Baby Steps

Thursday, July 28th, 2011
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The Effects of Alcohol Use during Pregnancy

By Angela Thomas

Last year, Chicago pediatrician Dr. Ira Chasnoff was here in the state to report on his findings regarding alcohol and drug use of pregnant women on Hawaii Island. He is best known as a national expert on substance abuse screening, referral, intervention and treatment of pregnant and parenting moms. His work specializing in women and children reaches across the country and his model of prevention work is being implemented in many communities both in the United States as well as other countries. His ambitious study was presented at the state capitol and included results collected from the first 1000 women screened.

The results clearly show that we, Hawaii Island, have a problem. Our numbers show that a large percentage of women use some drug or chemical (alcohol, marijuana, cigarettes or other drugs) that can impede or affect their child’s development in utero. And many use more than one substance.

Chasnoff’s message is simple and clear – we have a moral obligation to prevent the many potential developmental delays and the lack of brain growth found in our young children. And we begin this prevention effort by spreading the message that “No amount of alcohol or drug use is safe during pregnancy”.

The science of brain development has been popularized and with the help of modern medical technology, studies of the brain are now able to guide the way we work with children – both in terms of teaching strategies and in terms of determining therapies for developmental delays. We are also able to study much more about the design and function of the brain and how it affects learning and behavior.

Dr. Chasnoff has been here in the past to speak about substance abuse recovery and treatment, but most of his presentations focused on fetal alcohol syndrome. The reason for this is that most people who use other drugs began with alcohol. “Methamphetamine users don’t begin with ‘ice’ but rather move through a progression of drugs beginning with alcohol,” Chasnoff says. This phenomenon has caused the controversy around the effects of “ice” on newborns. Because women who use crystal meth are poly drug users, meaning they use other substances including alcohol and tobacco, it is sometimes difficult to determine which substance is the cause of particular problems in newborns. However, clear research has been done on the effects of alcohol and these are the results he shared.

Chasnoff spoke of the critical periods in pregnancy when the emphasis of the fetus’s growth is focused on the brain. For example, during the first trimester the center of the brain, the limbic system, is forming. Within the limbic system is a very important area called the corpus callosum. This is the part of the brain that is responsible for sensory integration and output. It’s like a message center that receives information, stores it in memory and then sends the message to the front of the brain to direct behavior. Chasnoff used the example of a child seeing a truck coming down the street she was about to cross. The visual image travels from the eye through the optic nerve to the occipital lobe (the part of the brain responsible for sight) then moves forward through the corpus callosum to the fore brain to release dopamine that regulates behavior. In this case the message would be to stop walking. In cases where the corpus callosum is not fully formed, or is changed in its form, the message might not produce the desired result. In fact, in this case the child saw the truck, but her message center didn’t translate the message appropriately and she kept walking. Fortunately the truck stopped in time, but the child’s response was “I saw the truck but I didn’t think it would get here while I was crossing the street.”

Sensory integration is basically the ability to take information in and to control the output. In the case of the child and the truck, this means taking visual input (seeing the truck coming) and creating a motor output (to stop walking). This area is also responsible for emotional regulation and behaviors, morality, and higher level cognitive functioning. It is also the area that receives social cues and regulates the way we act with others.

Many children suffer from this disorder and are enrolled in our schools. While they can recite the rules to you, they may not understand how to regulate their own behavior to actually follow the rules. Internalizing information is an executive functioning skill and children whose corpus callosum has been affected, are not able to do this well.

In the third trimester of a pregnancy a child’s brain grows significantly. While the actual size of the brain is limited by the child’s skull, the brain itself is developing in complexity. It begins to fold in on itself creating the folds we usually recognize as brain mass. The more folds a brain has, the more surface area it creates and the more surface area, the higher a child’s IQ. Children exposed to alcohol during this period develop fewer folds and therefore may have lower cognitive functioning. This phenomenon can also be responsible for mental retardation if fewer folds form; in fact, a largest percentage of retardation in our country is caused by alcohol use during pregnancy. The frustrating fact is it is totally preventable.

Pregnancy holds many risks, but alcohol or drug use during this period is guaranteed to alter your child’s development. Even with the slightest amount of alcohol a child’s likelihood towards juvenile delinquent behavior increases, more alcohol can result in decreases in the child’s IQ. So if you know someone who is pregnant, remind them how important it is not to drink. If you are pregnant, don’t drink. We need to offer children the opportunity to be all that they can be. After all, our children are the future and we need strong, vital, well-functioning adults making the decisions about our resources, our land and our country.

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