They may never be able to work.

What if I am pregnant and have been drinking?

If you drank alcohol before you knew you were pregnant, stop drinking now. You will feel better, and your baby will have a good chance to be born healthy. If you want to get pregnant, do not drink alcohol. You may not know you are pregnant right away. Alcohol can hurt a baby even when you are only 1 or 2 months pregnant.

How can I stop drinking?

There are many ways to help yourself stop drinking. You do not have to drink when other people drink. If someone gives you a drink, it is OK say no. Stay away from people or places that make you drink.

Do not keep alcohol at home.

If you cannot stop drinking, get help. You may have a disease called alcoholism. There are programs that can help you stop drinking. They are called alcohol treatment programs. Your doctor or nurse can find 229 Pregnancy and Birth Sourcebook, Third Edition a program to help you. Even if you have been through a treatment program before, try it again. There are programs just for women.

Section 27.3 Fetal Alcohol Spectrum Disorders Excerpted from "Fetal Alcohol Spectrum Disorders," by the National Center on Birth Defects and Developmental Disabilities (NCBDDD, www.cdc.gov/ncbddd), part of the Centers for Disease Control and Prevention (CDC), May 2, 2006.

What is FAS?

FAS stands for fetal alcohol syndrome. It is one of the leading known preventable causes of mental r.e.t.a.r.dation and birth defects.

FAS represents the severe end of a spectrum of effects that can occur when a woman drinks alcohol during pregnancy. Fetal death is the most extreme outcome. FAS is characterized by abnormal facial features, growth deficiency, and central nervous system (CNS) problems.

People with FAS can have problems with learning, memory, attention span, communication, vision, hearing, or a combination of these things. These problems often lead to difficulties in school and problems getting along with others. FAS is a permanent condition. It affects every aspect of an individual's life and the lives of his or her family. However, FAS is 100% preventable-if a woman does not drink alcohol while she is pregnant.

What are FAE, ARND, and ARBD?

Prenatal exposure to alcohol can cause a spectrum of disorders.

Many terms have been used to describe children who have some, but not all, of the clinical signs of FAS. Three terms are fetal alcohol effects (FAE), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD). The term FAE has been used to describe behavioral and cognitive problems in children who were prenatally exposed to alcohol, but who do not have all of the typical diagnostic features of FAS. In 1996, the Inst.i.tute of Medicine (IOM) 230 Nicotine, Alcohol, and Drug Use during Pregnancy replaced FAE with the terms ARND and ARBD. People with ARND can have functional or mental problems linked to prenatal alcohol exposure. These include behavioral or cognitive deficits, or both. Examples are learning difficulties, poor school performance, and poor impulse control. They can have difficulties with mathematical skills, memory, attention, judgment, or a combination of these. People with ARBD can have problems with the heart, kidneys, bones, hearing, or a combination of these.

What are FASDs?

The term fetal alcohol spectrum disorders (FASDs) has emerged to address the need to describe the spectrum of disorders related to fetal alcohol exposure. It is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects can include physical, mental, behavioral, learning disabilities, or a combination of these, with possible lifelong implications. The term FASDs is not intended for use as a clinical diagnosis.

Unlike people with FAS, those with other prenatal alcohol-related conditions under the umbrella of FASDs do not show the identifying physical characteristics of FAS and, as a result, they often go undiagnosed.

How common are fetal alcohol syndrome (FAS) and other prenatal alcohol-related conditions (known collectively as FASDs)?

The reported rates of FAS vary widely. These different rates depend on the population studied and the surveillance methods used.

CDC studies show FAS rates ranging from 0.2 to 1.5 cases per 1,000 live births in different areas of the United States. Other prenatal alcohol-related conditions, such as ARND and ARBD, are believed to occur about three times as often as FAS.

How do I know if my child has been affected by maternal alcohol use?

