Infant addicts: a preventable rage.

INFANT ADDICTS: A PREVENTABLE RAGE

Birthdays are for celebrations - except for babies and children born with drug or alcohol addiction. In The Broken Cord (Harper and Row, 1989), Michael Dorris shares the pain of raising an adopted son, Adam, whose every birthday brings rage to his parents against the tragedy "that he was not born whole." For Adam, you see, is mentally retarded because of fetal alcohol syndrome. He will never enjoy life to the full because of the alcohol his body was exposed to before he was born. The grief for what might have been will never entirely disappear.

For those babies who survive infant withdrawal and develop enough mental capacity to recognize their disadvantages, will birthdays always remind them that they were shortchanged on life? And what will their mothers' future relationship with such children be like? How will they parent children with drug-induced hyperactivity? Or stop grieving for the damage their actions have caused? Fathers too have a responsibility for their children's addiction: what did they do to help the mother stop using drugs during pregnancy? How will fathers cope?

Research scientists are not yet sure what the long-term impact of maternal drug use during pregnancy may be. But a surge of new studies confirms the devastation that addictive drugs can wreak on fetal growth and development. Would-be parents need to understand that drug use during pregnancy is more than a recreational option or social activity. Maternal drinking and drugging may permanently ruin one's chances of a rewarding motherhood.

But such a tragedy is preventable. Avoiding alcohol and other drugs during the child-bearing years is the most ideal strategy. Or if a mother is already using them, quitting alcohol or drugs should happen as soon as possible after pregnancy is confirmed.

Drug-addicted babies are increasing. Physicians have recognized for many years that even medically useful, legal drugs should be avoided, if possible, during pregnancy because of the risk of birth defects. But today a tidal wave of addicted-infant births is occurring in response to the growing use of addictive drugs, especially crack cocaine, among women.

Cocaine-addicted newborns are swamping the neonatal units of some city hospitals. Women abusing cocaine sometimes view their pregnancy as an inconvenience, continuing to free-base cocaine right up to delivery, according to Cardwell C. Nuckols, Florida addictions consultant and author of Cocaine: Dependence to Recovery. Cocaine babies are born small in size and are extremely irritable. Many of these babies must remain in the hospital for extended periods because the mother has abandoned them or is unable to stay cocaine-free, and foster parents willing to assume responsibility are scarce.

Researchers at Northwestern University medical school recently reported that cocaine-exposed infants had significant impairment of orientation ability and motor behaviors compared to babies not exposed to cocaine. They were also born small. Ceasing use of cocaine early in pregnancy was helpful, but any cocaine use placed the infants at risk. These scientists think these changes could have implications for long-term development as well.

Marijuana use during pregnancy is more common than many realize. A study of deliveries at Boston City Hospital during three years showed that 27 percent of the mothers smoked marijuana during pregnancy. Infants averaged three ounces lighter and one fifth of an inch shorter than babies of drug-free mothers.

Phencyclidine or PCP, commonly called "angel dust," can have serious effects on pregnancy. A study of 55 babies born to PCP-abusing mothers showed that more than half of the babies went through narcotic withdrawal at birth: jitteriness, excessive sucking or poor sucking, excessive crying, sneezing, and vomiting.

A study of eight infants born to mothers in Sweden who abused prescription benzodiazepine tranquilizers showed that they were born with a syndrome similar to fetal alcohol syndrome. The infants had expressionless faces and reduced vitality at birth, were growth retarded, and suffered varying degrees of drug withdrawal.

Any drug ingested during pregnancy is a medical risk to the fetus, but repetitive use of addictive drugs appears to make inevitable problems in the newborn's future.

Alcohol is the most common problem. Alcohol is so taken for granted in our society that most of us don't even think of it as a drug. Yet whenever one has wine with a meal, a gin and tonic at a party, or a beer with the late movie, he or she is consuming a central nervous system depressant that affects nearly every organ in the body. Alcohol abuse over a period of time can contribute to a number of serious disorders, including muscle and heart disease, malnutrition, digestive problems, and liver cirrhosis. We should not be surprised that this powerful, addictive drug, when used during pregnancy, also can affect the delicate and developing system of the unborn baby.

Nevertheless, many mothers-to-be are still not taking seriously warnings to avoid drink during pregnancy. Each year more than 50,000 babies are born in the United States with alcohol-related birth defects each year. Fetal alcohol syndrome is the cause of 20 percent of all mental retardation and a greater threat than any other form of birth defect.

During the past 15 years, researchers have conducted many studies of infants born to women who drank heavily during pregnancy. The results are disturbing. Many infants studied were born with a definite pattern of physical, mental, and behavioral abnormalities that researchers named the "fetal alcohol syndrome" (FAS). Babies with this syndrome were shorter and lighter in weight than normal, and they didn't "catch up," even after special postnatal care was provided. They also had abnormally small heads, several facial irregularities (see drawing), joint and limb abnormalities, heart defects, and poor coordination. Most also were mentally retarded and showed a number of behavioral problems, including hyperactivity, extreme nervousness, and poor attention span. And for every infant born with fetal alcohol syndrome, there are several more born with only some of the features of the syndrome. When only some characteristics are present, they are called alcohol-related birth defects.

