tag:theconversation.com,2011:/us/topics/fas-23835/articlesFAS – The Conversation2019-09-23T13:21:17Ztag:theconversation.com,2011:article/1236152019-09-23T13:21:17Z2019-09-23T13:21:17ZWhy alcohol remains a big threat to unborn babies in South Africa<figure><img src="https://images.theconversation.com/files/293545/original/file-20190923-54744-135rv1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drinking during pregnancy is harmful and can lead to foetal alcohol spectrum disorders.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Alcohol consumption is socially acceptable for individuals of legal drinking age. However, drinking during pregnancy is harmful and can lead to irreversible foetal cognitive and developmental issues. These are collectively known as foetal alcohol spectrum disorder. </p>
<p>The disorder may include foetal alcohol syndrome – the most serious of these abnormalities – as well as partial foetal alcohol syndrome. It can also include alcohol-related neuro-developmental disorders and birth defects. </p>
<p>Common risk factors associated with the disorder include low socioeconomic conditions, a low level of education, and harmful patterns of alcohol consumption. In South Africa, some alcohol abuse is believed to be rooted in a <a href="https://www.mdpi.com/1660-4601/11/7/7406">“dop” system</a>. This is a practice in which farmworkers’ wages were paid using alcohol beverages. Although this practice has been abolished, its lingering effects still influence South Africa’s drinking patterns.</p>
<p>South Africa has the <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2649225">highest</a> recorded prevalence of foetal alcohol spectrum disorder in the world. The prevalence rates range from <a href="http://www.samj.org.za/index.php/samj/article/view/11009">29 to 290 affected children per 1000</a> live births. The rates vary a lot across the country, with the Western Cape province recording the highest. Australia could be considered to have the second highest recorded prevalence in the world with <a href="https://www.ncbi.nlm.nih.gov/pubmed/28499185">194.4 affected children per 1000</a> among Australian Aboriginals.</p>
<p>The South African government’s policy responses to this problem have been inadequate. We conducted two pieces of research. In the <a href="https://rdcu.be/bReov">first</a>, we looked at a range of policy documents to identify clauses attributed to the prevention and management of the condition in South Africa. We supplemented this <a href="https://europepmc.org/articles/pmc6466131">with in-depth interviews</a> to help inform our recommendations.</p>
<p>We <a href="https://rdcu.be/bReov">discovered</a> that South Africa had introduced a host of new policy documents and there are a range of clauses in various guidelines. But the interventions are fragmented and don’t speak to one another. </p>
<p>Another problem is that most of the current prevention and management approaches are informed generic statements embedded in different policy documents. The association of foetal alcohol spectrum disorder with other genetic conditions ignores the socio-economic factors associated with it. This means a comprehensive approach to addressing foetal alcohol spectrum disorder doesn’t exist. </p>
<p>Our findings explain why the country has failed to make a dent in reducing the high rates. In our conclusions we recommend that the South African government should respond to the epidemic in a more coordinated and comprehensive way by designing a specific policy and targeted interventions.</p>
<h2>What we found</h2>
<p>The analysis we did indicated that 22 policy documents contained elements related to the condition. These included generic clauses focused on the regulation of liquor outlets, enforcement of liquor laws, and the general management of people with mental and educational challenges. </p>
<p>There were also clauses focused on creating platforms to improve the awareness, screening, identification and support for people with disabilities.</p>
<p>The in-depth <a href="https://europepmc.org/articles/pmc6466131">interviews</a> explored policymakers’ perspectives on policies and interventions for the prevention and management of foetal alcohol spectrum disorder. We spoke to policymakers from the departments of social development, health and education. The interviews included officials working on issues related the problem. </p>
<p>Our research contributes to the debate around the prevention and management of the disorder in South Africa. It highlights the need for policymakers to develop a specific policy and to address the fact that current interventions and services are uncoordinated and fragmented. </p>
