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Dr. Janet Bryanton, associate professor at the UPEI's school of nursing, co-led with QEH pediatrician Dr. Kathy Bigsby an anonymous, provincial, population-based study to determine the incidence of prenatal fetal alcohol exposure in P.E.I. newborns.
Queen Elizabeth Hospital pediatrician Dr. Kathy Bigsby knew the problem of women in P.E.I. drinking while pregnant was not minor.
However, she never had any hard data to size up the actual extent of the problem. Now she does. And the numbers are jarring.
From November 2010 to November 2011, a meconium sample (baby’s first bowel movement) was collected from the diaper of 1,307 live P.E.I. newborns, including those born at the IWK in Halifax in what is believed to be the first province-wide study in Canada to involve meconium sampling from all live newborns for a full year.
A total of 1,271 meconium samples were successfully tested for alcohol metabolites (fatty acid ethyl esters or FAEEs) formed by the baby when a mother drinks during pregnancy.
Thirty-nine samples, or 3.1 per cent, returned positive results. Bigsby says the expectation is that about 40 per cent of babies with documented heavy prenatal exposure will likely exhibit fetal alcohol spectrum disorder (FASD), an umbrella term that includes a wide range of physical, cognitive and behavioural disabilities resulting from alcohol consumption by pregnant women.
The numbers in the anonymous study add up to at least 16 P.E.I. babies born during the one-year study period likely having FASD: at least 16, likely more.
Bigsby considers the toll heavy — a toll that is rung up year after year after year in the province.
“They are not just numbers,’’ Bigsby said of the disturbing study findings.
“These are Prince Edward Islanders who have been exposed (to alcohol). This is the next generation. So it kind of hits you really hard that way.’’
The effects on a child born with FASD are permanent. The primary disabilities include the presence of an inability to comprehend non-verbal social cues, attention deficits, sensory issues and emotional dysregulation.
Secondary disabilities are problems that individuals may develop as a result of their primary brain dysfunction, such as high risk of early school dropout, incarceration, dependent living and mental health problems like depression and addiction.
FASD is recognized as a significant public health concern having a profound impact on individuals, families and society in general. The estimated cost of FASD in Canada each year is about $5.3 billion and in the Atlantic region about $57 million.
The first major step in addressing the problem in P.E.I., notes Bigsby, was identifying the problem. The first comprehensive study of prenatal fetal alcohol exposure in P.E.I. babies that required the commitment of 80 or so nurses doing the regular collection of samples from babies was that first step.
People here in the province, says Bigsby, can no longer stick their heads in the sand with the belief that FASD is not a problem in Prince Edward Island.
It is. And it is a big problem.
The study determined that at least 3.1 per cent of Island women were drinking frequently during the last six months of pregnancy. No reason to believe that isn’t the case in any given year on P.E.I., give or take a percentage point.
“These are Prince Edward Islanders who have been exposed (to alcohol). This is the next generation." Dr. Kathy Bigsby
Bigsby and UPEI school of nursing associate professor Dr. Janet Bryanton, who led the study together, both say that number needs to come down: way down.
At least 16 P.E.I. babies being born in one year all with FASD, says Bryanton, is “a lot of harm.’’
The harm, of course, is quite avoidable. The answer to the problem is straightforward: get women to stop drinking alcohol while pregnant.
However, reducing the number of women consuming booze during pregnancy, let alone eliminating the occurrence, is no less than a magnificent challenge.
Dr. Nancy Poole, well known for her fetal alcohol spectrum disorder prevention research, says there are “tons of reasons’’ why women drink while they are pregnant.
Some simply are not aware of the risks. Ongoing public education is needed to reach this group. Warning labels on alcohol bottles and health curriculum in high school were a couple of suggestions offered.
Another group, those that know they shouldn’t be drinking during pregnancy but find it hard to stop, require more substantial deterrence, suggests Poole.
Some women who have a difficult time stopping drinking during pregnancy may have a history of complex issues including trauma, abuse, mental illness and poverty.
In some cases, notes Poole, women report that their partner did not want them to stop drinking while they were pregnant. Drinking, in those cases, is a pivotal component of the relationship.
“Alcohol use is a really common thing,’’ said Poole, who notes 75 per cent of Canadian women drink.
“It’s a health problem.’’
She says health-care providers need to be educated on how to have helpful conversations with pregnant women to assist them to not drink during their pregnancy. Addiction treatment, she adds, needs to be catered specifically to pregnant women in need of such intervention.
“We need to be responsive to the need,’’ she said.
“I think it’s (successful intervention) totally doable without a whole lot of money. It’s really about changing the paradigm. How can we be compassionate and effective rather than making (the pregnant woman’s) life hell.’’
Bryanton says the goal of the study is to improve the health of both babies and mothers in P.E.I. Work begins now at formulating approaches to best inform women about the dangers of drinking during pregnancy as well as establishing deterrent measures.
“Our role is to get the information out,’’ she said.
Bigsby says the message needs to be clear: drinking and pregnancy don’t mix. Period.
“Alcohol is teratogenic,’’ she said. “It causes birth defects. We don’t know what the threshold is. Why do we want to discover what the threshold is?’’
Bryanton is more succinct.
“The message that women need to get is they just shouldn’t be drinking during their pregnancy.’’