Global Prevalence of Prenatal Alcohol Exposure – A Call to Action

Let’s congratulate and commend Tracey W Tsang and Elizabeth J Elliott on their important publication of “High global prevalence of alcohol use during pregnancy and fetal alcohol syndrome indicates need for urgent action” in The Lancet, [http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30008-6/fulltext].  This publication mirrors the historical, epidemiological, and societal implications presented in my book, “The Silent Epidemic:  A Child Psychiatrist’s Journey beyond Death Row – Understanding, Treating and Preventing Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure” [www.prenatalalcoholexposure.com]; as well as a an international book chapter in Fetal Alcohol Spectrum Disorders in Adults: Ethical and Legal Perspectives [https://link.springer.com/chapter/10.1007/978-3-319-20866-4_3].  The authors clearly call for global paradigm shifts in public perception of alcohol’s effects on society – through advocacy efforts, the media, the alcohol industry, advertising and public policy.
 
I have just returned from Vilnius and Alytus, Lithuania where I gave two lectures daily for three days to large audiences of clinicians, social workers, public health professionals and policy makers (as well as the entire class of first year medical students at the Medical University of Vilnius) about this topic.  Here is a video of the talk at the Ministry of Health to a multidisciplinary group of professionals in the Center for Mental Health [https://www.youtube.com/watch?v=ZNc_RL5Z5Vo].  The introductions were given by the Director of Mental Health for the Ministry of Health who spoke about the epidemic created by alcohol abuse during the former Soviet occupation of the Baltic country.  I was moved and impressed by the city of Alytus’s efforts to end the mass institutionalization of children from alcoholic families, opting instead to offer the entire family therapeutic care with farming families where they are allowed to live in a safe, agrarian setting while learning adaptive functioning skills and vocational skills as well as parenting training.  [My trip was sponsored by a nonprofit family foundation dedicated to improving the lives of Lithuanian children.]
 
In my humble opinion, a medical journal as world renown as The Lancet taking on this issue will surely help awaken others to the devastation on developing brains caused by our western society’s social drug of choice: alcohol.  Just as the British Parliament took on the Gin epidemic in the 1750s, so too can our modern societies choose to urge doctors to encourage their patients (both male and female) to contracept if using alcohol.  After all, these problems occur as early as the 3rd week post conception – well before many know they are pregnant.  Methylation effects to sperm DNA occur up to three months prior to conception, and are transmitted through histone modifications for generations, resulting in familial anxiety, depression, addictive disorders, obesity, and a plethora of other conditions hidden within our tightly wound genome. 
There is no excuse that alcohol is allowed to cause 1 in 20 American children to be born with preventable neurodevelopmental deficits, deformities, and lifelong lost potential.  If the solvent ethanol was as important to mankind as a life-saving antitumor medication, it would not be allowed to cause 1 in 1,000 babies to be born each year with brain damage and birth defects.  We prescribe contraceptives and pregnancy testing to all patients receiving pharmaceuticals that have any potential for causing negative reproductive outcomes.  Just as condoms are promoted for HIV prevention, let’s agree that alcohol and unprotected sex don’t mix and promote contraception and preconception health for alcohol consumers. [https://www.cdc.gov/ncbddd/fasd/alcohol-use.html].   
In the spirit of prevention, identification, and treatment – Kudos to Drs. Tsang, Elliott, Horton and The Lancet.  Perhaps one day you all will be granted well-deserved knighthood!

ND-PAE/FASD Hidden between the lines of Prominent Research Findings

Results of a new study (see below) point to symptoms of prenatal alcohol exposure contributing to alcohol use by age 18. Of the 34 “risk factors” identified, early dating (i.e., sexual promiscuity), more externalizing behaviors (acting out, impulsivity, hyperactivity, aggression, disruptive behaviors), worse executive functioning (working memory, attention, processing speed), and thinner cortices (smaller white matter compared to gray matter in the “neocortex”), and less brain activation in diffusely distributed regions of the brain (also seen on qEEG and fMRI in affected individuals). In the FASD world, we have known for decades that individuals prenatally exposed to alcohol have much higher risk of alcohol use behaviors by their adolescent years.

