Academic journal article Alcohol Research

Maternal Risk Factors for Fetal Alcohol Spectrum Disorders: Not as Simple as It Might Seem

Academic journal article Alcohol Research

Maternal Risk Factors for Fetal Alcohol Spectrum Disorders: Not as Simple as It Might Seem

Article excerpt

Over the almost 40 years since fetal alcohol syndrome (FAS) was first described as a clinical diagnosis by Jones and Smith (Jones et al. 1973), several general maternal risk factors have been described in a number of studies using various approaches, including questionnaire-based surveys in prenatal clinics, surveillance using a variety of records, and population-based epidemiologic studies (May et al. 2009). One of the most difficult aspects of any research on fetal alcohol spectrum disorders (FASD) has been gathering accurate, honest, and detailed information on specific drinking patterns and actual or estimated blood alcohol concentration (BAC) levels and linking them to exact times of exposure in individual fetuses and children. Information on specific prenatal drinking behaviors that are the necessary causal factors for FASD has been elusive, and this has, in fact, limited the ability to determine the true prevalence of FASD more than any other factor (Eriksson 2007).

There are three major factors that must be addressed in the diagnosis of FASD in an individual: (1) physical growth, development, and structural defects (i.e., dysmorphology); (2) cognitive function and neurobehavior; and (3) maternal exposure and risk (Stratton et al. 1996). Of these three domains, detailed information on maternal drinking and cofactors of risk is most often missing for many cases. Without accurate and detailed maternal risk information, it is difficult to link specific, individual risk factors, or combinations thereof, to any particular diagnosis within the continuum of damage called FASD (Eriksson 2007). This article reviews highlights from the literature on maternal risk factors for FASD and illustrates that maternal risk is multidimensional, as there are a wide variety of variables that influence the development of a child with FASD. More research is needed to most clearly define what type of individual behavioral, physical, and genetic factors are most likely to lead to having a child with FASD.

When the diagnosis of fetal alcohol syndrome (FAS) was new in the medical literature in the mid-1970s, the link between alcohol use during pregnancy and FAS seemed simple. The literature was at first characterized by defining the unique traits of children with FAS, the most severe form of alcohol damage to the fetus (Clarren and Smith 1978; Jones and Smith 1973). Later, in 1981, the first Surgeon General's warning on FAS simply stated: "The Surgeon General advises women who are pregnant (or considering pregnancy) not to drink alcoholic beverages and to be aware of the alcoholic content of foods and drugs" (U.S. Surgeon General 1981, p. 9). The simple truth reflected in the Surgeon General's warning was that any woman who drank substantial amounts of alcohol during pregnancy could produce a child with FAS. But, to a great degree, no one was fully aware then of how much prenatal exposure to alcohol in any particular individual woman was necessary to cause the recognizable features of FAS that met the diagnostic criteria at the time. Some researchers believed that there might be a critical level of alcohol, a minimum "threshold" BAC that, once exceeded, would uniformly guarantee or produce FAS in children of the typical woman. However, as both early human and animal studies have shown, there is indeed a great deal of variation in the traits or features of FASD produced by individual mothers, different species of laboratory animals, and different animal strains within a species (Maier and West 2001; Thomas et al. 1996; West and Goodlett 1990). Because alcohol damage in humans ranges from mild to severe, examination of a variety of maternal behaviors and traits that might explain some or all of this variation is needed. Although some part of the differential vulnerability for the development of FASD likely is the result of genetic and epigenetic factors in the mother and/or fetus (Warren and Li 2005), evidence gathered to date suggests that the most substantial contributor to the variability in dysmorphology and other developmental deficits arises from differences in the extent of alcohol exposure, drinking pattern, and other maternal risk factors. …

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