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Alcohol Abused

As Drinking During Pregnancy Continues, Researchers Find Reasons For Greater Alarm

By HILARY WALDMAN
Courant Staff Writer

October 14 2002

But he said unto me, Behold, thou shalt conceive, and bear a son; and now drink no wine nor strong drink, neither eat any unclean thing: for the child shall be a Nazarite to God from the womb to the day of his death.

- Judges: 13:7

Sharon Kozaczka did not need a picture of her adopted son Matthew's brain to tell her that his mental retardation, his incessant spinning, his inability to put on his own socks or ride a two-wheeler were caused by his birth mother's alcoholic binges during pregnancy.

Nobody did.

Matthew Kozaczka wears the face of fetal alcohol syndrome. The Suffield 14-year-old was born with the constellation of facial abnormalities that researchers discovered 30 years ago could be caused by only one thing: maternal drinking.

But despite the centuries-old Biblical warning against drinking during pregnancy and three decades after the damage was given a name, researchers now are discovering that many more people without the signature facial features are affected, and they are pinpointing just where the profound brain damage occurs.

"The bottom line is that maybe 8,000 kids a year are born with fetal alcohol syndrome," said Edward P. Riley, chairman of the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect.

"But there may be 80,000 born who [have the effects but] do not have the face," said Riley, a psychologist and fetal alcohol researcher at San Diego State University. "We've got to identify these kids and get them into treatment."

People with fetal alcohol exposure, regardless of their IQ or facial structures, are more likely to wind up in jail, be unable to hold jobs, abuse drugs or alcohol, or have other mental health issues, research has shown.

The problem, Riley and others said, should take on new urgency in light of figures published earlier this year showing that binge drinking and frequent drinking among pregnant women in the United States have not declined, despite 20 years of public health warnings.

Since fetal alcohol syndrome was first described in the scientific literature in 1973, research has been stymied by the stigma of maternal drinking and by the difficulty in discerning the precise mechanism by which alcohol affects the developing brain.

But with the cooperation of people such as the Kozaczkas and more government support for research in recent years, some answers have begun to emerge.

Smaller Brain Structures

Using advanced methods of magnetic resonance imaging, researchers have discovered how the brains of confirmed victims such as Matthew have been damaged by alcohol exposure during fetal development.

Sarah Mattson, a neuropsychologist who works with Riley at San Diego State, has found that four parts of the brain are smaller than average in children with confirmed exposure to alcohol during fetal development.

The smaller areas seem to correspond with intellectual and behavioral deficits exhibited by people with fetal alcohol syndrome, but Mattson acknowledges that no correlation has been proved yet.

One affected area of the brain, the basal ganglia, is a group of nerve cell clusters involved in the ability to shift from one task to another. Inhibition of inappropriate behavior and spatial memory also are governed by this area of the brain.

The corpus callosum, which allows the right and left hemispheres of the brain to communicate, also appears to be affected. Corpus callosum deficits have been linked to problems with intellect, attention, reading and other higher levels of learning.

Motor skills and balance originate in the cerebellum, which also is smaller in people with fetal alcohol syndrome, while a smaller hippocampus deep inside the brain, may be linked to memory problems.

"What do these changes in the brain mean as far as functioning?" Mattson asked. "That's a huge question."

An MRI of Matthew Kozaczka's brain at the University of Connecticut Health Center revealed that his entire corpus callosum is missing.

Kathryn Grant, a researcher at UConn who is also doing MRI studies, said such information might eventually help to tailor services to address the specific strengths and weaknesses of children exposed to alcohol.

"Right now these children are treated in any variety of ways that are largely inappropriate," said Grant.

One of the biggest obstacles to treatment is that some children with fetal alcohol syndrome have normal or nearly normal intelligence. This often masks crippling behavioral and judgment problems that can destroy their lives.

The First 12 Weeks

Because the brain develops during the first 12 weeks of pregnancy, before some women realize they are pregnant, even conscientious women can unknowingly damage their babies.

While drinking during pregnancy has declined steadily as doctors and others have warned against any alcohol use, there remains a stubborn proportion of women - about 2 percent - who continue to drink frequently or go on binges during pregnancy. Large concentrations of alcohol appear to most seriously damage a fetus. More than seven drinks a week is considered frequent drinking, and consuming five or more drinks on one occasion is a binge, according to the U.S. Centers for Disease Control and Prevention.

The National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, is sponsoring research on how alcohol interrupts development of the fetal nervous system. Researchers also have recently identified two molecules that can protect a fetus from alcohol's devastating effects.

"If we can identify substances that can prevent birth defects in mothers who drink, maybe we can develop medications," said Dr. Michael E. Charness, chief of neurology at the VA Boston Healthcare System.

Kenneth Warren, director of the office of scientific affairs for the NIAAA, said it's also crucial to identify the invisible victims. He said advances in neurobehavioral testing and brain imaging could result in guidelines that would be used to identify fetal alcohol syndrome, with or without facial characteristics or a known history of maternal drinking.

Nobody expects people who are damaged to be cured. But a better understanding of their unique behavior problems could lead to better strategies for helping them cope. Warren noted that a new federal task force on fetal alcohol syndrome published its first recommendations last month and that a special unit of the U.S. Substance Abuse and Mental Health Services Administration had been created to address the problem.

Spinning Aimlessly

Before Sharon Kozaczka adopted Matthew seven years ago, he lived with his biological parents, who were both alcoholics. Kozaczka said his parents met in a detox program and that his mother was hospitalized during her pregnancy so she would not drink. Apparently that came too late.

When he arrived at Kozaczka's home, Matthew was 7, but still not fully toilet-trained, and he did not know how to dress himself. He bit himself frequently, annoyed the other children in the family and slept for only a few hours each night. During his first month in the house he wore out three pairs of shoes as he stood spinning in aimless circles.

Although IQ tests showed that he is extremely mentally retarded, Matthew is charming and speaks well. He can sit for an hour reading Gray's Anatomy and appear to devour every word and diagram, but, says his mother, he does not understand a single thing.

His appearance of mental competency has made it difficult for Kozaczka to get Matthew the help he needs. She said the image of his damaged brain has helped her persuade school officials that he has serious mental health and special education needs.

But, said Grant, more commonly the brain of a child with fetal alcohol syndrome will appear roughly normal, just smaller than average. The child will be short and skinny, but that can be said of a lot of children.

"To identify kids has been a difficult task," said Kozaczka, explaining why she allowed Matthew to participate in Grant's research. She said that with intensive work, Matthew has come a long way and now can swim, ride a bike and attends high school with the help of special education classes and an aide to accompany him.

But, she said, none of this ever should have happened to him. Fetal alcohol syndrome is the leading preventable cause of mental retardation in the United States.

"My feeling is if one person is going to stop drinking," Kozaczka said, "it would be wonderful."

Grant is seeking children with fetal alcohol syndrome and a group of normal children for comparison to participate in her study. For information call 860-679-4680.

Families raising children with fetal alcohol syndrome can find support from the Fetal Alcohol Syndrome Family Resource Institute on the web at www.fetalalcoholsyndrome.org.

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