Fetal Alcohol Spectrum Disorders

In the postpartum period, home-visiting of women at high risk by health professionals or lay supporters improves child outcomes and reduces the risk of PAE in future pregnancies227,231,232. Application of a FASD prevention framework requires consideration of local policy and practices. Best practice programmes support the needs of both the mother and child, recognizing the connections between women’s alcohol use, parenting, family influences and child development. Central to the effective implementation of prevention strategies is the establishment of strong cross-cultural and community partnerships and the embrace of cultural knowledge systems and leadership233. Mitigating stigma is vital while addressing the structural and systemic factors that promote prenatal alcohol consumption35. Alcohol stimulates the production of reactive oxygen species in microglia and astrocytes, leading to neuronal apoptosis84.

Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders

If you suspect your child has fetal alcohol syndrome, talk to your doctor or other healthcare professional as soon as possible. There is no amount of alcohol that’s known to be safe to drink during pregnancy. If you drink during pregnancy, you place your baby at risk of fetal alcohol syndrome. Longitudinal cohort studies of FASD consistently show that adverse outcomes are more likely where support services are lacking. These studies are limited by selection bias and are based on cohorts with severe deficits rather than population-based cohorts receiving adequate support267,270. Nevertheless, they suggest the potential to modify developmental trajectories by addressing postnatal environmental exposures and opportunities.

• Fetal alcohol syndrome (FAS) is a condition that develops in a fetus (developing baby) when a pregnant person drinks alcohol during pregnancy.
• In 2019, CDC researchers found that 1 in 9 pregnant people drank alcohol in a 30-day period of time.
• Informed consent was obtained from all patients for being included in the study.
• Timely, accurate diagnosis of FASD is crucial to enable early intervention and improve outcomes161, but there is no diagnostic test, biomarker or specific neurodevelopmental phenotype for FASD.
• One systematic review and meta-analysis identified more than 400 comorbid conditions among individuals with FASD, spanning 18 of 22 chapters of the ICD-10 (ref. 13).

How early can you tell if your child has fetal alcohol syndrome?

Advances in neuroscience research, including novel preclinical studies, may help elucidate the relationship between PAE-induced brain dysfunction and the FASD phenotype and inform therapeutics and prevention292. One systematic review and meta-analysis identified more than 400 comorbid conditions among individuals with FASD, spanning 18 of 22 chapters of the ICD-10 (ref. 13). The most prevalent conditions were within the chapters of “Congenital malformations, deformations, and chromosomal abnormalities” (Chapters Q00–Q99; 43%) and “Mental and behavioural disorders” (Chapters F00–F99; 18%). Comorbid conditions with the highest pooled prevalence (50–91%) included abnormal functional studies of the peripheral nervous system and special senses, conduct disorder, receptive and expressive language disorders, and chronic serous otitis media13. Other studies report a high prevalence of vision and hearing problems among people with FASD265,266. All of these comorbid conditions affect the function and QOL of individuals with FASD and their families (Box 1).

Global prevalence of fetal alcohol spectrum disorder among children and youth: a systematic review and meta-analysis

CFT involves 12 weeks of social and friendship skill training for children with FASD and their parents; it improves social skills and decreases problem behaviours in children with FASD250. Similarly, the Families on Track programme increases emotional regulation and self-esteem and decreases anxiety and disruptive behaviour251. However, interventions such as CFT and Families on Track are not widely available, and barriers to their use include the need to adapt to cultural context252.

International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-

A syndrome is a group of symptoms that happen together as the result of a particular disease or abnormal condition. When someone has fetal alcohol syndrome, they’re at the most severe end of drunken baby syndrome what are known as fetal alcohol spectrum disorders (FASDs). The pooled prevalence (per 1,000) of fetal alcohol spectrum disorders (FASD) is markedly higher in some subpopulations than in the general global population. Subpopulations with a high prevalence of FASD include children in out-of-home care, individuals involved with correctional services and those receiving special education. A clinical diagnosis of FASD requires recognition of neurodevelopmental disabilities and a reproducible pattern of minor malformations (dysmorphic features), none of which are pathognomonic, and many of which overlap with other teratogenic or genetic disorders (phenocopies). Thus, a diagnosis of FASD is a diagnosis of exclusion that is made after considering and excluding other causes for the phenotype10,167.

• Thus, PAE after major organogenesis may result in a FASD phenotype with neurodevelopmental disorder but without physical alterations, making diagnosis difficult80.
• Later studies found that, in addition to FAS, PAE could cause behavioural, cognitive and learning problems, such as attention deficit hyperactivity disorder (ADHD) and speech and language delay, in the absence of facial and other physical features10.
• In this study, no echocardiogram or other confirmatory tests were performed to document the prevalence of true cardiac defects.
• In some cases, your healthcare provider might be able to diagnose a child with fetal alcohol syndrome at birth based on small size and specific physical appearance.

J Paediatr Child Health

These approaches show promise in increasing awareness of FASD and decreasing alcohol use during pregnancy216; however, the quality of supporting evidence is highly variable. Public-health authorities agree that the alcohol industry should have no involvement in the development of public-health policies owing to their inherent conflict of interest218,219. 7 illustrates one approach that could be linked to national policy to address diverse aspects of population-based prevention of FASD. Alcohol (ethanol) metabolism to acetaldehyde and acetic acid generates reactive oxygen species (ROS) that induce programmed cell death.

Telehealth services will reduce the need for face-to-face care282 and tele-education could build clinician awareness and skills, especially in rural and remote areas283. However, in many low-income and middle-income countries, this technology is not widely available. Neurobehavioral disabilities in FASD include deficient global intellectual ability and cognition, and poor behavior, self-regulation, and adaptive skills.

• Alcohol is metabolized to acetaldehyde, a toxin that causes DNA damage, epigenetic gene regulation, mitochondrial and proteosome dysfunction, and altered cellular metabolism127,128,129.
• The field would also benefit from improved, population-based, normative data for growth and PFL as well as internationally accepted definitions of a standard drink and of the ‘low, moderate and high’ levels of risk of PAE.
• Palpebral fissure length (PFL) was measured with a rigid ruler marked in millimeters.
• Specialized medical or surgical interventions may be required for congenital anomalies and accompanying comorbidities.
• PAE may cause enduring changes in the gut microbiota150, and there is increasing recognition of the interplay between gut microbes and nervous system development and function.
• Collectively, these actions of alcohol result in altered neural circuits and decreased neuronal plasticity.

These disorders are the legacy of readily available alcohol and societal tolerance to its widespread use, including during pregnancy. FASD affect all strata of society, with enormous personal, social and economic effects across the lifespan. Neurodevelopmental impairments may lead to lifelong ‘secondary’ disabilities, including academic failure, substance abuse, mental health problems, contact with law enforcement and inability to live independently or obtain/maintain employment267 (Box 2). These conditions adversely affect QOL and require health, remedial education and correctional, mental health, social, child protection, developmental, vocational and disability services across the lifespan17,268,269.

melanie

All Author Posts