Madison NORML

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July 21, 2008

Wisconsin may have highest risk for infants born with FAS

At five months, the fetus growing inside Kathy Kidd-Wuest was old enough to suck his thumb if so inclined, or get the hiccups.

He was 10 inches long and weighed nearly a pound. Kidd-Wuest, who didn't know she was pregnant, was unaware of him, but he was aware of her. He was beginning to recognize the sound of her heartbeat. He was starting to recognize her voice too.

He even could hear sounds from the world outside – his mother's world.

The sounds that filled the Country Corners bar that night were the jangling chords of country songs. That was where Kidd-Wuest, 24, and her husband, Phil, had chosen to spend their night out. The Madison couple had left their 4-year-old daughter at home with a baby sitter.

Kidd-Wuest felt herself relaxing after a long week at work.

She finished her first drink and ordered another. Then another. Kidd-Wuest had five drinks in all. They cost $2.50 a pop. That seemed a bargain. But 18 years later, Kidd-Wuest still is paying the price for drinking during the first five months of her pregnancy.

So is her son, now 18, who was born with fetal alcohol syndrome.

The riskiest state

Each year as many as 200 Wisconsin newborns show the effects of prenatal alcohol exposure, according to the University of Wisconsin's Fetal Alcohol Spectrum Disorders Treatment Outreach Project.

Dr. Georgiana Wilton, an associate scientist at the University of Wisconsin Department of Family Medicine in Madison, believes it's likely the state leads the nation in that category, though such data is not kept by every state.

Prenatal alcohol exposure is a leading cause of mental retardation and learning disabilities nationwide. By that standard, Wisconsin babies are at greatest risk.

Wisconsin leads the nation in reported drinking among women of childbearing age. The state has the highest prevalence of frequent alcohol consumption among women ages 18 to 44, according to a 2006 risk-factor survey by the Centers for Disease Control and Prevention.

How much drinking is too much remains unclear and likely varies from one woman to another.What is known is that the more a woman drinks, the greater the chance problems will develop.

"Typically the research has shown most babies with FAS were born to moms who drank a lot of alcohol, and at an alcoholic level," Wilton said. "I have not worked with a woman who had one drink and caused FAS."

Effects of drinking

A pregnant woman provides the fetus vital nutrients, oxygen, antibodies and hormones through the placenta. The placenta filters out some substances that might harm the fetus.

Alcohol is not one of those. Instead, it acts as a teratogen. The word is derived from the Greek word for monster, "tera." It refers to any agent causing the malformation of a fetus. Alcohol is such an agent. A fetus absorbs every drop of an alcoholic beverage consumed by its mother and at the same level of concentration. But a fetus's liver is not mature enough to detoxify alcohol.

Exposure to alcohol puts a fetus at risk of a cluster of preventable developmental problems known collectively as fetal alcohol syndrome or the related fetal alcohol spectrum disorders — a term describing the range of effects that can occur in any individual whose mother drank alcohol during pregnancy.

Brain damage, facial deformities, growth deficits, heart, liver and kidney defects characterize fetal alcohol syndrome, as do difficulties with vision, hearing, learning, attention, memory and problem solving.

An individual with fetal alcohol syndrome can incur a lifetime health cost of more than $860,000, although the National Organization on Fetal Alcohol Syndrome says costs can be as high as $4.2 million. It costs the U.S. $5.4 billion annually in direct and indirect costs. Direct costs are estimated at $3.9 billion annually, which includes healthcare costs as well as costs associated with social services and incarceration.

Sixty percent of individuals with FASD will end up in an institution (mental health facility or prison). And it is estimated that almost 70 percent of the children in foster care are affected by prenatal alcohol exposure in varying degrees.

As long as doctors still are unsure of how much alcohol a pregnant woman has to drink to place her child at risk for FASD, the best public health message is abstinence.

"There's no safe time, no safe amount, no safe alcohol," Wilton said.

By the time Justin was 10, he was diagnosed with severe attention deficit disorder, mild to moderate mental retardation, hemi-cerebral palsy on the left side of his body, static encephalopathy and lordosis (curvature of the lower spine), which eventually will push up on his rib cage, lungs and chest to the point respiratory and/or cardiac failure may occur.

Today, Justin stands 5 feet 7 and weighs 199 pounds. He has difficulty discerning proper food serving amounts, and needs supervision to operate appliances. Until a year and half ago he couldn't control his bodily functions. He has no friends.

"It's exhausting," Kidd-Wuest said. "None of us live in a normal household. This is not a daily thing, it's a forever thing."