Foetal Alcohol Spectrum Disorders

by Michele Savage, Coordinator and Spokesperson Fetal Alcohol Support Ireland

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The following consensus statement on terminology reflecting the range and degree of effects arising from prenatal exposure to alcohol was issued in April 2004 by a group of international experts at the summit convened in the US by the National Organisation on Fetal Alcohol Syndrome (NOFAS): Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis.‘

This umbrella term expands upon what were previously known as Foetal Alcohol Syndrome and Foetal Alcohol Effects. Foetal Alcohol Spectrum Disorders are under-recognised and under-reported even in countries where there is much knowledge of the conditions. FASD include Foetal Alcohol Syndrome (with or without confirmed maternal consumption of alcohol), Partial Foetal Alcohol Syndrome, Alcohol-Related Neurodevelopmental Disorder and Alcohol-Related Birth Defects. However, as a nation Ireland lags behind the US and Canada in addressing issues around diagnosis, epidemiology, prevention, management of conditions, and provision of services for the full spectrum of disorders. Specific FASD screening methods/tools are being used in clinics in the US, in Canada and by Dr Raja Mukherjee at St George’s Hospital in London. Foetal Alcohol Syndrome, the rarest, albeit the most visible, of the conditions, is being officially recognised in this country, but there is an urgent need for greater general awareness of the scope of the whole spectrum of disorders.

There is no proven safe amount and no proven safe time for alcohol in pregnancy—the placenta cannot and does not protect the foetus from alcohol. Dr Peter Hepper (Queens University, Belfast) has found that there are concerted differences in responses between foetuses which had, and those which had not, been exposed to lower doses of alcohol than previously thought to be dangerous. By contrast, the recent statement by the Royal College of Obstetricians and Gynaecologists advising on how much alcohol a pregnant woman can drink, was an opinion not based on definitive research. The central nervous system is susceptible to damage right throughout the entire nine months of pregnancy, and the reality of the far-reaching effects of alcohol-related neurodevelopmental disorder will not be evident until long after an infant has left the care of the maternity hospital. Although prenatal exposure to alcohol is the leading known cause of avoidable educational disability, only 25% of children with FASD will be thus affected. 7.8 times more Irish pregnant women drink alcohol than their American counterparts (Barry et al 2006). Given that FASD occur annually in 1% of all US births, Ireland has serious cause for concern, as there is good reason to believe that up to 1800 babies born here each year are at risk of being affected, to a greater or lesser degree, by these avoidable lifelong effects. The government has a responsibility in this area, and it is a scandal that successive Irish governments have been passive for so long regarding alcohol and pregnancy, while now emphasising the benefits of folic acid in prenatal care. Not only does alcohol interfere with the absorption of folic acid and minimises the benefits thereof, the drug does more damage than nicotine or any of the other so-called ‘recreational’ drugs.

Diagnosis is not a means to attribute blame. There is very little general awareness in Ireland about the risks of alcohol and half of all pregnancies in Ireland are not planned. So much damage can be done by the time a woman attends her GP, not to mention before her first appointment at the maternity hospital. It is important that conditions on the spectrum are diagnosed so that subsequent pregnancies will not be affected, and appropriate FASD-specific early intervention programmes are instituted for the affected child (a need emphasised by Dr Fionnuala Kelly in her extensive article on Foetal Alcohol Syndrome in Frontline (53, 2003). Even though it may be difficult for parents or carers to learn that their child has one of the conditions on the spectrum, diagnosis and early intervention will minimise the likelihood of secondary effects, such as mental health issues, entry into foster care, early school leaving, inability to live as an independent adult, criminal justice issues, and promiscuity. Recent research has shown that prenatal exposure to alcohol had a more harmful effect on children than socioeconomic status and later maternal drinking habits.

In his lecture at the National Institute of Learning Difficulties at Trinity College Dublin in May 2005, Dr Kieran O’Malley (formerly ofthe Fetal Alcohol and Drug Unit of the Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle) stated that FASD are masked by other conditions such as attention-deficit difficulties and Autism Spectrum Disorder-type behaviours. Dr O’Malley emphasised the need for multi-modal interdisciplinary programmes in order to help affected babies, children, young people and adults affected to reach their potential.

Foetal Alcohol Support Ireland was set up by a group of foster-carers and/or professionals who have cared for children affected by prenatal exposure to alcohol. For more information on FASD and links to other relevant websites please log on to our website www.fasd.ie.

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