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Category: pregnancy and childbirth

Published on Leave a comment on New Book Warning Us About Endocrine Disruptors

The following is a really nice article about endocrine disruptors (chemicals that can interfere with the body's hormonal system). Journalist Hillary Brueck writes about where they are found (all around us!), some of the many negative health effects, and about NYU physician and researcher Dr. Leonardo Trasande and his new book: "Sicker, Fatter, Poorer: The Urgent Threat of Hormone-Disrupting Chemicals to Our Health and Future ... and What We Can Do About It." Also, some things we can do to lower our exposure to endocrine disruptors.

By the way, once again Europe is ahead of the US in dealing with this problem. Excerpts from Business Insider: A toxic-chemicals expert is sounding the alarm about 4 cancer-linked chemicals that could be making us sicker and fatter

Through the course of a single day, your hands, mouth, and body come in contact with countless pieces of paper, plastic, fabric, and furniture. You probably don't think about the chemicals these substances might harbor, or consider that they have a drug-like effect on health. But some do. They can make metabolisms slow down, subtly lower IQs, contribute to ADHD in children, and mess with sperm counts in men.

They're called "endocrine disruptors," and they're around us all the time. The chemicals change how our bodies work by shifting the way hormones operate, according to Leo Trasande, a pediatrician and public-health researcher at NYU Langone Health. "Hormones are the basic signaling molecules in our body that take on so many actions for practically every organ system," Trasande told Business Insider. "And endocrine disruptors are synthetic chemicals that scramble those signals, contributing to disease and disability."

In his new book, "Sicker, Fatter, Poorer: The Urgent Threat of Hormone-Disrupting Chemicals to Our Health and Future ... and What We Can Do About It," Trasande lays out the four big categories of endocrine disruptors he's most concerned about, based on evidence from scientific studies and observations in his patients. They are: Bisphenols, like BPA, which are often found in the linings of aluminum-canned food and drinks and on cash-register receipts. Brominated flame retardants that are in some carpets, furniture, and clothing. Synthetic pesticides on food. "Plasticizer chemicals" called phthalates that show up in plastic food packaging, lotions, and cosmetics.  ...continue reading "New Book Warning Us About Endocrine Disruptors"

Published on Leave a comment on Personal Care Products and Puberty

Once again research finds that endocrine disruptors are associated with health effects - this time with earlier puberty in girls.  Endocrine disruptors are chemicals that interfere with the body's endocrine (or hormone) systems and can produce all sorts of negative health effects, including all sorts of reproductive problems in both males and females. Phthalates, parabens, and phenols (all used in common everyday products) are examples of endocrine disruptors.

The researchers asked the question: Is a baby's exposure before birth or exposure around the time of puberty (peripuberty) to phthalates, parabens, and phenols (which are found in personal care products) associated with the timing of when he or she starts puberty? In other words, does the mother's exposure to these chemicals during pregnancy have an effect on the fetus, which then has an effect years later on the child's puberty? And how about peripubertal exposure? The answer is a strong YES for girls, and minimal effect on boys (but boys did have earlier genital development with propyl paraben exposure).

What is scary is that almost all women (and men) are exposed to these chemicals - which can be measured in the urine. Studies find these chemicals in over 96% of American women. What to do?  One can't totally escape these chemicals, but one can really minimize exposure by reading labels and avoiding personal care products that list phthalates, parabens, phenols, as well as Triclosan (found in some anti-bacterial soaps). Avoid products that include "fragrances" or "scents" (those have a multitude of chemicals in them, including endocrine disruptors). Avoid air fresheners, dryer sheets, scented candles, room deodorizers, essential oils (lavender, tea tree oil). Buy "unscented" or "fragrance free" products.