Children with FAS have evidence of growth deficiency, CNS (central nervous system) problems, and a distinct pattern of facial characteristics such as a thin upper lip, smooth philtrum (the groove running vertically between the nose and lips), and small eye openings. Children with different FASDs have CNS problems like children with FAS and/or a pattern of behavior or cognitive abnormalities such as learning difficulties and poor school performance. People with FASDs can have poor 231 Pregnancy and Birth Sourcebook, Third Edition coordination or hyperactive behavior. They can have developmental disabilities such as speech and language delays, learning disabilities, mental r.e.t.a.r.dation, or low IQ (intelligence quotient). They can have problems with self-care such as tying shoes or organizing one's day. People with FASDs can have poor reasoning and judgment skills. Infants with FASDs have sleep and sucking disturbances. People with FASDs often have problems as they get older. These might include mental health problems, disrupted school experiences, trouble with the law, unemployment, inappropriate s.e.xual behavior, or a combination of these.

Can FASDs be treated?

FASDs are permanent conditions. They last a lifetime and affect every aspect of a child's life and the lives of his or her family members.

There is no cure for these conditions. However, FASDs can be completely prevented-if a woman does not drink alcohol while she is pregnant.

With early identification and diagnosis, a child with an FASD can get services that can help him or her lead a more productive life.

If a woman has an FASD, but does not drink during preg- nancy, can her child have an FASD? Are FASDs hereditary?

FASDs are not genetic or hereditary. If a woman drinks alcohol during her pregnancy, her baby can be born with an FASD. But if a woman has an FASD, her own child cannot have an FASD, unless she drinks alcohol during pregnancy.

Is there any safe amount of alcohol to drink during preg- nancy? Is there a safe time during pregnancy to drink al- cohol?

When a pregnant woman drinks alcohol, so does her unborn baby.

There is no known safe amount of alcohol that a woman can drink during pregnancy. There is also no safe time during pregnancy to drink alcohol. Alcohol can have negative effects on a fetus in every trimester of pregnancy. Therefore, women should not drink if they are pregnant, planning to become pregnant, or could become pregnant (that is, s.e.xually active and not using an effective form of birth control).

What is a drink? What if I drink only beer or wine coolers?

All drinks containing alcohol can hurt an unborn baby. A standard drink is defined as .60 ounces of pure alcohol. This is equivalent to 232 Nicotine, Alcohol, and Drug Use during Pregnancy one 12-ounce beer or wine cooler, one 5-ounce gla.s.s of wine, or 1.5 ounces of 80 proof distilled spirits (hard liquor). Some alcoholic drinks have high alcohol concentrations and come in larger containers (22 45 ounce containers). There is no safe kind of alcohol. If you have any questions about your alcohol use and its risks to your health, talk to your health care provider.

How does alcohol cause these problems?

Alcohol in the mother's blood crosses the placenta freely and enters the embryo or fetus through the umbilical cord. Alcohol exposure in the first 3 months of pregnancy can cause structural defects (e.g., facial changes). Growth and CNS problems can occur from drinking alcohol any time during pregnancy. The brain is developing throughout pregnancy. It can be damaged at any time. It is unlikely that one mechanism can explain the harmful effects of alcohol on the developing fetus. For example, brain images of some people with FAS show that certain areas have not developed normally. The images show that certain cells are not in their proper place and tissues have died in some areas.

Is there anything I can do now to decrease the chances of having a child with an FASD?

If a woman is drinking during pregnancy, it is never too late for her to stop. The sooner a woman stops drinking, the better it will be for her baby. A woman should use an effective form of birth control until her drinking is under control. If a woman is not able to stop drinking, she should contact her physician, local Alcoholics Anony-mous, or local alcohol treatment center, if needed. The Substance Abuse and Mental Health Services Administration has a Substance Abuse Treatment Facility locator. This locator helps people find drug and alcohol treatment programs in their area.

If a woman is s.e.xually active and not using an effective form of birth control, she should not drink alcohol. She could be pregnant and not know it for several weeks or more.

Mothers are not the only ones who can prevent FASDs. Spouses, partners, family members, friends, schools, health and social service organizations, and communities can help prevent FASDs through education and support.

233.

Pregnancy and Birth Sourcebook, Third Edition I just found out I am pregnant. I have stopped drinking now, but I was drinking in the first few weeks of my preg- nancy, before I knew I was pregnant. Could my baby have an FASD? What should I do now?

