For the Birth Parent of a Child with an FASD
"Pregnant women do not cause FASD.
Alcohol causes FASD."​ Dr. Ken Jones
"There is a tendency to single out and blame the birth mother of an individual with an FASD. Even the name of the condition can suggest intentional harm by the mother. In reality, pregnant women who drink alcohol do not intend to cause harm to their children". Read more at FASD United on alcohol exposed pregnancy, FASD, and stigma
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Common questions:
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What if I am pregnant and have been drinking?
If you drank alcohol before you knew you were pregnant or before you knew that no alcohol use was the safest choice, stop drinking now. Every day matters. The sooner you stop drinking, the better for your baby.
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What if I drank during my last pregnancy and my child was fine?
Every pregnancy is different. Alcohol exposure before birth may harm one child more than another. You could have one child that is born healthy and another child born with problems. Some intellectual and behavioral problems related to FASD may not be apparent initially and can appear at any time during childhood.
For more information Alcohol and Your Pregnancy NIAAA
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Many things lead to an alcohol exposed pregnancy:​
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Not knowing we are pregnant.
Most people quit drinking when they find out they are pregnant.1 However, almost half of pregnancies are unplanned. Most people do not find out they are pregnant until four weeks or more into the pregnancy. They may drink alcohol during that time without knowing they are pregnant.
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Not knowing the risks related to drinking during pregnancy.
Some people might not be aware of the effects that drinking during pregnancy can have. They may have heard incorrect information or no information at all.
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Hearing incorrect information from a doctor.2
Many doctors are not telling their patients that there is no known safe amount of alcohol during pregnancy. One reason for this is that they may not have been trained on how to have these conversations with patients; this can cause them to feel unprepared and uncomfortable. However, patients and their partners report wanting information on alcohol use during pregnancy. Health care providers must be ready and willing to provide it.
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Knowing someone who drank during pregnancy and whose child has not been diagnosed with an FASD.
In the U.S. one in seven pregnancies (13.5%)3 are exposed to alcohol. If someone has a friend who drank alcohol during pregnancy but their child does not have an FASD diagnosis, they might think that drinking alcohol during pregnancy is safe. They may then choose to drink throughout their own pregnancy. However, alcohol affects each pregnancy differently. Even twins with the same level of alcohol exposure can have different effects.4 There is no way to confirm how alcohol will affect a certain pregnancy. The safest choice is not to drink any alcohol during pregnancy.
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Being part of a community where drinking is the norm.
Alcohol use is legal and generally acceptable in the United States. Even binge drinking is relatively common: 1 in 6 adults engage in binge drinking. Binge drinking during pregnancy can be especially dangerous for the fetus.5
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Having an alcohol use disorder.
Nearly 5% of people in treatment for substance use are pregnant.6 For those who need extra support to have an alcohol-free pregnancy, resources are available. However, there may be barriers to use these services. One major barrier7 is the stigma and guilt surrounding alcohol use during pregnancy. Feeling ashamed or judged for their drinking can prevent people from seeking help and support.
Thank you to PROOF Alliance for this information.
Support: It is normal for caregivers and family members to have feelings of grief and guilt when they discover their child has an FASD. No parent sets out to harm their child but feelings of loss or regret are common and can be overwhelming. Support for parents is available:
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Support groups like those provided by the FASD Collaborative, for families affected by FASD and specifically for the birth parent.
"Welcome to the Circle of Hope! The Circle of Hope was founded in 2004 by FASD United Vice President Kathy Mitchell. It is a network of women who have consumed alcohol during pregnancy and may have a child or children with Fetal Alcohol Spectrum Disorders."
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Northern Light Mercy Hospital McAuley Residence ..."provides a comprehensive transitional housing program for women with and without children who are in recovery from substance use disorder. We serve a diverse group of women whose primary concern is substance use disorder. Women come from all over the state of Maine and either apply on their own or are referred through community agencies.We have a holistic approach covering all aspects of recovery, including spirituality, parenting, physical and emotional wellness, career and education, financial responsibility, and recreation. This is done through professional staff who provide comprehensive individual coaching, psycho-educational and therapeutic groups, and community meetings."
McAuley Residence locations:68 High Street, Portland - 207-747-4121 Bangor - 207-659-7341
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MaineMOM improves care for pregnant and postpartum people with opioid use disorder* and their infants by integrating maternal and substance use treatment services. MaineMOM offers a team-based approach to care, including a perinatal provider, substance use counselor, patient navigator, nurse care manager, behavioral health clinician and recovery coach. For more information about MaineMOM services, their service locations, and how to refer to services can be found at MaineMOM.org.
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*CDC Information on polysubstance use in pregnancy
FASD Maine is an informational site provided to professionals and families for information on fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD). It is not intended to replace professional medical, psychological, behavioral, legal, nutritional or educational counsel. Reference to any specific agency does not necessarily constitute or imply its endorsement, recommendation, or favoring by FASD Maine.
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Stigma - Language Matters Women drink alcohol during pregnancy for a wide range of reasons, including not knowing they are pregnant, lack of information about the harms of alcohol during pregnancy, and problems with alcohol and drug use. The language we use can help women feel safe to ask questions about alcohol use during pregnancy, seek help if they are having difficulties stopping their use, and challenge stereotypes about people with FASD. See expanded infographic, "Talking About FASD." Thank you CANFASD (Canada FASD Research Network) for this vital information.