The good news is that once a person avoids these chemicals, the levels in the body go down. So it's worth the effort minimizing exposure to them. By the way, animal studies find numerous reproductive effects from these chemicals, including timing of puberty. From Medical Xpress:

Chemicals in personal care and household products linked to earlier puberty in girls

Chemicals that are widely used in personal care and household products are linked to girls entering puberty at earlier ages, according to findings from a long-running study of mothers and children published today. The study in Human Reproduction, one of the world's leading reproductive medicine journals, found that chemicals such as phthalates, parabens and phenols were all associated with earlier puberty in girls, although there was no similar association observed in boys.   

...continue reading "Personal Care Products and Puberty"

Published on Leave a comment on Keep Caffeine To A Minimum During Pregnancy

Pregnant women have been advised to keep their consumption of coffee and other caffeinated beverages (tea, sodas, cocoa, energy drinks), and chocolate containing foods to a minimum for decades. Currently the American College of Obstetrics recommends that women consume less than 200 mg of caffeine (from any source) per day during pregnancy. This is less than 2 cups of regular coffee  or 4 cups of regular black tea. But a recent  study's findings suggest that the levels should be kept much lower.

The study of 941 mother/baby pairs in Ireland found that each 100 mg increase of caffeine per day was associated with a lower birth weight, shorter length of pregnancy (gestational age), shorter birth length of the baby, and smaller head circumference of the baby at birth. The strongest associations between those who consumed the most caffeine (when compared to those who consumed the least) was with lower birth weight.

The researchers think this occurs because caffeine crosses the placenta easily, but during pregnancy there is a slowed metabolism of caffeine (so it takes longer to get it out of the body). Similar results have been found in other recent studies. [On the other hand, for not pregnant women - coffee and tea are linked to all sorts of health benefits - here, here.]

From Medical Xpress: Caffeinated beverages during pregnancy linked to lower birth weight babies

...continue reading "Keep Caffeine To A Minimum During Pregnancy"

Published on Leave a comment on Can Pesticides Be Detected In Your Home?

Can pesticides be detected in your home? A Cornell University study found that every single home they studied in different areas of upstate New York had detectable pesticide residues in the homes. Every single one of the 132 rural homes.

Pesticides are colorless and odorless, but they still may be in your home from applications in the home or around the home from long ago. Pesticides can also be tracked in by your shoes or bare feet, on fur and clothing, or come in on the air (drift from pesticides being applied nearby), even off-gassing from soil. They stay in the dust in homes, and are absorbed by soft materials (such as rugs and upholstery, and even stuffed toys). Pesticides stay around so long (some even years) inside homes because they are not broken down easily (as they can be outdoors in the sun and rain).

The researchers pointed out that Americans use over 1 billion pounds of pesticides each year. Pesticides have health risks, even at low doses - for example, higher risks of various cancers, birth defects, neurological and immunological problems. Pregnant women (developing babies) and children are especially vulnerable to pesticide effects. For example, children are playing and crawling around on the floor sticking objects and their hands into the mouth. Pets also have health risks from pesticides, such as cancer.

While the pesticide residue samples in this study were taken in 2001 to 2002, the findings should apply today because pesticide use has risen tremendously since then - both on farms and elsewhere. And they tested for pesticides that are still commonly used today - such as 2.4-D (a commonly used herbicide, e.g. weed & feed for lawns, and on crops genetically modified to resist 2,4-D). The researchers didn't test for all the possible pesticides commonly used - just 15 of them. Unfortunately they didn't test for glyphosate , which is in Roundup, and heavily used nowadays - in crops and elsewhere as an herbicide (weed killer).

Think about it - at least in in the northeast, more people are using lawn pesticide services to get that "perfect, carpet-looking lawn" (really a monoculture that is environmentally horrible -  to bees and butterflies, soil organisms, birds, and anyone walking on it).

How many people do you know get monthly or annual pesticide treatments in or around their homes "just in case"? In every instance  people are getting exposed to pesticides - breathing them in, getting them on their shoes, feet, clothing, bodies. Besides this study, other studies have also found pesticides in household and daycare center dust. How do studies measure pesticides in people? Typically by measuring their levels in blood and urine.

So what can one do to lower the amount and number of pesticides in the home?

