Women are furious about the CDC’s suggestion that doctors tell women who are of childbearing years, sexually active and not using some form of contraception to abstain from alcohol, as part of an awareness campaign toward doctors and women to decrease the incidences of fetal alcohol spectrum disorder (FASD) in the nation. Every year, the United States spends approximately 5.5 billion dollars on people who were prenatally exposed to alcohol. Some estimates, according to the CDC, show prevalence rates of children with a FASD as high as one in 20 kids.
— The New York Times (@nytimes) February 4, 2016
FASD is a spectrum disorder. There are varying degrees of alcohol damage and a variety of damage that can be inflicted on a fetus by alcohol exposure in the uterus. Inquisitr reported about the CDC recommendations, which were released Tuesday, that state all women of childbearing age should abstain from alcohol if they might become pregnant.
An opinion piece published on Grounded Parents entitled, “The CDC Can Rip the Wine Glass Out of My Childbearing-Aged Hand” has gone viral with almost 70 thousand Facebook shares as of Friday morning.
Everyone seems to be missing an important fact: The CDC is not mandating that women stop drinking if they are having sex without some form of contraception. The CDC is merely informing people of ways they can help prevent FASDs. The CDC stated that health professionals can help prevent FASD by recommending birth control to their patients who are having sex, not on a form of contraception, and consuming alcohol.
Is it against women’s liberation to suggest birth control to women drinkers who are having sex?
The CDC also says that doctors can help prevent FASDs by telling women who are actively trying to get pregnant to stop drinking. Given limitations on earlier studies, misconceptions about the potential effects of alcohol consumption during pregnancy, the fact that countless women who get pregnant and drink will not choose to terminate their pregnancy, and revelations from most current research on alcohol-related fetal damage, I’d say it’s responsible advice.
The CDC also made a recommendation to pregnant women and women who might be pregnant.
“It is recommended that women who are pregnant or might be pregnant not drink alcohol at all. FASDs do not occur if a developing baby is not exposed to alcohol before birth.”
The CDC suggested that in order to reduce the chances of FASD, women can stop drinking alcohol if there is a chance that they might get pregnant.
“Women can,” the CDC advises, “talk with their health care provider about their plans for pregnancy, their alcohol use, and ways to prevent pregnancy if they are not planning to get pregnant.”
“Can.” Not, “must.”
The CDC is not forcing a choice upon anyone. The CDC is just giving advice that is based on the latest available research and data. This outrage was not seen when the CDC recommended folic acid to women. No one accused the CDC of treating women as mere incubators then.
“All women between 15 and 45 years of age should consume folic acid daily because half of U.S. pregnancies are unplanned and because these birth defects occur very early in pregnancy (3-4 weeks after conception), before most women know they are pregnant.”
Yet, when an even less demanding suggestion is made about alcohol consumption, everyone loses their minds.
— TODAY (@TODAYshow) February 5, 2016
“While the U.S. government has not yet formalized restrictions on what I can and can’t do as a woman of childbearing age, this culture shift – viewing women as vessels for potential babies – scares me. I am an adult human. I am whole. I am not less important than my potential future unborn fetuses,” the Grounded Parents author wrote. “It’s wrong to assume that women will continue with an unplanned pregnancy.”
While it’s true that many unplanned pregnancies will be terminated, the purpose of the CDC’s recommendation is not to prevent abortions, it’s to prevent added hardship to those particular fetuses that inevitably will be born and to the people who will be raising the alcohol-exposed baby.
There is a misconception, based on studies from four years ago or older, that alcohol won’t affect a fetus in early pregnancy and that light to moderate alcohol consumption does not contribute to the incidences of FASDs.
The author of the Grounded Parents post pointed to research cited on the CDC’s site from a few years ago to show why the CDC’s newest recommendation is moot. As someone who has seen the effects of fetal alcohol exposure, I make it a point to stay up-to-date on the most recent and comprehensive available research, and to carefully examine the whole text of the papers pertinent to FASDs, including their self-admitted study limitations.
Let’s look at those studies on the older CDC webpage (that contrast with the newer CDC recommendations) and the limitations the authors of those studies admit to.
