FASD Myths & Commonly Asked Questions
In researching our previous blog post What is FASD & Why is Diagnosis Important, researchers, advocates and mothers with lived experience expressed their concerns with the amount of FASD misinformation, not just online but from health professionals.
In 2009, Australia’s guidelines on alcohol consumption while pregnant changed from low to no alcohol intake. Prior to 2009, the National Health and Medical Research Council deemed it safe to drink up to two standard drinks per day and no more than ten per week during pregnancy.
‘My doctor told me that it was okay to continue to drink wine during pregnancy. He said I could have a glass of wine at night with dinner. He said it might even help me relax and improve circulation.’
Melissa - Participant in FASD My Story
Australia didn’t have it’s own diagnostic guidelines for FASD until 2016, despite more children being affected each year by FASD in Australia than Autism Spectrum Disorder, Spina Bifida, Cerebral Palsy, Down Syndrome and SIDS combined, according to NOFASD’s report.
We were also slow to implement pregnancy warning labels on alcohol. Australian Food Ministers approved all alcoholic beverages for displaying a pregnancy warning label in 2020, with a three-year transition period for companies to comply. In comparison, the United States has had these labels since 1989.
It's not hard to see why our ideas on alcohol and pregnancy fall into a grey area. But now we better understand the risk of combining alcohol and pregnancy and can provide soon-to-be parents with the correct information. Here are some of the commonly asked questions on FASD and consuming alcohol during pregnancy.
Are facial features the best indicator of FASD?
Presenting with all three of the “typical” facial anomalies associated with FASD is one of three diagnostic criteria, along with evidence of neurological impairment and prenatal alcohol exposure.
What are the three facial features of fetal alcohol syndrome? The “typical” FASD facial features include a thin upper lip, a smooth groove above the lip and additional space between the eyes.
However, facial features are not the best indicator of FASD, as 80% of people with FASD don’t have the three typical identifiable facial features. In the first trimester, alcohol exposure may leave physical signs, but in second to third-trimester alcohol exposure (when the body structures have formed), visible cues may not be present, but brain damage can still occur.
Does the placenta filter out alcohol?
The temporary pregnancy organ, the placenta, provides an unborn baby with oxygen and nutrients. It also removes harmful waste and carbon dioxide to protect the baby, acting as it’s kidney’s liver and lungs until birth.
Some believe it can protect a baby from alcohol, or are at least unsure if it does. This 2021 FARE survey of 1,497 pregnant/planning to be pregnant women who occasionally drink alcohol found 44% were unsure if the placenta filters out some of the alcohol.
Alcohol does cross the placenta, with a foetus exposed to the same blood level of alcohol as the mother. As the fetus doesn’t yet have a fully formed liver, it can’t process the alcohol at the same rate as the mother. This means it can hold the same blood alcohol content as a mother or higher, and remain at that level for longer.
Is a FASD diagnosis bad?
Without a name, there is no place to begin. Diagnosis can lead to life-changing treatment options. The more a multidisciplinary team can understand what is going on, the more can be done to help the individual adapt to their environment.
A diagnosis is especially important to help individuals make-sense of themselves and their experience in the world. It can also foster greater understanding and communication in relationships with loved ones, health professionals and educators. When the individual’s support network is aware of a FASD diagnosis, they can understand brain-based differences, which affect behaviour, emotions and learning.
‘Oh, thank God. That means I’m not the problem, I have a problem. I can deal with that.’
15-year-old boy at Banksia Hill on receiving a FASD diagnosis
FASD only affects women from low socioeconomic backgrounds
Seen in Dr Carmela Pestell’s presentation on FASD myths, around 60% of women in Australia drink during pregnancy; around half stop once realising they are pregnant, but the rest continue to drink throughout their pregnancy.
From a 2010 study, Dr Pestell highlights women from middle to higher income families tend to drink more, 38% from the middle sector, 51-52% in the higher sector.
‘I was never asked if I’d consumed alcohol during pregnancy, you see. As an educated white woman from a middle-class background, I didn’t fit the stereotypes that most of society believe to be true (which are actually incorrect).’
A Birth Mother’s Story - NO FASD
Is there a safe amount of alcohol during pregnancy?
‘The amount of alcohol necessary for fetal damage is unclear, and it remains debatable whether there is a threshold level below which alcohol does not harm the fetus.’ - Medical Journal Australia
Researchers don’t know what a safe level of alcohol to consume while pregnant is, there are too many variables. The Alcohol Think Again campaign highlights we do know alcohol affects the foetus throughout all stages of pregnancy, so the safest amount is zero. There is also no type of alcohol that is safer to consume while pregnant than another, one standard drink of wine or spirits is still one standard drink of alcohol.
If I drink while pregnant will my child have FASD?
If a mother drinks during pregnancy, it doesn’t mean the child will have FASD. It’s unknown why some children experience the effects of alcohol during pregnant and others don’t.
The variables preventing researchers from suggesting any safe amount to drink include diet, genetics, cortisol levels and other lifestyle factors.
FASD is the mother’s fault
There’s a nasty stigma putting mothers at sole blame for alcohol consumption in pregnancy. People drink for all sorts of different reasons. There may be psychosocial stressors, partner influence, dealing with substance use, societal factors, misinformation or having been told by a health professional that it is ok. Kathleen Mitchell, Vice President and International Spokesperson of NOFAS said:
‘In over 20 years of working on FASD prevention, I have never met a mum who intentionally wanted to harm her unborn baby. Either she didn’t know that alcohol was harmful during pregnancy or she needed help to stop drinking.’
It’s everyone’s role to support mothers to not drink during pregnancy. Parents need support and access to resources to stop or reduce alcohol consumption during pregnancy. Health professionals should be having more conversations on alcohol consumption in all stages of pregnancy, and fostering these conversations in a non-judgemental way, so mothers may be more likely to disclose alcohol consumption and seek support services.
Managing FASD
With more open conversations, disclosure of alcohol consumption during pregnancy could result in early intervention and diagnosis for individuals with FASD. What support services are available for children with FASD?
Services like occupational therapy can support individuals with FASD to develop cognitive, social and independent living skills or strategies to assist with sensory processing. Speech therapy can be helpful to develop language or communication skills, and physiotherapy can help with fine and gross motor skill development.
These supports may be accessed through an NDIS plan for participants with FASD, as well as support to assist with enjoyment and participation in daily-life and the community.
NOFASD Australia's NDIS Portal is a collaboration with the agency to provide more information on how the scheme can support individuals with FASD.
As well as for parents and caregivers, NDIS providers, Local Area Coordinators or Support Coordinators may also find the information in the Portal useful.
Ruby Wheeler