Township Trauma: The Terrible Cost of Drinking During Pregnancy (The Guardian)


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Mentors helped Veronic Blom stop using alcohol and crystal meth when she was pregnant with her youngest son. Photograph: Kate Hodal for the Guardian

In a dusty township in South Africa’s sun-drenched wine country, Charay Afrika says only one thing helped numb her through a turbulent relationship and two pregnancies: alcohol.

She drank all day, every day, throughout her full-term pregnancies – unaware of the effect alcohol could have on her children.

Afrika was still at school when she met her first boyfriend, a man who would go on to beat her and rob her at gunpoint multiple times before she finally escaped him. “He’d beat me and lock me in the house with no food and then disappear for days,” Afrika, 28, says quietly. “I once had to drug him with sleeping pills so that I could call the neighbours and beg for help to sneak out. But he found me again and robbed me at gunpoint, and the whole thing started all over again. I drank as a way of escaping it all. I drank the whole time. I didn’t stop.”

Now eight years old and at school in Roodewal township, her eldest child has learning difficulties and behavioural problems – telltale signs of foetal alcohol syndrome (FAS), a condition under the broader umbrella of foetal alcohol spectrum disorder (FASD), which can manifest in birth defects such as brain damage, physical and mental impairments and stunted growth. It is directly caused by the mother’s drinking during pregnancy.

FAS affects more children in South Africa than anywhere else in the world: prevalent in 111 per 1,000 children, a rate 14 times higher than the global average of 7.7 per 1,000, according to the American Medical Association journal JAMA Pediatrics. But even this estimate may be lower than the true figure, say social workers in the Western Cape, as FAS is often a “hidden disability” that can affect a child in a number of ways, not all immediately obvious to parents or doctors.

“It’s a development issue,” says Sudene Jeftha, a social worker with FASfacts, an NGO based in Worcester. “You can’t necessarily see it when the child is born, only later when the child isn’t talking or crawling or walking like other children.”

The condition is endemic in the Western and Northern Cape, where high levels of unemployment, alcohol and substance abuse and teen pregnancies are intrinsic to daily life. In high-risk rural areas, up to 72% of school-age children are believed to suffer from FAS. Experts point to the 200-year-old dop system, in which Afrikaner farmers pay black and mixed-race workers in wine, or dop, as the primary cause of the regions’ high prevalence of alcoholism. Although the system was outlawed long ago, as many as 20% of vineyards are estimated to still pay their workers in wine, and binge-drinking in the Western Cape is a major health concern.

There is no concerted national health effort to tackle the issue, nor have there been any government studies to measure the socioeconomic impacts. But in a country where as many as six million people are thought to be affected by FASD and an additional three million are thought to have had foetal alcohol exposure, comparisons with other nations come in handy. In the UK, research has shown that it costs £2.9m to raise a child with FASacross their lifespan, while a Canadian study found that FAS youths were 19 times more likely to end up in jail than their peers.

A number of NGOs, including FASfacts, now run courses in at-risk communities to spread awareness of the condition, as well as “mentor mother” programmes, which rely on local mothers going door-to-door to speak to pregnant women about drinking. FASfacts, founded in 2002 by François Grobbelaar (an Afrikaner whose father used to pay his farmworkers in dop), claims this approach has helped reduce the number of pregnant women who drink by as much as 84%.

Veronic Blom, 33, drank and used tik (crystal meth) throughout her first two pregnancies. She was approached by one of FASfacts’ mentor mothers and stopped using both during her third pregnancy. Blom is now a mentor mother herself. “I smoked heavily – heavily – for the whole nine months of the pregnancy,” she says of her second child, now aged two. Making a rectangle with her thumb and forefinger, she indicates the size of a full gram of meth. “I’d smoke the full packet and smoke the whole day. I can only thank God he wasn’t born with any problems with his face.”

From the corrugated-iron shack in the Esselen Park township she shares with her two youngest children, Blom says the programme has changed her for the better. “I’m very talkative and I like to give back and speak to other mothers,” she says. “I usually tell them my own story so they know they don’t have to use their stories as an excuse: they can do better. The women are mostly keen to do better, but teenage pregnancy here is very common, you know, women selling their bodies to buy drugs or food.”

