• Wounded by alcohol
• Rebuilding a shattered life
• Anatomy of a disease
• Alcohol's heavy toll on the brain
• Alcohol-related deaths in 1992

Staff art. Source: Maine Bureau of Health

It is known as the hangover that lasts a lifetime.

Each year, more than 5,000 babies in the United States are diagnosed with Fetal Alcohol Syndrome, or FAS. Their mothers drank alcohol heavily at least once while the fetuses formed in the womb, stunting the infants' growth, leaving them with smaller, retarded brains, learning disabilities and behavioral problems.

Another 50,000 babies are born each year with Fetal Alcohol Effects or FAE. These children suffer from milder but similar symptoms.

In Maine, an estimated 33 infants are born annually with Fetal Alcohol Syndrome. Another 660 babies are born with Fetal Alcohol Effects.

But many believe those estimates fall far short of the true number of Maine children harmed by their mothers' drinking habits.

''It's almost impossible to identify the real number of pregnant women who drink,'' said Dr. Michael Pinette, a Scarborough doctor who specializes in high-risk pregnancies. ''Almost all women know that drinking during pregnancy is bad but they don't want to admit that they're doing something that could harm their babies.''

Each month, Pinette sees a couple of new pregnant patients who admit they have a drinking problem.

''From what I've seen, Maine has more of a fetal alcohol problem than Connecticut, where I last worked,'' Pinette said. ''I'd say we're probably at the top when it comes to pregnant mothers who drink.''

A 1995 national survey on the drinking habits of women of childbearing age appears to validate Pinette's fear. The U.S. Centers for Disease Control and Prevention ranked Maine 18th highest among the 50 states for women between the ages of 18 and 44 who drink heavily.

Some 13.4 percent of the Maine women surveyed reported having seven or more drinks each week or five or more in one sitting. Since many women don't know they're pregnant for up to a month, many of these future Maine mothers who binge-drink may be putting their unborn children at risk.

Another indicator that fetal alcohol in Maine is more widespread than the recorded numbers show is an increase in special education students. The number of children needing counseling or therapy, or suffering from learning disabilities, jumped 14 percent from 27,891 students in the 1991-92 school year to 31,870 students in the 1995-96 term.

''The number of kids we're seeing in special education is skyrocketing,'' said Colleen McGeoghegan, social worker at Biddeford Primary School. ''We see a lot of kids with poor attention spans. A lot of them are on medications. And I can't help but think their prenatal care and alcohol had something to do with this.''

*Consumption of an average of seven or more drinks per week or five or more drinks on at least one occasion during the preceding month. Staff art. Source: Centers for Disease Control

When a pregnant mother drinks, the alcohol is passed from her bloodstream into the placenta, the fluid-filled organ that nourishes the fetus. Because the unborn baby's organs are still developing, it takes the fetus twice as long to break down the alcohol as it takes the mother. This means the fetus's blood-alcohol level will be much higher than the mother's. It can be on the verge of passing out while the mother is just beginning to feel the effects of alcohol.

''In a developing fetus the liver is premature and can't metabolize alcohol, so it's going to have much more pronounced effect than on an adult,'' said Pinette.

The alcohol also kills cells that are rapidly dividing in the fetus.

Brain damage, retardation, memory and coordination problems, hyperactivity, sleeping problems and facial abnormalities can result from a mother drinking during pregnancy.

Alcohol poses the greatest danger to the fetus in the first three months, when the brain, heart, lungs, legs and arms are forming. Mothers who drink later in pregnancy chance miscarriages and giving birth to premature or low-weight babies.

Though some doctors believe one or two drinks weekly present no threat to an unborn baby, there is no known safe level of alcohol consumption for pregnant women. The more heavily a mother drinks, the greater the likelihood that her baby will be affected in some way.

The harm caused in the womb is irreversible and lasts a lifetime. The cost of special care and education for one child with Fetal Alcohol Syndrome or Fetal Alcohol Effects ranges from $300,000 to $3.3 million. Nationally, experts estimate that up to $9.7 billion is spent yearly on these children.

Though most doctors counsel their pregnant patients about their drinking habits, it remains an uncomfortable topic with many physicians, health workers say.

''Many doctors feel they don't have the time or emotional energy to deal with women who drink during pregnancy,'' said Beth Wilson, a Maine Medical Center nurse who travels the state educating doctors, nurses and midwives about counseling pregnant women. ''They don't ask about their patients' drinking habits because they think it's better not to open this potential can of worms.''

Some doctors, Wilson says, also rely on misguided stereotypes, believing that poor and uneducated women are more likely to drink during pregnancy.

''Alcohol crosses all boundaries, yet I think some doctors are reluctant to ask professional pregnant women if they're drinking,'' Wilson said.

A 1993 and 1994 Maine Bureau of Health survey supports Wilson's concerns.

Women whose prenatal care was paid for by Medicaid were more likely to be questioned about drinking during pregnancy than women who have private insurance. Some 91 percent of the mothers who received care at community and rural health centers were counseled about Fetal Alcohol Syndrome, compared to 76 percent of mothers who sought care at private doctors' offices.

In one case, a doctor told Wilson he didn't feel he had to question a pregnant female lawyer about her drinking habits, because she had plenty of education and should know better. In another situation, a physician smelled alcohol on the breath of a wealthy pregnant patient. Not wanting to offend her, he didn't ask about the frequency of her alcohol consumption.

''Instead, he decided to wait and see if the baby looked funny,'' Wilson said. Though doctors may believe wealthier and college-educated women are apt to drink less during pregnancy, the opposite is true.

In Maine, according to the Bureau of Health, women with college degrees are four times as likely to drink during the last three months of pregnancy as women with only a high school diploma.

Doctors should be more vigilant than ever about counseling their pregnant patients, Wilson says, since the U.S. Centers for Disease Control and Prevention recently learned that pregnant women are drinking harder than they did four years ago.

A 1995 CDC survey found that 3.5 percent of the 1,313 pregnant women they questioned consumed seven or more drinks per week or binged on five or more drinks at least once in the previous month. That's an increase from 0.8 percent ofthe 1,053 pregnant women surveyed in 1991.

''Doctors can't afford to wait and see if the baby looks and acts abnormal in the nursery,'' Wilson said. ''They've got a moral obligation to prevent these problems before the baby is born with lifelong defects.''

For more information on Fetal Alcohol Syndrome or drinking during pregnancy, call the Maine Office of Substance Abuse at 1-800-499-0027.