Why the Best Way to Prevent Birth Defects Isn't About Zika

Why the Best Way to Prevent Birth Defects Isn't About Zika

By Joseph Spadafino


Because this disorder affects one in 100 live births. 

By Joseph Spadafino

The author is an epidemiologist for the Arizona Department of Health Services.

No doubt Zika is frightening. Since its emergence in Brazil this past October, cases of infant microcephaly — babies born with shrunken heads — have skyrocketed, from 147 in 2014 to a whopping 4,000 since the start of last year. There appears to be a strong link between Zika virus, which is transmitted by mosquito, and microcephaly. And, yes, pregnant women should postpone travels to areas affected by the virus.

Given the media frenzy around Zika virus, one might assume a disease responsible for 10 times as many birth defects in the United States — that’s one in 100 live births — would generate 10 times the attention in the media. Instead, that disease has slowly found its way to the back burner of our collective cognizance: fetal alcohol spectrum disorders (FASD). Some 40,000 babies are born each year with FASD, which include fetal alcohol syndrome (FAS) and other non-FAS neurological or developmental disorders caused by alcohol consumption during pregnancy.

The more people who understand the risks of drinking during pregnancy, the greater chance they will have to correct another person’s misconception.

To be sure, it’s easy to dismiss FASD as a non-newsworthy subject. After all, the deleterious effects of alcohol on fetuses is well known, and we know how to prevent FASD: Mothers shouldn’t drink while pregnant. Zika, in contrast, is new, mysterious and harder to avoid. But in truth, even after requiring the surgeon general’s warning on alcoholic beverage labels since 1988, cases of FASD persist. And the reasons why some women fail to abstain from drinking during pregnancy are often multifaceted, ranging from bad information to addiction to shame. It is not as simple as “some women care about the health of their child and others don’t.”

Several myths about drinking while pregnant remain. These include notions that a glass of wine a day during pregnancy is actually beneficial, or that a woman can drink until she is showing. Another one is that only alcoholic women can have babies born with FASD. The fact that these myths persist is an indictment of public health education campaigns. At any point where someone interacts with the health care system, the message should be clear: No amount of alcohol consumed during pregnancy is known to be safe for a baby.

This message need not be targeted only at women. Soon-to-be-fathers can also be agents for change. The more people who understand the risks of drinking during pregnancy, the greater chance they will have to correct another person’s misconception. Correcting myths about drinking during pregnancy is one important facet if we intend to tackle FASD, but what about the women who are already aware of the risks of drinking but are unable to abstain because of an addiction? This is an area where the public health infrastructure may not be doing enough for women. Counseling and other forms of social support are accessible to pregnant women who have an alcohol addiction, but many women might not be willing to use them for fear of being stigmatized.

Without condoning drinking during pregnancy, local health departments and community health organizations must make it clear that a woman’s inability to abstain does not give health workers the right to pass judgment on her. Physicians and community health workers alike must convey that they understand that any woman who is struggling to abstain is in need of help, and that they are there to help her — judgment-free.

So what could be accomplished if a Zika-esque frenzy was instead focused on FASD? For one, we would climb out of this state of apathy and indifference toward drinking during pregnancy. We would start to question how 40,000 new cases of FASD each year were ever acceptable. We would start a discourse and realize that 40,000 cases of FASD are not just an unavoidable background-noise number, but actually reflect a tragically high figure that is the direct result of failures on the part of our health care systems and public health infrastructure. The uproar over Zika virus may be warranted, but we as a country should reassess what risks really face women and their babies.