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Need information about fetal alcohol syndrome

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Practicing since : 1999
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I am writing for a second opinion regarding fetal alcohol exposure. When I was 28 days from my last period (about 14 or 15 days from conception), I did not know I was pregnant. I had a wine drinking holiday and consumed about 12 glasses of wine over the course of six or seven hours. My blood alcohol level was at least 0.20, based on my informal calculations.

My question is - what is the likelihood that my child will have fetal alcohol syndrome and/or significant developmental/intellectual disabilities as a result of this incident of heavy drinking?

When I mentioned my concerns to my OBGYN, she told me that she was not very familiar with what damage heavy alcohol consumption could do that early pregnancy. She indicated that the baby was "just a dividing ball of cells at that point XXXXXXX but from what I've read, a developing baby is most vulnerable to toxins like alcohol during weeks 3 through 8 of pregnancy.
Posted Sun, 4 Aug 2013 in Pregnancy
 
 
Answered by Dr. Timothy Raichle 32 hours later
Thank you very much for the direct question. I am sorry that it took me so long to respond.

This is actually not such an uncommon problem brought up at prenatal visits. It is possibly more common than we realize: a woman, such as yourself, who conceives and has drinks before she realizes that she was pregnant. Your doctor's response is not exactly wrong, but rather insensitive to your concerns.

Here is a quote from a reputable source to start off my answer:

"The Surgeon General of the United States and the Secretary of Health and Human Services recommend abstinence from alcohol for women planning pregnancy, at conception, and during pregnancy because a safe level of prenatal alcohol consumption has not been determined...there is no exact dose-response relationship between the amount of alcohol consumed during the prenatal period and the extent of damage caused by alcohol in the infant...Infants whose mothers consume alcohol during pregnancy can manifest fetal alcohol effects (FAE), alcohol-related birth defects (ARBD), fetal alcohol syndrome (FAS), or they may be normal."

Noone knows the "threshold" of exposure above which these effects become apparent, and it is very difficult to find studies that look at single exposure such as a one night binge. Most of the reviews that look at FAE's and FAS base their findings on how many drinks PER DAY the pregnant woman was consuming. The main concerns are growth problems of the fetus, facial 'dysmorphology' and neurologic effects, and these effects were DOSE-RELATED over time.

In a patient presenting with your situation (as I stated, this is not uncommon), my usual response is:
1. The exposure was extremely early, at a point where maternal-fetal circulation is not well established and the chance of harm is extremely low
2. The exposure was a ONE TIME exposure and most evidence points to a dose-related effect OVER TIME - i.e. drinking on some regular basis
3. Based on studies looking at FAE's, the chance of a problem that is detectable is extremely low and likely zero
4. If you child developed problems during the pregnancy, such as poor growth in the third trimester, I would probably not look to the one-time early alcohol exposure as the cause.

So, I think that it is unfortunate that you have to carry this with you throughout the pregnancy, but at this point there is nothing you can do except proceed with healthy behavior and expect the best. You can try to find peace in the fact that the exposure was a one time thing, very early in the pregnancy and at such an early point that the chance of causing harm was extremely unlikely.

I hope that this helps you - please ask if you have any followup questions.
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Follow-up: Need information about fetal alcohol syndrome 4 hours later
Thank you for your response. I should mention that I remained on the holiday for a few days, and the very heavy consumption on one night (at 12 glasses of wine) was certainly the worst of it and was very out of character for me. I did, however, have 3 drinks the next night (2 glasses of wine and a beer over the course of 4 hours) and 4 beers the next night (over 8 hours).

It was not until the day after the holiday, when I was 31 days from my last period (about 16 or 17 days from conception) that I took a pregnancy test, realized I was pregnant, and ceased all risky behavior, including alcohol consumption.

Does this additional information change your assessment at all regarding the likelihood that my child will have significant developmental and intellectual disabilities as a result of the drinking before I realized I was pregnant?

I am asking about the likelihood of birth defects because (1) I want to be fully prepared for the reality of raising my child and the likelihood that there will be deficits that I caused and (2) I am considering whether I should seek out a pediatrician who can assist a child with special needs. From what I read, the earlier the intervention for a child with fetal alcohol damage, the better. There is no "cure" for fetal alcohol birth defects, but there are therapies that can help the child cope (speech therapy, occupational therapy, etc.), and I read that these therapies can start before age 3.
 
 
Answered by Dr. Timothy Raichle 2 hours later
Thank you. Please answer the following questions:

1. What is your age?
2. What is your pregnancy history?
3. If you have had kids, were there any complications during those pregnancies?
4. Do you have any medical problems?
5. Are you on any medications?

Let me know and I will get back to you!
Above answer was peer-reviewed by
 
Follow-up: Need information about fetal alcohol syndrome 3 hours later
Responding to your questions:

1. What is your age?

28

2. What is your pregnancy history?

This is my first pregnancy.

