This is a major public health crisis.

No, this warning is not about the rising abuse of opioids gripping our nation and now killing more than 100 Americans a day.

No, this is a silent public health crisis within our families and communities — the prenatal alcohol exposure of our children. PAE is a major cause of birth defects — brain damage causing neurodevelopmental impairments and learning problems, which are commonly known now as Fetal Alcohol Spectrum Disorders (FASD).

How common is this disability? Until recently, we did not have a reliable answer. However, a new study on the prevalence of FASD published in the Feb. 6 online edition of the Journal of the American Medical Association reveals a more startling picture of the problem.

Researchers assessed 6,639 first-graders in four U.S. regions and found a range of 1 percent to 5 percent of children with an FASD (an average of one child out of 50). They also suspected substantial underreporting of prenatal alcohol use and that “we are missing kids.” In short, these results are likely to be a conservative estimate of FASD prevalence.

This new study is particularly important in that 1) researchers physically screened youth, whereas other prevalence studies have been based on birth record reports and record reviews; 2) they also learned that youth with this disability can be readily identified in U.S. mainstream populations; and 3) they found that race, ethnicity and socio-economic status were not significant factors. The youth with FASD mirrored the demographics of their communities.

Youth with FASD often have chronic health care problems, need special education and disability services, mental health and substance abuse treatment and may end up in our foster care and juvenile or adult criminal justice systems. Obviously, these services are costly.

A 2002 estimate on extra lifetime costs for someone with FASD was $2 million, for total annual U.S. costs of $4 billion. It is estimated that for every child born with FASD, three additional children are born who may not have the physical characteristics of FASD but who, as a result of prenatal alcohol exposure, suffer neurobehavioral deficits that affect learning and behavior. These cost estimates could dramatically increase based on the new prevalence data.

Identifying youth with FASD can prevent school failure, getting into trouble with the law, mental health problems, etc. We have found that these youth can lead meaningful and successful lives with compassion and understanding of their disability.

The message to not drink alcohol during pregnancy is well known. Since 1981, the U.S. surgeon general has provided the warning that there is no safe level of alcohol consumption for pregnant women. So why do women drink during pregnancy?

It happens for many reasons. Some women may be unaware of the extent of damage that can occur; some underestimate the harm because they have heard of other women who drank alcohol while pregnant and whose children appear healthy. Others may suffer from alcohol use disorder. Still others may engage in excess or binge drinking before knowing of a pregnancy.

In my 20 years of involvement in this issue, I have never heard a mother say that she intentionally drank alcohol to harm her child.

Studies have shown that women who have given birth to one child with FASD are at greater risk of giving birth to another child with FASD. Such women may also have FASD themselves or face serious social, mental and physical health issues.

Twenty years ago I founded the Minnesota Organization on Fetal Alcohol Syndrome (MOFAS), which has received state funding for programs that provide outreach and support to these women in obtaining alcohol and drug treatment, staying in recovery and resolving myriad complex problems related to their substance abuse. These programs have shown excellent results preventing future children with FASD and need to be the standard of care in all Minnesota communities.

The prevalence study also confirmed that binge drinking is driving up the numbers of children with FASD. Particularly alarming is that Minnesota ranks higher in binge and excessive drinking than do the states in this study. A 2017 Centers for Disease Control and Prevention (CDC) study found Minnesota women to have the fourth-highest level of binge drinking in the U.S. at 22.6 percent.

Minnesota will need to target its prevention efforts on the drinking behaviors of the mothers of youth with FASD and their husbands or partners. It is critical that we have a renewed focus on binge drinking and other alcohol abuse and its harmful effects on our children.

Preventing FASD and helping those affected will require an energetic local, state and federal focus. It cannot happen soon enough.


Susan Shepard Carlson is founder and president of the Minnesota Organization on Fetal Alcohol Syndrome, a retired Hennepin County judicial officer and former first lady of Minnesota.