The most important thing is that you have completely stopped drinking after learning of your pregnancy. It is never too late to stop drinking. The sooner you stop, the better the chances for your baby's health. It is not possible to know what harm might have been done already. Some women can drink heavily during pregnancy and their babies do not seem to have any problems. Others drink less and their babies show various signs of alcohol exposure. Many body parts and organs are developing in the embryonic stage (weeks 3 to 8 of the pregnancy). This is the time when most women do not know they are pregnant. There is no known safe amount of alcohol or safe time to drink alcohol during pregnancy. It is recommended not to drink at all if one is pregnant or planning to become pregnant. Also, if a woman is s.e.xually active and not using an effective form of birth control, she should avoid alcohol. The best advice is to try not to be alarmed, talk to your doctor about this, and be sure to receive routine prenatal care throughout your pregnancy.

Can a father's drinking cause FASDs?

How alcohol affects the male sperm is currently being studied.

Whatever the effects are found to be, they are not FASDs. FASDs are caused specifically by the mother's alcohol use during pregnancy.

However, the father's role is important. He can help the woman avoid drinking alcohol during pregnancy. He can encourage her abstinence from alcohol by avoiding social situations that involve drinking. He can also help her by avoiding alcohol himself.

234.

Nicotine, Alcohol, and Drug Use during Pregnancy Section 27.4 Drug Use during Pregnancy Excerpted from "Drugs," by the Center for the Evaluation of the Risks for Human Reproduction (CERHR, cerhr.niehs.gov), part of the National Inst.i.tute of Environmental Health Sciences, April 23, 2008.

Drugs use by pregnant women can result in harm to unborn children. The March of Dimes provides information about pregnancy and the use of legal drugs such as tobacco and alcohol and illegal drugs such as cocaine, PCP [phencyclidine], and heroin. Because some prescription and over-the-counter drugs can also harm unborn children, the March of Dimes recommends that pregnant women speak to their doctors before taking any medication.

Cocaine Use during Pregnancy The March of Dimes offers the following information about cocaine use during pregnancy.

What are the risks with use of cocaine during pregnancy?

Cocaine use during pregnancy can affect a pregnant woman and her unborn baby in many ways. During the early months of pregnancy, it may increase the risk of miscarriage. Later in pregnancy, it can trigger preterm labor (labor that occurs before 37 weeks of pregnancy) or cause the baby to grow poorly. As a result, cocaine-exposed babies are more likely than unexposed babies to be born with low birthweight (less than 5 1/2 pounds). Low-birthweight babies are 20 times more likely to die in their first month of life than normal-weight babies, and face an increased risk of lifelong disabilities such as mental r.e.t.a.r.dation and cerebral palsy. Cocaine-exposed babies also tend to have smaller heads, which generally reflect smaller brains.

Some studies suggest that cocaine-exposed babies are at increased risk of birth defects, including urinary tract defects and, possibly, heart defects. Cocaine also may cause an unborn baby to have a stroke, which 235 Pregnancy and Birth Sourcebook, Third Edition can result in irreversible brain damage or a heart attack, and sometimes death.

Cocaine use also may cause the placenta to pull away from the wall of the uterus before labor begins. This condition, called placental abruption, can lead to extensive bleeding and can be fatal for both mother and baby. (Prompt cesarean delivery, however, can prevent most deaths.) Babies who were regularly exposed to cocaine before birth may score lower than unexposed babies on tests given at birth to a.s.sess the newborn's physical condition and overall responsiveness. They may not do as well as unexposed babies on measures of motor ability, reflexes, attention and mood control, and they appear less likely to respond to a human face or voice.

Babies who are regularly exposed to cocaine before birth sometimes have feeding difficulties and sleep disturbances. As newborns, some are jittery and irritable, and they may startle and cry at the gentlest touch or sound. Therefore, these babies may be difficult to comfort and may be described as withdrawn or unresponsive. Other cocaine-exposed babies "turn off" surrounding stimuli by going into a deep sleep for most of the day. Generally, these behavioral disturbances are temporary and resolve over the first few months of life. Some studies suggest that cocaine-exposed babies have a greater chance of dying of sudden infant death syndrome (SIDS). However, other studies suggest that poor health practices that often accompany maternal cocaine use (such as use of other drugs) also may play a major role in these deaths.