One older study showed that low to moderate alcohol consumption had little or no effect on the executive functioning ability of Danish 5-year-olds. First of all, a great deal of executive function, according to the set of studies, isn’t taxed until children are as old as 11-years-old. The suggestion was that executive functioning should be re-evaluated when children are older, because 5-year-olds face nowhere near the executive functioning expectations needed to find a full range of deficits from alcohol exposure. Children as young as five are still allowed to not know how to count back change. Many 5-year-olds may view a quarter as more valuable than a dollar simply because it’s heavier. It’s fully understandable if a 5-year-old wets the bed and gets mad at the bed. None of these things are acceptable for an 11-year-old, though. Yet, 11-year-old children with a FASD will potentially show any of these behaviors and more.
Another limitation of that study was that the Danish 5-year-olds were assessed by their preschool teachers and parents (not licensed psychologists) using the Behaviour Rating Inventory of Executive Function (BRIEF) test. Mind you, in Denmark, preschools are a bit different than in the United States. In the U.S., preschool is a way to prepare children for kindergarten, but in Denmark, preschool is about “about learning, developing and playing in a caring environment.” Keep in mind, BRIEF is not a full cognitive assessment, it’s a “questionnaire developed for parents and teachers” asking them how children have been seen performing compared to their peers. In Denmark, daily preschool executive functioning tasks are so different from those in the United States, that an FASD-related executive functioning deficit could easily be missed by a parent or preschool teacher. Additionally, the BRIEF questionnaire was designed for children aged 5-18, so many researchers believe that more light would be shed on the effects of alcohol on a child’s executive functioning if the BRIEF was given to teachers and parents to fill out when the child was at least a few years older.
Another study focused on the IQ of the Danish 5-year-olds. Keep in mind, many children with a FASD struggle immensely, simply because they have a normal IQ and present well, but fail in other cognitive areas daily. One limitation of the IQ test study was that it took into consideration “potential confounding factors” such as a child’s health status and hearing and vision abilities. Mind you, alcohol exposure can damage every system of a child, including non-cognitive systems. Poor health, hearing and vision problems are commonly associated with fetal alcohol exposure. Allowing for IQ variation simply because a child has a hearing problem or a health issue means they also potentially and unknowingly adjusted the IQ scores of children with a FASD.
Another limitation of that study is the assessors used the Wechsler Preschool and Primary Scale of Intelligence—Revised (WPPSI-R), which is now considered obsolete. According to the University of Cambridge, there is a new version that has been revised to reflect “contemporary advances in the fields of cognitive development, intelligence theory and cognitive neuropsychology.” We know so much more about cognitive impairments now than we did between 2008 and 2012, when the Danish 5-year-olds were being given the now-obsolete IQ test.
Another of the older studies referenced on the earlier CDC webpage (that the now-viral blogger cited) measured the effect of different drinking patterns in early to mid pregnancy on the five-year-old Danish children’s intelligence, attention, and executive function, but the authors wrote that, in the future, “multiple outcomes should be included in studies of neurodevelopment, as in utero exposure to alcohol may result in a diverse pattern of cognitive strengths and weaknesses that may only be detected across outcome measures for any particular sample of children.”
The researchers who wrote the paper admitted that the design of the study put women who drank less than one entire drink in a day (most of them in the category) into the category of “light drinkers.” An accurate assessment of the effects of a full, occasional drink could not be measured. Additionally, the authors state that the 51 percent participation rate in this study could have significantly skewed the results to make it seem like alcohol had less of an effect on the children, because they can’t say how many of the women from the original birth cohort refused to participate in the study either because of their own alcohol status or because of their child’s neurodevelopmental functioning.
“Such selection bias could potentially mask an apparent association with maternal alcohol use,” the authors wrote.
Even older tests looking for FASD associations were greatly limited, because they did not take into account the nature of alcohol damage to a fetus. Many focused only on things like motor skills or balance and failed to address some of the most life-affecting aspects of living with a FASD.
“Alcohol can cause damage to multiple regions of the brain, specifically to the corpus collosum (connects brain hemispheres), cerebellum (consciousness and voluntary processes), basal ganglia (movement and cognition), hippocampus (emotional behavior and memory), hypothalamus (sensory input), among other neural regions,” the National Organization on Fetal Alcohol Syndrome explains.
