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Article Excerpt
Background
For a long time numerous studies have shown that alcohol and other drug consumption during fetal gestation causes diverse health problems for the mother and child (American Academy of Pediatrics [AAP] Committee on Substance Abuse 1995; Centers for Disease Control [CDC] 1989; Cnattingius et al. 2000; Huestis & Choo 2002; Espinoza 1999; Kullander & Kallen 1971; Lacassie & Nunez 2000; Lemoine, Harouseau, Borteryu & Menuet 2003; Mann 2004; Sokol 1981). The effects are lifelong, not limited to the embryonic and fetal stages, and can also be observed in the placenta (Larsen & Graem 1999; Vander Veen & Fox 1982). One of the most common effects seen in newborn babies is low birth weight, which can result from preterm gestation (before 37 weeks) or restricted intrauterine growth.
According to the World Health Organization (WHO), a weight below 2,500 grams is considered to be low birth weight. Epidemiological studies show that newborn babies who weigh less than 2,500 grams at birth have 20 more chances of dying than those born weighing more. Low birth weight is also associated with greater morbidity and less growth and development, as well as chronic diseases, as well as fetal, maternal and environmental diseases. It is related to the mother's body mass index (BMI); the altitude at which she resides; her age (very young mothers have smaller children); diseases such as acute diabetes, hypertension, syphilis, and other infectious diseases such as human immuno deficiency virus (HIV); the mother's diet and nutrition; poverty; extreme workloads; and tobacco, alcohol and caffeine, as well as other, illegal drugs. The sum of these factors can increase the negative effects on the fetus.
In its 2002 Action Plan, the United Nations (UN) established lowering the incidence of low weight in newborn babies as one of their goals in "A World for Children." This reduction is also part of the UN's Millennium Development Goals (MDG), with the aim of decreasing the number of infant deaths. Low birth weight is a major indicator for monitoring progress in achieving these objectives. More than 20 million children (15.5% of all births) are born with low birth weight, and 95.6% are in developing countries. Thus, 16% of newborns in these countries present low birth weight, whereas the figure for developed countries is less than half of this (7%).
In Uruguay, according to the most recent report of Sistema Informatico Pernatal (SIP) (Sistema Informatico Perinatal en el Uruguay 2001), the percentage of newborns presenting low birth weight is 10.1% in the public hospital sector and 6.4% in the private hospital sector, with an increase clearly evident in both. According to the Pan-American Health Organization (PAHO), one of the main ways of preventing low birth weight is basic prenatal assistance. An adolescent mother is expected to mature not only biologically and psychologically but also socially. The menarche, which in many cases now begins when a girl is 10 years old or younger, may lead to mothers who have matured but who are still physically small. This, combined with nutritional deficiencies that result in anemia, can also predispose their children to low birth weight. They have not yet achieved maturity at a psychological and social level, and that can affect the newborn as much as the mother herself. The ideal reproductive age is considered to be between 20 and 34 years old; mothers younger than 20 years of age and those older than 34 incur social and reproductive risks.
When we want to determine the prevalence of some of the factors in low birth weight, such as drugs, surveys can be unreliable if they are based exclusively on self-declaration of consumption and if the respondent recognizes that certain responses may imply that they acted irresponsibly (Derauf, Katz & Easa 2003). Behavior concerning alcohol consumption is also linked to cultural guidelines. In the River Plate area in Uruguay and Argentina, up until 20 years ago alcohol was part of a family's diet because of a marked Mediterranean influence. However, this cultural pattern began to change into more "harmful, risky and dangerous" forms, according to Miguez (2004).
Psychoactive substance consumption as a risk factor
Alcohol consumption is the main problem, considering its popularity among Uruguay's adult population; almost 50% of the female population consumes alcohol (Junta Nacional de Drogas 2001), 32% tobacco and 5.3% illegal drugs. Fetal exposure to other substances, prescribed by medical doctors, also has its effects and must be taken into account when evaluating the results obtained. Effects vary according to maternal use, health and nutrition and the mother's socioeconomic situation.
As for the risks associated with alcohol consumption, we find that alcohol can be harmful to practically every organ and system in the body. It is psychoactive and can cause alterations in most, if not all, cerebral systems and structures. Alcohol consumption is also linked to a series of risky behaviors such as unsafe sexual relations and use of other psychoactive substances. Therefore alcohol use shows a high level of co-morbidity with disorders connected with the use of other substances--nicotine dependence in particular--and with sexually transmitted diseases. Recent studies also imply that perhaps there is a link between disorders caused by alcohol and HIV/Acquired immune deficiency syndrome (AIDS).
Alcohol consumption in women during their fertile years can increase the risk of unplanned pregnancy or prenatal exposure of the fetus to alcohol and can contribute to congenital defects and growth anomalies, including fetal alcohol syndrome. There is still controversy about the levels of alcohol capable of producing fetal problems during pregnancy. However, the American Academy of Pediatrics suggests that "there is no safe figure until new studies are available to science" (AAP Committee on Substance Abuse and Committee on Children with Disabilities 2000). Alcohol has proven to be a neuroteratogen (Calvo Botella 2003; Guerri 1998c; Jones & Smith 1973a) to lower-than-needed thresholds, producing alterations in fetal growth and persistent inhibitory effects on deoxyeibonucleic acid (DNA) synthesis and irreversible neuronal loss.
Alcohol consumption among women
Alcohol and other drug consumption during gestation is also linked to the relationship between the mother and her health team and the information that is given to her. This implies an opportunity for the health team to provide accurate information. The World Health Organization has already encouraged all countries to "consider the harmful use of alcohol, particularly in youth and pregnant women" (WHO 2004).
Recent epidemiological data in Uruguay indicate a slow increase in female drug consumption and an increase in prevalence rates, and show that women start consuming drugs at younger ages than in previous years (Junta Nacional de Drogas 2001). The highest prevalence is found in the age range that also has the higher pregnancy rate (Taylor et al. 2007).
The effects of alcohol on the fetus were first recognized in terms of the fetal alcohol syndrome, or FAS, a group of physical and behavioral anomalies that include prenatal and postnatal deficiencies. The syndrome is defined as including a delay in intrauterine growth (Jones et al. 1973b; Jouitteau, Massias & Sanyas 2000; Canada's Drug Strategy Division 2000), defects in the central nervous system that result in mental retardation (Guerri & Renau-Piqueras 1997), and facial defects characterized by microcephaly, a flat face, an indistinct philtrum, a thin upper lip and a short, snub nose, as well as small palpebral indentations (Gerberding, Cordero & Floyd 2005).
The FAS concept was later amplified, adding the term fetal alcohol effect (FAE) for cases in which only one of the characteristics found in FAS appeared or whenever there was a problem during pregnancy that could be related to alcohol. It is estimated that the incidence of FAE is double that of FAS. Major or minor problems such as low birth weight and mental and motor difficulties generally appear in a child that has FAE. In recent years many terms have been used to describe the effects of alcohol on the fetus, including FAE, alcohol-related birth defects (ABD) and alcohol-related development/neurological disorder (ARND).
Eventually a new term was introduced: fetal alcohol spectrum disorder (FASD). In April 2004 some...
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