Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ digital
    • Subscribe to CMAJ print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ digital
    • Subscribe to CMAJ print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Instagram
  • Listen to CMAJ podcasts
Commentary

Fetal alcohol spectrum disorder: reconsidering blame

Anna Maria Abadir and Abel Ickowicz
CMAJ February 16, 2016 188 (3) 171-172; DOI: https://doi.org/10.1503/cmaj.151425
Anna Maria Abadir
Department of Psychiatry (Abadir, Ickowicz), University of Toronto; Department of Psychiatry (Ickowicz), The Hospital for Sick Kids, Toronto, Ont.
BHSC MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Abel Ickowicz
Department of Psychiatry (Abadir, Ickowicz), University of Toronto; Department of Psychiatry (Ickowicz), The Hospital for Sick Kids, Toronto, Ont.
MD MHSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: [email protected]
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Fetal alcohol spectrum disorder (FASD) is a widely accepted umbrella term used to encompass various effects of prenatal exposure to alcohol. The revised Canadian guideline for the diagnosis of FASD describes in detail the diagnostic requirements informed by evidence, such as sentinel facial features and impairment in specific neurodevelopmental capacities.1 Although the guideline emphasizes early detection and diagnosis of FASD as hallmarks for the provision of timely care and resources to those affected, far less attention is given to biological mothers.2 Here, we question and discuss common beliefs that have led to negative attitudes toward biological mothers of children with FASD.

The nefarious effects of prenatal alcohol exposure have been recognized for several hundred years;3 albeit, reference to alcohol teratogenicity appears much later in the health literature.4 Mothers of children with FASD are often viewed as having wilful problematic patterns of alcohol use, and being neglectful and unfit parents. Many people consider that drinking alcohol during pregnancy is a selfish act in which the mother gives more weight to her immediate inclinations than to the potential optimal health of her unborn child, either by intent or neglect. The erroneous belief that alcohol use disorder is a “disorder of will,” and hence these mothers can and should make different choices, leads to an assumption that the FASD is entirely the mother’s fault. However, ascribing blame to biological mothers of children with FASD is often unjustified, and careful reflection on emerging evidence is prudent.

The belief that pregnant women always drink alcohol deliberately while aware of their pregnancies and aware of the effects of alcohol on their progeny presupposes that they make a conscious decision to ignore information on harms and that fathers have no role to play. Population and qualitative studies2,5,6 have shown that many mothers of children with FASD do not have an alcohol use disorder. In many instances, mothers were unaware of the pregnancy at the time of alcohol consumption. A qualitative study in New Zealand that involved biological mothers living with their children affected by FASD, showed that many were ignorant of the effects of alcohol exposure on their developing offspring and had no knowledge of the potential risk of FASD while pregnant.2 Not surprisingly, in this study mothers at the highest risk of having children with FASD came from lower socioeconomic backgrounds, had lower education levels, had partners who used alcohol regularly, had inadequate nutrition during pregnancy, were undergoing stress or abuse during pregnancy and had reduced access to prenatal care.2

The teratogenic effects caused by alcohol exposure during pregnancy occur through complex gene–environment interactions during early development of the embryo, sometimes as early as gamete formation.7 Studies of alcohol exposure in rodents have identified important epigenetic effects in DNA methylation and histone modifications that result in changes in gene expression. It is important to note that the teratogenic potential of alcohol is present before conception and may affect would-be fathers as well as mothers. The impact of alcohol use by men during the preconception period and its consequences on progeny was recognized more than 100 years ago.7 Alcohol use by fathers before children are conceived has been associated with reduced birth weight and cognitive impairments.7 In the New Zealand study, many women stated that their husband or partner was drinking heavily at the time of conception.2

The revised FASD guideline appropriately identifies primary care physicians and front-line service providers as having a critical role in screening pregnant women for problematic alcohol and substance use. The guideline also stresses that abstinence should be recommended for all women during pregnancy to ensure the safest outcome for the fetus.1 In addition, we suggest that a strong emphasis should be placed on the avoidance of alcohol use before conception by men and women who are contemplating having children. Although it still plays an important role during prenatal care, education about the teratogenic risk associated with alcohol use needs to start much earlier. It is also necessary to take into consideration that the population at highest risk is characterized by marked psychosocial adversity;2 consequently, education alone falls short when the social determinants of health that impede patient access to care are ignored.