Once these alcohol-caused birth defects were the major worries associated with FAS. Now, however, more subtle behavioral problems are being described. Newborn infants are jittery, show failure to thrive, and as they grow older are likely to be hyperactive, have motor problems, attention deficits, and delayed development.

FAS is an entirely preventable tragedy. If a woman, even an alcoholic, stops drinking before she becomes pregnant, the infant will not develop FAS or any alcohol-related birth defect. Unfortunately, not all pregnancies are planned. A drinking mother may be pregnant for several crucial weeks of early fetal development before she has pregnancy confirmed; these are the days when fetal organ systems are forming and may be readily deformed. Drinking throughout pregnancy is likely to affect the fetal brain, since it is developing during all nine months. The more a mother drinks and the longer she drinks, the higher the risk that her infant will be harmed.

How alcohol affects the fetus. It may be hard to believe that alcohol can cause such devastating effects in the unborn baby. An understanding of how alcohol interacts with the fetus may help. When a pregnant woman takes a drink, the alcohol readily crosses the placenta to the fetus. It then travels through the baby's bloodstream in the same concentration as in the mother. So if the expectant mother drinks at a party, her unborn baby drinks as well. But the tiny, developing system of the fetus is not equipped to handle alcohol, so the unborn baby must depend on its adult mother to burn up the alcohol. Unfortunately, the fetus can't say "no."

Moderate drinking is harmful, too. What are the effects of social drinking? A recent study by Dr. Ann Streissguth of the University of Washington medical school showed that some effects were seen among children of mothers who drank an average of just slightly more than one drink per day. These children showed reduced intelligence and memory, attention deficits, and delayed fine and gross motor development up to 7 years of age. These 7-year-olds were observed to be more distractible, more disorganized, less cooperative, and more rigid in problem-solving than children of nondrinking mothers. Streissguth's work confirms observations reported from animal research.

How many drinks are OK during pregnancy? The answer must be a resounding "none!"

Compromising the future. Dr. Streissguth and her colleagues have also studied some of the original FAS children 10 years later, to discover how they have done as they entered adolescence. Of the original 11 FAS children first reported, two had died and one could not be located, leaving eight children, several of whom had entered their teens. Four (half) are in the borderline-retarded to low-normal range of intelligence (IQ 70-86) but have attended regular classes along with receiving remedial education. The other four, with IQs ranging from 20 to 57, are severely retarded and must be in special classes.

The physical characteristics remain similar to those reported initially, although facial appearances have changed somewhat with growth of the chin and nose. All the children are below average in height and have smaller than normal heads. The adolescent girls have a short, stocky stature and the boys are short and thin. Some new physical problems have appeared as the children have matured. These include chronic middle ear infections, sustained hearing loss, severe dental problems, and vision problems. The cardiac defects present at birth have not been a major medical problem.

Two of the children still live with their natural mother; the mothers of three others (who were among the most severely handicapped) have since died of alcoholism. Two of the children with the most severe problems have had the benefits of a stable foster home, which has produced some improvement in social and emotional development, but has not remedied the physical and mental damage caused by prenatal alcohol.

For your future's sake, be drug-free. Considering the aftereffects of prenatal drinking or drug-abuse, the smartest conclusion is: don't take the chance. Who can measure what might have been? For your baby's sake, for your own sake as a parent, prevent a lifetime of grief and rage. Don't use alcohol or other drugs during pregnancy. If you are using them now and can't stop alone, get help. Your physician or local health department can help you locate that help.

A baby with fetal alcohol

syndrome may...

1. Be smaller than other comparable children in body size and weight. 2. Have an abnormally small head. 3. Have a peculiar appearing face, including a flattish appearance

when seen from the side. 4. Suffer from an abnormally formed heart or from kidney problems. 5. Have trouble bending or moving its arms and legs. 6. Have trouble learning at a normal rate, or be mentally retarded. 7. Fail to develop, grow, and thrive like other infants.

Other children with fetal

alcohol syndrome may...

1. Suffer from mental retardation that cannot be corrected by training or

education. 2. Display abnormally high levels of activity. 3. Be unable to concentrate or to settle down when told to do so. 4. Show behavior problems in school that result from hyperactivity. 5. Have a skinny appearance and fail to gain weight as other children of

the same age do. 6. Have abnormal sleeping patterns for a child of his or her age.

PHOTO : FACIES IN FETAL ALCOHOL SYNDROME Adapted from How many Drinks are OK. Memorial Hospital Continuing Education Institute, South Bend, Indiana.

Patricia B. Mutch, Ph.D., is director of the Institute of Alcoholism and Drug Dependency at Andrews University, Berrien Springs, Michigan.