POLLUTING BABY'S FIRST ROOM

The uterus should be a smoke- and booze-free zone, doctors and researchers say

For a pregnant woman, the temptations are ever present. A glass of wine
before dinner, another with the meal. A cigarette afterward. A few more
smokes to relax. How can it hurt?

Potentially plenty, if it happens too often.

Two or more drinks a day is well within the risk range for fetal alcohol
effects (FAE), which may include hyperactivity, attention deficit and major
learning disorders.

And those cigarettes? Smoking increases the risk of numerous problems,
including miscarriage, stillbirth and low birth weight.

``Some of my most frightening deliveries have been of mothers who were
heavy smokers,'' says Dr. Lynn Wilson, a family physician at St. Joseph's
Health Centre and the Addiction Research Foundation. ``During labour, the
babies can experience tremendous distress.''

For more than a decade, public health campaigns have sounded the
no-smoking-or-drinking warning, but some studies indicate it may not be
sinking in, especially among socially disadvantaged and young women.

Researchers also worry that tobacco and alcohol use may be significantly
under-reported by pregnant women embarrassed by their risky behaviour.

``Women are good at feeling guilty,'' Wilson says. ``It may be difficult
for them to be forthright with their physician for fear of being judged.''

Abstinence is the best policy, say doctors, since no guaranteed safe level
for booze or cigarettes is known.

There are a lot of unknowns. Researchers can't explain why one pregnant
woman may drink and smoke heavily and deliver a healthy baby, and another
will indulge moderately and have an infant with serious substance-related
problems.

Researchers can't say with 100 per cent certainty that one drink or one
cigarette won't cause harm, just that it's far less likely.

``There are no absolutes,'' says Dr. Peter Selby, a medical consultant for
the foundation, who encourages any pregnant woman to get help. ``It's all a
matter of risk.''

At Breaking The Cycle, an agency that helps mothers and pregnant women who
use drugs or alcohol, and their children, a group of women talk about why
they drank in pregnancy.

``You need a crutch, and alcohol is easy to get,'' says one. ``I kept
thinking, `Alcohol won't hurt,' '' explains another.

``The guilt isn't as heavy to bear (as using drugs),'' says a mother of an
infant.

``It's more socially acceptable. I thought it was less dangerous than
drugs, but found out it can be more dangerous.''

The baby can be permanently brain damaged. Drinking during pregnancy can
cause fetal alcohol syndrome, the leading preventable cause of mental
retardation. An FAS child may have distinctive facial features such as
short eye slits, a small chin and a flat upper lip as well as lifelong
learning disabilities and behaviour problems.

An estimated one to three fetal alcohol syndrome babies are born out of
every 1,000 births in Canada.

A less severe condition called fetal alcohol effect is harder to diagnose.
Alcohol effect children don't have the facial deformities, but may
experience reduced or delayed growth and learning and behavioural disorders
that can go unnoticed for several years. While the incidence of fetal
alcohol effect is uncertain, estimates range up to 2 per cent of all
births, says Dr. Gideon Koren, director of the Hospital for Sick Children's
Motherisk clinic.

Counsellors at Motherisk answer questions about any type of exposure during
pregnancy. In November, a new national hotline will be set up by Motherisk,
funded by the Brewers' Association of Canada. ``We found a clear lack of
factual information on substance use in pregnancy,'' says association
spokesperson Blair Dickerson.

Doctors don't fully understand the biology of how alcohol affects the fetus
or why some babies will suffer and not others.

Out of 100 babies of heavy drinkers, about 30 will show damage, says Koren.
What saves the others?

``Is it the placenta? Is it the mother's different metabolism? Is it the
sensitivity of the fetus? We don't know.''

With publicity about alcohol's dangers, drinking during pregnancy declined
during the 1980s. But in the U.S., a recent study shows that the number of
pregnant women drinking at risky levels increased fourfold between 1991 and
1995.

Health Canada is currently working on a similar study here. An Ontario
survey of 561 pregnant women in 1994 showed that 23 per cent reported
regularly consuming two drinks of alcohol a week, 8 per cent more than
seven drinks a week.