The authors of the study concluded the following: “The results provide evidence that multimodal neuroimaging data, as well as neuropsychological testing, can be used to generate predictions of future behaviors.”  To me, it’s interesting that the same highly expensive neurocognitive and neuroimaging studies are useful to predict prenatal alcohol exposure, yet the surest way to prevent it is to have alcohol consumers use reliable contraception.

I believe we as a society should do more to ensure that men and women stay away from alcohol during reproductive years unless they are using birth control. Alcohol use by males affects sperm development up to 3 months prior to conception and as many as 75% of children with effects of “prenatal alcohol use” is due to the father drinking prior to conception.  The point at which our offspring are most vulnerable is the time in which most people are unaware they may cause harm to their future child.  There is no safe amount of alcohol if you are having unprotected sex.

Pass on the word: If you are using alcohol, prevent pregnancy (i.e., contracept). If you are already pregnant or planning a pregnancy, stop using alcohol (beer, wine, and liquor).

 

http://alert.psychnews.org/2016/08/new-model-found-useful-for-predicting.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+PsychiatricNewsAlert+%28Psychiatric+News+Alert%29

 

Male’s Drinking and How It Affects Their Sperm

Alcohol and Unprotected Sex Don’t Mix – It’s Better to Be Safe Than Sorry! Our message not only goes out to women but also to men. Their alcohol consumption has an impact as well on whether a baby is healthy or not. A recent Danish study reveals that just five units of alcohol a week (one unit = one beer, glass of wine or 40ml of liquor) lower sperm quality.
Researchers strongly recommend that men drink less to be healthier overall!
To read the full article visit

Alcohol Research Roundtable at the Physicians Committee for Responsible Medicine

Dr. Susan Rich, President and Founder of 7th Generation Foundation, Inc. – BSTS’s parent organization, was one of three guest speakers on friday december 5th at a roundtable discussion at the Physicians Committee for Responsible Medicine (http://www.pcrm.org/about/about/about-pcrm) in Washington, DC. 
To view the roundtable agenda see PCRM Agenda
PCRM is dedicated to “dramatically changing the way doctors treat chronic diseases such as diabetes, heart disease, obesity, and cancer. By putting prevention over pills, doctors are empowering their patients to take control of their own health.”  The nonprofit has recently redirected its efforts toward research funding and policy related to Fetal Alcohol Spectrum Disorders. PCRM has partnered with Dr. Rich to help highlight solutions to prevent the epidemic caused by our social drug of choice: alcohol.
 
More than 40 years of animal and human research since Fetal Alcohol Syndrome was characterized in 1973 by Drs. Ken Jones and David Smith has shown that alcohol is a neurotoxin and teratogen (cause of birth defects).  In 1981, Dr. Kathleen Sulik of the University of North Carolina showed that these problems occur as early as the late 3rd to early 4th week after conception – long before most women know they are pregnant.  It is not enough to focus prevention of FASD/ND-PAE on pregnant women and put a tiny label on alcohol.  Over 50% of U.S. pregnancies are unplanned and few Americans understand that this condition happens as early as the first few weeks.
Each year, the National Institutes on Alcohol Abuse and Alcoholism funds $30 million toward FASD research – $17 million devoted to animal research, rather than evaluating effective ways to prevent and treat FASD/ND-PAE in people.  Montgomery County, MD where NIAAA is located earns $30 million in profit from the sales of alcohol – equivalent to the entire national budget of NIAAA FASD research. Yet not one warning sign is posted by the local liquor control board or anywhere else in Maryland to raise awareness about the dangers of alcohol during pregnancy or prior to pregnancy recognition (41 other states have adopted such point of purchase signage).
Dr. Rich shared her insights and highlighted the Better Safe than Sorry Project at the roundtable to promote more effective FASD/ND-PAE prevention research.