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Foetal alcohol syndrome may be more common than previously thought

Symptoms consistent with disorder found in 17% of children screened

Caroline White

Friday, 30 November 2018

Foetal alcohol spectrum disorder, or FASD for short, may be more common than previously thought, suggests a screening study* of nearly 14,000 children, published in the journal Preventive Medicine.

Up to 17% of those screened had symptoms consistent with FASD. They were more likely to be boys and to be the result of an unplanned pregnancy.

Despite relatively high levels of prenatal alcohol use there are no population-based estimates on how many people in the UK may have FASD─ a group of lifelong conditions caused by foetal exposure to alcohol in pregnancy that affect learning and behaviour.

The researchers assessed a wide range of information on mothers’ drinking habits during pregnancy and studied the development of 13,495 of their children. All of them were part of the Bristol’s Children of the 90s study.

Using a screening tool, they found that up to 79% of children in the sample had been exposed to alcohol while in the womb and that to up to 17% of these children had symptoms consistent with FASD.

A positive FASD screen was defined as problems in at least three different areas of learning or behaviour, with or without physical abnormalities, such as stunted growth and distinctive facial features.

“The results are based on a screening tool, which is not the same as a formal diagnosis,” cautioned lead author, Dr Cheryl McQuire, University of Bristol. But she added: “Nevertheless, the high rates of prenatal alcohol use and FASD-relevant symptoms that we found in our study suggest that FASD is likely to be a significant public health concern in the UK.”

The results were important because without UK estimates of FASD prevalence, awareness will remain low and children, teenagers and adults will continue to find it difficult to seek diagnosis and to access the support they may need, she said.

“Although information on prenatal alcohol use was collected several years ago and guidance on drinking during pregnancy has since changed, rates of prenatal alcohol exposure in the UK have remained high,” she continued.

“Recent estimates suggest that three quarters of women drink some alcohol during pregnancy, with one third at binge levels. This suggests that many individuals in our population today could also have symptoms of FASD.”

Co-author, Dr Raja Mukherjee, who runs a diagnostic clinic for FASD at Surrey and Boarders Partnership NHS Foundation Trust, added: “These are really important results that show there are likely to be many individuals with this disorder already out there who are being missed. There seems to be a disconnect between these findings and what many clinicians often report as a rare condition.

“It shows that it is a disorder that is seemingly hidden in plain sight that we need to pay attention to. Unless we start looking for it we will continue to miss it.”

Chief executive of the charity, National Organisation for Foetal Alcohol Syndrome-UK, Sandra Butcher, added: “No policy maker who cares about the mental and physical health of the most vulnerable in our society should rest easy until we have in place UK-wide comprehensive action and training on FASD prevention, diagnosis and support that extends across the individual’s lifespan.”

Dr Christopher Steer of the Royal College of Paediatrics and Child Health said: “The UK has one of the highest pregnancy drinking rates in the world, at just over 40%, only exceeded by Ireland, Belarus and Denmark. Not surprising, therefore, to identify such a large number of children affected by alcohol harm in utero. The figure of 17% is certainly strikingly high, well above previous indirect indications, pointing to levels of between 2 and 5%.

“Under current circumstances many cases of FASD remain undiagnosed. Lack of early detection and necessary support increases the risk of long-term disability and secondary difficulties affecting learning, behaviour, health, and indeed in the more severe examples of FASD, life expectancy. FASD remains the most common, and potentially preventable cause of learning and behavioural difficulties in the world.”

He continued: “The UK chief medical officers’ advice and message 'No Alcohol, No Risk' is therefore supported by this research, which also underlines the pivotal importance of awareness raising and preventative strategies to reduce the prevalence of FASD in the UK.”

*McQuire C, et al. Screening prevalence of fetal alcohol spectrum disorders in a region of the United Kingdom: a population-based birth-cohort study. Preventative Medicine 2018, doi:10.1016/j.ypmed.2018.10.013

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