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Less Birth Defects in the World: FASD Prevention and Intervention

September 11, 2013

There is no safe level of alcohol consumption for pregnant women.

mayPhilip May, PhD, a research professor with the UNC Chapel Hill Nutrition Research Institute at the North Carolina Research Campus in Kannapolis, makes that statement with authority because he is one of the world’s leading experts in the field of Fetal Alcohol Spectrum Disorders (FASD). FASD children have a number of disabilities that range from abnormal facial features, to learning and behavioral deficiencies to problems with hearing, vision, the heart, kidneys and bones.

“All mothers are not equal in the face of the types of damage that occur in their children from consuming alcohol while pregnant,” May explained. “With similar levels of drinking, there are huge variations in child outcomes from severe to mild. Nutrition, body mass and the general health of the mother all play a role.”

Some of May’s most recent research identified “multiple maternal cofactors of risk for FASD” that include a mother’s age, her body mass index, amount and frequency of alcoholic consumption, socioeconomic status, the number of pregnancies and the number of children born as variables that demonstrate the likelihood of a child being born with FASD.

May began researching Fetal Alcohol Syndrome (FAS) in 1979 making him a pioneer in the field. Since that time, his research has grown to a network of over 30 researchers in the United States and South Africa. He conducts epidemiological or population-based studies that include everything from genetics to community education. One of his many contributions is leadership in establishing the diagnostic categories of FASD. Fetal Alcohol Syndrome (FAS) is the most severe diagnosis followed by Partial FAS (PFAS) and then Alcohol-Related Neurodevelopmental Disorder (ARND) and Alcohol-Related Birth Defects (ARBD).

“We have worked hard to operationalize the actual diagnostic criteria and cut-off points for each of the different levels of FASD,” May said. “Over the years, my team has examined and catalogued well over 10,000 children.”

 

FASD Around the World

May conducts a substantial amount of research in South Africa, working in one community for over nine years. Some communities in South Africa, he noted, “make it, unfortunately, the FASD capital of the world.” The cultural tradition in a number of the urban and rural communities is for women to abstain from drinking during the week and drink heavily on the weekend.

“In South Africa, now that we are diagnosing the full spectrum, we find anywhere from 16 to 21 percent of the children are on the spectrum,” May said, “and that matches very closely with the level of maternal drinking the mothers report to us.”

May’s research shows that South African women who drink only in the first trimester are 12 times more likely to have a child with FASD than if she didn’t drink at all. Drinking only in the first and second trimesters increases the likelihood to 60 times, and drinking in all trimesters to 64 times.

In comparison, May pointed to research that shows that in the United States and Europe, women tend to drink, sometimes heavily, in the first trimester and then quit. This habit lowers the rates of FAS, the most severe diagnosis, to two to seven children per 1,000, and total FASD to two to five percent of the population.

In countries like the United States, most women receive good prenatal care and have access to a healthy diet. “Our prenatal diet here is really very good for kids’ brains,” May noted.

His research in Italy demonstrated a link to nutrition and the development of FASD. “Even though there is substantial prenatal drinking, we found a lot fewer full blown FAS children,” he said. “We found a lot of kids on the lower end of the spectrum. This is probably because the mothers were robust with a moderate to high body mass index (BMI) and adequate nutrition. Low BMI mothers are more likely to have a FASD child than high BMI mothers.”

 

Prevention and Intervention

May’s research in South Africa and with Native American Indians shows that drinking habits can be changed. His research teams have conducted interventions that helped stop maternal drinking early enough so that a mother with an FASD child had healthy, non-FASD children in subsequent pregnancies.

Other studies that May conducted found that cognitive, behavioral, language and literacy interventions improved the prognosis for FASD children. “In other words,” May explained, “with special attention to stimulate them, their brains can repair to some degree. Usually, some problems with impulsivity and working memory persist, but overall their performance and behavior can be improved significantly. We’ve shown improvement in children as late as eight or nine years old in South Africa. We are attempting interventions now at 12 months in South Africa.”

A $5.3 million grant from the National Institute of Health’s National Institute on Alcohol Abuse supports his research in South Africa. May has an $8.9 million grant also from the NIH to examine prevalence and characteristics of FASD in the United States. The goals of the grant are to identify nutrient risk factors related to alcoholism during pregnancy and, by studying first graders in four US locations, develop improved criteria for an accurate diagnosis at the earliest age possible.

“We are working to improve kids’ lives,” May concluded. “We are trying to do that through prevention and understanding of how to intervene with nutritional and educational enhancement at an early age.”

To learn more about May’s research, view this selection of journal articles:

Neuropsychological Deficits Associated With Heavy Prenatal Alcohol Exposure Are Not Exacerbated by ADHD. Neuropsychology. Glass L, Ware AL, Crocker N, Deweese BN, Coles CD, Kable JA, May PA, Kalberg WO, Sowell ER, Jones KL, Riley EP, Mattson SN; Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD).

Maternal alcohol consumption producing fetal alcohol spectrum disorders (FASD): Quantity, frequency, and timing of drinking. Drug and Alcohol Dependence. May PA, Blankenship J, Marais AS, Gossage JP, Kalberg WO, Joubert B, Cloete M, Barnard R, De Vries M, Hasken J, Robinson LK, Adnams CM, Buckley D, Manning M, Parry CD, Hoyme HE, Tabachnick B, Seedat S.

Approaching the prevalence of the full spectrum of fetal alcohol spectrum disorders in a South African population-based study. Alcoholism, Clinical and Experimental Research. May PA, Blankenship J, Marais AS, Gossage JP, Kalberg WO, Barnard R, De Vries M, Robinson LK, Adnams CM, Buckley D, Manning M, Jones KL, Parry C, Hoyme HE, Seedat S.

Maternal factors predicting cognitive and behavioral characteristics of children with fetal alcohol spectrum disorders. Journal of Developmental and Behavioral Pediatrics: JDBP. May PA, Tabachnick BG, Gossage JP, Kalberg WO, Marais AS, Robinson LK, Manning MA, Blankenship J, Buckley D, Hoyme HE, Adnams CM.

Maternal risk factors predicting child physical characteristics and dysmorphology in fetal alcohol syndrome and partial fetal alcohol syndrome. Drug and Alcohol Dependence. May PA, Tabachnick BG, Gossage JP, Kalberg WO, Marais AS, Robinson LK, Manning M, Buckley D, Hoyme HE.

View more NCRC journal articles.

For more information, visit www.uncnri.org.

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