The American Academy of Pediatrics announced new recommendations this fall that encourage women who are pregnant to refrain from drinking any alcohol or face a greater prospect of giving birth to a child with mental, behavioral or physical disabilities.
Academy-related researchers reported in last month’s edition of Pediatrics that first-trimester drinking, compared to no drinking, results in 12 times the odds of a mother giving birth to a child with Fetal Alcohol Spectrum Disorder. First- and second-trimester drinking increased the odds 61 times, and women who drink during all trimesters increased the likelihood by a factor of 65.
“The bottom line story is that we don’t really know if there’s a safe level of drinking, so it’s better not to drink at all,” said Rina Das Eiden, a senior research scientist and research associate professor of pediatrics and psychology for the University at Buffalo Research Institute on Addictions. She was not involved in the latest research but specializes in studying the development of children born to parents with tobacco, alcohol and other substance addictions.
Eiden holds a master’s in developmental psychology from Purdue University and doctorate in applied developmental psychology from the University of Maryland. She has worked at the UB institute in Buffalo since 1992 and specializes She and her husband, Mark Eiden, a Fort Wayne, Ind. who she met at Purdue, live in Clarence with their son, Kiran, 17, and a Portuguese water dog, Tessa.
Q. You and Institute Director Kenneth Leonard have been collaborating together since 1996 on a Children of Alcohol Fathers Study. Can you talk about that?
We recruited 227 families from the community through birth records. Roughly half had an alcoholic father in the household. They all had a child who was a year old at the time. The other half was a control group of non-alcoholic families. And we’ve been following them ever since. We just finished analyzing one model to look at pathways to substance use in these families. We assessed the kids when they were 12 months, 18 months, 2 years, 3 years, 4 years, kindergarten, second grade, fourth grade, sixth grade, eighth grade and we just finished the high school grade. It’s a really rich data set. We can look at pathways to risk and resilience for these children.
Q. What did you look at?
We looked at three pathways to risk from infancy through adolescence. One is through continued parent monitoring to substance use. Another pathway is continued external behavior problems: aggression, delinquency. Another pathway that didn’t pan out was through social competence.
Q. What are some of your key findings?
One really key finding is that when you have an alcoholic parent in the household, the nonalcoholic parent – which in the majority of our study was the mother – can play a very key protective role, and can play that role very early. One of the early implications in the study is that if you have an alcoholic father in the household, then chances of having mothers who are warm and sensitive during interactions with you when you are 2 years old are lower. But if they’re able to be warm and sensitive, that sets up a cascading protective effect over time. That’s a huge thing because it tells you that if you’re intervening with alcoholic families, intervene early if you want to prevent problems ... The other thing we found is that if mothers are warm and sensitive, the children have higher levels of self-regulation in the preschool period when self-regulation develops. These are things like being able to internalize rules of conduct. Ultimately, we as parents want to help our children socialize, develop a conscience, to know the rules of conduct, to be able to control their impulses in a way that suits external demands. That then sets up another series of cascading protective effects. If you have children who have low self-regulation at 3 years, they are more likely to have continued externalizing problems from childhood to adolescence. When they get closer to adolescence, they are more likely to engage with delinquent and substance using peers and that’s one of the most significant proximal predictors of substance use in adolescence.
We’re just beginning to analyze this data. It tells us something about the timing of interventions and what the timing of them could be. One of the things driving this research was that we know not all children of alcoholics are uniformly at risk or develop a risk. So one of our goals was to examine what are some reasons for resilience and protective effects that lead to resilience in some children and not in others. Right now, were working on the impact, resilience and vulnerability.
Q. Can you talk about some of the similar challenges that children who have parents who abuse substances face across the board?
In terms of maternal substance use during pregnancy, alcohol is the biggest teratogin (agent that can disturb fetal development). One of the diagnostic criteria for Fetal Alcohol Syndrome is cognitive deficiencies, including mental retardation, so alcohol use during pregnancy is the single most preventable cause of mental retardation in our society. Cigarettes, alcohol and cocaine all affect fetal growth. Fetal growth is one of the most common outcomes across all these substances but the other are also behavioral difficulties. Higher rates of behavioral problems is common with alcohol and cigarettes. Cocaine is a very complex issue. In our sample of 200 some mothers, I don’t think we had a single mother who used just cocaine during pregnancy. Cocaine-using women are also more likely to smoke during pregnancy, use alcohol or marijuana.
Q. So which children are at highest risk?
In some sense, it’s hard to rank order these things, they’re all bad, but if you gave me five things and said I could only stop using one thing, I’d tell you to stop using alcohol. The worst outcomes are associated with the most chronic, heavy use.
Q. What happens if a woman is drinking socially before she realizes she is pregnant?
That happens to a lot of women. I would say, it’s OK, but stop as soon as you know. It’s the best you can do at that point. It’s the chronicity that increases risk. Twelve versus 65 in terms of risk is a huge difference, so even if you can stop within the first trimester, the odds of having an alcohol-affected baby are much lower than if you continue even into the second trimester.
Heavy, chronic drinking in the first trimester is very different than social drinking in the first trimester.
Q. So once you become you’re aware you’re pregnant, just stop.
Yes. It’s never too late to quit. It does reduce the risk substantially.
Q. And if you’re planning to get pregnant or thinking about getting pregnant?
Don’t drink. People have been researching this for years; 1973 is when we discovered this syndrome. Nobody has been able to come up with a safe level of drinking. Obviously, less is better than more. Lower duration is better than longer duration.
Q. You’ve also done research about smoking and substance abuse during pregnancy. Can you talk about those findings?
One of the most common effects of smoking during pregnancy is low birth weight and prematurity. Our study is no different. One of the most persistent causes of continued smoking during pregnancy is mothers using smoking to try to curb negative emotions, anger and hostility. Trying to teach women different strategies to cope with negative emotions other than smoking may be really helpful. We have a paper out on that. We also wrote a paper on a partner’s smoking and the huge role that plays on a mother’s continued smoking during pregnancy. To all the fathers out there: Often fathers feel neglected and left out, and not part of the process, but a really solid way they can help their partners and their children is to quit along with the mother.
Q. What are you working on now?
We just got a grant to look at pathways to violence and victimization in a sample of children who were exposed to cocaine and other substances in pregnancy. We recruited them when they were born and we’ve been following them over time. Now they’re in adolescence. We plan to do family assessments when the kids are between 12 and 14 years of age and 15 and 17. We’re interested in looking at developmental mechanisms that predict violence, victimization and substance use in the sample. As you can imagine, they’re at higher risk because of multiple, multiple issues, including poverty and living in poor neighborhoods and being exposed to lots of violence in their neighborhoods and communities.
Q. What would you say to expectant moms who are addicted and worried they might not be able to get through pregnancy?
There is a lot of help.
Pregnant and new mothers and their families concerned about alcohol and substance abuse, recovery and education are encouraged to call the Robert Warner Center at Women’s & Children’s Hospital at 878-1374, the Buffalo Prenatal-Perinatal Network (parentnetworkwny.org) at 332-4170, the Joan A. Male Family Support Center at 892-2172 or the New York State Smokers’ Quitline (nysmokefree.com) at (886) 697-8487.
Twitter: @BNrefresh, @ScottBScanlon