Banner by Amanda Devine

Drinking for Two

by Janin Apreku

The classic debate asks if the glass is half full or half empty—but with Fetal Alcohol Spectrum Disorder (FASD), the real issue isn’t the amount in the glass. It is what is poured in it that changes everything. Many still believe an occasional glass of wine during pregnancy is harmless. However, this is far from reality. Fetal Alcohol Spectrum Disorders (FASDs) are behavioral, cognitive, and physical deficits that develop in children who were exposed to alcohol while in the womb. The term “fetal” is misleading, since this isn’t a condition that disappears after birth. The impacts of FASD are irreversible and last a lifetime. Individuals with FASD experience facial deformities and permanent brain damage that affects their learning, memory, coordination, and social skills. Despite being preventable, the CDC reports that up to 1 in 20 U.S. school-aged children have FASDs, amounting to 5% of children in the country. A more concerning reality is that stigma and underdiagnosis likely means the true number is much higher. FASD is a hidden epidemic that continues to affect millions, and yet is not talked about enough.  

Cognitive impairments caused by FASD often include difficulties with learning, memory, attention, and problem-solving. When facial traits associated with FASD are absent, it is common for individuals to be misdiagnosed with other neurodevelopmental disorders such as ADHD. Although children with both FASD and ADHD share struggles such as maintaining focus and following directions, there are some important distinctions between the two. For example, children with FASD often display less impulsivity than those with ADHD, who are more prone to hyperactive and impulsive behaviors.. A comparative study conducted by Dr. Tarah Raldiris involved 164 children divided into four groups (FASD, FASD and ADHD, ADHD, and other neuropsychological disorders). When comparing hyperactivity, aggression, atypical behaviors, and attention, children with FASD showed greater difficulties than those with ADHD, particularly in aggression and atypical behaviors. They also exhibited more pronounced cognitive deficits, including lower IQ and weaker verbal comprehension, perceptual reasoning, and working memory. This result remained true when children with FASD were compared to individuals diagnosed with other neurodevelopmental conditions. Additionally, those with a comorbid diagnosis of FASD and ADHD  showed the greatest deficits. FASD, therefore, is linked with the most profound cognitive impairments in a child, more than ADHD and other disorders.  

Measures of behavior and cognition are not the only indicators of impairment in those with FASD. Structural brain comparisons by Dr. Theresah Boateng provides physiological evidence that children with FASD have reduced total brain volume compared to healthy controls. Specifically, children with fetal alcohol syndrome (FAS), the most severe form of FASD, or partial FAS showed significant reductions in brain volume. Children with alcohol-related neurodevelopmental disorders (ARNDs)—a subtype of FASD without the characteristic facial features or growth deficits—had total brain volumes more similar to controls, yet still exhibited reductions in key regions such as the cerebellum, caudate, and pallidum, which are critical for decision-making, learning, and thought processes. This evidence helps highlight a simple fact— any prenatal alcohol exposure can profoundly impact fetal development, even when physical signs of FASD are not present. The CDC makes this clear: there’s no safe amount, no safe time, and no safe type of alcohol when pregnant.  

To gain a clinical perspective on prenatal alcohol exposure, Dr. Lauren Sutherland, M.D., a second-year Maternal-Fetal Medicine fellow with a focus in perinatal addiction, explained that one of the biggest concerns surrounding alcohol consumption during pregnancy is the development of Fetal Alcohol Spectrum Disorders (FASDs). Dr. Sutherland describes FASDs as a “constellation of findings for a newborn,” which can include certain facial features, reduced growth, and intellectual delays, but early exposure can also increase susceptibility to cardiac and renal defects.  

 When asked whether there’s truly “no safe amount or no safe time” for alcohol during pregnancy, Dr. Sutherland confirmed that no threshold has been identified as safe, noting that risk levels can vary geographically. This uncertainty, she emphasized, is exactly why medical organizations recommend complete abstinence during pregnancy. However, Dr. Sutherland also touched on a major challenge that comes with this “no drink is safe” mentality— stigma. Abstinence counseling, while well-intentioned, can sometimes lead to shaming mothers rather than supporting them. She mentions how questions are often framed in a judgemental way, that makes it less likely for mothers to disclose alcohol use. For example, during prenatal visits, providers might ask, “You haven’t used any alcohol during your pregnancy, right?” This phrasing pressures mothers to deny use instead of opening the door to a real conversation. Additionally, the stigma doesn’t just come from individual providers, but from the healthcare system itself. Dr. Sutherland noted that alcohol use during pregnancy is often screened for only once, at the first prenatal visit, and that the tools used aren’t always sensitive or effective.  

 According to Sutherland, there are ways we can better support mothers who are struggling, in a way that fosters understanding rather than shame. In her view, the best way to help these mothers dealing with alcohol use disorder is through universal, nonjudgmental, and patient-centered screening. “Everyone should be asked, everyone should be asked more than once, and everyone should be asked using a validated screening tool,” she says.  

FASD remains a silent and overlooked issue that is widespread despite its lifelong damaging effects. From the results of reduced cognitive ability to reduced brain volume, alcohol exposure to a fetus can change and cause harm to a child’s development in irreversible ways. Spreading awareness regarding the cost of drinking during pregnancy is important and helping mothers in need is crucial whether it’s a family member, sister, friend or even a pregnant woman in a bar. It is necessary we think twice and take steps towards prevention—because when FASD steals from a child’s potential future, the glass will always be left half empty.