<p>The development of a separate policy is not a panacea to address the problem. It would, nevertheless, be a good starting point as it would lay the basis for a comprehensive approach. And it would help to address the social drivers of foetal alcohol spectrum disorders. </p>
<h2>Policy considerations</h2>
<p>Current approaches have clearly not been effective. </p>
<p>The policymakers we spoke to expressed the need to develop a specific policy to address foetal alcohol spectrum disorder. But to be effective it should be multi-sectoral, family-centred and evidence-based. The policy should consider the needs of people with the disorder across their lifespan and their caregivers. It should also be clear about referral pathways and be based on a public health framework. </p>
<p>Such a policy should promote:</p>
<p>1) Awareness and education on the dangers of using alcohol during pregnancy in schools, clinics and communities.</p>
<p>2) The use of contraceptives and safe sex education to avoid unplanned pregnancies.</p>
<p>3) The training of service providers on how to counsel people with alcohol problems and diagnosis and management of foetal alcohol spectrum disorder.</p>
<p>4) The training and support of mothers and caregivers in the management of foetal alcohol spectrum disorder.</p>
<p>5) Skills training and empowerment programmes for people with the condition. </p>
<h2>Way forward?</h2>
<p>In the short term, the government can expand and link the clauses relating to foetal alcohol spectrum disorder that already exist in current policy documents. Existing services must be streamlined and current efforts to address the condition must be systematically evaluated to identify the gaps in services and interventions.</p>
<p>In the long term, South Africa needs to develop a separate policy for foetal alcohol spectrum disorder. This will facilitate the multi-sectoral collaborative approach needed to address the problem. Such an approach would go beyond managing the condition. Addressing foetal alcohol spectrum disorder would help the response to other societal problems. These include mental health problems, crime, intellectual disability and low levels of achievement in education.</p>
<p>The process of developing this policy must include a wide range of actors such as researchers, policymakers, service providers, people with the condition, their parents and caregivers. </p>
<p>We also argue that the South African government should replicate the success recorded in managing HIV and Aids. A <a href="https://sahivsoc.org/Files/ART%20Guidelines%2015052015.pdf">specific policy</a> was developed – based on goals set by the United Nations – that set a target known as <a href="https://theconversation.com/search/result?sg=1eb592ae-f39a-45cb-9713-b7961dc0f3de&sp=1&sr=1&url=%2Fhiv-aids-and-90-90-90-what-is-it-and-why-does-it-matter-62136">90–90–90</a>. The aim is that by 2020 90% of everyone with HIV must know their status, 90% of those diagnosed with HIV must receive antiretroviral therapy, and 90% of people receiving antiretroviral therapy must be virally suppressed.</p>
<p>In addition, the government should learn from approaches adopted by other countries like Australia and Canada, which developed action plans that led to an increase in government funding. The increased government funding led to the expansion of prevention programmes and the establishment of specialist diagnostic service.</p><img src="https://counter.theconversation.com/content/123615/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ferdinand C. Mukumbang receives funding from The South African Medical Research Council. </span></em></p><p class="fine-print"><em><span>Lizahn G. Cloete is the chairperson of the board of directors for FASfacts, a non-governmental organization that focuses on education and raising awareness for reduction and cessation of drinking during pregnancy. This organization does not, however, benefit directly from this article and were not involved in the conceptualization, initiation or implementation of this research or this article. </span></em></p><p class="fine-print"><em><span>Anna-Marie Beytell and Babatope O. Adebiyi do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is no specific policy guiding the prevention and management of foetal alcohol spectrum disorder in South Africa.Babatope O. Adebiyi, Postdoctoral Researcher, University of the Western CapeAnna-Marie Beytell, Senior Lecturer, University of the Western CapeFerdinand C. Mukumbang, Researcher, University of the Western CapeLizahn G. Cloete, Senior lecturer, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1095852019-01-29T14:05:26Z2019-01-29T14:05:26ZHow easy access to alcohol, and adverts, affect women in South Africa<figure><img src="https://images.theconversation.com/files/255405/original/file-20190124-135142-lwqv10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Global evidence suggests that alcohol advertisements increase adolescents’ favourable attitudes towards drinking.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Public health <a href="https://www.jsad.com/doi/abs/10.15288/jsad.2018.79.302">research</a> suggests that concerns about alcohol advertising and accessibility warrant strong regulatory action.</p>