1) First of all, don't use pesticides casually or routinely in your him. Use non-toxic alternatives instead - this is called least toxic IPM (Integrated Pest Management), which emphasizes monitoring the problem, looking for what causes the pest problem (moisture getting into the house, holes in the wall, etc.) and then treating the cause. It uses alternatives to "just spraying a pesticide" such as baits, traps, vacuuming of pests!, caulking where needed, fixing wet areas. It means thinking like a pest and what attracts the pest (the cause), and using the most non-toxic way possible to correct the problem.

2) Very important: take off shoes when entering your home.

3) Wipe up dust and vacuum frequently in the home. Other contaminants are also in the dust, such as lead and fire retardant chemicals.

4) Use organic approaches to gardening and taking care of your lawn. [Click on category PESTICIDES for all posts on pesticides, including their health effects. All 2,4-D posts. All pregnancy and pesticide posts.]

The study by Laquatra et al in JSM Health Education & Primary Health Care: Common Pesticide Residues in Rural Homes of New York State

Excerpts from Beyond Pesticides discussion of this study in its Daily News Blog: Study of New York State Homes Finds Pesticides In Every Sample Tested ...continue reading "Can Pesticides Be Detected In Your Home?"

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Published on 2 Comments on Will All Men Eventually Be Infertile?

The following article in a popular magazine follows up on research that came out last year about the alarming steep decline in male sperm counts and sperm concentration over the past few decades. This is true for the U.S., Europe, Australia, New Zealand, and it is thought world wide. The article discusses the causes: environmental chemicals and plastics, especially those that are endocrine disruptors (they disrupt a person's hormones!). These chemicals are all around us, and we all have some in our bodies (but the amounts and types vary from person to person). Some examples of such chemicals are parabens, phthalates, BPA and BPA substitutes.

Even though there are effects from these chemicals throughout life, some of the worst effects from these chemicals seem to be during pregnancy - with a big effect on the developing male fetus. Testosterone levels in men are also dropping. Bottom line: males are becoming "less male", especially due to their exposure to all these chemicals when they are developing before birth (fetal exposure). Since it is getting worse with every generation of males, the concern is that soon males may be unable to father children because their sperm count will be too low - infertility. Dogs are experiencing the same decline in fertility!

Why isn't there more concern over this? What can we do? We all use and need plastic products, but we need to use safer chemicals in products, ones that won't mimic hormones and have endocrine disrupting effects. Remember, these chemicals have more effects on humans than just sperm quality (here and here). While you can't totally avoid plastics and endocrine disrupting chemicals, you can definitely lower your exposure. And it's most important before conception (levels of these chemicals in both parents), during pregnancy, and during childhood.

Do go read the whole article. Excerpts from Daniel Noah Halpern's article in GQ: Sperm Count Zero

A strange thing has happened to men over the past few decades: We’ve become increasingly infertile, so much so that within a generation we may lose the ability to reproduce entirely. What’s causing this mysterious drop in sperm counts—and is there any way to reverse it before it’s too late? 

Last summer a group of researchers from Hebrew University and Mount Sinai medical school published a study showing that sperm counts in the U.S., Europe, Australia, and New Zealand have fallen by more than 50 percent over the past four decades. (They judged data from the rest of the world to be insufficient to draw conclusions from, but there are studies suggesting that the trend could be worldwide.) That is to say: We are producing half the sperm our grandfathers did. We are half as fertile.

The Hebrew University/Mount Sinai paper was a meta-analysis by a team of epidemiologists, clinicians, and researchers that culled data from 185 studies, which examined semen from almost 43,000 men. It showed that the human race is apparently on a trend line toward becoming unable to reproduce itself. Sperm counts went from 99 million sperm per milliliter of semen in 1973 to 47 million per milliliter in 2011, and the decline has been accelerating. Would 40 more years—or fewer—bring us all the way to zero? 

