A recent rethink about alcohol
Several decades ago, it was believed that it was safe to consume alcohol during pregnancy. However, in the early 1970s, researchers found a pattern: Babies born to mothers with severe alcohol use disorders often developed striking facial features, such as a thin upper lip, a small head, and a flat nasal bridge. These characteristics were often accompanied by a variety of mental and physical challenges throughout life, such as learning disabilities, difficulty thinking, growth problems, heart and kidney problems.
Since then, scientists have discovered that prenatal exposure to alcohol can affect brain and body development, even without affecting the face. Diagnosis requires complex tests and treatments that, due to limited resources and knowledge, many patients are never able to obtain.
Currently, the term fetal alcohol spectrum disorders describes a range of conditions, from immune dysregulation to attention deficit disorders linked to prenatal alcohol exposure. But the exact symptoms are often inconsistent from one patient to the next. For example, although both of Joel’s adopted children were exposed to alcohol in the womb, his daughter does not experience the same developmental problems as her son.
“Alcohol affects the brain in different ways, depending on when the brain is exposed during pregnancy and the amount to which it is exposed, on top of everything else that is going on, whether it be nutritional factors, genetics and other related things. with the mother and fetus,” says Jeffrey Wozniak, a neurobehavioral developmental researcher at the University of Minnesota. “So there’s a lot of variety in terms of brain effects.”
Brain effects of alcohol exposure in utero
While impacts on the face, immune system, hormonal signaling and cognition vary, there are some anatomical features that scientists tend to find more often in the brains of people who were exposed to alcohol prenatally.
Jeffrey Wozniak explains that these people’s brains tend to be smaller overall. “We see this consistently in almost every study that we do.”
Another common feature is related to the corpus callosum, a thick band of neurons that runs from the front of the brain to the back, connecting the right and left hemispheres. “This coordinates everything between the two halves of the brain,” says Jeffrey Wozniak. In cases of people who were exposed to alcohol in the prenatal period, this range tends to be underdeveloped. According to Julie Kable, this can impact a variety of skills.
Many of the children and adults with FASD need more time than most people to process information. For example, Joel explains that if he asks his son to do the dishes, and if Sam waits five minutes to start, Joel knows that his son is not disrespecting him. Sam’s brain is just processing what his father asked him to do, and only then does he stop focusing on his current task (such as playing on the console) to go do the dishes.
In 2011, Jeffrey Wozniak and his team published a study based on brain scans that examined neural activity between the two hemispheres. The investigators have shown that the activity of the two hemispheres is less coordinated in patients with FASD, leading to problems with motor coordination, verbal development and executive functions.
Memory is also affected. Teachers are often able to identify students’ memory problems even if they do not identify the problem as being related to prenatal alcohol exposure. “Sam can absorb knowledge,” says Joel. “But the next day he no longer remembers what [a professora] said, and does not know how to apply this knowledge.”
Deep in the brain’s central region is a small seahorse-shaped area that is responsible for consolidating memories, the hippocampus. The effects of prenatal alcohol exposure in this area are “pretty profound,” says Jeffrey Wozniak, with the hippocampus showing smaller, disorganized cells.
Another region of the brain, called the prefrontal lobe, can also show abnormalities in FASD patients. “This is an area of the brain that is involved in planning, organizing, reasoning and judging,” explains Julie Kable. Julie’s team found that in animal models exposed to alcohol in the womb, the system of blood vessels and veins that carry oxygenated blood around this area of the brain can become disorganized.
This suggests that people with FASD have “more forks in the road, meaning instead of a regular pattern capable of delivering oxygen to areas, that oxygen is distributed in a disorganized way,” adds Julie Kable. This can result, for example, in difficulty replenishing oxygen to areas of the brain that help people deal with frustration.
Although they have already identified these and many other brain features common to these disorders, doctors say that currently brain scans cannot diagnose prenatal alcohol exposure because each case is so different. Most of the time, this disorder is not recognized.
In the early 2000s, Jerrod Brown of Concordia University worked at an adult counseling center in St. Paul, in Minnesota. Patients continued to arrive with what appeared to be unbelievably long lists of diagnoses. “It felt like every time they went to a different doctor, they got a new diagnosis.” Eventually, Jerrod noticed a trend: many of the patients believed their birth mothers might have used alcohol or drugs during pregnancy.
For many years, doctors did not ask pregnant women or their families about their drinking habits. “I think doctors are sometimes afraid to ask because they don’t feel confident about what to do if the answer is yes,” says Christie Petrenko, a DEAF specialist at the Mt. Hope in Rochester, New York.
In the early 2000s, however, studies began to show that targeted therapies could help people exposed to alcohol prenatally. For example, Jukie Kable says that by cooperating with the US Centers for Disease Control and Prevention (CDC), her team found that providing adaptive support could help people with FASD learn and understand math better, a discipline that requires a strong working memory and that is often tricky for people with FASD. A very simple option is to present the number lines vertically instead of horizontally.
“It sounds like a simple thing, but a vertical number line is almost an automatic thing. If we want to add numbers, we go up, and if we want to subtract, we go down,” says Julie Kable. The team also provided tools that help individuals count and keep track of numbers to mitigate short-term memory failures.
Researchers have also developed similar programs to help with executive functions and decision making. “We can no longer allow pediatricians to say things like: Why should I diagnose him if we can’t do anything about it?” says Julie Kable.
Still, there are currently few diagnostic centers in the US and some states do not even have a diagnostic center for these disorders. As diagnosis requires comprehensive assessments, available centers have limited capacity to perform them. Many institutions only look at patients they know were likely to have been exposed to alcohol in utero, which is a fraction of those believed to be actually affected.
Assessments are also very expensive and “take almost a full day, so we try to prioritize this limited resource for people we are sure we can diagnose,” says Christie Petrenko, whose clinic is the only one in the New York area. Christie emphasizes that for children who may need a less intensive assessment, the clinic has consultations where children can get a briefer assessment of their strengths and weaknesses, and referred for further assessment if necessary.
While most experts agree on the basic features of these disorders, there are also slight differences in diagnostic criteria across states, countries, and clinics. A child who shows a deviation of one and a half below the standard norm on a given learning test may be diagnosed in one clinic, while another clinic requires the same child to be two deviations below the norm. This means that each expert can “detect things a little differently depending on how strict or relaxed they are,” says Christie Petrenko.
This can create challenges for researchers struggling to build huge datasets, but it also has more immediate impacts. For example, Christie Petrenko says that individuals with FASD in some US states, such as New York, do not qualify for disability services because the state states that the CDC only has consistent diagnostic criteria for alcohol syndrome. fetal, not for the full spectrum of disorders.
Information and awareness has also suffered, although Susan Carlson hopes that will change with the FASD Respect Act, which currently has nearly 50 supporters in the House of Representatives. Joel Sheagren says he was shocked at how little he knew about the ways in which alcohol can affect fetal development. Joel is now working on a documentary about the effects of prenatal alcohol exposure. “This is an extremely prevalent issue that does not have the support or awareness [suficientes]” says Joel. “It’s just a bizarre situation.”
This article was originally published in English on site nationalgeographic.com