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We’re Separating Babies From Their Teenage Mothers in Care, Perpetuating a Never-ending Cycle


Elizabeth Wall-Wieler – for CBC News

There is a well-known connection between teen pregnancy and child protection services. Girls who spend time in the care of child protection services have higher rates of teenage pregnancy, and teenage mothers are more likely to have their child taken into care.

Teenage mothers who give birth when they are in out-of-home care (e.g. foster care, kinship care) are also more likely to have their children taken into care.

Until recently, we didn’t know how often this happens. It turns out, it is all too common.

In a recently published study in Pediatrics, my colleagues and I followed the children of 5,942 teenage mothers in Manitoba up to their second birthday to see how many were placed into care. We found that among teenage mothers who were themselves in care when they gave birth, 49 per cent of their children were placed into care before their second birthday, with 25 per cent being placed in care in their first week of life.

For teenage mothers who were not in care when they gave birth, 10 per cent of their children were placed in care before age two (2.5 per cent were placed in their first week of life).

This means that teenage mothers who were in care when they gave birth were more than 11 times more likely to have their child placed in care in their first week of life, and more than seven times more likely to have their child placed in care at any point before their child’s second birthday.

Even though all teenage mothers are at high risk of having their child placed in care, why are teenage mothers who give birth while in care at a significantly higher risk?

Young women in foster care face many challenges and often lack the financial and parenting supports provided to teenage mothers by their families. Although becoming a mother can be a joyful time and can give young women an opportunity to create a family that they may not have had, parenting while in care comes with additional challenges. These young mothers often feel like they are under constant scrutiny by their social workers and are always needing to prove to everyone that they are able to parent.

Keeping mothers with babies

Placement in care within the first week of life is sometimes associated with substance use by the birth mothers, which is more prevalent among adolescents in care. However, evidence shows that treatment for substance use disorder is less successful when women are separated from their children.

Programs such as Portage’s Mother and Child Program in Montreal have found success by providing accommodations for mothers and their children in their rehabilitation program. More such facilities should be made available across Canada.

When a child is placed in care, the government takes on the role of surrogate parent to that child. But by separating a quarter of young mothers from their infant within the first week of life, and almost half before the child turns two, the government is failing in its role of surrogate parent, and in these cases, surrogate grandparents.

A much greater emphasis needs to be put on dual placements – whenever possible, mothers and children should be placed together. This ensures that mothers and children have the chance to bond. This should be supplemented with specific supports to mothers (e.g., financial, housing, child care and education) to assist young mothers in their transition to motherhood.

In general, we know that most children are placed in care due to neglect, not due to abuse. Dedicated funds for prevention, as well as support workers committed to working with mothers and their children in this period of transition, can help to address that.

Our study used data from Manitoba, which has the highest rate of children in care among the provinces. However, this is not an issue that is limited to Manitoba. Canadian provinces with relatively low rates compared to other provinces still have higher rates of children in care than many other countries, and Indigenous children are hugely overrepresented in the child welfare system across the country.

The tireless work of many children’s advocates has resulted in a renewed effort to address challenges in the Canadian child welfare system, specifically in Indigenous communities. Failing to support young mothers who are in care is contributing to what has become known as “the millennial scoop,” sadly analogous to the systematic removal of children in the Sixties Scoop.

To prevent this cycle of involvement in care from continuing, the child welfare system needs to put in place dedicated resources (money and support workers) to help families stay together. Let’s make sure that these families get the support they need to ensure they are the last generation with this experience.

This column is part of CBC’s Opinion section.

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Report: Alcohol Related Deaths in Canada Increasing Faster for Women Than Men

Amanda Colleta,
Published Thursday, May 31, 2018 10:00AM EDT

Alcohol-related deaths and hospitalizations in Canada are increasing at a faster rate for women than men, according to data released by the Canadian Institute for Health Information on Thursday.

The non-profit group found that from 2001 to 2017, the rate of women who died from causes linked directly to alcohol jumped a whopping 26 per cent. For men during that same period, the rate increased roughly 5 per cent.

Kathleen Morris, vice president of research and analysis at the CIHI, said in a statement that “it is troubling to see the rates for women increase so much faster than those for men.”

Historically, men have been far more likely to be hospitalized for alcohol-related reasons than women, but women “are catching up,” said Joseph Amuah, a senior researcher with the health system performance branch of the CIHI and an adjunct professor at the University of Ottawa.

