South Africa has the highest recorded rate of foetal alcohol syndrome (FAS) in the world. Scientists estimate that as much as 10% of the population is affected by either FAS or the spectrum of disorders related to it. As we observe World Foetal Alcohol Syndrome Day on 9 September, the South African Breastmilk Reserve (SABR) urges government and society to support mothers in abstaining from alcohol use during pregnancy and moderating use during breastfeeding.

“Foetal alcohol syndrome is a widespread and persistent blight on the wellbeing of our nation,” says Dr Mhleli Masango, Medical Director of the South African Breastmilk Reserve (SABR). “While there is no cure for FAS, it is entirely preventable. All that is required is consistent interventions to educate and assist mothers who struggle with alcohol abuse.”

The effects of FAS lasts a lifetime. Children born with the syndrome are underweight and stunted (short for their age), have lower IQ scores (around 70 compared to the average of 100) and struggle with basic life skills like handling money, remembering things and understanding the consequences of their actions.1&2

Children within the FAS spectrum drop out of school more frequently, and are disproportionately likely to be involved in crime before the age of 21. When they reach adulthood many FAS sufferers are unable to find or maintain employment, suffer mental health problems and abuse drugs or alcohol.2

FAS can be completely avoided by simply abstaining from alcohol during pregnancy. Because a foetus’s developing brain is very sensitive to alcohol, even small amounts may cause permanent brain damage. There is no “safe” amount of alcohol during pregnancy, and no safe time to drink – it should be avoided completely.

Although this solution is simple, some mothers may struggle to remain abstinent. Alcoholism, poverty or peer pressure may lead a mother to continue drinking even after pregnancy has been confirmed. Friends, family members and other community members should actively support pregnant mothers to avoid alcohol, both during social gatherings and while at home.3

Once the baby is born, a mother may resume drinking even while she is breastfeeding, but only in strict moderation. “While a baby cannot develop FAS from ingesting alcohol in breastmilk, excessive amounts can still cause harm,” warns Dr Masango. “Mothers should limit themselves to one drink per day or less.”

Because alcohol passes freely into a mother’s breastmilk and peaks 30 to 60 minutes after ingestion, nursing should be delayed until at least two hours after the alcohol has been drunk. Always keep in mind the baby’s age when considering the effect of alcohol. A newborn has a very immature liver, so minute amounts of alcohol would be more of a burden. Up until around 3 months of age, infants process alcohol at around half the rate of an adult. An older baby or toddler can metabolize the alcohol more quickly.4

“Expecting mothers to entirely abstain from alcohol while breastfeeding is unnecessarily restrictive,” says Dr Masango, “but caution and moderation are essential to ensuring a baby’s health. By allowing two hours of breathing room between the drinking of alcohol and nursing your child, you limit any potential harm. In general, if you are sober enough to drive, you are sober enough to breastfeed.”

To get involved with the SABR, including breastfeeding advocacy and foetal health education in South Africa, click here or call 011 482 1920 or send an e-mail.

References:
1. Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape Province. American Journal of Public Health. May, P., Brooke, L., Gossage, J., Croxford, J., Adnams, C., Jones, K., Robinson, L., & Viljoen, D. (2000).
2. Fetal Alcohol Spectrum Disorder (FASD) FAQ – Public Health Agency of Canada
3. FAQ, The Foundation for Alcohol Related Research
4. Breastfeeding and the Use of Human Milk, The American Academy of Pediatrics, Mar 2012, 129 (3) e827-e841

Submitted by: De Wet Bergh
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