Last fall, I was honored to have a pediatrician and her husband, a neurologist, from Lithuania visit Dream Catcher Farm to learn more about our therapeutic farm animal sanctuary for children with Fetal Alcohol Spectrum Disorder (FASD) / Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE). They spoke about their challenging work moving Lithuanian children from orphanages into foster care homes in the community. Unfortunately, many foster families are unable to care for the children who have short attention spans, are impulsive, are triggered into “fight or flight” (emotional reactivity) very easily, are sensitive to ordinary environmental stimuli and have difficulty learning new information. As a result, many children are returned to the orphanages. After I explained the 4 domain model of working with these children and told them about a novel program for women and their dependent children in North Carolina, they returned to Lithuania with renewed hope for families suffering from alcohol abuse. Little did I know they would be sending me to Lithuania this fall to help build a farm program.
Parenting children with FASD/ND-PAE can be frustrating, overwhelming, and nearly impossible for those who are not trained to understand that these children can’t follow directions, and perform daily activities without continuous reminders and prompting. They also have difficulty attuning to parents and caregivers because of wiring differences. It turns out that children respond well to and are eager to learn how to care for animals. Farm animal therapy incorporates gentle stroking, petting, cuddling, and grooming animals in addition to feeding and watering them daily. Hand raised animals like mine are eager to be touched, nurtured, and cared for and seek people out rather than running away. For this reason, children are drawn to the gentle goats, rescue pig, and barn cats at Dream Catcher Farm.
On their return to Lithuania, the visiting physicians said, “We have children and we have animals.” Yet what the idea they developed was to put the entire family on a farm with a farming family who would give the parents meaning and purpose living a substance free life, allowing the children to remain in their family of origin. I feel blessed though maybe a little naive that my farm may inspire others like it to help children with prenatal alcohol exposure and their families live happier, healthier lives.
When I wrote my book, The Silent Epidemic: A Child Psychiatrist’s Journey beyond Death Row, I naively thought that I could stem the tide of public awareness about alcohol use during childbearing years – helping unknowing young women understand the importance of contraception if using alcohol. Articles like this one recently in the Washington Post are a big reason people are missing the message that a lot of damage happens to babies before you find out you’re pregnant. And alcohol doesn’t just cause Fetal Alcohol Syndrome! https://www.washingtonpost.com/opinions/five-myths-about-pregnancy/2017/05/12/7cf6e12a-3666-11e7-b373-418f6849a004_story.html?nid&utm_term=.fddddfca9788#comments
I can’t help but wonder what responsibility the media has for creating the confusion and societal ambivalence about alcohol use during reproductive years. Like some other drugs, alcohol is a neuroteratogen – a chemical solvent that causes birth defects of the brain and nervous system. Yes, it’s a solvent. Like household cleaning supplies, dry cleaning solution, gasoline, paint thinner, and rubbing alcohol. Alcohol kills the tiny cells migrating out of the neural tube as early as the 3rd week after conception – well before most women know they are pregnant.
In my book, I indicate the role of the alcohol industry, the medical community, and the government in preventing brain damage caused by our social drug of choice in 1 in 20 American children. The article in the Post reminds me of the media forces keeping the waters muddy about use of alcohol for women who are pregnant or planning pregnancy. So much more can and should be done to help them as well, as women who are sexually active and using alcohol but not preventing pregnancy.
One risk of the “Five Myths” article and the book is that women will become confused by the stance that a little alcohol is okay. What is a little alcohol to one woman is a long island iced tea to another (equivalent of 6 shots). As a board certified child/adolescent and adult psychiatrist, I see patients adopted from foster care in the U.S., Eastern Europe, South/Central America, China, and Southeast Asia with a range of neurodevelopmental problems (learning, attention, memory, anxiety/arousal, mood, sensory, motor, social/communication, etc.) stemming from prenatal alcohol exposure. Psychiatrists see these patients, not obstetricians. The condition is called “Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure” (ND-PAE, ICD-10 code F88).
Most people know that alcohol abuse during pregnancy can cause “The Fetal Alcohol Syndrome” (FAS). What is less known is that as little as 4-5 servings of alcohol mistimed in the late 3rd week post conception is enough to cause the full FAS. Most women don’t know they are pregnant then. Our genetics, health factors, nutrition status, and other lifestyle behaviors can protect us and our babies or make the situation worse. We also know that a man’s sperm DNA is methylated by alcohol consumed up to 3 months prior to conception (it takes 3 months for sperm to develop from the earliest stages to “fertile”). Methylation of DNA has been linked to a variety of mental health, learning, medical, and other conditions.
I am a believer in educating alcohol consumers about the risks of unintentional prenatal alcohol exposure before knowing you are pregnant and to use contraception (prevent pregnancy) if using alcohol. Preconception health is the best way to prevent ND-PAE. I believe it’s time for the alcohol industry to be held accountable that our social drug of choice (alcohol) has caused brain damage in 1 in 20 U.S. children (CDC, 2015).
For more information about Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure, check out my book at www.prenatalalcoholexposure.com.
The first female physician in the United States, Dr. Elizabeth Blackwell, would turn 196 today. In her honor, a group of physicians established February 3 as National Women Physician’s Day. Inspired by her maverick spirit (after all, how dare a woman in the mid-19th century think she could be a doctor?!) and participation in the recent Women’s March, I envision a paradigm shift when we female doctors are going to end the ignorance surrounding prenatal alcohol exposure.
