Researchers take a closer look at Fetal Alcohol Syndrome
By Katie Scarvey
KANNAPOLIS — So why would a pre-eminent researcher in fetal alcohol spectrum disorders (FASD) end up at the Nutrition Research Institute?
It’s a valid question, and Dr. Philip May — who admits that he used to be “nutritionally ignorant” — attempted to answer it recently during an Appetite for Life lecture at the N.C. Research Campus, presented by the University of North Carolina Nutrition Research Institute. Maternal nutrition, May’s research suggests, can have a protective effect on children who are exposed to alcohol in utero.
May, who graduated from Catawba College in 1969, is one of the newest faculty members at the Nutrition Research Institute.
He led the first epidemiology study on FAS and directed the first major Fetal Alcohol prevention program.
May says that 30 years ago, some scientists were saying prenatal alcohol exposure might well be the leading cause of mental deficiency in the world. He didn’t really believe it at the time, he says, but his research has convinced him otherwise. In fact, he believes that 2 percent to 7 percent of school populations will fall somewhere on the fetal alcohol spectrum.
So how does a mother’s drinking affect the fetus?
“All parts of the brain are damaged if the drinking is constant and heavy,” May emphasized. Damage may be mild or severe — and why some damage is mild and some is severe, when the level of alcohol exposure is similar, is an important question.
Mother and baby have essentially the same blood alcohol concentration, May says. And that is a problem for the fetus, since alcohol is a teratogen, an agent that can cause a birth defect.
Examining children’s faces has long been used to help determine whether fetal alcohol syndrome is present. An unusually short eye opening, or “palpebral fissure,” for example, is one sign that the brain hasn’t developed properly.
Other visual cues to possible fetal alcohol syndrome: short nose, flat mid-face, smooth upper lip with no border. Minor ear anomalies and abnormal hand creases may be present as well.
While there are certain classic physical signs, researchers are now finding that there are “a lot of different faces” that show up with fetal alcohol syndrome, May says, noting that severe cases can’t always be spotted.
Alcohol is most likely to damage the central nervous system, May said. Along with facial dysmorphology, there may be psychological and behavioral problems.
The research that May’s teams have done indicates that the severity of FAS is likely to increase with each subsequent child. In other words, a woman’s fourth child would be more likely to show signs of FAS than her firstborn child.
May’s research team has done a great deal of research in South Africa, which has the highest fetal alcohol syndrome rates in the world.
The team focused on studying first graders in order to determine the prevalence of FAS. Using a multi-pronged, multi-disciplinary approach, with geneticists, psychologists and educational diagnosticians all playing a role
Since undertaking their research in South Africa in 1996, they have diagnosed almost 1,300 cases of FAS.
May’s decision to pursue research there came about because a dysmorphologist he knew in South Africa had suggested that a startlingly high number of children he saw in his clinic — perhaps 35 percent — appeared to have FAS.
As they began to examine cultural habits closely, they realized that alcohol was the only drug people were using, and that it was typically ingested on the weekends as a form of entertainment— binge drinking, which produces high levels of blood alcohol.
While people often assume it would be difficult or impossible to gather information about maternal alcohol use, it’s a myth that you can’t get accurate information from women about their behavior during pregnancy, says May. He says researchers have found a way to sequence questions so that women are more likely to be forthcoming
Mother’s nutritionis important
When they first started asking women about their diet, the questions were a smokescreen, May says. They were mainly interested in alcohol intake, and looking at overall nutrition was a way to delve into the topic. (“What did you eat for lunch? For dinner? What did you drink with dinner? How much?”)
But they began to see a pattern.
Many of the women who had babies with FAS had a very low body mass. In other words, “they were skinny,” May says. Mothers of children with fewer problems were typically more robust, with a body mass of 25 or more. That led researchers to posit that the overall nutrition of the mothers who drank while they were pregnant was vitally important in a child’s developmental outcome. Researchers are also interested in how women might vary in how their bodies metabolize food and alcohol.
Binge drinking — usually beer — caused most cases. May’s research has shown that FAS babies are born to women who drink almost six drinks a day for two days a week. Mothers of children with partial fetal alcohol syndrome were drinking 4 drinks a day two days a week.
In South Africa, an estimated 13.6 percent to 21 percent of all children are affected by FASD in one area and 18 percent to 25 percent in another area — an almost unbelievably high rate, May says.
In response, his team has helped to increase awareness and urge women not to drink during pregnancy.
Still, the effects are not completely irreversible, May says.
“Early intervention can help the brain heal itself,” he says. “Kids (who are affected) can develop much better than we thought 30 years ago.
Long-term studies are being done to track children with FAS. Researchers are hoping to be able to eventually identify FAS early — at 12-18 months, so that early intervention is a possibility.
“Early diagnosis does lead to better chances,” May says. FAS children who get language and literacy training have been shown to make dramatic developmental progress in a relatively short period of time.
Besides cognitive stimulation May speculates that giving affected children adequate levels of choline and omega 3s that feed the central nervous system will help them progress.
For expectant mothers, the nutrition aspect is something that can be influenced, May says, even by something as simple as giving Ensure as a supplement for women with low body mass who might be at high risk of having a child with FAS.
May believes that the incidence of FAS is greater than has previously been estimated. Old estimates put the number at three per 1,000 children. His research indicates that the incidence is more than twice that. And if you include the full spectrum of disorders, the news is worse. His research suggests that perhaps 5 percent of all children are affected, though many will likely never be identified.
“If we don’t actively seek FASD cases, we won’t find the majority of them,” May said.
His research team is undertaking a study of fetal alcohol syndrome in a North Carolina county that hasn’t been made public yet.