Of the latter, 3 per cent had more than 14 drinks a week, says author Dr.
Donna Stewart, chairperson of women's health at Toronto Hospital and the
University of Toronto. (A drink was defined as a 4 ounce glass of wine, a
can of beer or 1 ounce of hard liquor.)

Those who had more than seven drinks a week tended to be socially
disadvantaged, young and unemployed.

At the Motherisk clinic, Koren is particularly concerned about pregnant
women on society's fringes. Most of the warning campaigns have not been
geared to these women, who may already be problem drinkers, he explains.

``The addiction rate increases as the poverty rate increases,'' he says.

At Breaking The Cycle, which is funded by Health Canada, most clients
receive social assistance, but some are middle-class, says program manager
Margaret Leslie. ``Fetal alcohol syndrome crosses socio-economic levels,''
she explains. ``Middle-class women drink for many of the same reasons -
losses in life, abuse, trauma, conflict.''

But many women take the dangers-of-alcohol message very seriously. The
Motherisk clinic gets calls from women upset because they drank a few times
before knowing they were pregnant.

That scenario is not uncommon, says Koren, since about half of young women
drink socially and half of all pregnancies are unplanned. Some of the
callers are ready to terminate the pregnancies because of fear of the risk.

Generally, these women shouldn't worry. ``It's a relatively complex
message,'' says Koren. ``Don't drink in pregnancy. But if you had two
drinks on a couple of nights, it's not likely to cause damage.''

As for smoking, it not only harms the mother's health, but the fetus' as well.

Tobacco smoke contains more than 4,000 chemicals and increases the risk of
miscarriage, premature birth (before 37 weeks gestation), and low birth
weight (less than 2,500 grams or 5 pounds, 8 ounces). The more the mother
smokes, the less the baby tends to weigh.

Low birth-weight babies are at greater risk of stillbirth, need for
neonatal intensive care, and illness or even death in infancy.

Delivery can be dicey. Smoking causes the placenta to age faster, explains
Selby. ``It's like having a loose connection. In the stress of labour, the
baby gets into distress.''

Even if the mother doesn't smoke, the fetus can be affected by the mother
inhaling second-hand smoke.

Whether smoking affects the baby's brain development is still
controversial, says Koren. As for cancer, recent research in the U.S. found
evidence that pregnant smokers may pass cancer-causing substances to their
babies.

About 26 per cent of Canadian women smoke. For women aged 20 to 34, prime
childbearing years, it's 31 per cent.

But despite the dangers, only about one-third of smokers quit during
pregnancy. ``Pregnancy is the time they're most motivated,'' says Wilson.
``That indicates how difficult it is.''

About 70 per cent of those who do quit relapse after the baby is born, says
Wilson. The child is then exposed to smoke, increasing risk of asthma,
respiratory illnesses, ear infections and sudden infant death syndrome. If
a woman chooses to smoke, she should at least do it outside, says the
family physician.

Smoking also decreases a mother's breast milk and changes its quality.

A woman can try to stop smoking cold, says Wilson, but may need help from
her doctor with behavioural strategies, relaxation techniques and other
coping tricks. In some cases, Wilson will prescribe a low-dose nicotine
patch for a pregnant woman. For someone planning a pregnancy, she advises
quitting smoking six months ahead.

At Breaking The Cycle, a 44-year-old mother finishes a cigarette before
entering the centre. ``Quitting that is my next project,'' she says.

Once a heavy drinker, the former secretary tried to stop the booze during
her pregnancy, but slipped a few times, including one binge of six glasses
of wine. She has since been through a treatment program, counselling and
therapy, and has been sober for a year.

Her son is healthy and developing normally. ``I thank God for looking after
me,'' she says. ``This feeling I have of starting life over is truly
amazing.''

For more information, contact Motherisk at (416) 813-6780 or Breaking The
Cycle at (416) 364-7373.

Checked-by: Pat Dolan