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I have questions about fetal alcohol syndrome. If a woman

I have questions about fetal...
I have questions about fetal alcohol syndrome. If a woman drinks on a daily basis (no more than 2-3 drinks) during the week and has one binge drinking episode (12+ drinks) when she is 4 weeks from her last period (about 2 weeks from conception), what is the risk that her child will have fetal alcohol syndrome or similar alcohol related neurological defects?
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Answered in 27 minutes by:
3/13/2013
Dr. Gupta
Dr. Gupta, Pediatrician
Category: Pediatrics
Satisfied Customers: 8,201
Experience: MD, practicing Pediatrician with 19 years of experience. Member American Academy of Pediatrics.
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PediatricMD :

Hello & welcome to Just Answer!

If you have any questions after reading my answer, be sure to let me know.

PediatricMD :

When a mother drinks, her unborn child is exposed to alcohol. As opposed to a
common misconception, the baby is not protected in the uterus from alcohol exposure.
Excessive drinking by the mother at any time after fertilization of the egg may result in
damage to the developing child.

PediatricMD :

Everyone wants to know “how much is too much”. Although alcohol-related birth
defects are believed to be induced in a dose-response manner, low dose effects are
very difficult to scientifically assess in human populations. Whether there is a threshold
below which alcohol can be consumed without harming the conceptus is not known.
Also, due in part to individual variability (susceptibility), research will not be able to
provide an accurate answer for everyone. To date, studies indicate that most
neurobehavioral effects can be caused by a pregnant woman drinking from 0.5 to 2
ounces of absolute alcohol per day (7 – 28 drinks with each containing 0.5 ounces of
absolute alcohol per week; an 8 oz. can of beer contains the same amount of alcohol as
a glass of table wine or a serving of fortified wine or a 1 oz. shot of liquor). Although this
would indicate that even one drink per day can cause measurable consequences to the
offspring, the drinking patterns of many of the women studied were such that the
majority of the drinks consumed in one week were on only one or two occasions, rather that one drink each day. It is expected that self-reported data showing a relationship
between moderate use and alcohol-related birth defects may often underestimate the
true level of drinking. High peak blood levels of alcohol are important predictors of
adverse outcome. Binge exposures (at least 5 standard drinks on any occasion) result in
a greater frequency of neurological sequellae than the same amount of alcohol
distributed across a greater time course.

PediatricMD :

. Because it is not known at what dosage alcohol damage begins, it is prudent to recommend that pregnant women abstain from alcohol use

PediatricMD :

Source
http://pubs.niaaa.nih.gov/publications/Science/PdfFiles/Supplementary.pdf

PediatricMD :

Now in the situation that you have described, the above information suggests that there would certainly be a small yet significant risk of FAS or ALCOHOL-RELATED BIRTH DEFECTS (ARBDS) in this situation

PediatricMD :

The exact risk may be difficult to quantify, BUT it certainly exists, and this needs to be discussed with the treating doctor, so that early detection & management of the baby can be initiated if there are any symptoms

PediatricMD :

Please leave a positive feedback, & get back for any clarifications

PediatricMD :

Warm regards

Customer:

How can the risk of FAS or ARBDS be a "small yet significant risk"? Are you saying that the risk is small but the consequences related to that risk are significant?

Customer:

To put it another way, is the significant risk that you identified one where I should consider terminating the pregnancy, in light of the risk?

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Dr. Yogindra Vasavada
Dr. Yogindra Vasavada, Pediatrician
Category: Pediatrics
Satisfied Customers: 3,289
Experience: M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
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Hello,
You have not indicated what your term is now. You should also have undergone ultrasound and other antenatal checks. Very early in conception there is only embryo and very few organs are formed.
A cessation of drinking at this early stage will most probably prevent any lasting damage to fetus and a healthy offspring is very likely.
Fetal alcohol syndrome is referring to a condition when mother continues drinking most through out the term.

There is no association between low or moderate prenatal alcohol exposure and birth defects.

Dr. Yogindra Vasavada
Dr. Yogindra Vasavada, Pediatrician
Category: Pediatrics
Satisfied Customers: 3,289
Experience: M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
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Customer reply replied 4 years ago

I was 4 weeks and 3 days from my last menstrual cycle (about 2 weeks after conception) when I stopped drinking, although the drinking before that time was moderate on a daily basis (no more than 1-3 drinks), with one occasion of binge drinking (12+ drinks).

I am now 9.5 weeks since my last period, and fetal growth was on track at the last ultrasound at 8 weeks 4 days. The fetal heartbeat at that time was 160 beats per minute.

To confirm, the likelihood that the child will be healthy is still high, even though I had the binge drinking episode at exactly 4 weeks from my last period? I thought the previous pediatrician indicated that I have a small but significant risk for fetal alcohol syndrome or alcohol related neurological birth defects.

a healthy outcome is very likely and you should continue monthly check-up and ultrasounds till 14-16 weeks and less frequently there after. There is no need to panic and consider termination.
Dr. Yogindra Vasavada
Dr. Yogindra Vasavada, Pediatrician
Category: Pediatrics
Satisfied Customers: 3,289
Experience: M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
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Customer reply replied 4 years ago

Thank you!

You need to carefully monitor yourself for chances of FAS with repeated USG, and follow up with the pediatrician after deliveryThis is NOT an indication for termination of pregnancy though.
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Customer reply replied 4 years ago

Why is that not an indication that the pregnancy should be terminated? I thought you said that there is a significant chance that the child will have fetal alcohol syndrome.

The reason I mentioned SMALL yet significant chance was due to two reasons.
1. There was BINGE drinking involved
2. This occurred during the first trimester, when there is maximum potential for damage to the baby
On the other hand, this was a single episode of Binge drinking, and overall consumption is limited, hence the risk remains small, and certainly not enough to merit an abortion.
Monitoring the baby by level 3 Ultrasound will get us better idea as to whether there are chances of potential damage, and further decision needs to be based on this,
I hope that I have been able explain my self clearly,
Warm regards
Dr. Gupta
Dr. Gupta, Pediatrician
Category: Pediatrics
Satisfied Customers: 8,201
Experience: MD, practicing Pediatrician with 19 years of experience. Member American Academy of Pediatrics.
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You are welcome.
The most common, serious and specific syndrome of alcohol effects in pregnancy—FAS—has been described only for regular/daily high dose alcohol users.
Please read article for details :
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872283/
Good luck to both of you.
Dr. Yogindra Vasavada
Dr. Yogindra Vasavada, Pediatrician
Category: Pediatrics
Satisfied Customers: 3,289
Experience: M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
Verified
Dr. Yogindra Vasavada and 87 other Pediatrics Specialists are ready to help you
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Dr. Yogindra Vasavada
Dr. Yogindra Vasavada
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