of every 13 pregnant women who drank alcohol during pregnancy delivered a child with FASD.
What apparently protected some women is not known.
The five countries with the highest prevalence of FASD are South Africa, Croatia, Ireland, Italy and Belarus. The countries with the lowest prevalence were those with large Muslim populations.
It’s supposed to affect 1 in every 20 Americans. This used to be difficult to believe. Recent events up there may have changed minds.
Because prenatal alcohol exposure has multiple effects on multiple organ systems, it is difficult to make the diagnosis. The history of alcohol consumption is crucial but it’s very difficult for anyone to own up to drinking during pregnancy, especially when in fact it may have been done when not knowing of the pregnancy. And the idea that even one drink could cause harm is difficult to accept or forget.
In general, alcohol causes three common features: delayed growth, unusual facial features and central nervous system problems. So, a small, short child with an unusual face who has neurodevelopmental problems. The typical facial features can easily be Googled. There may be other abnormalities in the heart, kidney, eyes etc.
The impact on the brain is widespread and can result in a range of conditions, including children whose IQ is normal but whose behaviour is not. It can start with fussiness and developmental delays as a baby. As the children grow, they may struggle with attention problems, hyperactivity and learning. Later on, as a teen or adult, they might have trouble understanding the consequences of their actions, managing daily tasks and inappropriate sexual behaviour.
So, it’s very difficult to diagnose and most doctors, including paediatricans, cannot make a diagnosis. This needs a team of specialists in the disease and we do not have this service here. One wonders at the possibility that many of the low-functioning children in our schools are brain-alcohol-damaged.
Given that CNS damage is permanent, there is no cure. The treatment is management of the neurodevelopmental problems.
Unlucky children.