Researchers with the CIHI don’t have a definitive explanation for what is driving the trend, but they note that Canada is not an outlier.

“One key thing to remember is that the hospitalizations entirely caused by alcohol indicator is only one indicator and that we just started looking at it in the past two years,” Amuah told

“But if we look at this trend from the long-term side of things, this is part of a pattern that we are seeing globally.”

Girls aged 10 to 19 have already closed the gap with boys. While the rate of hospitalizations entirely caused by alcohol from 2016 to 2017 was 44 boys per 100,000, for girls of the same age, it was 69 per 100,000.

The research also found that the rate of hospitalizations caused by alcohol for females grew 3 per cent from 2016 to 2017 when compared to the previous year. For males, the year-by-year increase was less than 1 per cent.

Amuah said greater gender equality around the world, as seen in the workplace, may be extending to alcohol consumption. Women are drinking more heavily than in the past, he said, which means they’re also more exposed to health risks.

And because women’s bodies metabolize and process alcohol differently than men, they suffer a more pronounced response to heavy drinking and binge drinking than men, he added.

The CIHI’s data also found that for the second consecutive year, there were more hospital admissions in Canada for alcohol-related conditions than for heart attacks.

Nearly 80,000 Canadians were admitted for alcohol-linked conditions from 2016 to 2017, compared to 77,000 hospital stays for heart attacks during that same period.

Mental health and addiction-related conditions were responsible for early 75 percent of those alcohol-related hospital stays.

Amuah said policymakers should consider tighter rules on alcohol advertising. He argues that a comprehensive strategy similar to the one that targeted tobacco consumption is needed here, particularly to prevent the normalization of alcohol consumption among Canadian youth.

“It’s important not to rest on our laurels,” he said.

The CIHI’s data comes from an indicator called “hospitalizations entirely caused by alcohol,” which measures hospital stays linked to conditions such as alcohol poisoning, chronic alcohol abuse, liver disease, alcohol withdrawal, hepatitis and liver failure.

A study released by the group in 2017 cautioned that this indicator represents only “the tip of the iceberg of alcohol harm” because it excludes hospitalizations partially related to alcohol consumption such as heart disease or injuries stemming from drinking and driving.

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Red Shoes Rock: Start the Conversation About FASD!

In their hopes to make Edmonton and the surrounding area the most ‘FASD Friendly’ place in Canada, the  Edmonton and area Fetal Alcohol Network is hosting their Red Shoes Rock: Start the FASD Conversation challenge (open to anyone anywhere). But we think, working together, we can make Alberta the most ‘FASD Friendly’ province in this country. Let’s all join the conversation and rock some red shoes as we educate and inform all of our communities about FASD, its prevention, and how we can help to support children, youth, adults, caregivers, and communities whose lives are impacted by Fetal Alcohol Spectrum Disorder. Please see below for more information!Screen Shot 2018-05-24 at 2.32.14 PM

Why Rock in Red?

There are tens of thousands of people and their families living with FASD who:

  • Need friends and understanding.
  • Need support to live safely in our communities.
  • Need to participate in life and have a purpose.

The color RED often signifies life!

  • Red signals stop and take immediate action.
  • Red is a warm, strong and positive color.
  • Red is energizing and stands out.

Red excites emotions and motivates us to take action!

Red Shoes? Where did this all start?

Now, that is a good question!

With RJ Formanek, founder of the very successful Facebook support group for adults with FASD called Flying with Broken Wings. 

RJ Formanek is an adult with FASD and he decided to wear RED SHOES to stand out, be noticed and have some fun starting the FASD conversation with strangers in 2013. Back then it was all about:

  1. Turning invisibility into visibility
  2. Creating conversation
  3. Changing stigma into understanding and acceptance

In 2014, Jodee Kulp, from Better Endings New Beginnings, a graphic designer and parent of an adult with FASD stepped in to help him build visibility and get the word out – she has continued to be the Little Engine That Could behind this grassroots all-volunteer movement. The goal was to build awareness and momentum to celebrate FASDay. We hoped Red Shoes would help more people notice International FASDay on September 9.

The Logos

You are free to mix and match any of their logo artwork to fit your local campaign. Please email if you need original artwork.