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A few words from researchers and physicians:
Due to misinformation, it is assumed by some medical providers and lay people that only those individuals who have an alcohol use disorder(AUD), drink daily, or binge drink, or continue to drink throughout pregnancy will have a child with an FASD. This is not the case. Because alcohol is a teratogen (causes birth defects), and affects the developing fetus throughout pregnancy, the effects of alcohol exposure/FASD may occur even when alcohol consumption is "low", infrequent, or when one stops drinking after a positive pregnancy test, in the earliest weeks of the pregnancy.
Also, the effect of alcohol exposure depends on many factors - maternal age, nutritional status, maternal and fetal genetics, number of pregnancies, polysubstance use - e.g., tobacco use increases vasoconstriction of the umbilical artery, increasing duration of alcohol exposure.
Burd, Larry, PhD et al. Review of ethanol dispersion, distribution, and elimination from the fetal compartment. Birth Defects Res A Clin Mol Teratol. 2014 Apr;100(4):277-83
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"Although parents with a substance use disorder (a treatable chronic disease)* have a higher likelihood of having a child with FASD, most children with FASDs are born to parents who do not have a substance use disorder... Prenatal alcohol exposure and potential harm can occur before a person is aware they are pregnant. Children with prenatal alcohol exposure come from every social, economic, racial, and ethnic group. In the United States, nearly 1 in 7 pregnant people report alcohol use in the past 30 days."
The American Academy of Pediatrics (AAP) advises:
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There is no amount of alcohol during pregnancy that is risk-free.
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There is no kind of alcohol during pregnancy that is risk-free.
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There is no time during pregnancy when alcohol consumption is risk-free.
Screening for prenatal alcohol exposure is an essential function of the primary care medical home and the responsibility of all pediatricians. Early identification of a child at risk for developmental disability because of a positive history for prenatal alcohol exposure should lead to further evaluation and, when warranted, diagnosis and treatment.​
The AAP also advises against using tobacco, e-cigarettes, marijuana, and other harmful substances during pregnancy:
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No amount of marijuana has been proven safe to use during pregnancy or while breastfeeding.
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No kind of e-cigarette ― also known as e-hookah, e-pens, vape pens, or tanks ― is safe to use while pregnant or while breastfeeding. E-cigarettes are NOT a safe way to quit smoking during pregnancy either.
“Asking about alcohol use [and other substances] is the best way to decrease the stigma, increase diagnosis, provide appropriate information, and prevent future problems,” said Dr. Amelia Burgess, M.D., M.P.H., FAAP, FASAM, a board-certified pediatrician and addiction specialist who practices addiction medicine with Bicycle Health, a nationwide telehealth group.
Dr. Vincent Smith MD MPH Division Chief of Newborn Medicine at Boston Medical Center (Complete article here)
*Substance use disorder is a treatable disease - Substance Use Disorder in Pregnancy: Improving Outcomes for Families
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"Many women may feel unsafe disclosing their alcohol use because of stigma, fear of judgement from health and social service providers, and fear of child protection involvement. Health and social service providers who are judgemental, who adopt punitive approaches, or who insist on complete abstinence from substances, can limit women from accessing necessary harm reduction and support services, such as housing, nutritional supports, or substance use treatment programs. This is particularly true for women of colour, women from lower socioeconomic brackets, or those who experience other inequities. Moreover, when providers hold a belief that only certain ‘types’ of women can have a child with FASD, women from other groups who may need help to reduce their drinking may be deterred from asking for it, or may be incorrectly reassured that their drinking is not problematic."
Mothers' Experiences of Stigma: Multi-level Ideas for Action - Canada FASD Research Network CANFASD​​
1. Hettema J, Cockrell S, Ingersoll K, et al. Missed Opportunities: Screening and Brief Intervention for Risky Alcohol Use in Women’s Health Settings. Journal of Women’s Health. 2015;24(8):648-654.
2. ​Smith, Vincent, et al. Caring for Patients with Prenatal Alcohol Exposure: A Needs Assessment. J Popul Ther Clin Pharmacol Vol 24(1):e25-e39; January 27, 2017.
"Prenatal alcohol exposure (PAE) is the United States’ most common preventable cause of birth defects and intellectual and developmental disabilities collectively referred to as Fetal Alcohol Spectrum Disorders (FASD). This study was designed to identify gaps in pediatric providers’ knowledge and practices regarding FASD patient identification, diagnosis, management and referral, and to inform needs-based FASD resource development."
3. Gosdin LK, Deputy NP, Kim SY, Dang EP, Denny CH. Alcohol Consumption and Binge Drinking During Pregnancy Among Adults Aged 18–49 Years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep 2022;71:10–13. DOI: http://dx.doi.org/10.15585/mmwr.mm7101a2.
4. ​Hemingway Astley, Susan J., et al. Twin study confirms virtually identical prenatal alcohol exposures can lead to markedly different fetal alcohol spectrum disorder outcomes - fetal genetics influences fetal vulnerability. Advances in Pediatric Research. 2019;5:23
5. Roozen S, Peters G-JY, Kok G, et al. Systematic literature review on which maternal alcohol behaviours are related to fetal alcohol spectrum disorders (FASD). BMJ Open. 2018;8:e022578.
6. Stone R. Pregnant women and substance use: Fear, stigma, and barriers to care. Health and Justice. 2015;3:2. "The findings suggest that policies that substance-using women find threatening, discourage them from seeking comprehensive medical treatment during their pregnancies. The implications of the findings are discussed, particularly the need for further expansion of treatment programs and social services to meet the needs of substance-using women."
7. Corrigan, P. W., Shah, B. B., Lara, J. L., Mitchell, K. T., Combs-Way, P., Simmes, D., & Jones, K. L. (2019). Stakeholder perspectives on the stigma of fetal alcohol spectrum disorder. Addiction Research & Theory, 27(2), 170 -177.
