Susan Astley responds to a study that concluded light prenatal alcohol exposure of 1-2 drinks per week does not increase risks of cognitive and behavioral deficits in children aged 0-3. She provides statistics from her clinic showing the percentage of children with fetal alcohol spectrum disorder diagnoses showing severe central nervous system impairment increases dramatically with age. Even children with full fetal alcohol syndrome can appear normal under age 3, but many experience severe dysfunction later. She argues the long-term effects of even light prenatal alcohol exposure on brain development in young children remain unclear.

1. -----Original Message-----
From: Susan Astley [mailto:astley@...]
Sent: Friday, September 03, 2010 11:23 AM
Subject: Re: Drinking for Two
Dear all,
The conclusions drawn by Kelly et 2009 Intnl J Epi are unfortunate and
short-sighted.
Here are some sobering statistics from our clinic (no pun intended).
Among 160 individuals diagnosed with FAS/PFAS using the 4-Digit Code:
here are the CNS functional outcomes (CNS Ranks: 1 normal,2 mod impaired,3
severely impaired) by age category.
CNS 0-3yr 4-5 6-10 11-15 15-19
Rank
1 70% 33% 6% 3% 0%
2 13% 11% 13% 10% 0%
3 17% 56% 82% 86% 100%
total N 46 27 55 29 3
The point here is that even kids with full FAS can look 'pretty good'
under the age of 3yrs. Only 17% of 0-3yr olds met our criteria for severe
dysfunction. But the prevalence of severe dysfunction increases
dramatically in the older age groups. Clearly, ones ability to assess the
full impact of alcohol on brain function in birth to 3 is limited.
When Kelly et al report kids 0-3yrs are not at increased risk for cogn/beh
deficits after light prenatal exposure to alcohol (1-2 drinks/week), one
has to wonder what these kids will look like at age 10?
While the AVERAGE reported drinking during pregnancy for FAS/PFAS in our
clinic is 8 drinks/occasion, 5 days per week, that average reflects a very
broad range. We have a child with full FAS whose reported exposure was 1
glass of wine daily for just the first trimester. We have another whose
reported exposure was 1-2 drinks once a month. We have yet another whose
mother was told by her doctor to drink during pregnancy to reduce stress
(this was 30 years ago). She followed doctors orders, reportedly drank 2
glasses of wine daily and gave birth to a child with full FAS. So were
these birth mothers not telling the truth? Or were these fetuses especially
vulnerable to the adverse impact of alcohol? We will never know. Thus I
remain deeply concerned when professionals imply 1-2 drinks per occasion
is 'safe'. Safe for whom? Safe for all? Tell that to the birth mothers
above whose children were born with full FAS. Better yet, tell that to the
individuals born with FAS.
Susan
__________________________________________________
Susan J. Astley, Ph.D.
Professor of Epidemiology/Pediatrics
Director, WA State FAS Diagnostic & Prevention Network
Vice-Chair, Faculty Senate
Center on Human Development & Disability Phone (206) 598-0555
Room 459, Box 357920 FAX (206) 598-7815
University of Washington FASDPN website: fasdpn.org
Seattle, WA 98195-7920
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