I called Shanna H. Swan, a reproductive epidemiologist at Mount Sinai and one of the lead authors of the study, to ask if there was any good news hiding behind those brutal numbers. Were we really at risk of extinction? She failed to comfort me. “The What Does It Mean question means extrapolating beyond your data,” Swan said, “which is always a tricky thing. But you can ask, ‘What does it take? When is a species in danger? When is a species threatened?’ And we are definitely on that path.” That path, in its darkest reaches, leads to no more naturally conceived babies and potentially to no babies at all—and the final generation of Homo sapiens will roam the earth knowing they will be the last of their kind.

...continue reading "Will All Men Eventually Be Infertile?"

Published on Leave a comment on Does Diet Play a Role in Intestinal Bowel Disease?

Two recent studies caught my eye – both reviews of scientific research that looked at the issue of diet and whether it contributes to the development of Intestinal Bowel Disease (IBD), specifically Crohn’s disease and ulcerative colitis. These are chronic inflammatory disorders of the gastrointestinal tract, and which are rapidly increasing in developed countries (over 1 million individuals in the US). The main question is: Does a person’s diet contribute to the development of IBD?

Both articles (one in the journal Nature Reviews and one in Immunology) said: YES, there is growing evidence that a person’s diet has a role in the development of IBD. Both articles stated that the current view is that some individuals may be genetically susceptible, and their diet (which feeds the microbes in the gut) then makes them more prone to the disease due to the mucosal lining becoming permeable and inflamed. Studies have shown that people with IBD have gut microbial communities that are imbalanced or out of whack (dysbiosis).

What does this mean? A person’s diet has a key role in what microbes live in the gut (human gut microbiome) – what one eats feeds the microbes in the gut, and a person’s general dietary pattern feeds some types of microbes and not others. So what one eats determines what lives in the gut microbial community. Unfortunately a fiber-deficient diet (typical Western diet) is both linked to increased mucosal inflammation (the mucus layer of the intestines) and it makes it leaky. In other words, a fiber deficient diet impairs the mucus layer of the intestines. Animal studies also support this (that the diet regulates mucosal barrier function).

People in developed countries such as the US typically eat a Western style diet. A Western diet is characterized by high amounts of red meat, processed food, high-fat foods, refined grains, sugary desserts, and low intakes of dietary fiber. However, the Western style diet has been linked to increased mucosal inflammation of the intestines, and to a higher incidence of a number of diseases, including ulcerative colitis and Crohn’s disease.

What diet is best? A diet rich in fruits and vegetables, whole grains, nuts, seeds, legumes (beans), and fish. Low in red meat, but moderate amounts of poultry. High in vitamin D, and high in omega-3 fatty acids. High in dietary potassium and zinc. Eat the foods, not supplements. One good example to follow is the Mediterranean diet. Think of it this way: high fiber diets lower inflammation in the gut, low fiber diets increase inflammation.

Both articles had similar diagrams showing that diet has an effect on the microbes in the gut (the microbiome), which results in either 1) a healthy mucosal lining of the intestines, or 2) a disturbed mucosal lining, disturbed permeability, and inflammation. The one article calls it the “mucinous layer” and the other calls it the gut “barrier” in the diagrams, but both are talking about the mucosal lining of the intestines.

The following image contrasts the effects on the intestines of the two types of diet - the intestines on the left have "homeostasis" (balance) from a healthy dietary pattern (lots of fiber, fruits& vegetables, etc) , and the one on the right has inflammation from a Western dietary pattern.  To see it more clearly, go to the original Figure 1. in the article by L. Celiberto et al: Inflammatory bowel disease and immunonutrition: novel therapeutic approaches through modulation of diet and the gut microbiome

The other review:  The role of diet in the aetiopathogenesis of inflammatory bowel disease

Published on Leave a comment on Study Finds An Average of 56 Suspect Chemicals In Pregnant Women

The reality is that we are exposed to thousands of industrial chemicals in our daily lives - in our foods, products, even in dust. Chemicals can get into us through ingestion (food and contaminated water), through inhalation (in dust and contaminated air), and can even be absorbed through the skin. Blood and urine tests can measure the chemicals that we have been exposed to - this is called biomonitoring. Of course, each of us has different levels of these unwanted chemicals - but yes, even those living off the grid and eating all organic foods will have some unwanted chemicals in their bodies. Studies are finding that these chemicals have negative health effects - some effects we know about, but many, many are still unknown.