What is the long-term outlook for babies who were exposed to cocaine before birth?

Some studies suggest that most children who are exposed to cocaine before birth have normal intelligence. This is encouraging, in light of earlier predictions that many of these children would be severely brain damaged. A 2002 study at Harvard Medical School and Boston University found that children up to age 2 who were heavily exposed to cocaine before birth scored just as well on tests of infant development as lightly exposed or unexposed children. However, other studies suggest that cocaine may sometimes affect mental development, possibly lowering IQ [intelligence quotient] levels.

A 2002 study at Case Western Reserve University found that cocaine-exposed 2-year-olds were twice as likely as unexposed children from similar low socioeconomic backgrounds to have significant delays in mental development (14 percent and 7 percent, respectively).

236.

Nicotine, Alcohol, and Drug Use during Pregnancy It is not known whether these children will continue to have learning problems when they reach school age.

Studies are inconclusive regarding the risk of learning and behavioral problems. Studies from the National Inst.i.tute on Drug Abuse suggest that most adolescents who were exposed to cocaine before birth seem to function normally. However, some may have subtle impairments in the ability to control emotions and focus attention that could put them at risk of behavioral and learning problems. Other studies suggest that cocaine exposure may adversely affect language abilities. Researchers continue to follow cocaine-exposed children through their teen years to clarify their long-term outlook.

Marijuana Use and Pregnancy Marijuana is often mistakenly viewed as a "safe" drug. However, a study funded by the National Inst.i.tute on Drug Abuse (NIDA) and the National Inst.i.tute on Child Health and Human Development (NICHD) suggests that exposure to cannabinoids, psychoactive chemicals present in marijuana, can affect early embryonic development.

What are the risks with use of marijuana during preg- nancy?

Some studies suggest that use of marijuana during pregnancy may slow fetal growth and slightly decrease the length of pregnancy (possibly increasing the risk of premature delivery). Both of these factors can increase a woman's chance of having a low-birthweight baby.

These effects are seen mainly in women who use marijuana regularly (six or more times a week).

After delivery, some babies who were regularly exposed to marijuana in the womb appear to undergo withdrawal-like symptoms including excessive crying and trembling.

Couples who are planning pregnancy also should keep in mind that marijuana can reduce fertility in both men and women, making it more difficult to conceive.

What is the long-term outlook for babies exposed to mari- juana before birth?

There have been a limited number of studies following marijuana-exposed babies through childhood. Some did not find any increased risk of learning or behavioral problems. However, others found that 237 Pregnancy and Birth Sourcebook, Third Edition children who are exposed to marijuana before birth are more likely to have subtle problems that affect their ability to pay attention and to solve visual problems. Exposed children do not appear to have a decrease in IQ.

238.

Chapter 28.

Prenatal Radiation Exposures and Home Monitoring Chapter Contents.Section 28.1-X-Rays, Pregnancy, and You .............................. 240 Section 28.2-Pregnant Women Should Avoid Fetal Keepsake Images and Heartbeat Monitors ....... 243 Section 28.3-Home Uterine Monitors Not Useful for Predicting Premature Birth ............................... 245 239.

Pregnancy and Birth Sourcebook, Third Edition Section 28.1 X-Rays, Pregnancy, and You From "X-Rays, Pregnancy, and You," by the Centers for Devices and Radiological Health (CDRH, www.fda.gov/cdrh), part of the U.S. Food and Drug Administration, May 11, 2001. Reviewed by David A. Cooke, MD, FACP, April 12, 2009.

Pregnancy is a time to take good care of yourself and your unborn child. Many things are especially important during pregnancy, such as eating right, cutting out cigarettes and alcohol, and being careful about the prescription and over-the-counter drugs you take.

Diagnostic x-rays and other medical radiation procedures of the abdominal area also deserve extra attention during pregnancy. This information is to help you understand the issues concerning x-ray exposure during pregnancy. Diagnostic x-rays can give the doctor important and even life-saving information about a person's medical condition. But like many things, diagnostic x-rays have risks as well as benefits. They should be used only when they will give the doctor information needed to treat you.

You'll probably never need an abdominal x-ray during pregnancy.