<p>Alcohol is a major <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.12916">contributor</a> to the global burden of disease. It’s also a key risk factor for preventable illness and death in Africa. For example, alcohol <a href="http://www.scielo.org.za/scielo.php?pid=S0256-95742011001000023&script=sci_arttext&tlng=pt">consumption</a> during pregnancy is associated with many adverse effects on children. These include childhood behavioural and developmental disorders such as foetal alcohol spectrum disorders.</p>
<p>Easy access to alcohol is a critical risk factor in problem <a href="https://www.sciencedirect.com/science/article/pii/S0033350614001899">drinking</a>. This is particularly true among <a href="https://link.springer.com/article/10.1007/s10461-018-2250-y">adolescents</a>. The problem has been exacerbated on the continent by the fact that alcohol companies have <a href="http://apps.who.int/iris/bitstream/handle/10665/109914/9789290231844.pdf?sequence=1&isAllowed=y">targeted</a> young women in their marketing efforts.</p>
<p>Global evidence also suggests that alcohol advertisements increase adolescents’ favourable attitudes toward <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/1107550">drinking</a>. These adverts are also associated with higher <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13591">consumption</a>, as well as earlier initiation and higher intensity of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13591">drinking</a>. And recent <a href="https://www.ajol.info/index.php/samj/article/view/178644">research</a> indicates associations between exposure to alcohol advertisements and alcohol consumption among adolescents in South Africa.</p>
<p>We conducted a <a href="https://www.jsad.com/doi/abs/10.15288/jsad.2018.79.302">study</a> on the impact of access to alcohol and exposure to alcohol advertisements on women of childbearing age in rural and urban areas of South Africa. We conducted interviews with 1,018 women in one of the country’s largest cities, Tshwane, as well as in rural areas in the Western Cape.</p>
<p>Our paper found that in both urban and rural sites easy access to alcohol – as well as exposure to alcohol advertisements – were associated with significant negative social and health impacts.</p>
<h2>What we found</h2>
<p>In urban Tshwane, easy access to alcohol was related to a number of problems. These included binge drinking (defined as six or more drinks per occasion) among partners and problem drinking in the community. Complications during pregnancy were another issue. And exposure to alcohol advertisements was related to hazardous drinking in the community and inter-partner violence.</p>
<p>In rural Western Cape, easy access to alcohol was related to problem drinking among community members. It was also inversely related to families’ ability to pay for health care. For its part, exposure to alcohol advertisements was related to a number of negative outcomes. These included hazardous drinking among women and community drinking. Inter-partner violence was also a problem.</p>
<p>The slight differences between patterns in urban and rural communities were likely because of varied social and economic contexts.</p>
<p>Our findings confirm what has been found <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13682">elsewhere</a>: alcohol advertising is not a harmless brand-promoting activity. It is associated with harmful health and social outcomes. Similarly, easy access to alcohol is associated with multiple adverse health and social impacts.</p>
<p>These effects might be ameliorated by stronger laws and regulations. That’s why <a href="https://www.parliament.gov.za/storage/app/media/Docs/bill/9f8c83b4-bd7c-4dc1-af55-8d32310d64e9.pdf">amendments</a> have been proposed to the country’s National Liquor Act. Our findings support these efforts to limit access to alcohol and alcohol advertisements.</p>
<p>But South Africa has a mixed record when it comes to legislating against alcohol use.</p>
