Friday, 27 July 2012

Fetal alcohol syndrome

Pregnancy is a special time for both prospective mum and dad. OK, dad's role is a little more 'peripheral' at this stage; more about support and understanding, doing that little more around the house - 'its called a washing machine' - and generally just being there when, for example, the words 'could you nip out and get me some pickled onions darling' are said late at night.

Pregnancy is also an important time for both foetal (English-spelling) and maternal health; as information comes thick and fast about health, diet, nutrition and exercise. So, lots of things to do (exercise, folic acid(!), etc) and lots of things to avoid (smoking, drinking alcohol, eating raw shellfish, old paintworketc). Whilst there is some good evidence behind these dos and don'ts, in recent times some of the suggestions have been the source of some debate. 


Take for example the advice about drinking alcohol during pregnancy. Down the years, there's been an almost operatic battle about what is and isn't a safe level of alcohol consumption during pregnancy. It seems some days expectant mums are advised no alcohol at all during pregnancy, other days reports come out saying a little moderate consumption is probably going to be alright. I can perhaps see how it all could be quite confusing (as per other health advice - see here). 


More confusion has arrived at the time of writing, as several studies have recently emerged looking at alcohol consumption during pregnancy and future offspring development (see here) followed by quite a few headlines such as this one from the BBC "Moderate drinking in early pregnancy branded 'safe'". I might add that I am not endorsing this or any other stance but would also direct readers to this post by the NHS Choices website for some balance regarding the publications in question.


I have to say that I always get a little bit nervous when something is 'branded safe'; thinking back to a certain British Politician and a daughter's hamburger a few years back. Indeed, these latest studies got me thinking about alcohol and pregnancy and how, if it is so safe, do we arrive at something called fetal alcohol syndrome (FAS). I want to talk about FAS with autism in mind but tread very, very carefully here so as not to make connections where none exist.


A short description first. FAS is quite a nebulous term characterised by quite a lot of different symptoms covering everything from cognitive and learning issues to specific facial features to other overlapping features more readily covered under the more general term fetal alcohol spectrum disorder (FASD). Some quite recent research (here) has reiterated the cognitive side of things as being central to the effects of alcohol exposure.


With autism - autistic behaviours - in mind, the research path goes something like this:

  • Various cases of the presence of FAS and autism are dotted around the research landscape. So, this paper by Nanson* seems to be one the earliest, describing six cases of children with FAS who also "fulfill the criteria for diagnosis of autism". Followed in succession by this paper by Harris and colleagues** and a few others.
  • I was drawn to this short reply by Eric Fombonne*** (click 'show summary') on the question of an association between FAS and autism in light of the previous findings. Drawn to it because some good issues are raised here, not least that autism is not universal to all children with FAS (2% of cases is the suggestion) and also that the other features normally accompanying FAS are not normally associated with autism. Indeed, there is a strong argument in this piece that the coincidence of autism in FAS is nothing more than just a chance finding as per the recent autism prevalence figures.
  • Further analysis of the presentation of behavioural features in cases of autism vs. FASD has also revealed some interesting issues. Bishop and colleagues**** described a comparative study based on ADOS and ADI measures in both groups. They suggested that whilst social issues like appropriate behaviour and peer relationships were common between the groups, the core 'social affect' behaviours (as it will become) seem to be firmly rooted in autism not FASD. The lack of other control groups (speech and language delay, learning disability, etc) is a bit of a short-coming to this study but the results still hold up demonstrating differences between autism and FASD.

There are other papers mentioning autism and FAS / FASD but I have to say the suggestion of a link between these conditions is rather unimpressive based on the current data. That's not to say that certain behaviours linked to autism might not also be present in FAS / FASD, but that autism as a diagnostic package is likely not to show strong associations with these conditions.

----------

* Nanson JL. Autism in fetal alcohol syndrome: a report of six cases. Alcoholism, Clinical & Experimental Research. 1992; 16: 558-565.

** Harris SR. et al. Autistic behaviors in offspring of mothers abusing alcohol and other drugs: a series of case reports.. Alcoholism, Clinical & Experimental Research. 1995; 19: 660-665.

*** Fombonne E. Ask the Editor: Is exposure to alcohol during pregnancy a risk factor for autism? JADD. 2002; 32: 243.


**** Bishop S. et al. Re-examining the core features of autism: a comparison of autism spectrum disorder and fetal alcohol spectrum disorder. Journal of Child Psychology & Psychiatry & Allied Disciplines. 2007; 48: 1111-1121.