Of big concern is a pregnant woman's exposure to chemicals because they can have health effects on the developing baby, including life-long effects (e.g. neurological effects, endocrine disrupting effects, immunological effects). Yes, this is scary stuff, especially because we know so little about their effects.

A group of University of California researchers figured out a new way to measure these chemicals in the blood (it's called liquid chromatography-quadrupole time-of-flight mass spectrometry), and looked for the presence of 696 chemicals in a group of 75 pregnant women in California. They found an average of 56 chemicals in each woman (the number of chemicals ranged from 32 to 73 chemicals per woman), and also found a number of chemicals never monitored before. Yikes.

What to do? We can't totally avoid unwanted chemical exposure, but we can lower our exposure to some chemicals. Look at the last post for ideas on how to minimize exposures in our foods. Try to avoid pesticides - both in your home, yard, and in food (eat organic food as much as possible). Avoid fragrances and products containing fragrances. Avoid dryer sheets, air fresheners, and scented candles. Read labels and avoid products with fragrances, parabens, stain protectors, flame retardants, and antibacterials , anti-odor, or anti-mildew products.  Avoid non-stick or Teflon cookware. Avoid BPA and also the replacement chemicals (yes, they're as bad). Don't microwave plastic containers (glass dishes are OK). Glass & stainless steel for foods is fine. Wash hands before eating. Yes, it's a lifestyle change, but one worth doing.

From Medical Xpress: Study finds 56 suspect chemicals in average pregnant woman

Each year, tens of thousands of chemicals are manufactured in or imported into the United States—more than 30,000 pounds of industrial chemicals for every American—yet experts know very little about which chemicals may enter people's bodies, or how these substances affect human health. Now, scientists at UC San Francisco have found a way to screen people's blood for hundreds of chemicals at once, a method that will improve our ability to better assess chemical exposures in pregnant women, and to identify those exposures that may pose a health risk. 

...continue reading "Study Finds An Average of 56 Suspect Chemicals In Pregnant Women"

Published on Leave a comment on Pediatricians Have Health Concerns About All the Additives In Food

The American Academy of Pediatrics (representing 67,000 pediatricians) has come out with a statement expressing serious health concerns about the Food and Drug Administration's  (FDA) lax regulation of chemicals added to food and food packaging - such as additives, BPA, colors, flavors, nitrates, nitrites, etc. They also list ways that this problem could be fixed (Congress needs to pass legislation!), and also give some steps on how people can lower their exposure to these chemicals.

A panel of experts representing the group issued both a technical report and a statement which talked about the scientific evidence (which grows yearly) against such compounds such as bisphenol A (BPA), phthalates, perfluoroalkyl chemicals (PFCs) used in grease-proof paper, certain colors (dyes), and preservatives. These chemicals can enter into the body and cause harm or health problems, for example  by disrupting crucial biological processes such as the endocrine (hormone) system and immune system. A number of these chemicals are thought to mimic or suppress natural hormones - they are endocrine disruptors. Children and developing fetuses are especially vulnerable to long-term effects. They also expressed concern with nonpersistent pesticides.

Many of the chemicals currently in the food supply "have not been tested at all, while others have not been tested for endocrine disruption or their impact on brain development, and their effect on children's health is still unknown," said Trasande, the paper's lead author and an associate professor of pediatrics at New York University School of Medicine in New York. This is because the old required tests are too simplistic, too crude, using old out-dated technology and knowledge.

The American Academy of pediatrics points out in the statement that currently: "more than 10 000 chemicals are allowed to be added to food and food contact materials in the United States, either directly or indirectly, under the 1958 Food Additives Amendment to the 1938 Federal Food, Drug, and Cosmetic Act (FFDCA)". Many of these were grandfathered in for use by the federal government before the 1958 amendment, and an estimated 1000 chemicals are used under a “generally recognized as safe” (GRAS) designation process..."  Whew.... so many chemicals...