<h2>Strong industry lobby</h2>
<p>The alcohol industry has used intense lobbying <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.12832">to hold back</a> efforts to limit the availability of alcohol and alcohol advertisements.</p>
<p>For example, national legislation to ban advertising in South Africa has been <a href="https://www.businesslive.co.za/bd/national/2017-05-30-nedlac-stalls-on-tough-liquor-law-changes-without-social-cost-report/">stalled</a>. Provincial legislation in the Western Cape has been weakened by the liquor, sporting and advertising <a href="https://www.businesslive.co.za/bd/national/2017-05-30-nedlac-stalls-on-tough-liquor-law-changes-without-social-cost-report/">industries</a>.</p>
<p>The alcohol industry promotes <a href="http://gsri.worldwidebrewingalliance.org/docs/DTI_Convention_brochure_final.pdf">self-regulation</a>. But this leaves adolescents vulnerable to the harmful effects of alcohol <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13410">advertisements</a>.</p>
<p>The alcohol industry claims that it plays an indispensable role in South Africa’s <a href="http://5737034557ef5b8c02c0e46513b98f90.cdn.ilink247.com/ClientFiles/econometrix/Econometrix/Company/Documents/Economic_Impact_of_an_Ad_Ban_Econometrix.pdf">economy</a>. But public health researchers estimated that alcohol consumption cost the country <a href="https://www.ajol.info/index.php/samj/article/view/100577">approximately 10%-12%</a> of its gross domestic product in 2009.</p>
<p>Limiting alcohol advertisements and regulating the availability of alcohol are critical to ensuring the well-being of women and children in South Africa. This is particularly true because the country has the highest <a href="https://www.ajol.info/index.php/samj/article/view/89464">rates of foetal alcohol syndrome</a> in the world. These rates emerged, in part, from a system adopted in the colonial period of farmers paying workers with alcohol. The practice continued in some Western Cape farms well into the <a href="https://www.sciencedirect.com/science/article/pii/S0376871699001209">post-apartheid period</a> even though it was illegal.</p><img src="https://counter.theconversation.com/content/109585/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leslie London receives funding from the South African Medical Research Council, the UK Medical Research Council, the International Development Research Centre and the US Centres for Diseases Control. He is a member of the non profit advocacy organisation, the People health Movement and has consulted to the Southern African Alcohol Policy Alliance.
</span></em></p><p class="fine-print"><em><span>Neo Morojele receives funding from the South African Medical Research Council, UK Medical Research Council and the International Development Research Centre and is affiliated to the Southern African Alcohol Policy Alliance.</span></em></p><p class="fine-print"><em><span>Hanna Amanuel does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Easy access to alcohol and exposure to alcohol advertisements affect social and health outcomes.Leslie London, Head of the Division of Public Health Medicine in the School of Public Health and Family Medicine, University of Cape TownNeo Morojele, Chief Specialist Scientist : Alcohol Tobacco and Other Drug Research Unit, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/577362016-04-17T21:25:13Z2016-04-17T21:25:13ZFactCheck Q&A: does Australia have some of the highest rates per capita of fetal alcohol syndrome in the world?<figure><img src="https://images.theconversation.com/files/118898/original/image-20160415-11198-gbqerv.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Liberal MP Sharman Stone, speaking on Q&A.</span> <span class="attribution"><span class="source">Q&A</span></span></figcaption></figure><p><strong>The Conversation is fact-checking claims made on Q&A, broadcast Mondays on the ABC at 9:35pm. Thank you to everyone who sent us quotes for checking via <a href="http://www.twitter.com/conversationEDU">Twitter</a> using hashtags #FactCheck and #QandA, on <a href="http://www.facebook.com/conversationEDU">Facebook</a> or by <a href="mailto:checkit@theconversation.edu.au">email</a>.</strong></p>
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<figcaption><span class="caption">Excerpt from Q&A, April 11, 2016.</span></figcaption>
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<blockquote>
<p>Australia has some of the highest rates per capita of FAS or FASD in the world. – *<em>Liberal Party backbencher Sharman Stone, <a href="http://www.abc.net.au/tv/qanda/txt/s4424409.htm">speaking</a> on Q&A on Monday April 11, 2016.