RedShoe-DecalLimited $$$ for RED SHOES? – Red Flip Flops, Red Socks, Red Shoelaces and Red Toenails all qualify. Or simply join us to participate in the FUN and the FASD conversation!

Source: Prevention Conversation

Up to 3% of Toronto-area Children Could Have Fetal Alcohol Spectrum Disorder: Study

The study's lead researcher says there is no safe amount of alcohol to consume during pregnancy or while trying to get pregnant.

The study’s lead researcher says there is no safe amount of alcohol to consume during pregnancy or while trying to get pregnant.

Anshuman Poyrekar/Hindustan Times via Getty Images

new study has found rates of fetal alcohol spectrum disorder among school children in the Greater Toronto Area are at least double previous rough estimates for Canada — suggesting that the condition may be more widespread than previously thought.

The team behind the assessments has estimated the prevalence of FASD at 1.9 per cent to 2.9 per cent.

READ MORE: Reality check: Is light drinking during pregnancy safe?

None of the 21 cases identified had previously been diagnosed, according to lead researcher Dr. Svetlana (Lana) Popova, a senior scientist at CAMH’s Institute for Mental Health Policy Research.

“That means we are missing these kids,” she told the Tasha Kheiriddin show on 640 Toronto on Tuesday.

“We are misdiagnosing or even simply not recognizing them.”

FASD, which includes fetal alcohol syndrome and milder forms, is an umbrella term for conditions caused by prenatal exposure to alcohol. FASD can have a broad range of lifelong impacts on the brain and the body.

“A major target of alcohol is obviously [the] brain, that’s why people with FASD have difficulties with learning, attention, memory, problem-solving, language and communication and many other things, but alcohol can also affect many other organs and systems of the fetus,” Popova said.

Those with FASD have been shown to be at risk for substance abuse, mental-health issues and many other difficulties as adults.

LISTEN: Dr. Svetlana (Lana) Popova, senior scientist at CAMH’s Institute for Mental Health Policy Research

The CAMH study is the first time FASD has been examined through population-based research in Canada, according to the authors.

The results peg the number of those affected far ahead of previous estimates. Health Canada’s website states that an estimated 3,000 babies are born with FASD every year, a figure that puts the rate below 1 per cent.

“For a long time, we believed that prevalence of FASD in Canada is only 1 per cent, but indeed, it was not properly estimated because this estimate was just extrapolated from very old American studies,” Popova said.

READ MORE: Should women drink alcohol when they’re breastfeeding?

While the study found that mothers of children with FASD were more likely to have lower education, the incidence of the condition wasn’t tied to any other factors.

“Our study found that FASD is not restricted to any particular group of people, but rather occurs throughout society regardless of socioeconomic status, regardless of age or ethnicity,” Popova said.

Popova said it’s likely the results of this study reflect how widespread FASD is in similar large cities in Canada. However, much higher rates are found in northern communities and among children in care and those in jail or mental-health institutions, she said.

READ MORE: ‘Their life is tough’: mom of 2 kids with FASD shares their struggles

The research was conducted as part of a global study in partnership with the World Health Organization and the U.S. National Institute for Alcohol Abuse and Alcoholism.

Popova said there is no safe amount — or type — of alcohol to consume during pregnancy, or while trying to get pregnant.

Source: Global News


Dispensaries Think Weed is Safe to Treat Morning Sickness. It’s NOT.

morning-sickness-639375656-59f8cadbaad52b00103489a3As marijuana legalization expands and cannabis products become more common, consumers suddenly find they have access to alternative cannabis-derived treatments that claim to help a host of medical conditions.

Could one of those ailments include morning sickness of expectant mothers? People who work at marijuana dispensaries think so.

But medical experts caution it isn’t a good idea, and using marijuana can harm a pregnancy.

A new study published in the June issue of Obstetrics and Gynecology — the American College of Obstetricians and Gynecologists (ACOG) journal — found that nearly 70 percent of Colorado cannabis dispensaries contacted by study investigators recommended cannabis products to treat nausea during the first trimester.

This recommendation from dispensary employees goes directly against the guidance of the experts at ACOG.

“Obstetrician-gynecologists should be discouraged from prescribing or suggesting the use of marijuana for medicinal purposes during pre-conception, pregnancy, and lactation,” the study authors wrote, citing ACOG’s recommendation.

