Maternal Risk Factors for Fetal Alcohol Spectrum Disorders: Not as Simple as It Might Seem
May, Philip A., Gossage, J. Phillip, Alcohol Research
Gathering information about drinking during pregnancy is one of the most difficult aspects of studying fetal alcohol spectrum disorders (FASD). This information is critical to linking specific risk factors to any particular diagnosis within the FASD continuum. This article reviews highlights from the literature on maternal risk factors for FASD and illustrates that maternal risk is multidimensional, including factors related to quantity, frequency, and timing of alcohol exposure; maternal age; number of pregnancies; number of times the mother has given birth; the mother's body size; nutrition; socioeconomic status; metabolism; religion; spirituality; depression; other drug use; and social relationships. More research is needed to more clearly define what type of individual behavioral, physical, and genetic factors are most likely to lead to having children with FASD. KEY WORDS: Maternal alcohol consumption; prenatal alcohol exposure; maternal alcohol exposure; fetal alcohol spectrum disorders; risk factors; maternal risk factors; literature review
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 questionnairebased surveys in prenatal clinics, surveillance using a variety of records, and populationbased 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 mid1970s, 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. …