*</em></p>
</blockquote>
<p>Fetal Alcohol Spectrum Disorders (FASD) is a group of disorders that include Fetal Alcohol Syndrome (FAS). They are caused by alcohol consumption in pregnancy.</p>
<p>FASD are associated with a range of birth defects, including characteristic facial features and abnormalities in brain structure and function.</p>
<p>Liberal MP Sharman Stone told Q&A that Australia has some of the highest rates per capita of FAS or FASD in the world. Is that right?</p>
<h2>Checking the data</h2>
<p>When asked for a source to support her statement, Stone referred The Conversation to data from Australia’s first ever prevalence study of FASD, the <a href="http://www.georgeinstitute.org.au/projects/marulu-overcoming-fetal-alcohol-spectrum-disorders-fasd">Lililwan project</a> in the Fitzroy Valley of Western Australia.</p>
<p>Meaning “all the little ones”, Lililwan brought together experts in local Aboriginal culture, Aboriginal and Torres Strait Islander health, paediatrics, research, epidemiology and human rights.</p>
<p>The project aimed to estimate the number of children affected by FASD and develop a FASD management plan involving each child’s family, doctor and teachers. The project also sought to educate community members about the significant risks of drinking during pregnancy. I am an author on some of the publications reporting on this research that are cited in this article. </p>
<p>Data from the Lililwan project in the Fitzroy Valley of Western Australia show that 120 per 1000 children, or <a href="http://www.ncbi.nlm.nih.gov/pubmed/25594247">12%</a> examined by the multi-disciplinary team of health professionals had physical features and neurodevelopmental impairment consistent with FAS or partial FAS. In 127 of the pregnancies studied, 55% of the mothers drank during pregnancy.</p>
<p>A 2015 paper on the data <a href="http://www.ncbi.nlm.nih.gov/pubmed/25594247">reported</a> that:</p>
<blockquote>
<p>The population prevalence of FAS/pFAS (partial fetal alcohol syndrome) in remote Aboriginal communities of the Fitzroy Valley is the highest reported in Australia and similar to that reported in high-risk populations internationally. </p>
</blockquote>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/26879822">study</a> of the same data found that an additional 7% of children had neurodevelopmental disorder with prenatal alcohol exposure, giving a prevalence of FASD of about 19% or 190 cases per 1000 children. </p>
<p>These population-based prevalence data are consistent with <a href="http://onlinelibrary.wiley.com/doi/10.1111/dar.12232/abstract">high rates of documented prenatal alcohol exposure</a> in these communities.</p>
<h2>Among the highest in the world?</h2>
<p>Research doesn’t show Fitzroy Crossing has <em>the</em> highest rates per capita of fetal alcohol syndrome in the world. Prevalence data are scarce, but it is fair to say this sample has among the highest <a href="http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2013-3319">rates we</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/19731384">know of</a>.</p>
<p>By comparison, a <a href="http://www.ncbi.nlm.nih.gov/pubmed/19731384">recent study</a> in children of a similar age in the US midwest, the rate of FAS ranges from six to nine per 1000 children. The rate of partial fetal alcohol syndrome ranged from 11 to 17 per 1000 children, and the total rate of FASD is estimated at 2.4% to 4.8%. </p>
<p>One <a href="http://www.ncbi.nlm.nih.gov/pubmed/23241076">study</a> of first-grade children in a South African community found a rate of FASD similar to that revealed by the Fitzroy Crossing data. In the South African population studied, the overall rate of FASD was between 135.1 and 207.5 per 1000 (or 13.6% to 20.9%).</p>
<h2>Some limitations</h2>
<p>It should be noted that the high prevalence rates in Fitzroy Crossing were obtained from a high risk population with a relatively small sample. They cannot be used to generalise about the scale of the problem across Australia. As I have <a href="http://www.theaustralian.com.au/national-affairs/indigenous/worlds-worst-fetal-alcohol-hits-one-in-eight/news-story/4e1c8a4d1617d0f72700abb9ce96a3c0">said publicly</a> before, FASD is not exclusively an Aboriginal problem and I rarely see an Aboriginal child among patients with FASD in my Sydney clinic. </p>
<p>We don’t really know the scale of the problem in other parts of Australia, because no other population-based prevalence data are available anywhere in the nation. Such data are expensive and time-consuming to collect, requiring detailed clinical assessments. </p>
<p>It may appear at first glance the problem has got worse; previously estimates of birth prevalence in Australian states and territories ranged from <a href="http://www.ncbi.nlm.nih.gov/pubmed/23617437">0.01 and 0.68 per 1000 live births.</a>.</p>
<p>However, it is important to remember that these data were not population-based, relied on ad hoc reporting, or were incomplete data collections and are likely to have underestimated true prevalence. </p>
