Vol. 2 No. 2 Specials

Crack babies – the American fetuses infamously forced to do unwitting lines of coke – have in the past few decades generated enormous public sympathy and concern. Yet there is little scientific evidence to suggest that they consistently manifest any severe long-term symptoms. Instead, imagine a substance known to be far more damaging to the fetus than cocaine, one whose in utero effects collect into an entire spectrum of disorders; a drug so noxious to an unborn child that maternal ingestion during pregnancy is the number one cause of mental retardation in the Western world. Next time you’re savoring a glass of Beaujolais or pounding a six-pack, stop drinking for three seconds to think about it. Or six. Or nine months, if you’re pregnant.

Alcohol is a teratogen, a substance that causes malformation of a developing embryo. Like Russian roulette with the barrel at the belly, ingesting alcohol while pregnant can result in a number of disastrous phenotypic permutations. These fall under the banner of fetal alcohol spectrum disorder (FASD), along whose length are found a number of different diagnoses, such as the extremely disabling fetal alcohol syndrome (FAS) and the milder yet still serious fetal alcohol effects (FAE). That the disabilities resulting from in utero alcohol exposure have been categorized along a spectrum indicates their great breath and variability in severity. Still, they generally share certain consequences, including problems with feeding as infants, attention, impulse control, verbal aptitude, abstract thinking, mathematical ability, anger and aggression management, social interaction, memory, fine and gross motor skills, inhibition, and judgment. The obstacles faced by an individual with FAS or FAE are manyfold, with large clusters of multiple deficits blocking normal cognitive and behavioral function.

Children with the more severe fetal alcohol syndrome are forced to advertise their illness on a daily basis; just as their minds are marked by the in-utero exposure, so too are their physical profiles. Their bodies never seem to catch up. Before delivery, they develop at a significantly slower rate, culminating in a birth weight that almost always falls markedly below all gestational averages. Once out of the womb, they tend to be hard to calm and even harder to feed, and independent of their nutritional intake they continue to lag behind their baby peers in size. This pattern of low height and weight persists into adolescence and adulthood.

Despite characteristic facial features, it is extremely challenging for researchers to determine the pervasiveness of fetal alcohol syndrome. Clinicians continue to face ambiguous diagnoses and unreliable self-reported drinking histories, as they attempt to map the spread of the illness. Prevalence rates vary widely depending on the geographical, ethnic, national, religious, and socioeconomic qualities of the population in question. The Centers for Disease Control and Prevention estimates that for every 1000 live births in the United States, (which discounts the most serious prenatal effect of alcohol exposure – fetal death), 0.2 to 1.5 have FAS, depending on the population considered. This figure excludes the majority of fetuses poisoned by alcohol, whose injuries may not warrant a fullblown FAS diagnosis, but who are nevertheless clinically disabled.