Is there a problem with GRAS? Of the approximate 1,000 GRAS compounds added to food and food packaging, the large majority were designated as such by either the company that manufactures them or a paid consultant. (Do you see a problem here? The conflicts of interest are huge - the fox is guarding the chickens.)

How can you personally lower your exposure to all these chemicals? 1) Eat as many fresh fruits and vegetables as possible, and avoid eating canned foods (the can lining has BPA or other just as worrisome chemicals - bisphenols), 2) Avoid processed meat, especially during pregnancy (nitrates, nitrites, etc), 3) Avoid microwaving food or liquids in plastic containers (chemicals leach out) - including infant formula and breastmilk, 4) Avoid putting plastics in the dishwasher (chemicals leach out), 5) Use alternatives to plastic such as glass and stainless steel, 6) Avoid plastics with recycling codes 3 (phthalates), 6 (styrene), and 7 (bisphenols) unless plastics are labeled as “biobased” or “greenware,” indicating that they are made from corn and do not contain bisphenols, 7) Wash  hands before eating, and wash fruits and vegetables that cannot be peeled. 8) Also - read the ingredients on all labels, and look for "real" ingredients ...continue reading "Pediatricians Have Health Concerns About All the Additives In Food"

Published on Leave a comment on Popular Weedkiller Found In Pregnant Women

A recent study of pregnant women found new health problems with the pesticide glyphosate, which is the active ingredient in the weedkiller Roundup (made by Monsanto).

The researchers found that women  with higher levels of glyphosate are more likely to have shorter pregnancies. Another major finding was that almost all the pregnant women (93%) in this study had detectable levels of glyphosate in their urine. I posted about this study earlier, but now it has been published in the journal Environmental Health.

All the pregnant women were living in central Indiana (in the cornbelt) in a mix of areas (suburban, urban, and rural), and whether they had well or public drinking water. In case you don't know, it is not good for a baby to be born early, and there can be lifelong health consequences - so every extra week (till full term) is good during pregnancy.

The researchers found higher levels of glyphosate in women living in rural areas (farm areas) and those drinking greater than 24 ounces a day of caffeinated beverages. The researchers thought that diet (food) and inhalation of contaminated dust were the major ways that the glyphosate got into the pregnant women.

Glyphosate is the most heavily used herbicide (a type of pesticide) in the world. Nearly 300 million pounds were applied in the U.S. in 2015, with much of the application in the Midwest. Scroll down to see a USGS map of glyphosate (Roundup) use in 2015 in the US. You can see that incredibly huge amounts of glyphosate are used in the midwest on farmland - greater than 88.6 pounds per square mile! (it's the dark brown areas on the map). Top crops it's used on are corn, soybeans, and canola, especially genetically modified Roundup Ready crops.

It is also used as a dessicant right before harvest ("preharvest") on many crops. This is why crops have glyphosate residues on them, and why so many streams and lakes are contaminated (due to agricultural runoff). About 90% of corn and soybean crops grown in the United States are Roundup Ready, and then these grains are used in most processed foods. Note: glyphosate (Roundup) can not be used on organic crops.

The herbicide has been linked to a number of health problems, including cancer, birth defects, endocrine disruption, and reproductive problems. (Posts on glyphosate.)  There are currently hundreds of lawsuits from farmers and others claiming that Roundup gave them cancer.

...continue reading "Popular Weedkiller Found In Pregnant Women"

Published on Leave a comment on How Many Children Have Fetal Alcohol Disorders?

