Alcohol use during pregnancy is among the leading causes of birth defects and mental retardation in the United States.

But some studies show that as many as 55 percent of women aren't aware of Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Spectrum Disorders (FASD) said Dr. Edward Goldson, a pediatrician with the University of Colorado Medical School and The Children's Hospital in Denver.

About five children in the Natrona County School District have been clearly identified as having FAS, but many more deal with a range of consequences of their parents' alcohol and drug use. Nationwide, as many as 40,000 children are born with FASD annually, with full FAS affecting an estimated two out of every 1,000 children born each year, according to the National Organization on Fetal Alcohol Syndrome. National and state health organizations don't accurately track FAS and FASD cases, though, because the syndromes often are missed in diagnosis and maternal drinking can be hard to verify.

"It's a pretty tough diagnosis," said Tammie Bertelson, the district's principal of special education. "We look at what's most prevalent, what's the primary concern. Really, when we look at providing educational services, we're looking at meeting educational needs, regardless of the diagnosis or the background of the child or family."

Still, she said, educators know that FASD may cause anything from mild learning disabilities to severe physical and mental health issues - all preventable if a mother abstains from drinking alcohol during pregnancy.

Goldson, who spoke to a crowd of nearly 200 students, social workers and health care professionals in Torrington earlier this month, said such birth defects are 100 percent preventable.

"When you drink, your baby drinks," Goldson said. "You don't have to drink, so your baby doesn't have to drink."

Identifying the problem

Fetal Alcohol Syndrome was first identified in the 1970s by researchers who noted children born to mothers who drank while pregnant shared similar birth defects, including particular facial abnormalities and cognitive delays. in more recent years, medical experts have expanded their definition of alcohol-related birth defects, identifying Fetal Alcohol Spectrum Disorders as a range of physical and mental abnormalities caused by prenatal alcohol exposure.

Goldson, however, said the danger of drinking while pregnant has been known even longer. The Old Testament of the Bible, for example, warns women not to drink while pregnant in the Book of Judges, and ancient Greek and Roman cultures posited the same cautions. In the 1700s, British researchers identified health risks for children prenatally exposed to alcohol.

The effects of the disorders now known are profound, Goldson said. Children born with FAS often have low birth weight and never catch up to their peers in weight and height. FAS also typically causes children to be born with small eyes, thin upper lips and flattened-looking faces.

Even more troublesome, prenatal alcohol exposure also affects brain development, and children with a range of FASD symptoms often have significant trouble with speech and language skills, memory, attention and behavior and emotion functions, Goldson said.

Such problems last a lifetime, starting in infancy with trouble sleeping, excessive crying and tremors. In early childhood, children with FASD may continue to have trouble sleeping and following directions, are often hyperactive and reach milestones such as walking, talking and toilet training more slowly, Goldson said. By preschool age, FASD symptoms may cause children to be overly friendly, lacking a natural fear of strangers, which poses a safety challenge for parents and caretakers.

Elementary school children with FASD continue to be hyperactive and often have trouble following rules or understanding social expectations. High school students have similar academic issues, often "reaching their academic ceiling," Goldson said. An inability to sense social rules also can lead to behavior problems and issues with sexuality, he said, and many teens with FASD begin showing signs of depression because "they know they're different, but they don't know why."

Tallying the cost

FAS and FASD pose a significant cost to the community at large, Goldson said. Some FAS children are taken from their biological parents and cycled through the foster care system. Most who suffer physical and cognitive impairments require special accommodations in school. And, there is a segment of FAS adults who never are able to live independently, he said.

Bertelson said youth with FASD symptoms can challenge educators because they often lack impulse control.

"A lot of time, those students don't understand the consequences for their actions," she said. "It's hard for them to realize, 'Last time I was impulsive, this was the consequence. Next time I'm impulsive, this will be the consequence.'"

All told, Goldson said FASD taxes not only individuals with the condition, but also puts a strain on parents and foster parents, educators and public health and social services agencies. The National Organization on Fetal Alcohol Syndrome estimates that an individual with FAS can face lifetime health care costs of $860,000, and the condition costs the U.S. some $5.4 billion each year.

Meanwhile, alcohol problems in general account for about 15 percent of all U.S. health care costs - about $100 billion, Goldson said.

"That's more than most countries' gross national product, and we're spending it on an avoidable disease," he said.

Dr. Jack Bottenfield, president of Eastern Wyoming College, where Goldson spoke, said the data on the disease and the consequences of something as simple as drinking were overwhelming.

"We have this specter of drugs," Bottenfield said. "I always thought of drugs as marijuana and cocaine. But I know a lot of people who smoke and use alcohol. I never thought of that in the same context of a dark alley in an urban area with someone peddling a box of crack cocaine."

In many ways, though, it is the same, said Goldson. But, he said, the problems of FAS and FASD can all end if women choose to avoid alcohol during pregnancy.

"This cascade of many events is all because Mommy decided to drink. The impact is absolutely extraordinary," he said. "Whenever possible, the prevention of a mother's substance abuse is the best goal for mothers, children, families and society."

Staff writer Jenni Dillon can be reached at (307) 266-0619 or Jenni.Dillon@casperstartribune.net.