As a pioneer in medicine who graduated medical school in 1849, Dr. Blackwell may well have been at the forefront of the Temperance Movement, which occurred in the late 1800’s to early 1900’s. At that time, medical doctors understood the devastating effects of alcohol on reproductive outcomes, low birth weight, prematurity, child/family mental health, and infant/child morbidity and mortality. Public health statistics abounded, fueling the fire for Prohibition in 1920. What a pity we lost all that knowledge after its repeal in 1933.
At that time in history, mostly men called the shots in society because they were the main holders of wisdom in science. Professional papers were written, published in high brow journals, read by a handful of intellectuals and scientists, then put on shelves to collect dust. There was no Internet for information sharing. If one did not make it to college, medical school, or professional school (i.e., law school, doctorate programs, etc.), then most scientific advancements and knowledge about medical matters were hidden within academic institutions.
Today, only those of us motivated, bright, and resourceful can endure the rigors of 4 years of college, another 4 years of medical school, and another 3-6 years of residency in our desired field. In many ways, our knowledge is as hidden from plain site as ever. One of the key areas of my interest has been in raising awareness about the leading known and preventable cause of neurodevelopmental disorders, birth defects, and developmental delays – which can occur as early as the third week after conception. Since this time frame is often before a woman may know she is pregnant, our society can and must do more to encourage sexually active alcohol consumers to contracept to avoid unintentional exposure of their offspring.
It is my hope to help childbearing age alcohol consumers understand that they should stop using alcohol if pregnant or planning a pregnancy and to use contraception until they have stopped using alcohol. Their partners should support them in this effort – after all, it takes sperm 3 months to develop, and alcohol methylates the sperm DNA. These methylation effects last for several generations, passing silently through the genome into unsuspecting offspring.
Theodore Geisel, also known as Dr. Seuss, once wrote – “Unless someone like you cares a whole awful lot, nothing’s going to get better, it’s not!” Unless we speak up about what we know about prenatal alcohol exposure happening early in pregnancy so the lay public understands, people will not hear our message. As a change agent and spirit sister of Dr. Elizabeth Blackwell, I am determined to get this message across.
Susan D. Rich, MD, MPH, DFAPA
Pictured from left to right: Senator Brian Feldman, Susan Rich, Bob Fuhrman – Rotary Pres., and Representative Aruna Miller.
It was a remarkable honor to speak last night to the prestigious group of service-oriented citizen members of the Potomac-Bethesda Rotary Club. As a public health entrepreneur, I’m grateful to have the support of State Senator Brian Feldman and District 15 Representative Aruna Miller, who attended the Rotary club dinner presentation about my new book – The Silent Epidemic: A Child Psychiatrist’s Journey beyond Death Row.* Sharing my journey with these remarkable legislators and the imminent Rotary scholars and community leaders was truly humbling.
My main points were to let them know much about the public health warnings and efforts leading up to Prohibition, and the reasons why our society seems deaf to the damage caused to our future generations from a chemical so ubiquitous as alcohol. None of the Rotarians knew that as little as 4-5 standard servings of beer, wine or liquor exquisitely timed late in the 3rd week post conception can cause the Fetal Alcohol Syndrome (FAS), or that only 10-15% of children with effects of prenatal alcohol exposure have the identifiable facial characteristics. They also didn’t know that a Long Island Iced Tea contains nearly 1.5 times the amount of alcohol (6 shots, no tea) to cause FAS. Since 50% of U.S. pregnancies are unplanned and 13.5% of childbearing age women drink alcohol, we have an epidemic (1 in 20) of affected school-aged children in this country.
They were dismayed that future generations could be impacted by a process known as “methylation” – the addition of “CH3-switches” placed on DNA’s histone proteins to interfere with the process of translation of the DNA/RNA into protein. Not only is a child’s neuronal wiring affected by a mother drinking alcohol (i.e., killing the progenitor brain cells that will form important structures of the midline especially), the child’s gonads are affected (their “germ cells” – eggs and sperm) by effects of methylation. This process affects future generations – even if the mother does not drink. Since it takes 3 months for the process of spermatogenesis (sperm development) in the male, his use of alcohol can also potentially “methylate” his sperm DNA. These permanent switches created by preconceptional alcohol exposure are transmitted for generations into the future. Thus, conditions such as alcoholism, chemical dependency, anxiety disorders, and neurodevelopmental disorders are carried down generation after generation – silently within the replication process of DNA.
The fact that most people don’t know that their children and grandchildren may be affected by their inebriated sperm is a problem our society should begin to face. The Better Safe Than Sorry Project, as well at the CDC and the US Surgeon General, recommend for alcohol consumers to avoid alcohol if pregnant or planning pregnancy (for males, this should be 3 months prior to conception); and to avoid pregnancy (i.e., contracept) until they are ready to abstain from alcohol.
In an effort to stem the tide of unintentional prenatal alcohol exposure (and prior to pregnancy recognition), we are hoping to work with the state legislature this fall on a state bill to require “point of purchase” messaging where alcohol is sold. Forty-one states already have such signage, indicating that those who are pregnant or planning to be should avoid alcohol. I would hope that we Marylanders would go one step further with an additional statement – “Alcohol consumers should avoid pregnancy (i.e., contracept), since problems can occur with exposure before knowing one is pregnant.”
Remember – alcohol and unprotected sex don’t mix!
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MOTHERS-to-be are being warned about the incurable condition that strikes one baby born each day in the North-East. More than 300 babies born in the region every year suffering from Foetal Alcohol Spectrum Disorder (FASD). Source: http://www.thenorthernecho.co.uk/news/14709699. Condition_affects_one_baby_born_each_day_____and_is_more_common_than_autism_/ A pregnant woman with a glass of wine The condition is more common than autism, spina bifida […]