Thalidomide

In class, we recently discussed the thalidomide incident and how it represented a pivotal shift in the way drugs were developed—particularly in providing an insight into the way drugs taken by a pregnant mother affect her baby. I was reminded of this while reading the news yesterday, as I came across this article discussing a case that could lead to the criminalization of alcohol consumption during pregnancy. (Gander, 2014)

Case: A six-year old girl suffered brain damage because of her mother’s alcohol consumption while carrying her—and it is now being argued that she is the victim of a crime / criminal offense committed by her mother.

This article deeply intrigued me, as I thought about all the implications that a law like this, if passed, could have. As we have (in our Medicines & Drugs unit) studied the effects that alcohol has on the body, I decided to investigate the chemistry of alcohol as it affects her mother and baby to answer the following question: to what extent does alcohol consumption by a mother negatively impact her baby?

I found that, once consumed, most substances are broken down in an intermediate step by enzymes (biological catalysts) to “metabolites”: other compounds that can be easily processed by the body. However, the alcohol we consume (ethanol– CH3CH2OH), is broken down by the body to the toxic and carcinogenic Ethanal (also called ‘Acetaldehyde’: CH3CHO). (Alcohol Metabolism: An Update, 2007)

The breakdown of Ethanol

Figure 1. The breakdown of Ethanol by the body.
(Alcohol Metabolism: An Update, 2007)

Note: ADH (Alcohol Degenerase) and ALDH (Aldehyde Degenerase) are the enzymes that catalyze the reactions.

As we can see from the above equation, in normal (non-pregnant) individuals the Ethanal is usually short-lived as it serves as an intermediate to when it is further broken down to Ethanoic Acid (also called ‘EthylAcetate’: CH3COOH), and then to carbon dioxide and water, after which it is eliminated from the body. (Alcohol Metabolism: An Update, 2007)

Ethanal itself is an aldehyde, and contains 2 carbons, a methyl group and its characteristic aldehyde functional group (C=O double bond).

Structure of Ethanal

Figure 2. Structure of Ethanal
(Environmental Chemistry: Lecture 21, n.d)

In pregnant women, this compound does pose a risk for their babies. A meta-analysis of 14 studies found that while 43% of pregnant alcoholics had high levels of acetaldehyde in their blood, 34% of them gave birth to a baby with ABRD (Alcohol Related Birth Defect). The researchers concluded that acetaldehyde “may play a major role in the cause of ARBD”. (Hard, Einarson, & Koren, 2001)

The precise mechanism as to how acetaldehyde impacts a fetus is not yet known, but alcohol in general has also been found to increase risk of foetal damage, and the risk of miscarriage. (Abuse and Mental Health Services Administration, n.d;  Bailey & Sokol, 2011) Other investigations have linked alcohol to damaging the DNA of a growing/ developing baby in the womb (however, these investigations have so far only been conducted on lab mice). (Medical Research Council, 2011) Already, a 50% increase has been seen in FAS cases (Fetal Alcohol Syndrome) in the past three years, and the Department of Health estimates that 1/100 babies are born with alcohol-related disorders. (Gander, 2014)

The adoptive mother of the six-year old has seen first-hand the consequences that alcohol consumption can have on children, and strongly believes that the legal system should step in and enforce some laws to prevent against further cases of FAS. “You can’t make it a criminal offense if you are still legally saying this a safe amount to drink, or you can drink. It needs to be clear from the start that you can’t [drink]”. (Gander, 2014)

Her argument is also supported by Dr. Raja Mukherjee, a consultant psychiatrist, who asserts that even minimal consumption by a woman during pregnancy puts her baby at risk for FAS, “If you want to guarantee safety and you want to guarantee no risk then no alcohol is the best way forward”. (Gander, 2014)

The implications of a law criminalizing the consumption of alcohol while pregnant will certainly serve to reduce the high numbers of babies suffering from ABRDs such as FAS. Babies suffering from FAS are usually hyperactive and delayed in their development– if exposed to high levels of alcohol while in the womb, they can display withdrawal symptoms such as extreme irritability, shaking, and diarrhea. Additionally, school aged children with FAS often experience learning and behavioral disabilities, and for this reason find themselves falling behind in school. They also are high at risk for having trouble with the law, developing mental health problems and themselves abusing alcohol and/ or drugs. (Canadian Paediatric Society, 2002) Considering this, as well as the previously conducted research demonstrating other harmful effects of alcohol consumption during pregnancy, it is apparent that alcohol is to a large extent extremely damaging to developing babies. A law criminalizing this act may not be the worst idea.

References

(2007). Alcohol Metabolism: An Update. Alcohol Alert, 72. Retrieved February 23, 2014, from http://pubs.niaaa.nih.gov/publications/AA72/AA72.htm

Bailey, B. A., & Sokol, R. J. (2011). Prenatal Alcohol Exposure and Miscarriage, Stillbirth, Preterm Delivery, and Sudden Infant Death Syndrome . Alcohol Research & Health, 34(1), 86-91. Retrieved February 23, 2014, from the NIAAA Publications database.

Paediatric Society. (2002). Fetal alcohol syndrome: What you should know about drinking during pregnancy. Paediatrics & Child Health , 7(3), 177-178. Retrieved February 24, 2014, from the PMC database.

Environmental Chemistry: Lecture 21. (n.d.). NAU Courses. Retrieved February 23, 2014, from http://jan.ucc.nau.edu/~doetqp-p/courses/env440/env440_2/lectures/lec21/lec21.html

Gander, K. (2014, April 23). Drinking alcohol while pregnant could become a crime after landmark test case . The Independent. Retrieved February 23, 2014, from http://www.independent.co.uk/life-style/health-and-families/health-news/drinking-alcohol-while-pregnant-could-become-a-crime-after-landmark-test-case-9147417.html

Hard, M. L., Einarson, T. R., & Koren, G. (2001). The Role of Acetaldehyde in Pregnancy Outcome After Prenatal Alcohol Exposure. Therapeutic drug monitoring, 23(4), 427-434. Retrieved February 23, 2014, from the PubMed database.

Research Council. (2011, July 6). Excess alcohol could damage our DNA. Medical Research Council News. Retrieved February 23, 2014, from http://www.mrc.ac.uk/Newspublications/News/MRC008040

Abuse and Mental Health Services Administration. (n.d.). Effects of Alcohol on the Developing Embryo and Fetus. FASD Center for Excellence. Retrieved February 23, 2014, from http://fasdcenter.samhsa.gov/educationTraining/courses/CapCurriculum/competency1/effects1.aspx

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