<p>Other evidence supports the under-recognition and under-diagnosis of FASD in Australia. Researchers have <a href="http://www.ncbi.nlm.nih.gov/pubmed/21649674">documented</a> an urgent need to address failure of health professionals to ask about alcohol use in pregnancy (and hence recognise children at risk) and lack of health professional knowledge about how to diagnose FASD and where to refer for diagnosis. </p>
<h2>Verdict</h2>
<p>Sharman’s Stone’s statement is broadly correct. Based on current – albeit scarce – global data, results from the Liliwan project in Fitzroy Crossing reveal among the highest rates per capita of FAS or FASD in the world. However, it is important to note this is a study of a high risk population and cannot be used to make generalisations about Australia as a whole. <strong>– Elizabeth Elliott</strong></p>
<hr>
<h2>Review</h2>
<p>This is a fair summary of the facts and, importantly, makes it clear that the rate of FAS or FASD in one study in one small community is not representative of Australia as a whole. <strong>– Carol Bower</strong></p>
<hr>
<p><div class="callout"> Have you ever seen a “fact” worth checking? The Conversation’s FactCheck asks academic experts to test claims and see how true they are. We then ask a second academic to review an anonymous copy of the article. You can request a check at checkit@theconversation.edu.au. Please include the statement you would like us to check, the date it was made, and a link if possible.</div></p><img src="https://counter.theconversation.com/content/57736/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Elliott receives funding from the NHMR, the federal government and philanthropic funding for work on FASD. She is a board member or ambassador for several NGO, including the Institute for Creative Health, the Học Mãi Foundation at the University of Sydney, the National Organisation for FASD and Cure Kids Australia.
</span></em></p><p class="fine-print"><em><span>Carol Bower receives funding from the ARC and the NHMRC.</span></em></p>Liberal Party backbencher Sharman Stone told the Q&A audience that Australia has some of the highest rates per capita of fetal alcohol syndrome in the world. We check the research.Elizabeth Elliott, Professor of Paediatrics & Child Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/528352016-01-13T11:51:35Z2016-01-13T11:51:35ZHow foetal alcohol spectrum disorders could be a hidden epidemic<figure><img src="https://images.theconversation.com/files/107664/original/image-20160108-3317-1nq3qpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is no safe limit of alcohol consumption during pregnancy</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=pregnant&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=232623784">www.shutterstock.com</a></span></figcaption></figure><p>The new Department of Health <a href="https://www.gov.uk/government/consultations/health-risks-from-alcohol-new-guidelines">guideline on alcohol</a> says that there is no safe alcohol limit for pregnant women. Alcohol should simply be avoided. </p>
<p>Alcohol exposure during pregnancy can cause damage to the body and brain of the baby, causing a range of lifelong problems. These problems are grouped under the umbrella term “foetal alcohol spectrum disorders” (FASD). The most recognised form of FASD is foetal alcohol syndrome (FAS). People with FAS have distinctive facial features, are small for their age and have problems with learning. </p>
<p>The exact number of drinks a woman can have before harming her baby is unknown (and is likely to vary from woman to woman), so most countries, including Canada, Australia and the USA, have taken a conservative approach and recommended that no alcohol is the safest option. This new guideline now brings the UK in line with those and many other countries. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=679&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=679&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=679&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=853&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=853&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=853&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Signs of FAS.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3APhoto_of_baby_with_FAS.jpg">Teresa Kellerman/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p><a href="http://tinyurl.com/jbntjdj">Recent research</a> has revealed a large number of problems experienced by people with FASD. Around half of all people with FASD have attention-deficit hyperactivity disorders (ADHD), 62% have vision impairment (a rate more than 30 times higher than the general population), 58% have hearing problems (more than 100 times higher than the general population), 83% have speech and language delays and 91% suffer from impulsivity and inappropriate behaviour. </p>
<p>Each person with FASD may have some or all of these problems, and each person may have these problems from a mild to severe degree.</p>
<h2>May be as prevalent as autism</h2>
