Alcohol's Youngest Victims

By ANDREA DORFMAN

Everyone should know by now that drinking alcohol during pregnancy can cause serious physical and mental problems in the unborn child. Most doctors have told their patients, television announcements have dramatized the dangers, and warning signs have gone up in restaurants and bars. But too many mothers-to-be are not getting the message. More than 50,000 babies are born in the U.S. each year with alcohol-related defects. In about one-fourth of these cases, the damage -- ranging from facial deformities to heart abnormalities -- is severe enough to be classified as fetal alcohol syndrome.

Many people still do not realize how common FAS is and how devastating it can be. According to some researchers, FAS is responsible for an estimated 20% of all U.S. cases of mental retardation. That makes FAS the No. 1 threat to children's mental health, greater than either Down syndrome or spina bifida.

Unlike such drugs as barbiturates and opiates, which affect the nervous system, alcohol can attack virtually any of the body's cells. It can cause stunted growth, distorted faces, poor eyesight, learning disabilities and hyperactivity. In the recently published book The Broken Cord (Harper & Row; $18.95), author Michael Dorris tells the heartbreaking story of his adopted son Adam, whose Sioux parents died of alcohol abuse. Adam was institutionalized and diagnosed as retarded before he turned three. At five, he still wore diapers, could not count consecutively or even identify colors. "Adam's birthdays are reminders for me," writes Dorris. "For each celebration commemorating that he was born, there is the pang, the rage, that he was not born whole."

The tragedy of FAS is that it is entirely preventable. If a woman, even an alcoholic one, stops drinking before she tries to become pregnant, her fetus will not develop FAS or any alcohol-related birth defects. But pregnancies are not always planned. If a woman does not realize for several weeks that she is pregnant, she may not stop drinking in time to prevent harm to the fetus.

Researchers believe the damage is probably minimal in the first two weeks, but during the rest of the first trimester, when the fetus' organs are forming, the effects may be especially severe. If the drinking continues, additional damage can occur, since the brain develops during all nine months and rapid body growth does not occur until the third trimester. Even after the baby is born, abstinence may be advisable. A study in last week's New England Journal of Medicine suggests that when mothers have one or more drinks a day, their children ingest alcohol in breast milk, which may impede the infants' motor development.

Nearly all known cases of FAS involve children whose mothers have chronic alcohol problems. Says Barbara Morse, director of the Fetal Alcohol Education Program at the Boston University School of Medicine: "The more a woman drinks while she is pregnant and the longer she drinks, the higher the risk of FAS." Even so, moderate drinking is not considered safe. "Our best evidence is that we cannot detect adverse consequences to very light drinking," says Dr. Robert Sokol, head of the federally funded fetal alcohol research center at Wayne State University, in Detroit. "But that doesn't mean they don't exist." Beer, wine and hard liquor do not seem to differ in their impact on the fetus.

Studies conducted in Boston, Atlanta and Scandinavia indicate that at least some of the injuries to the fetus may be corrected in the womb if a mother gives up alcohol before her third trimester. Says Sterling Clarren, professor of pediatrics at the University of Washington School of Medicine: "It's pretty clear if a woman stops drinking in her second trimester, the size and the healthiness of the baby will improve, but there is no evidence that its intelligence will improve." Moreover, even the improvement in appearance may be deceptive. "The babies definitely are bigger and look healthier," says Dr. Sokol, "but that doesn't mean that all the effects go away."

Scientists still do not know why FAS strikes the children of some alcoholic mothers but not others, and why susceptibility varies among different ethnic groups. Native Americans, for example, are 33 times as likely as Caucasians to have a child with FAS; for blacks, the rate is 6.7 times as high as for Caucasians. Women who give birth to a child with FAS have a greater-than- average risk of bearing additional children with the affliction. Such evidence suggests there may be a genetic predisposition to FAS, but scientists have not been able to identify the offending genes.

Researchers are also trying to determine whether fathers' drinking habits play any role in FAS. At Wayne State, studies of male laboratory rodents have shown that alcohol exposure affects their sperm as well as the immune system and behavior of their offspring. "I don't think the possibility of the father's effect can be written off," says Dr. Sokol. "We're not saying the baby would have FAS, but it's possible there may be some impact on how the kid comes out."

There is no treatment for FAS, and so the only way health officials can fight the scourge is to step up educational efforts. In New Hampshire, for example, couples must read a pamphlet on FAS before they can obtain a marriage license. Beginning in November, liquor bottles will carry a cigarette-style & warning label advising women that alcohol and pregnancy do not mix. But for women who are addicted to alcohol, the need to drink often overcomes caution and reason. Until better ways are found to identify and treat alcoholics, they will continue to inflict a devastating toll on their children.

CHART: NOT AVAILABLE

CREDIT: TIME Chart by Cynthia Davis

CAPTION: THE RAVAGES OF ALCOHOL

With reporting by Georgia Harbison/New York