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Astley re kelly study

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Susan Astley responds to a study that concluded light prenatal alcohol exposure of 1-2 drinks per week does not increase risks of cognitive and behavioral deficits in children aged 0-3. She provides statistics from her clinic showing the percentage of children with fetal alcohol spectrum disorder diagnoses showing severe central nervous system impairment increases dramatically with age. Even children with full fetal alcohol syndrome can appear normal under age 3, but many experience severe dysfunction later. She argues the long-term effects of even light prenatal alcohol exposure on brain development in young children remain unclear.

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-----Original Message----- From: Susan Astley [mailto:astley@...] Sent: Friday, September 03, 2010 11:23 AM Subject: Re: Drinking for Two Dear all, The conclusions drawn by Kelly et 2009 Intnl J Epi are unfortunate and short-sighted. Here are some sobering statistics from our clinic (no pun intended). Among 160 individuals diagnosed with FAS/PFAS using the 4-Digit Code: here are the CNS functional outcomes (CNS Ranks: 1 normal,2 mod impaired,3 severely impaired) by age category. CNS 0-3yr 4-5 6-10 11-15 15-19 Rank 1 70% 33% 6% 3% 0% 2 13% 11% 13% 10% 0% 3 17% 56% 82% 86% 100% total N 46 27 55 29 3 The point here is that even kids with full FAS can look 'pretty good' under the age of 3yrs. Only 17% of 0-3yr olds met our criteria for severe dysfunction. But the prevalence of severe dysfunction increases dramatically in the older age groups. Clearly, ones ability to assess the full impact of alcohol on brain function in birth to 3 is limited. When Kelly et al report kids 0-3yrs are not at increased risk for cogn/beh deficits after light prenatal exposure to alcohol (1-2 drinks/week), one has to wonder what these kids will look like at age 10? While the AVERAGE reported drinking during pregnancy for FAS/PFAS in our clinic is 8 drinks/occasion, 5 days per week, that average reflects a very broad range. We have a child with full FAS whose reported exposure was 1 glass of wine daily for just the first trimester. We have another whose reported exposure was 1-2 drinks once a month. We have yet another whose mother was told by her doctor to drink during pregnancy to reduce stress (this was 30 years ago). She followed doctors orders, reportedly drank 2 glasses of wine daily and gave birth to a child with full FAS. So were these birth mothers not telling the truth? Or were these fetuses especially vulnerable to the adverse impact of alcohol? We will never know. Thus I remain deeply concerned when professionals imply 1-2 drinks per occasion is 'safe'. Safe for whom? Safe for all? Tell that to the birth mothers above whose children were born with full FAS. Better yet, tell that to the individuals born with FAS. Susan __________________________________________________ Susan J. Astley, Ph.D. Professor of Epidemiology/Pediatrics Director, WA State FAS Diagnostic & Prevention Network Vice-Chair, Faculty Senate Center on Human Development & Disability Phone (206) 598-0555 Room 459, Box 357920 FAX (206) 598-7815 University of Washington FASDPN website: fasdpn.org Seattle, WA 98195-7920 "The above email may contain patient identifiable or confidential information. Because email is not secure, please be aware of associated risks of email transmission. If you are a patient, communicating to a UW Medicine Provider via email implies your agreement to email communication; see http://www.uwmedicine.org/Global/Compliance/EmailRisk.htm The information is intended for the individual named above. If you are not the intended recipient, any disclosure, copying, distribution or use of the contents of this information is prohibited. Please notify the sender by reply email, and then destroy all copies of the message and any attachments. See our Notice of Privacy Practices at www.uwmedicine.org."

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Astley re kelly study

  • 1. -----Original Message----- From: Susan Astley [mailto:astley@...] Sent: Friday, September 03, 2010 11:23 AM Subject: Re: Drinking for Two Dear all, The conclusions drawn by Kelly et 2009 Intnl J Epi are unfortunate and short-sighted. Here are some sobering statistics from our clinic (no pun intended). Among 160 individuals diagnosed with FAS/PFAS using the 4-Digit Code: here are the CNS functional outcomes (CNS Ranks: 1 normal,2 mod impaired,3 severely impaired) by age category. CNS 0-3yr 4-5 6-10 11-15 15-19 Rank 1 70% 33% 6% 3% 0% 2 13% 11% 13% 10% 0% 3 17% 56% 82% 86% 100% total N 46 27 55 29 3 The point here is that even kids with full FAS can look 'pretty good' under the age of 3yrs. Only 17% of 0-3yr olds met our criteria for severe dysfunction. But the prevalence of severe dysfunction increases dramatically in the older age groups. Clearly, ones ability to assess the full impact of alcohol on brain function in birth to 3 is limited. When Kelly et al report kids 0-3yrs are not at increased risk for cogn/beh deficits after light prenatal exposure to alcohol (1-2 drinks/week), one has to wonder what these kids will look like at age 10? While the AVERAGE reported drinking during pregnancy for FAS/PFAS in our clinic is 8 drinks/occasion, 5 days per week, that average reflects a very broad range. We have a child with full FAS whose reported exposure was 1 glass of wine daily for just the first trimester. We have another whose reported exposure was 1-2 drinks once a month. We have yet another whose mother was told by her doctor to drink during pregnancy to reduce stress (this was 30 years ago). She followed doctors orders, reportedly drank 2 glasses of wine daily and gave birth to a child with full FAS. So were these birth mothers not telling the truth? Or were these fetuses especially vulnerable to the adverse impact of alcohol? We will never know. Thus I remain deeply concerned when professionals imply 1-2 drinks per occasion is 'safe'. Safe for whom? Safe for all? Tell that to the birth mothers above whose children were born with full FAS. Better yet, tell that to the individuals born with FAS. Susan __________________________________________________ Susan J. Astley, Ph.D. Professor of Epidemiology/Pediatrics Director, WA State FAS Diagnostic & Prevention Network Vice-Chair, Faculty Senate Center on Human Development & Disability Phone (206) 598-0555 Room 459, Box 357920 FAX (206) 598-7815 University of Washington FASDPN website: fasdpn.org Seattle, WA 98195-7920 "The above email may contain patient identifiable or confidential information. Because email is not secure, please be aware of associated risks of email transmission. If you are a patient, communicating to a UW Medicine Provider via email implies your agreement to email communication; see http://www.uwmedicine.org/Global/Compliance/EmailRisk.htm The information is intended for the individual named above. If you are not the intended recipient, any disclosure, copying, distribution or use of the contents of this information is prohibited. Please notify the sender by reply email, and then destroy all copies of the message and any attachments. See our Notice of Privacy Practices at www.uwmedicine.org."