But sometimes, because of a particular medical condition, your physician may feel that a diagnostic x-ray of your abdomen or lower torso is needed. If this should happen-don't be upset. The risk to you and your unborn child is very small, and the benefit of finding out about your medical condition is far greater. In fact, the risk of not having a needed x-ray could be much greater than the risk from the radiation. But even small risks should not be taken if they're unnecessary.

You can reduce those risks by telling your doctor if you are, or think you might be, pregnant whenever an abdominal x-ray is prescribed.

If you are pregnant, the doctor may decide that it would be best to cancel the x-ray examination, to postpone it, or to modify it to reduce the amount of radiation. Or, depending on your medical needs, and realizing that the risk is very small, the doctor may feel that it is best to proceed with the x-ray as planned. In any case, you should feel free to discuss the decision with your doctor.

240.

Prenatal Radiation Exposures and Home Monitoring What Kind of X-Rays Can Affect the Unborn Child?

During most x-ray examinations-like those of the arms, legs, head, teeth, or chest-your reproductive organs are not exposed to the direct x-ray beam. So these kinds of procedures, when properly done, do not involve any risk to the unborn child. However, x-rays of the mother's lower torso-abdomen, stomach, pelvis, lower back, or kidneys-may expose the unborn child to the direct x-ray beam. They are of more concern.

What Are the Possible Effects of X-Rays?

There is scientific disagreement about whether the small amounts of radiation used in diagnostic radiology can actually harm the unborn child, but it is known that the unborn child is very sensitive to the effects of things like radiation, certain drugs, excess alcohol, and infection. This is true, in part, because the cells are rapidly dividing and growing into specialized cells and tissues. If radiation or other agents were to cause changes in these cells, there could be a slightly increased chance of birth defects or certain illnesses, such as leukemia, later in life.

It should be pointed out, however, that the majority of birth defects and childhood diseases occur even if the mother is not exposed to any known harmful agent during pregnancy. Scientists believe that heredity and random errors in the developmental process are responsible for most of these problems.

What If I'm X-Rayed before I Know I'm Pregnant?

Don't be alarmed. Remember that the possibility of any harm to you and your unborn child from an x-ray is very small. There are, however, rare situations in which a woman who is unaware of her pregnancy may receive a very large number of abdominal x-rays over a short period. Or she may receive radiation treatment of the lower torso. Under these circ.u.mstances, the woman should discuss the possible risks with her doctor.

How You Can Help Minimize the Risks * Most important, tell your physician if you are pregnant or think you might be. This is important for many medical decisions, such as drug prescriptions and nuclear medicine procedures, as well 241 Pregnancy and Birth Sourcebook, Third Edition as x-rays. And remember, this is true even in the very early weeks of pregnancy.

* Occasionally, a woman may mistake the symptoms of pregnancy for the symptoms of a disease. If you have any of the symptoms of pregnancy-nausea, vomiting, breast tenderness, fatigue-consider whether you might be pregnant and tell your doctor or x-ray technologist (the person doing the examination) before having an x-ray of the lower torso. A pregnancy test may be called for.

* If you are pregnant, or think you might be, do not hold a child who is being x-rayed. If you are not pregnant and you are asked to hold a child during an x-ray, be sure to ask for a lead ap.r.o.n to protect your reproductive organs. This is to prevent damage to your genes that could be pa.s.sed on and cause harmful effects in your future descendants.

* Whenever an x-ray is requested, tell your doctor about any similar x-rays you have had recently. It may not be necessary to do another. It is a good idea to keep a record of the x-ray examinations you and your family have had taken so you can provide this kind of information accurately.

* Feel free to talk with your doctor about the need for an x-ray examination. You should understand the reason x-rays are requested in your particular case.

242.

Prenatal Radiation Exposures and Home Monitoring Section 28.2 Pregnant Women Should Avoid Fetal Keepsake Images and Heartbeat Monitors From "Avoid Fetal Keepsake Images, Heartbeat Monitors,"

by the U.S. Food and Drug Administration (FDA, www.fda.gov), March 24, 2008.

While ultrasonic fetal scanning is generally considered a safe medical procedure, the use of it for unapproved and unintended purposes raises concerns.