IT DOESN'T TAKE MANY DRINKS TO HARM FETUS

FORT LAUDERDALE, Fla. -- The message seems inescapable: After two decades
of warnings from the surgeon general, the family doctor and even the label
on the liquor bottle itself, every pregnant woman should know that drinking
can damage her baby.

But the message doesn't seem to be sinking in.

The number of pregnant women drinking at risky levels increased four-fold
between 1991 and 1995, according to the most recent CDC study, which
estimated that 140,000 pregnancies a year were endangered. Sixteen percent
of pregnant women admitted they had not completely stopped drinking.

This, at a time when scientists are steadily lowering the level of drinking
they believe is dangerous -- to a threshold many people consider mere
social drinking. Just one drink a day, or more than four drinks in a single
outing, may be enough to cause lifetime learning and behavioral problems.

"Most everybody knows that drinking during pregnancy can affect a fetus,"
said Mark Sobell, a researcher at Nova Southeastern University in Fort
Lauderdale who is participating in a national study on Fetal Alcohol
Syndrome. "But hardly anybody thinks drinking is enough to affect their
fetus. It's not processed at the gut level. It's like smoking -- what
smoker doesn't know it's bad for them at this point?"

So the federal Centers for Disease Control is sponsoring a national study
aimed at social and moderate drinkers. The two-part study aims first to
gather more information about the drinking patterns of women at risk and
then to design treatment and prevention programs to lower the number of
alcohol-exposed babies.

They hope to reduce the numbers of babies whose potential is cut short by
Fetal Alcohol Syndrome and Fetal Alcohol Effects. FAS, usually seen in the
children of alcoholics, is a battery of physical and mental birth defects
thought to be among the leading causes of mental retardation in this
country. Its calling cards are a distinctive pattern of facial deformities
and unusually short stature; its effects can include learning disabilities,
attention deficit disorder and behavioral problems.

FAE is used to describe children who don't have all the symptoms of the
full syndrome but still suffer from alcohol-related birth defects.

No one is sure how many children are affected because there is no mechanism
to keep count and because many children are never properly diagnosed. No
one may suspect a problem in a child with more subtle disabilities until he
or she has trouble in school -- and at that point, no one is likely to ask
about the drinking habits of the child's mother.

So scientists' and advocates' estimates vary wildly. The CDC uses the most
conservative estimates, which put the range of FAS babies at somewhere
between 800 and 4,000 a year. Studies done by the March of Dimes, which
advocates for prevention of birth defects, put the number of FAS babies at
5,000 a year and estimate 50,000 children are born with FAE.

But statistics don't matter to Sue Egert, who has two adopted sons crippled
by exposure to alcohol in the womb. For her it's simple: One baby with
Fetal Alcohol Syndrome is too many when we know how to prevent the problem.

Her 14-year-old, Sam, has had 55 surgeries to solve an appalling list of
physical disabilities, including a heart defect, digestive problems,
seizures and a cleft palate. He is also mentally retarded.

"It's a tough row to hoe; Sam never gets a simple cold -- his lungs
collapse, and you have to rush him to the hospital," said Egert, of
Altamonte Springs, Fla. "This is a very hard disability to live with. .. If
you're going to drink and be pregnant, you'd better be ready for a lifetime
of this."

Nine-year-old Anthony, who has FAE, is of normal intelligence and has far
fewer physical problems. But his learning disabilities have kept him back
at a first-grade reading level, and he is hobbled by poor memory and
difficulty with abstract thinking.

"You watch them give up," said Egert sadly. "You watch their self-esteem go
down the toilet. ... It's hard to parent these children, because they don't
understand cause and effect. They don't understand consequences."

The CDC hopes to reduce the numbers of children in that plight. Even though
the heaviest drinkers deliver the most severely disabled babies, this study
targets social and moderate drinkers because they are more likely to
respond to prevention efforts than chronic alcoholics, who may be least
able to change, said Louise Floyd, director of the CDC study.

Sam's biological mother came from a long line of alcoholics and started
drinking at age 9. She had 10 alcohol-exposed children with such severe
disabilities that only two survived her when she died at 34.

It's a controversial approach. Some advocates and researchers feel
prevention efforts should be aimed at heavy drinkers. But researchers think
the problem may be sneaking up on women with more moderate drinking habits,
Sobell said.

Most women are responsible and quit drinking when they learn they are pregnant.

But about half of all pregnancies are unplanned, so many women may be
drinking at levels they don't realize are dangerous during the critical
first weeks or months, before realizing they are pregnant. And a woman who
drinks a little too much is more likely to be careless about contraception,
increasing the odds of her becoming pregnant.

In addition, some women may underestimate the risks simply because they
drank during an earlier pregnancy or know their mothers drank through
theirs, with no obvious dire consequences.

And, for reasons scientists don't fully understand, not all women who drink
harm their babies even when they drink heavily. Some babies may have a
genetic pre-disposition that makes them susceptible. The risk also
increases in older women, those who smoke, and some minority women.

Binge drinking seems to be more dangerous than a daily drink because it
raises blood-alcohol levels much higher, Floyd said.

Because many alcohol-exposed pregnancies may be accidental, the study hopes
to convince women to take preventive steps even before they become
pregnant. The idea is to get them to use contraception more carefully or
reduce their drinking.

"We can't tell women not to drink alcohol at all because that would be
ignored," said Floyd. "So what we're trying to do is set a threshold where
there's sufficient scientific evidence to say, if you could become
pregnant, we advise you to drink below this level."

But anyone who is pregnant or trying to get pregnant should abstain
completely, doctors say. No one can be sure any level of drinking while
pregnant is safe.

In fact, one study has shown an increased risk of miscarriage, kidney and
cardiac problems associated with as little as four drinks a week. Most, but
not all, scientists agree that seven drinks a week -- or more than four
drinks at one sitting -- is the level where they start to see measurable
cognitive problems like a loss of IQ, difficulties in information
processing and learning problems. Others suspect the threshold might be
higher.

Copyright 1998 Knight Ridder Newspapers