FASD History
It has been suggested that the adverse effects of alcohol on the developing fetus have been recognized for centuries. Some of the earliest references date back to Greek and Roman mythology and Judeo-Christian tradition, such as the ancient Carthaginian custom that forbade bridal couples from drinking wine on their wedding night, and the belief that alcohol consumption at the time of procreation leads to the birth of defective children (Jones and Smith, 1973). Passages in Robert Burton’s The Anatomy of Melancholy allegedly quote Aristotle describing an association between alcoholic mothers and disabled children in Problemata : “...foolish, drunken and harebrained women [for the] most part bring forth children like unto themselves, morose and languid” (Burton, 1621).
However, there remains much controversy regarding the validity of these claims and sources. Although many authors have assumed Burton to be quoting Aristotle’s words verbatim, there is no evidence of any such statement in Problemata, nor in any of Aristotle’s other works (Abel, 1999). Others have claimed that the Carthaginians did not truly understand that drinking during pregnancy caused problems; rather, they believed that intoxication at the exact moment of conception led to the birth of a deformed offspring (Calhoun and Warren, 2007).
More recent and credible historical reports, however, have documented alcohol’s teratogenic effect. During the 1700s, a group of English physicians described children born to alcoholic mothers as “weak, feeble, and distempered” (Royal College of Physicians of London, 1726). A deputy medical officer of the Convict Prison in Parkhurst, England, noticed that imprisoned pregnant alcoholic women had high rates of miscarriage, and that those offspring which survived displayed distinctive patterns of birth defects (Sullivan, 1899). From these observations, Sullivan concluded that alcohol had a direct effect on the developing embryo.
Despite these observations and early animal studies supporting an association between gestational alcohol exposure and adverse outcomes (e.g., Stockard, 1910), the first clinical accounts of alcohol’s teratogenic effects were not published until the late 1960s. In 1968, Lemoine and colleagues published their report entitled “Outcome of children of alcoholic mothers” (Lemoine et al., 1968), which established a connection between maternal alcohol consumption during pregnancy and abnormal fetal development, describing common problems of children born to mothers who drank heavily during pregnancy.
Though many attribute the beginning of scientific inquiry to the 1960s and 1970s, physicians have been aware of the negative effects of maternal consumption of alcohol on the developing fetus since ancient times. The Bible in Judges 13:7 states: “Behold thou shalt conceive and bear a son: and now drink no wine or strong drink” hinting at the problems associated alcohol and pregnancy. In Carthage, there was reported to be a prohibition against couples drinking on their wedding night to prevent producing an affected offspring. Aristotle, the founder of western thought, even proclaimed “Foolish,, drunken and harebrained women most often bring forth children like unto themselves, morose and languid” (Streissguth at al, 1980).
From 1720-1750, the British government attempted to support the grain producing gentry by reducing control on producing and selling gin, thus resulting in an increase in its consumption. During this period, known as the “Gin Epidemic”, fetal and infant death rates were much higher than previous years yet, unlike earlier periods, the social factors usually contributing to this - war, famine, poor wages among others - were not existent. This was the first time that health care providers highlighted the effects of what today is known as FASD. So pervasive and obvious was the problem, that in 1725 the College of Physicians in London warned the British House of Commons that alcohol is “too often the cause of weak and feeble, distempered children” (Warren and Bast, 1988).
Reports of alcohol’s negative effects on children continued throughout the eighteenth and nineteenth century. A study in 1899 by Dr. William Sullivan observed 600 children born from 120 alcoholic mothers and represents one of the earliest thorough descriptions of FAS (Warren and Bast, 1988). Sullivan also noted that female drunkards in the Liverpool jail had a stillbirth and infant death rate of 56% and that the problems with the fetus increase with the mother’s alcohol intake (Martin and Blake, 1980). With the onset of prohibition in the 1920s, alcohol’s negative effects on pregnancy were ignored. The research that began again in the 1940s and lasted through the 1960s often attempted to refute the idea that alcohol is detrimental to developing fetuses. This research was in part due to a backlash against the pre-Prohibition views on drinking and morality (Warren and Bast, 1988).
The revival and beginning of modern science’s interest in alcohol related effects on child development began in 1967 with the presentation of Dr. Alexandre LeMache’s report to the French Academy of Medicine concerning his observations of over 1200 children born to alcoholic mothers over 37 years (Warren and Bast, 1988). In the United States, a study published in 1970 by University of Washington scientists examined grown children of alcoholic mothers and discovered a pattern, a syndrome, in a significant number and were the first to coin the term Fetal Alcohol Syndrome (FAS) in their report published in 1973 (Warren and Bast, 1998).
The United States set up commissions to study the effects and their adequate response. In 1981 the Surgeon General first advised that women should not drink alcohol when they were pregnant due to risks to the infant. That thinking progressed to mandating warning labels stressing the risks to mothers on alcoholic beverages in 1989 and later to the US Government explicitly stating the risks to women if they drink alcohol (Gilbert, 2004).
Unfortunately, the authors did not present any diagnostic criteria to facilitate the recognition of fetal alcohol effects in future cases (Hoyme et al., 2005), and the paper was published in French, which limited its wide availability. As a result, FAS remained unrecognized for five more years until Jones and colleagues reported a series of case studies which documented consistent patterns of physical and developmental abnormalities in infants and children exposed to alcohol in utero (Jones and Smith, 1973 ; Jones and Smith, 1975 ; Jones et al., 1973). These authors coined the term “fetal alcohol syndrome,” and laid the foundation for the diagnosis of this disorder.
Fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE) are conditions associated with drinking alcohol during pregnancy. FAS causes a variety of mental, physical, and developmental disabilities in the baby. FAE is a milder form of FAS.
If a pregnant woman drinks any alcohol at any time during pregnancy, the alcohol crosses the placenta to the fetus. Alcohol damages the developing cells of the fetus. The brain and central nervous system are particularly sensitive to alcohol and can suffer permanent damage.
Any amount can have some effect, so there is no minimum amount of alcohol in pregnancy that is safe. The developing fetus can’t break down the alcohol as quickly as an adult, so its exposure to alcohol is actually higher than the mother’s.
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Tanya T. Nguyen, Jennifer Coppens, and Edward P. Riley
Edited by Edward P. Riley, Sterling Clarren, Joanne Weinberg, and Egon Jonsson
Tanya T Nguyen practices as a Pediatrician in Alhambra, CA.
Jennifer Coppens, Medical Student, University of Alberta
Prof. Dr. Edward P. Riley San Diego State University Center for Behavioral Teratology
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REFERENCES
- Abel, E.L. (1999) Was the fetal alcohol syndrome recognized by the Greeks and Romans? Alcohol Alcohol., 34 (6), 868 – 872.
- Adnams, C.M., Sorour, P., Kalberg, W.O., Kodituwakku, P., Perold, M.D., Kotze, A., September, S., Castle, B., Gossage, J., and May, P.A. (2007) Language and literacy outcomes from a pilot intervention study for children with fetal alcohol spectrum disorders in South Africa. Alcohol, 41 (6), 403 – 414.
- Barry, K.L., Caetano, R., Chang, G., DeJoseph, M.C., Miller, L.A., O’ Connor, M.J., Olson, H.C., Floyd, R.L., Weber, M.K., DeStefano, F., Dolina, S., Leeks, K., and National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect (March 2009) Reducing Alcohol - Exposed Pregnancies: A Report of the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect, Centers for Disease Control and Prevention, Atlanta, GA.
- Bertrand, J. (2009) Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects. Res. Dev. Disabil., 30 (5), 986 – 1006.