Tuesday, 22 August 2017

8 in 1000 babies born with foetal alcohol spectrum disorder

The results of the systematic review and meta-analysis published by Shannon Lange and colleagues [1] make for important reading with their conclusion that the global prevalence of foetal alcohol spectrum disorder (FASD) is estimated to be around 8 in 1000 live births. The accompanying editorial by Albert Chudley [2] rightly talks about 'high time for action' on the basis of such figures, particularly because FASD is a largely preventable condition and specific groups of people and specific geographical regions seem to carry elevated risk(s) when it comes to offspring FASD and so can be targeted for additional support.

Looking at the collected data from 24 studies examining the prevalence of FASD - a condition whereby babies exposed to alcohol in the womb present with specific morphological features and accompanying behavioural / cognitive issues - researchers concluded that around 7.7 per 1000 live births presented with FASD. They reported that 76 counties (of 187 countries providing data) showed an estimated prevalence rate for offspring FASD above 1% of total births. South Africa came top with over 1 in 10 births being estimated to present with FASD. Croatia, Ireland, Italy and Belarus filled the other top 5 hotspots for FASD with estimated prevalence rates between 3-5% of births derived from various methods.

'Special populations' are also mentioned in the Lange paper. Specifically: "the prevalence of FASD among special populations was 15.6 to 24.6 times higher among aboriginal populations... 5.2 to 67.7 times higher among children in care... 30.3 times higher in a correctional population... 23.7 times higher in a population with low socioeconomic status... and 18.5 times higher among a population in psychiatric care compared with the global prevalence among children and youth in the general population." One might argue that at least for some of these at-risk populations, issues such as binge drinking habits combined with an elevated risk of unplanned pregnancy [3] could lie at the root of the estimates detailed by Lange et al. I say that minus any sweeping generalisation but in light of the scientific 'facts' detailed in the latest review paper.

I note that some of the media around the Lange findings (see here) have already mentioned about some of the behavioural manifestations of FASD 'crossing over' with diagnoses such as attention-deficit hyperactivity disorder (ADHD) and autism. I would perhaps draw your attention to a previous blogging occasion when I discussed some of the research specifically looking at any overlap between autism and FASD (see here) and how one needs to be quite careful not to overplay any would-be links despite some data on possible overlap [4] (this paper was also from Lange).

Then to the specifics of the hows-and-whys of alcohol exposure in-utero causing FASD and whether effects might somehow be mitigated. Alcohol (ethanol) is a known teratogen [5] so effects are likely to be numerous in terms of how it affects the developing foetus. I note that the word 'epigenetics' has entered the vocabulary when it comes to possible mechanisms of effect(s) and that would suggest that at some point there may be ways and means of mitigating the effects of alcohol consumption at critical periods during pregnancy. At some point.

For now the message from Lange and colleagues is clear: FASD is not an uncommon finding in many different countries and different populations, and remains largely preventable. Abstinence from alcohol is advised before and during that special time (see here). And just in case anyone thinks I'm only zooming in on mums-to-be, dads might also heed similar advice at critical periods too.

Straight Edge from Minor Threat seems an appropriate song to conclude this post given what the song title means (veganism and the non-use of prescription medicines are optional extras I might add)...

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[1] Lange S. et al. Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth. JAMA Pediatrics. 2017. Aug 21.

[2] Chudley AE. Fetal Alcohol Spectrum Disorder—High Rates, High Needs, High Time for Action. JAMA Pediatrics. 2017. Aug 21.

[3] Font-Ribera L. et al. Socioeconomic Inequalities in Unintended Pregnancy and Abortion Decision. Journal of Urban Health. 2008;85(1):125-135.

[4] Lange S. et al. Prevalence of Externalizing Disorders and Autism Spectrum Disorder among Children with Fetal Alcohol Spectrum Disorder: Systematic Review and Meta-analysis. Biochem Cell Biol. 2017 May 18.

[5] Randall CL. Alcohol as a teratogen: a decade of research in review. Alcohol Alcohol Suppl. 1987;1:125-32.

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