We know for more than 40 years what the cause is and what the consequences of fetal alcohol spectrum disorder (FASD) are. However, FASD continues to harm millions of people all around the world – approximately one in every 100 live births [1]. In countries where alcohol intake among women of childbearing age is common, the prevalence of fetal alcohol spectrum disorder can be substantially higher. This disorder is of overwhelming concern in some populations [2].

The fact that the unborn baby is harmed by someone else’s alcohol intake, is a clear example for alcohol harming others than the user him/ herself. Alcohol’s Harm to Others demands to consider that health and social harm overlap and often multiply one another. Alcohol violence, e.g. intimate partner violence, causes health as well as social problems; children of alcoholics are exposed to health harms and all too often to the complete collapse of the functioning of their social life and environment. Alcohol is more harmful to a developing fetus than heroin or cocaine.

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No amount of alcohol is safe (during pregnancy)

Alcohol is a carcinogen, toxic, terratogen and addictive substance. It’s foreign to the body and no amount of alcohol is “safe”. Alcohol reduces fertility, increases the risk of miscarriage and causes brain damage and birth defects [3].

Prenatal exposure to alcohol can cause cognitive damage, learning disorders, mental retardation, as well as behavioral disorders such as ADHD and autism. Poor motor coordination is common. Difficulty with judgment and understanding social situations contributes to long term outcomes such as unemployment, psychiatric illness, and criminality [4].

Even low amounts of alcohol intake or a single binge can cause permanent damage [567].

Many babies are prenatally exposed to alcohol

It is estimated that between 35 and 50% of Dutch women use alcohol during pregnancy [3].

A recent study in Barcelona showed that 45% of babies were heavily exposed to alcohol [8]. In Dublin, the Coombe Women’s Hospital study found that 63% of women consume alcohol during pregnancy [9]. Most women do not know that alcohol intake in low doses can harm their babies. Well-educated women are at high risk for alcohol consumption during pregnancy.

Foetal Alcohol Spectrum Disorder – and all the abbreviations

FASD is an umbrella term covering a range of birth defects and brain damage resulting from prenatal exposure to alcohol. The term FASD is not used as a clinical diagnosis, but encompasses diagnoses such as Fetal Alcohol Syndrome (FAS) and related disorders. FAS is diagnosed when a child shows retarded growth, a specific pattern of minor facial anomalies and neurological damage.

Children who do not show all the features of FAS may receive a diagnosis of partial FAS, Fetal Alcohol Effects (FAE), Alcohol-Related Neurodevelopmental Disorder (ARND), or Alcohol-Related Birth Defects (ARBD). All persons with FASD have lifelong cognitive, social and behavioral disabilities.

Prevalence

The full scale prevalence of FASD is difficult to know because cases are diagnosed as learning disorders, ADHD or other disorders while the underlying role of prenatal alcohol exposure remains unrecognized.

FASD prevalence rates have been evaluated in a variety of settings including the community, schools, foster care systems, prisons and correctional systems. The magnitude of FASD prevalence vary according to the setting in which it was evaluated, with higher estimates identified in foster and justice systems compared to those obtained from community and school samples. All of them, however, deserve attention for the planning and organization of prevention strategies. The epidemiology of FASD does not seem to be isolated into a specific region and impacts many communities around the world.

The usual estimates of prevalence in the western world run from 1 to 3 per thousand for full FAS, and 9.1 per thousand for all FASD [10].

A recent and alarming study in the Lazio region of Italy showed that 20 to 40 children per thousand have FASD [11].

  • Prevalence of FASD among children in foster care:

Prevalence estimates of overall FASD in foster care settings ranged from 30.5% to 52%, which translate to FASD rates of 305 to 520 per 1000 population in foster care settings.

Prevention – the International Charter on Prevention of FASD

Like much of the harm to others that alcohol causes, FASD can largely be prevented. The imperative for prevention measures is paramount because there is no cure for FASD.

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Guidelines WHO, 2014

The International Charter on Prevention of FASD was produced and adopted at the 1st International Conference on Prevention of FASD (Edmonton, Canada, Sept 23-25, 2013) by more than 700 people from 35 countries worldwide, including senior government officials, scholars and policymakers, clinicians and other front-line service providers, parents, families, and indigenous people.