As many (most?) people know nowadays - drinking alcohol during pregnancy can have negative effects on the developing baby. Drinking a lot of alcohol can result in fetal alcohol syndrome, but drinking smaller amounts (frequently or binge drinking now and then) can also have negative effects, even though not as severe. The effects from alcohol are called fetal alcohol spectrum disorders - because the effects are along the spectrum from major to minor effects. Currently they're called  fetal alcohol syndrome, partial fetal alcohol syndrome, or alcohol related neurodevelopmental disorder. Effects are generally determined by the child's facial features, physical growth, neurobehavioral development, and prenatal alcohol exposure (esp. by interviewing the mother).

A recent study tried to determine how common are fetal alcohol spectrum disorders in the United States. The researchers screened 6639 first grade children in 4 communities from different areas of the US, and fully evaluated about 3000 children for fetal alcohol spectrum disorders. They found that the disorders ranged from 1.1% to 5% in the communities studied - and they felt that this is a conservative estimate. Interestingly, almost all of these newly diagnosed children had not been diagnosed with fetal alcohol spectrum disorders before the study. So it's easy to miss, and to misdiagnose- thus a "hidden problem".

How to avoid this problem? Don't drink alcohol during pregnancy. But unfortunately many women don't realize that they are pregnant in the first trimester, especially if the pregnancy is unplanned. The Centers for Disease Control (CDC) says on its site (official advice) that women should: "Stop drinking alcohol if they are trying to get pregnant or could get pregnant." What about men who drink alcohol and then conceive a child? There is also some research (mainly animal research) that alcohol can have negative effects on the father's sperm and the resulting fetus. Not fetal alcohol spectrum disorders, but perhaps other health effects which are still being determined.

From  journalist Pam Belluck's article at the NY Times: Far More U.S. Children Than Previously Thought May Have Fetal Alcohol Disorders

More American children than previously thought may be suffering from neurological damage because their mothers drank alcohol during pregnancy, according to a new study. The study, published Tuesday in the journal JAMA, estimates that fetal alcohol syndrome and other alcohol-related disorders among American children are at least as common as autism. The disorders can cause cognitive, behavioral and physical problems that hurt children’s development and learning ability.

The researchers evaluated about 3,000 children in schools in four communities across the United States and interviewed many of their mothers. Based on their findings, they estimated conservatively that fetal alcohol spectrum disorders affect 1.1 to 5 percent of children in the country, up to five times previous estimates. About 1.5 percent of children are currently diagnosed with autism.

The range of fetal alcohol spectrum disorders (also called FASDs) can cause cognitive, behavioral and physical difficulties. The most severe is fetal alcohol syndrome, in which children have smaller-than-typical heads and bodies, as well as eyes unusually short in width, thin upper lips, and smoother-than-usual skin between the nose and mouth, Dr. Chambers said. A moderate form is partial fetal alcohol syndrome. Less severe is alcohol-related neurodevelopmental disorder, in which children have neurological but not physical characteristics and it is known that their mothers drank during pregnancy.

Then there is the stigma that often makes mothers reluctant to acknowledge alcohol consumption. “When you identify a kid with FASD, you’ve just identified a mom who drank during pregnancy and harmed her child,” said Susan Astley, director of the Fetal Alcohol Syndrome Diagnostic and Prevention Network at the University of Washington, who was not involved in the study. While Dr. Astley, a longtime expert in the field, said she admired the researchers’ hard work, she said the reliability of the study’s numbers was hampered by several factors. For example, only 60 percent of eligible families in the schools allowed their children to be evaluated and more than a third of those children’s mothers declined to answer questions about drinking during pregnancy.

The authors of the study, which was funded by the National Institute on Alcohol Abuse and Alcoholism, acknowledged the study’s limitations and tried to partly compensate by providing a conservative estimate (of 1.1 percent to 5 percent) that is likely low and another estimate (of 3.1 percent to 9.9 percent) that is likely high. Dr. Chambers also said the results might not generalize across the country because although the four communities were diverse, they did not include a large, high-poverty urban area or certain rural or indigenous communities that struggle with high rates of alcoholism. The locations, which are not named in the publication, include small-to-midsize cities in the Midwest and Rocky Mountains, a Southeast county and a Pacific Coast city the authors identified in interviews as San Diego. [Original study.]