ACOG notes children prenatally exposed to marijuana may be at increased risk for behavioral issues, decreased attention span, and other visual-motor conditions. Pregnant women who use marijuana may be at increased risk for stillbirth.

Dr. Katrina Mark, assistant professor in the department of obstetrics, gynecology, and reproductive sciences at the University of Maryland School of Medicine, said that as people’s attitudes on marijuana change, the medical community needs to make sure they can address and answer patients’ questions about the drug.

“The liberalization of laws related to marijuana use are rapidly changing. This is not necessarily a negative thing, but we as healthcare professionals need to make sure that we are keeping up with our evidence-based counseling of patients,” Mark said.

“Legalization does not equate to safety, particularly in pregnancy,” Mark added, pointing out the study is needed to bring attention to this topic.

“The most obvious example of this is alcohol,” she said. “No liquor store would recommend alcohol to treat pregnancy ailments, and neither should a marijuana dispensary. I actually think the fact that dispensaries are providing any recommendations for treatment of medical conditions is very much overstepping appropriate boundaries.”

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Improving Communication of Guidance on Drinking Alcohol in Pregnancy



Advice about alcohol consumption during pregnancy could be conveyed more effectively to parents and health professionals, research at Cardiff University has found.

Since 2016, guidance from UK Chief Medical Officers recommends that women who are planning a  or are pregnant abstain from  altogether.

A new stakeholder study by Dr. Rachel Brown and Heather Trickey of DECIPHer, (Development and Evaluation of Complex Interventions for Public Health Improvement) Cardiff University, considered the ways that this guidance is experienced and communicated by different groups. Mothers, antenatal teachers, midwives and policy makers were asked for their views. Following this work, the researchers have suggested ways in which communication of the advice might be improved.

Trickey said: “There is good evidence that  a lot in pregnancy can be harmful. There is also a ‘dose-response’ effect with more alcohol leading to more adverse outcomes and Chief Medical Officers (CMOs) were unable to determine a ‘safe level’ after commissioning a comprehensive evidence review.

“However, the evidence for harm from drinking small amounts in pregnancy (below 1-2 units a week) is limited. CMOs concluded that lack of evidence is not the same thing as a lack of harm. They decided to take a ‘better safe than sorry’ (precautionary) approach by issuing a simple ‘Don’t Drink’ message, intended to help women avoid any risk.

Dr. Brown added: “Taking into account the evidence available, avoiding drinking alcohol completely during pregnancy is certainly the safest option. But our research also highlights potential for unintended adverse effects from an abstinence message. These included raised anxiety among women who had drunk alcohol before they knew they were pregnant, experiences of social shaming for choosing to have a drink, and experiences of having their decisions policed by strangers. The guidance should be there to advise and support expectant mothers in a positive way.”

Brown and Trickey believe communication strategies need to align with a wider agenda to improve public understanding of the evidence and could do more to be relevant to women’s lived experience of pregnancy planning and the fact that social drinking is a normal part of many women’s lives. Rather than targeting messages to individual mothers, they suggest an approach which considers the role of partners, family and friends in affirming and supporting mothers’ decisions, for example by joining an expectant mother in not drinking.

The researchers intend to explore ways in which the guidance about drinking  during pregnancy can be communicated more effectively.

Explore further:Evidence for potential harms of light drinking in pregnancy ‘surprisingly’ limited

More information: Findings are available here: … nalReport_0151.1.pdf

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Girls, Women, Alcohol and Pregnancy:New Annotated Bibliography of Articles on FASD Prevention


Each year since 2013, researchers associated with the Prevention Network Action Team (pNAT) of the CanFASD Research Network search the academic literature for articles related to prevention of fetal alcohol spectrum disorder (FASD). Articles are reviewed for relevancy, identified by topic and country, and the findings briefly summarized. For this year’s Annotated Bibliography of Articles Published in 2017, a total of 113 articles were identified from 17 countries. Countries with highest number of published articles were USA, (51 articles) Canada (26 articles), Australia (10 articles).Findings are organized using a four-level prevention framework used by the pNAT to describe the wide range of work that comprises FASD prevention (see panel at left for more information). This year a record 32 articles pertained to Level 2 which involves discussion of alcohol use with all women of childbearing age and their partners/support systems. Articles pertaining to Prevalence of alcohol use in pregnancy, Influences on women’s drinking, and Preconception interventions were also well represented.