Governments must promote a consistent, evidence-based message about prevention by supporting the development and circulation of public health information that is clear and consistent: to abstain from alcohol use during pregnancy is the only certain way to prevent fetal alcohol spectrum disorder. This information must be widely available in every country, responsive to local contexts, and designed to allow access to supportive services for pregnant women. The incidences of FASD can be reduced by public information campaigns (such as warning labels on alcohol products), support of pregnant women, and clear preconception advice [12].

In addition, policies related to the social determinants of health should explicitly address FASD; its implications for the individual, family, and society; and how it can be prevented. Most effective are the three best buys of alcohol policy measures because an overall reduction of alcohol use, prevents alcohol consumption during pregnancy.

Great work by civil society organisations around the world

There are a number of excellent NGOs in different parts of the world that do important, inspiring and heart-driven work for the prevention of FASD.

NOFASD Australia has a strong commitment to FASD prevention at a primary, secondary and early intervention level.

The European FASD Alliance was founded in February 2011 to meet the growing need for European professionals and NGOs concerned with FASD to share ideas and work together. The European FASD Alliance is a nonprofit international organization registered in Sweden.

In the USA, the National Organization on Fetal Alcohol Syndrome (NOFAS) is the leading voice and resource of the Fetal Alcohol Spectrum Disorders (FASD) community. Founded in 1990, NOFAS is the only international non-profit organization committed solely to FASD primary prevention, advocacy and support. NOFAS seeks to create a global community free of alcohol-exposed pregnancies and a society supportive of individuals already living with FASD.

Time to act now

When more than a million babies are born every year with permanent brain injury from a known and preventable cause, response should be immediate, determined, sustainable, and effective. Broad-based policy initiatives and actions at different levels of every society are urgently needed to encourage abstinence from alcohol during pregnancy and to prevent fetal alcohol spectrum disorder.” [13]

For more detailed reading:

World Health Organisation, 2014: Guidelines for the identification and management of substance use and substance use disorders during pregnancy

SYSTEMATIC REVIEW ON THE PREVALENCE OF FETAL ALCOHOL SPECTRUM DISORDERS, by MARIA OSPINA, MSC, PHD (C) LIZ DENNETT, MLIS, Edmonton, April 2013

Reference List

1. May PA, Gossage JP, Kalberg WO, et al. Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Dev Disabil Res Rev 2009; 15: 176-190. PubMed

2. Warren KR, Calhoun FJ, May PA, et al. Fetal alcohol syndrome: an international perspective. Alcohol Clin Exp Res 2001; 25: 202S-206S. PubMed

3. Gezondheidsraad. Risico’s van alcoholgebruik bij conceptie, zwangerschap en borstvoeding. 2004/22. 2005. Den Haag, Gezondheidsraad.

4. Streissguth,A.P. et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J. Dev. Behav. Pediatr. 25, 228-238 (2004).

5. Willford,J.A., Richardson,G.A., Leech,S.L. & Day,N.L. Verbal and visuospatial learning and memory function in children with moderate prenatal alcohol exposure. Alcohol Clin. Exp. Res. 28, 497-507 (2004).

6. Barr,H.M. et al. Binge drinking during pregnancy as a predictor of psychiatric disorders on the Structured Clinical Interview for DSM-IV in young adult offspring. Am. J. Psychiatry 163, 1061-1065 (2006).

7. Does a pint a day affect your child’s pay? The effect of prenatal alcohol exposure on adult outcomes. Working paper5. Nilsson,J.P. 2008:4. 2008. Uppsala, IFAU–Institute for Labor Market Policy Evaluation.

8. Garcia-Algar,O. et al. Alarming prevalence of fetal alcohol exposure in a Mediterranean city. Ther. Drug Monit. 30, 249- 254 (2008).

9. Barry,S., Kearney,A., Lawlor,E., McNamee,E. & Barry,J. The Coombe Women’s Hospital study of alcohol, smoking and illicit drug use, 1988–2005. 2006. Dublin: Coombe Women’s Hospital.

10. Sampson,P.D. et al. Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder. Teratology 56, 317-326 (1997).

11. May,P.A. et al. Epidemiology of FASD in a province in Italy: Prevalence and characteristics of children in a random sample of schools. Alcohol Clin. Exp. Res. 30, 1562-1575 (2006).

12. Astley,S.J. Fetal alcohol syndrome prevention in Washington State: evidence of success. Paediatr. Perinat. Epidemiol. 18, 344-351 (2004).

13. The international charter on prevention of fetal alcohol spectrum disorder Egon JonssonAmy SalmonKenneth R Warren, in The Lancet

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