3. If you have had kids, were there any complications during those pregnancies?

N/A

4. Do you have any medical problems?

I have no medical problems.

At the beginning of the pregnancy, I was diagnosed with generalized anxiety. I was offered a prescription for Zoloft, but I deferred taking the medication, based on advice from my OBGYN regarding potential risks for the baby.

5. Are you on any medications?

The only medications that I am taking are prenatal vitamins with a DHA supplement and a Vitamin D3 supplement (1,000 IU per day).
 
 
Answered by Dr. Timothy Raichle 56 minutes later
Thank you for the clarification XXXXXXX I wanted to make sure that there were not other risks present for problems related to the current pregnancy.

Even with the small additional added exposure, I am going to stick with my prior answer - I think that the chance of having caused harm is going to remain undetectable after the birth. That being said, you could consider the following:
1. You should go ahead and get first trimester screening to rule out Down's syndrome / trisomy 13 / trisomy 18
2. You should make sure that you have a targeted ultrasound at 20 weeks
3. You should be honest with your OB/GYN & Pediatrician regarding your early exposure and concerns - I do not believe that they will judge you negatively
4. You should ask your OB about a followup growth around 28-32 weeks given the early exposure and concern regarding growth problems in pregnancy
5. At your initial Pediatric visits, make sure that your concerns are known and establish an honest line of communication regarding their concerns, if any.

I hope that this helps. I still do not think that you have much to worry about, but your vigilance on the topic will certainly help your child should any problems arise. Good luck!
Above answer was peer-reviewed by
 
Follow-up: Need information about fetal alcohol syndrome 12 minutes later
Thank you, Dr. Raichle. Your most recent response has me a little confused, and I would appreciate clarification on two points:

1. You indicated that I should ask my OB about "followup growth around 28-32 weeks given the early exposure and concern regarding growth problems in pregnancy." Are you saying that I should ask for an additional ultrasound during that time? Is normal growth in the first two trimesters followed by delayed or slow growth in the third trimester a sign of a fetal alcohol-related problem?

2. You stated that "Even with the small additional added exposure, I am going to stick with my prior answer - I think that the chance of having caused harm is going to remain undetectable after the birth." Does that mean that you think we will not be able to detect problems at birth but that there is a substantial risk of problems that would only be evident later on, like intellectual/developmental disabilities?
 
 
Answered by Dr. Timothy Raichle 10 minutes later
1. Fetal alcohol effects include problems related to the growth of the baby. The problem is that some of these fetuses will stop growing normally in the second to third trimester. I think that you should ask your OB if they would consider ordering a growth scan around this time because:
a. IF there was a FAE, this is one thing to screen for
b. Given your concerns, it would help to relieve your anxiety

2. I am stating that given how small and isolated the exposure is, even if there WAS an effect on the child, IF he/her had facial anatomic findings or neurologic impairment - that they could not be differentiated from the background rate of differences in appearance and cognition in the general population of newborns.

Does this make sense?
Above answer was peer-reviewed by
 
Follow-up: Need information about fetal alcohol syndrome 9 minutes later
On point 1, I understand what you are saying about fetal growth and FAE. I will ask my OB about adding a growth scan. I do not think my OB typically does ultrasounds beyond the 20 week anatomy scan, as a matter of practice, so I am glad that you raised this issue.

On point 2, I'm not sure I understand what you are saying, so I'm going to try to paraphrase it. Are you saying that, given the short-term alcohol exposure (heavy consumption over the course of one weekend), we would probably not be able to detect a difference in the appearance and level of cognition/intellect of the child? i.e. that there might be an impact, but it probably would not be significant?

 
 
Answered by Dr. Timothy Raichle 28 minutes later
They may not do it as a matter of practice unless it is "indicated". I would say that a first trimester exposure with risk of growth problems in the second and third trimester would be enough of an indication to justify getting it for the reasons that I mentioned.

On point 2 that is exactly what I am saying.

Let me know if you have any additional questions!!!
Above answer was peer-reviewed by
 
Follow-up: Need information about fetal alcohol syndrome 23 minutes later
Thank you for your responses. I just want to make sure I understood completely the overall conclusion:

A. The odds of the baby having mental retardation as a result of brief but very heavy exposure to alcohol at 28 to 30 days from the last menstrual period are very low; but

B. I should consult with my OB about having a growth scan at 28-32 weeks, as slowed or delayed growth in the third trimester could be a result of fetal alcohol effects.

Please let me know if this is not correct. Thanks!
 
 
Answered by Dr. Timothy Raichle 17 minutes later
You are very welcome.

A. Correct...

B. Correct...

Your doctor might downplay your concerns and say that it is not necessary. They would probably be correct, but given the lack of knowledge regarding the "threshold" of exposure above which there are FAE's, it certainly seems reasonable and justifiable to add in this one additional screen late in the pregnancy.

I wish you the best of luck!
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