Beer, wine and other spirits have been proven to increase the formation of free radicals, interfere with fetal cells’ ability to regulate growth and division, alter the formation of nerve cell extensions, alter biochemical and electrical signals within cells, and alter gene expression when a fetus is exposed to them, NOFAS states.
“Human development occurs in an orderly process of biochemical and structural transition during which new constituents are being formed and spatially arranged throughout gestation. At any time in the span of development these ongoing processes can be subtly or severely disturbed or abruptly halted resulting in abnormal development or fetal death.
“Therefore, at any time alcohol is present it has the potential to harm development. For example, the hallmark facial dysmorphology associated with Fetal Alcohol Syndrome will only occur if alcohol is present during the specific window of development.
“Of all the substances of abuse, including marijuana, cocaine and heroin, alcohol produces by far the most serious neurobehavioral effects on the embryo or fetus.”
The CDC made its newest recommendations based on the latest research. Significant new information is known thanks to scientific breakthroughs, considerations of earlier research limitations and errors, and a better scientific understanding of FASD in general.
The University of Queensland reported that a pregnant woman who has two glasses of wine in just one drinking session can adversely impact her future child’s results in school at age 11, regardless of how infrequently she does it. The findings came from a study of more than 7,000 English children and examined NAPLAN-style school test scores at age 11. The more sessions of two standard-sized drinks the women consumed, the more likely their children were to under-perform in school at age 11.
FASD is also associated with anxiety, depression and aggression. According to a publication in Pediatrics, there is a dose-dependent relationship between maternal drinking and anxiety, depression and aggressive behavior in kids when they are 6 and 7-years-old. Importantly, depression, anxiety, and aggression were worse even among the children of women who only drank lightly compared to the children of women who drank no alcohol during their pregnancies.
“Maternal alcohol consumption even at low levels was adversely related to child behavior; a dose-response relationship was also identified. The effect was observed at average levels of exposure of as low as 1 drink per week.”
The Pediatric‘s article also discovered that kids with any prenatal alcohol exposure were 3.2 times as likely to have delinquent behavioral scores in the clinical range when compared with children who were never exposed to alcohol, even after controlling for other factors associated with adverse behavioral outcomes.
Sometimes, a FASD presents itself less obviously, though. According to Alcohol News, fetal exposure to alcohol can be as subtle as making it difficult for a person to recognize social cues.
“People with FASD often ‘can’t take a hint,’ or recognize when others are suggesting something non-verbally. They may be overly demanding of attention and may lack empathy towards others. They also tend to be eager-to-please and easily lead, which means that if they fall in with anti-social peer groups, they may be preyed upon and pushed to commit crimes that they couldn’t have engineered themselves. Adolescents and adults with FASD also have a tendency towards sexual promiscuity, which may be linked both to their desire to please others and their impulsiveness.”
FASD is a spectrum disorder. Alcohol has the ability to affect every cell in a fetus, and therefore every and any system in the human body. The CDC is aware of this possibility and is now warning doctors, nurses and women of their risks.
Renee from Little Earthling wrote succinctly that the CDC’s recommendations are “about biology, not women’s rights.”
The CDC did not tell women that they are incubators in any way.
It didn’t even say that if a woman isn’t on birth control, she should never drink. The exact text of the CDC’s recommendation is completely reasonable, and will likely prevent numerous cases of FASD.
“More than 3 million U.S. women are at risk of exposing their developing baby to alcohol because they are drinking, having sex, and not using birth control to prevent pregnancy. About half of all US pregnancies are unplanned and, even if planned, most women do not know they are pregnant until they are 4-6 weeks into the pregnancy. This means a woman might be drinking and exposing her developing baby to alcohol without knowing it. Alcohol screening and counseling helps people who are drinking too much to drink less. It is recommended that women who are pregnant or might be pregnant not drink alcohol at all.”
In any given classroom in America right now, there is a statistical likelihood that at least one child will have problems for the rest of their lives simply because their mothers drank when they were pregnant with them. The CDC knows this, and so should the rest of us.
The CDC does not want to pry the wine class from anyone’s “child-bearing hand,” but it does want to make sure the public is both aware of the latest research and armed with the necessary information with which to prevent FASD, if they are so inclined.
[Image via Pixabay]