There is a clear benefit in taking active steps toward child protection when neglect or abuse is identified; however, it should be recognized that not all mothers of children with FASD are abusive or neglectful. Mothers of children with FASD often feel abandoned by the health care system and express much frustration at the attitudes of health care providers toward them.6 A blanketed attitude of blame and marginalization toward these mothers might indeed affect their sense of competency and ability to parent a child who already faces many challenges. Furthermore, blame becomes irrelevant when clinicians, policy-makers and the public collectively and actively assume responsibility for addressing the manifest determinants of health that contribute to the persistence of FASD.

There is no question that alcohol has a toxic effect on the unborn child. Our increasing understanding of the multifactorial nature of this phenomenon highlights the need to broaden our interventions, particularly in the realms of public health and prevention. We cannot globally attribute intentional neglect to all mothers of children with FASD. Assessments should be made on a case-by-case basis. Mothers and fathers who have children with FASD deserve to be treated with consideration and respect.

Key points
  • Many mothers of children with fetal alcohol spectrum disorder (FASD) do not have problematic patterns of alcohol use and are not neglectful, unfit parents.

  • The social determinants of health have a major role in the cause of FASD.

  • Preconception consumption of alcohol by would-be fathers and mothers is linked to FASD.

  • Preventive interventions should promote alcohol abstinence before conception as well as during pregnancy.

Footnotes

  • See also www.cmaj.ca/lookup/doi/10.1503/cmaj.141593

  • Competing interests: None declared.

  • This article was solicited and has not been peer reviewed.

  • Contributors: Both of the authors contributed equally to the conception and design of the manuscript, and the acquisition and interpretation of the available literature. Both of the authors drafted the manuscript, revised it critically for intellectual content, approved the final version to be published and agreed to act as guarantors of the work.

References

  1. ↵
    1. Cook JL,
    2. Green CR,
    3. Lilley CM,
    4. et al
    . Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan. CMAJ 2015 Dec. 14 [Epub ahead of print].
  2. ↵
    1. Salmon J
    . Fetal alcohol spectrum disorder: New Zealand birth mothers’ experiences. Can J Clin Pharmacol 2008;15:e191–213.
    OpenUrlPubMed
  3. ↵
    1. Abel EL
    . Gin Lane: Did Hogarth know about the fetal alcohol syndrome? Alcohol Alcohol 2001;36:131–4.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Jones KL,
    2. Smith DW
    . Recognition of the fetal alcohol syndrome in early infancy. Lancet 1973;302:999–1001.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Cannon MJ,
    2. Dominique Y,
    3. O’Leary LA,
    4. et al
    . Characteristics and behaviors of mothers who have a child with fetal alcohol syndrome. Neurotoxicol Teratol 2012;34:90–5.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Sanders JL,
    2. Buck G
    . A long journey: biological and non-biological parents’ experiences raising children with FASD. J Popul Ther Clin Pharmacol 2010;17:e308–22.
    OpenUrl
  7. ↵
    1. Ramsay M
    . Genetic and epigenetic insights into fetal alcohol spectrum disorders. Genome Med 2010;2:27.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 188 (3)
CMAJ
Vol. 188, Issue 3
16 Feb 2016
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Fetal alcohol spectrum disorder: reconsidering blame
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Fetal alcohol spectrum disorder: reconsidering blame
Anna Maria Abadir, Abel Ickowicz
CMAJ Feb 2016, 188 (3) 171-172; DOI: 10.1503/cmaj.151425

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Fetal alcohol spectrum disorder: reconsidering blame
Anna Maria Abadir, Abel Ickowicz
CMAJ Feb 2016, 188 (3) 171-172; DOI: 10.1503/cmaj.151425
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • Highlights
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Time to improve transparency at Health Canada’s Pest Management Regulatory Agency
  • Screening for preeclampsia risk and prophylaxis with acetylsalicylic acid
  • The value of a model to consider the cost-effectiveness of interventions for the treatment of major depressive disorder in Canada
Show more Commentary

Similar Articles

Collections

  • Topics
    • Alcohol misuse
    • Family medicine, general practice, primary care
    • Pharmacology & toxicology
    • Psychiatry & mental health: adult
    • Psychiatry & mental health: child & adolescent
    • Public health
    • Reproductive health, infertility & pregnancy

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected]

CMA Civility, Accessibility, Privacy

 

Powered by HighWire