Ireland takes aim at prenatal alcohol exposure

“I think it’s the way the Irish drink as well,” Boyle said. “If someone isn’t going out or drinking on a night out, everyone is like, ‘Oh, what’s wrong?’”

Outside The Dame Tavern, Paula Kennedy noted the ignorance of previous generations to the effects of alcohol on a fetus, adding that her mother didn’t change her habits during pregnancy.

“My sister was very unwell and I was born premature as well,” said Kennedy, 36. “Without having a doctor’s report on it, I would say my sense of it was because she smoked and drank with us that that happened.”

A woman pours a pint of Guinness in a pub in Dublin.Linda Givetash / NBC News

Doctors are also contributing to the confusion. A survey of Irish pediatricians found one-third of them were unaware of the existence of FASD and 17.3 percent believed mild alcohol intake in the third trimester is safe.

Dr. Kieran O’Malley, a Belfast-based psychiatrist who has written extensively about the disorders, said some doctors across the border in Ireland simply don’t believe that FASD exists.

“That’s why I treat it as the last taboo. I think alcohol is so interwoven into our society it’s hard to know where to begin,” he said.

O’Malley said the “level of transgenerational alcohol brain injuries is astounding” in Ireland, adding that “nobody knows about it.”

Public health specialist O’Mahony agreed that “conflicting advice is being given all over.”

FASD does not necessarily hit the poor harder, O’Mahony said. Wealthier women who can afford expensive wine or spirits with dinner at home are also at risk of having a child with FASD. And it doesn’t necessarily require drinking at what are considered problem levels. “Alcohol and damage from alcohol doesn’t discriminate by socioeconomic group,” she said.

Part of the confusion, O’Mahony said, stems from the lack of research showing precisely how many drinks it takes to damage a fetus.

A study on the global rates of FASD published last year in The Lancet found that for every 67 women who drank in pregnancy, at least one child was born with the most severe form of the disorder — Fetal Alcohol Syndrome — while nine or 10 others were born with symptoms on the spectrum.

Body type, nutrition, other health conditions and even genetics can affect how the body metabolizes alcohol, and in turn how it affects a fetus. The high risk of having irreversible effects on a child is why many medical authorities, including the Centers for Disease Control and Prevention (CDC), recommend no alcohol intake in pregnancy.

Ireland’s national statistics office says annual consumption in 2016 was 3.03 gallons of pure alcohol per capita. Considering an estimated 20 percent of the population doesn’t drink at all, it raises the average for the drinking population to over 3.7 gallons annually. In comparison, per capita consumption in the U.S. in 2016 was 2.59 gallons.

Wrongly diagnosed?

David Gerry understands the challenges that come with FASD first-hand. He raised two foster children with FASD and co-founded FASD Alliance Ireland, a support group for parents.

What sets FASD apart from other cognitive disorders is the impact on the brain’s ability to understand cause and effect. Children and adults with FASD struggle to learn from consequences as a result of the prenatal alcohol exposure.

Image: David Gerry
David Gerry leads workshops for Irish educators working with children who have Fetal Alcohol Spectrum Disorder.Linda Givetash / NBC News

Gerry said his foster daughter was smart and an articulate and engaging speaker as a child, but her logic was different and she lacked the adaptive behavior skills needed to manage abstract concepts like money.

The impact of not getting the right support in school is among the reasons why Gerry targets educators in his awareness-raising about FASD.

Last month, he ran a workshop for the Education Training Board for the county of Donegal. Many of the special-needs assistants attending the workshop said they could think of children in their schools who most likely have the disorder but have other diagnoses such as ADHD.