Perhaps nothing awakens maternal or paternal instincts, or evokes stronger judgments, than seeing a pregnant woman drink. Despite popular belief, however, addictions cannot be controlled by willpower alone. The "Diagnostic and Statistical Manual of Mental Disorders," the DSM-IV, outlines that those with alcohol dependence often drink larger amounts than intended, and they have persistent desires or unsuccessful efforts to cut down or control their drinking. Cause aside, alcohol dependence in pregnancy presents unique challenges, and severe consequences to the mother and fetus alike.
Significance
Despite widespread literature outlining potential life-long effects of alcohol on unborn fetuses exposed to alcohol, some pregnant women still drink. The Substance Abuse and Mental Health Services Administration, or SAMHSA, studied pregnant women, and found that in 2005 to 2006, an estimated 11.8 percent and 16 percent of women ages 15 to 44 and 15 to 17, respectively, used alcohol. In the adolescent age group, mothers drank an average of four drinks a day on the days they drank. Drinking leads to multiple problems for the fetus, not only at birth, but throughout the lifespan.
Effects
Alcohol is the leading preventable cause of mental and physical birth defects in the United States. Experts from The Nemours Foundation, a non-profit organization dedicated to healthy children, notes that each year, one in every 750 infants is born with a pattern of physical, developmental and functional problems, a condition known as fetal alcohol syndrome. Another 40,000 are born with fetal alcohol symptoms. Physical signs of fetal alcohol syndrome include low birth weight, small head circumference, failure to thrive, developmental delays, facial abnormalities like small eye openings and flattened cheekbones, epilepsy and poor coordination. Socially and academically, they have poor social skills, lack of imagination or curiosity, learning difficulties and behavioral problems like hyperactivity, social withdrawal, impulsivity, anxiety and stubbornness. Diagnosis is often missed, and problems intensify with age, often leading to mental health and legal problems, and difficulties living independently.
Identification
Tolerance, a need for markedly increased amounts of alcohol to become intoxicated, and withdrawal symptoms a few hours to days after the last drink, such as hand tremor, sweating, increased heart rate, difficulty sleeping, nausea/vomiting, agitation, hearing, seeing or feeling things, and seizure, may characterize alcohol dependence. These symptoms need not be present, however, for a person to be considered alcohol dependent, according to the DSM-IV. Other indications of alcohol dependence include drinking alcohol in larger amounts or for longer periods than intended, persistent desire or unsuccessful attempts to cut down or stop drinking, spending a great deal of time obtaining alcohol or recovering from drinking, missing important social, occupational or recreational activities because of alcohol, and continued drinking despite knowledge of having a significant physical or psychological problem most likely caused or exacerbated by drinking.
Solution
Many treatment options are available to assist pregnant women in managing alcohol dependence. As considerable evidence illustrates long-lasting changes in the brains of those with alcohol dependence contribute to persistent alcohol craving, and that no amount of alcohol is considered safe during pregnancy, detoxification at a medical facility followed by residential treatment may best serve pregnant women with alcohol dependence. Medications can be quite effective in reducing cravings and alcohol consumption, but they may not be safe for an unborn fetus. Various types of behavior treatment approaches, such as cognitive-behavior therapy, motivational enhancement therapy and 12-step facilitation therapy, equally help alcohol-dependent individuals reduce or stop their drinking.
Warning
Abruptly stopping drinking promotes seizures, which can result in harm and even death to the pregnant mother or the unborn fetus. Severe withdrawal syndrome, including grand mal seizures, the most severe kind, occurs in 2 to 5 percent of those who are alcohol dependent. This syndrome starts fewer than three days after the last drink, and can last up to seven days. Even with treatment, 1 percent of individuals still die. Collaborative consultation with physicians or health care providers remains crucial to prevent this fatality.
References
- "Desk Reference to the Diagnostic Criteria from DSM-IV-TR"; American Psychiatric Association; 2000
- KidsHealth: Fetal Alcohol Syndrome
- National Survey on Drug Use and Health: Alcohol Use among Pregnant Women and Recent Mothers
- American Academy of Family Physicians: Problem Drinking and Alcoholism