The annual literature search is intended to update those involved in FASD prevention in Canada, to inform their practice and policy work with current evidence. The members of the pNAT also have the opportunity to discuss the implications for their work of the findings of selected articles, in monthly web meetings.

Find earlier Annotated Bibliographies below and on the CanFASD Prevention page under “Bibliographies”.





Brain Studies Point to Perils of Adolescent Alcohol Use

The brain takes longer to develop and mature than any other organ in the body. Beginning in the third week of gestation and extending into the mid-20s, an ongoing interplay of genetic and environmental factors results in the mature human brain, a structure composed of more than 100 billion neurons. Some of the most rapid and pronounced changes in the brain take place during childhood and adolescence.

During normal adolescent brain development, widespread structural and functional changes occur rapidly within individual brain regions and in the connections between them. These changes help the brain systems that regulate cognitive, emotional, and social behavior to mature. The extent and complexity of these changes make the adolescent brain particularly vulnerable to the adverse effects of alcohol. Indeed, studies have associated heavy alcohol use during adolescence with harm to various brain structures, lingering problems with cognitive functions such as attention and memory, and an increased risk for future alcohol use disorder (AUD) and other mental health disorders.

“We have long known that adolescent alcohol use is associated with many adverse outcomes, both during adolescence and in later life,” says George F. Koob, Ph.D., Director, National Institute on Alcohol Abuse and Alcoholism (NIAAA). “Our expanding research investment in this area is allowing us to define more precisely why alcohol and the adolescent brain are a particularly dangerous combination.”

The brain is a highly complex organ. Human brain imaging studies have shown that, over the course of adolescence, the volume of gray matter—which represents the cell bodies of neurons and their connections with nearby neurons—decreases in the prefrontal cortex. This decrease likely reflects the normal process of “synaptic pruning,” through which the brain gets rid of excess connections that are no longer needed. However, the volume of white matter—which is important for pathways connecting neurons located at farther distances from each other—increases during adolescence, presumably reflecting enhanced brain connectivity and improved communication between areas. Initial findings from NIAAA-supported research indicate that adolescents who drink heavily, when compared with nondrinking adolescents, have accelerated reductions in gray matter and smaller increases in white matter.

To build on these findings, NIAAA supports the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA), a nationally representative, accelerated, longitudinal study of more than 800 youth. NCANDA’s accelerated design allows researchers to follow multiple youth cohorts, each starting at a different age, so that the cohorts together span a broader age range of interest than a traditional cohort design. The goals of the NCANDA study are to determine the short- and long-term effects of alcohol use on the developing adolescent brain and identify brain characteristics that predict AUD.

NIAAA, along with the National Institute on Drug Abuse, is a major contributor to the National Institutes of Health Adolescent Brain Cognitive Development (ABCD) Study, a 10-year longitudinal study of 10,000 youth, the largest long-term study of brain development and child health in the United States. NCANDA and ABCD investigators are providing much-needed information about the neurodevelopmental consequences of alcohol and other drugs, alone and in combination.

A recent NCANDA study led by Adolf Pfefferbaum, M.D., of SRI International in Menlo Park, California, and colleagues found disordered brain growth trajectories among young people who initiated drinking during adolescence. The researchers noted possible factors that contribute to the abnormal trajectories include peak alcohol consumption in the past year and having a family history of AUD.

Another recent NCANDA investigation led by Eva Müller-Oehring, Ph.D., also of SRI International, and colleagues found that development of intrinsic functional networks (IFNs)—brain circuits that underlie specific functions—were susceptible to adolescent alcohol use. In particular, they reported evidence that IFNs associated with cognitive and emotional functioning become rewired among adolescents who exceeded the study’s criteria for no or low alcohol use. This effect, they conclude, may impede maturation of complex social and emotional behaviors.

The growing evidence of alcohol’s impact on adolescent brain development, as well as its position as the substance of choice for young people, underscores the need for health professionals to screen adolescents for alcohol.

A 2016 study funded by NIAAA demonstrated that a single screening question about drinking frequency in the past year could help doctors identify adolescents at risk for alcohol problems. The study supported the use of the age-based screening thresholds put forward in NIAAA’s Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide and demonstrated that simple screening tools, such as those in NIAAA’s Youth Guide, are efficient and effective.

