1. Press reports of Fetal Alcohol Powers are highly premature ...

    I agree with the previous responder that the age of 5 and the battery of tests used here seem inadequate to detect many of the impacts of prenatal alcohol exposure.

    Even so, I still find it remarkable that this study fails to find statistically significant (after adjustment for confounders) impacts of heavy maternal drinking in this sample to date.

    This may have resulted from the relatively young age of the study group, inadequately sensitive measures, significant levels of 1st trimester "before I knew I was pregnant" alcohol exposure in the "not during pregnancy" group, optimistic self-reports of "light drinking," or the obvious confounding effects of socioeconomic status and environmental influences.

    Regardless, if this study is unable to find a specific impact of heavy drinking, how is it adequate to rule out impacts from light drinking?

    The authors do note some of these limitations in the discussion, but frustratingly these have not come across so clearly in the media coverage. From the press reports of this and the previous paper, it would seem that FAPs (Fetal Alcohol Powers) have been discovered.

    I think this conclusion, and even milder statements such as "At age 5, children of women who were light drinkers during pregnancy do not have higher risk of socioemotional or cognitive deficits than those of women who did not drink at all in pregnancy" are very premature, and in fact irresponsible, in light of current knowledge of alcohol as a neurotoxin, and one without a reliably described safe lower limit of exposure.

    Can we please keep these concerns in mind when interpreting this study, and future reports from this cohort, to the media?

    Conflict of Interest:

    FAS pediatrician at the UW FAS DPN

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  2. The Disappearing Link between Pregnancy and Drinking

    The findings by Kelley at al. (2010) were found in newspapers and TV shows and presented as evidence that light drinking during pregnancy may not be harmful after all. The study cannot be used as a dependable indication that low amounts of alcohol are beneficial to children, because the amount of alcohol consumed was measured by a self-report of the mother. Self-reported data on alcohol consumption does not produce accurate findings, as found in previous studies1,2. In addition to this, due to the use of a non-experimental design in the study by Kelley et al. (2010), there could have been a number of intervening variables that remain undiscovered and account for the absence of association between these two variables. The authors point to several that they accounted for to some degree, but understate the fact that causal inference is impossible, rather than just limited as they indicated. Yet, the authors use wording in the abstract conclusion of "not increased risk" which also overstates the findings. This wording implies that they somehow showed a cause-and-effect relationship between prenatal alcohol exposure and postnatal behavioral problems. A more cautious wording would have been better to prevent misunderstanding by the readers.

    The authors downplay the observation that mothers in their light drinking category had children who had fewer behavioral problems than mothers who did not drink at all. In other words, light drinking during pregnancy is beneficial, if their findings are any indication. The question is why did the authors not state that light drinking by the mother during pregnancy is beneficial for children? The answer might be that it would put a spotlight on the flaws in the study methodology.

    One other point is that negative effects of prenatal alcohol cannot accurately be studied unless the study is lifelong. Studying the child in question, at the age of five does not demonstrate later consequences that could emerge clear into adulthood. Finally, one drink once a week during pregnancy may not have the same effects on one woman as it does another due to genetic, dietary, and other differences. For these reasons, pregnant women and health care workers should not yet take any actions whatsoever based on this study. Until a well-executed experimental study with random assignment is conducted on this important topic, the answer will remain unknowable. Light drinking during pregnancy must be soundly discouraged - not encouraged -- until proven otherwise.

    Conflict of Interest:

    None declared

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  3. low level exposure - high level disfunction

    2288 Rougecrest Drive, Oakville, Ontario. Canada. L6H 6N2 tel. 905 257 7869 e-mail

    6th. October, 2010.

    Dear Editor.

    The SDQ is only a brief screening tool. It is questionable that its reliability extends to the highly charged questions of alcohol consumption during pregnancy and the effects on the child. The BAS is not comprehensive "were more specific abilities need investigating other diagnostic scales can be used to provide more detail"

    FASD [ fas and arnd ] is truly a spectrum from the death of the fetus to the articulate and intelligent individual who never the less has the secondary disabilities of FASD to varying degrees. The secondary disabilities are drug and alcohol problems, disrupted school experience, confinement, difficulty maintaining employment and living independently. In addition 94% will eventually be given mental health diagnoses. Adaptive and executive functioning are effected resulting in many issues e.g. money management.

    In order to identify the less effected all domains of brain function need to be evaluated, with subtests.

    I have seen many times adolescents and adults who are articulate and intelligent yet have chaotic lives, impacting others and society in general. They were never fully evaluated but when they are, as above, then significant deficiencies of brain function are found that account for their difficulties.

    The evidence is that the sooner the effects of alcohol on the developing fetus is established the less the secondary disabilities.

    There is research that shows low levels of alcohol exposure cause deficiencies in brain function. It is true the research is limited; a reflection of denial by the majority of politicians and professionals.

    Although the MCS is an ongoing longitudinal study I am left with the distinct and alarming impression that the two papers to date, and the response of the media, promote the consumption of alcohol during pregnancy rather than the urgent need for more research into the effect on the developing fetus of low levels of alcohol.

    I leave the reader with a question- If it is all right to expose the fetus to alcohol during pregnancy is it all right to give the same amount of alcohol to the infant?

    Barry Stanley, MB Ch.B, F.R.C.S[C] references provided on request

    Conflict of Interest:

    physician working with FASD Son 34 diagnosed fasd

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