<p>We don’t know how many people have FASD in the UK, but based on a <a href="http://onlinelibrary.wiley.com/doi/10.1111/acer.12939/abstract">large review</a> of data from other countries, it’s estimated that it may affect as much as 2% of the population. This would put FASD on a par with well-recognised developmental disorders such as autism spectrum disorder. In fact, a significant proportion of children currently diagnosed with <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938300/">ADHD</a> or <a href="http://www.sciencedirect.com/science/article/pii/S0149763410002149">autism</a> may have undiagnosed FASD as an underlying cause of their learning problem. </p>
<p>One problem with recognising the extent of the hidden epidemic is that FASD is <a href="http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-11-14">significantly under reported</a>. For example, out of a search of five years’ worth of outpatient hospital data in England, no cases of FASD were recorded. The researchers also looked at hospital admission data, expecting to find that areas with higher levels of alcohol-related illness in young women (such as in the north-west and north-east of England) would also have higher levels of FASD. This was not the case, suggesting that either FASD is not diagnosed, or it is diagnosed but not routinely recorded in hospital data. </p>
<h2>A difficult diagnosis</h2>
<p>Diagnosis is dogged by difficulties, including the fact that many healthcare professionals don’t know much about FASD and specialist training is needed to make a diagnosis. <a href="http://bmaopac.hosted.exlibrisgroup.com/exlibris/aleph/a21_1/apache_media/3UQ4QIHNR25DH7623BMFDY45UIK7LH.pdf">A diagnosis</a> has to be made by a team of different professionals following a thorough assessment of the child that involves a physical examination, intelligence tests, occupational and physical therapy, and psychological, speech and neurological evaluations, as well as genetic tests to rule out genetic causes of problems. </p>
<p>Another difficulty with getting a diagnosis is that the behavioural and developmental problems that are signs of FASD may not emerge until a child is at primary school, by which time vital evidence about whether the birth mother drank during pregnancy may be missing. This information is crucial to make a diagnosis if the distinctive facial features seen in full-blown FAS are not present. Another difficulty is that people with FASD usually have other disorders (such as ADHD or autism spectrum disorder), making it difficult to isolate FASD. </p>
<p>To get the true number of people with FASD, it would be necessary to screen a whole group of the general population. This has been done in other countries, such as Italy, the USA and Canada, but there has been no such study in the UK.</p>
<h2>Action at last</h2>
<p>Last summer, a cross-party group of MPs took an interest in FASD, forming the <a href="http://www.appg-fasd.org.uk/">All Party Parliamentary Group (APPG) for FASD</a>. In its first <a href="http://www.appg-fasd.org.uk/download/i/mark_dl/u/4013133754/4625658887/APPG%20on%20FASD%20Initial%20Inquiry%20Report.pdf">report</a>, released in December 2015, it made a number of recommendations including the call for a public health campaign to raise awareness of FASD. The APPG also called for “urgent consideration to be given by the government into commissioning a UK-wide study to ascertain the prevalence of FASD”. This would be a vital first step in uncovering the true extent of FASD. </p>
<p>Why is such recognition important? The consequences of unrecognised and unsupported FASD are wide, including addiction, mental health problems and disengagement with education. Children can appear bright and talkative and can appear to learn, but often forget what they have learned by the following day. They can also behave inappropriately. Because the cause of their difficult behaviour is not understood, they frustrate teachers and are often labelled as “naughty”. Sadly, another tragic consequence of unrecognised FASD, is that many go on to find themselves in <a href="http://www.cdc.gov/ncbddd/fasd/secondary-conditions.html#ref">trouble with the law</a>. </p>
<p>Early detection and intervention are important because with the right support, there is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1475-3588.2008.00504.x/full">growing evidence</a> that people with FASD can live and work independently. But, until the UK catches up with the USA, Canada and Italy, many people with FASD will continue to suffer in silence.</p><img src="https://counter.theconversation.com/content/52835/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Penny Cook is part of a national team of academics and doctors who have been working on grant applications in the hope of gaining funding to carry out a study to determine the prevalence of FASD in the UK.</span></em></p><p class="fine-print"><em><span>Raja Mukherjee is an independent volunteer (unpaid) medical adviser to various UK charities related to FASD</span></em></p>The UK government are finally waking up to the problem of foetal alcohol spectrum disorder.Penny A. Cook, Professor, University of SalfordRaja Mukherjee, St George's, University of LondonLicensed as Creative Commons – attribution, no derivatives.