Pfefferbaum, A.; Kwon, D.; Brumback, T.; Thompson, W.K.; Cummins, K.; Tapert, S.F.; Brown, S.A.; Colrain, I.M.; Baker, F.C.; Prouty, D.; De Bellis, M.D.; Clark, D.B.; Nagel, B.J.; Chu, W.; Park, S.H.; Pohl, K.M.; and Sullivan, E.V. Altered brain developmental trajectories in adolescents after initiating drinking. American Journal of Psychiatry 175(4):370–380, 2018. PMID: 29084454

Müller-Oehring, E.M.; Kwon, D.; Nagel, B.J.; Sullivan, E.V.; Chu, W.; Rohlfing, T.; Prouty, D.; Nichols, B.N.; Poline, J.B.; Tapert, S.F.; Brown, S.A.; Cummins, K.; Brumback, T.; Colrain, I.M.; Baker, F.C.; De Bellis, M.D.; Voyvodic, J.T.; Clark, D.B.; Pfefferbaum, A.; and Pohl, K.M. Influences of age, sex, and moderate alcohol drinking on the intrinsic functional architecture of adolescent brains. Cerebral Cortex 28(3):1049–1063, 2018. PMID: 28168274

Clark, D.B.; Martin, C.S.; Chung, T.; Gordon, A.J.; Fiorentino, L.; Tootell, M.; and Rubio, D.M. Screening for underage drinking and DSM-5 alcohol use disorder in rural primary care practice. Journal of Pediatrics 173:214–220, 2016. PMID: 27059911

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The Alcohol Pharmacology Education Partnership: When Can Alcohol Damage the Fetus?

Prenatal alcohol exposure can damage the fetus during the entire pregnancy, but depending on when the exposure occurs determines which organ is affected. Pregnancy can be subdivided into three trimesters, each about twelve weeks long. Important events in fetal development occur during each of these trimesters.

The majority of structural development takes place during the first trimester (the 1st twelve weeks of pregnancy). During the first trimester the musculoskeletal system is formed, along with the internal organ systems (for example, the endocrine system, respiratory tract, digestive tract, and the nervous system). The stage in development when organs are formed is referred to as organogenesis. Prenatal alcohol exposure during the first trimester can cause damage to specific cell populations crucial to organ formation. Some of the most common physical defects include facial abnormalities, small skull circumference, skeletal and muscle problems, and problems with internal organs.

An unfortunate reality is that during the early stages of the first trimester many women do not realize they are pregnant, and if they drink alcohol, they may unknowingly cause structural damage (skeletal and organ) to their unborn child.

Alcohol exposure at during the first trimester is not limited to skeletal and organ damage. Damage to the brain occurs as well, leading to cognitive and behavioral problems.

Alcohol-induced brain damage can occur at any time during pregnancy (and during breast-feeding as well!). During all 3 trimesters (and beyond), the major cells of the brain, the neurons and glia, are formed from stem cells (neurogenesis and gliogenesis, respectively). Then, neurons multiply, grow and establish their branches and connections. The long axons of neurons become surrounded by myelin, which insulates and protects the neurons and allows electrical information to be transmitted along the axon. When a pregnant mother drinks alcohol during periods of neurogenesis, the alcohol actually kills the neural stem cells, reducing neurogenesis. Thus, the fetus can still develop neuronal abnormalities leading to behavioral and learning deficits, without any manifestation of the physical abnormalities described above.

Learn more about neurogenesis and alcohol

Learn more about neurogenesis

module 05 figure 07Figure 5.7The stages of development of the brain and spinal cord over the 3 trimesters are shown. Alcohol affects brain development during all 3 trimesters.

There is a common misconception that the absence of facial abnormalities means that the child’s exposure to alcohol was minimal and therefore the child has a milder form of FAS. On the contrary, drinking during the second and third trimesters can produce children with severe cognitive and behavioral problems in the absence of facial abnormalities.

Alcohol consumed throughout pregnancy (during all three trimesters), can cause a wide variety of effects on the fetus, ranging from brain damage to musculoskeletal damage and growth retardation. In cases of episodic binge drinking (once in a while), injury to the brain and other organs may be more selective. Damage to specific organs (including the brain) will depend on whether the particular organ is undergoing a significant step in development or a growth spurt at the time when alcohol consumption takes place.

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