Special Feature: Understanding FASD Burden and Solutions

Making the invisible problem visible

Of all the behavioral choices people make in conjunction with pregnancy, none are of greater importance to the child’s future health and development than the ones people make in relation to alcohol.

A landmark report from 2020 shows that parenthood and the role alcohol plays or does not play is a shared responsibility and an important equality issue.

The report clearly shows that alcohol can cause more foetal damage than virtually any other substance. In every other context, people would avoid things that can be hazardous to the unborn child, even in the absence of 100% proof of the potential for harm.

This is even more important when it comes to alcohol, where the research findings are clear and the risks substantial. New research, which is highlighted in the report, shows that a man’s alcohol consumption prior to the pregnancy can damage the foetus and impact the child’s birth weight and health by causing changes to the sperm’s genome. 

FASD refers to a group of disorders caused by prenatal alcohol exposure, of which fetal alcohol syndrome (FAS) is the most severe form. FASD encompasses a broad range of mild to severe symptoms, including physical impairments and mental, behavioral and emotional difficulties.

Report highlights

Consequences of alcohol exposure in connection to pregnancy

• Alcohol exposure in pregnancy is the most common cause of preventable cognitive deficits among children globally, affecting an estimated 1% to 5% of live births each year.
• Even though the brain is the organ most severely impacted by prenatal alcohol exposure, abnormalities within the heart, kidney, liver, gastrointestinal tract, and the endocrine system can also occur.
• Possible causal mechanisms include alcohol-induced brain cell death and damage to the DNA of immature male and female reproductive cells, causing changes which can potentially last for generations.

Alcohol use in the time surrounding pregnancy

• The natural inclination is to perceive alcohol and pregnancy as a problem restricted to pregnancy, and a problem restricted to women.
  • Neither is true. 
  • The effects of alcohol on pregnant women and their offspring are related to the alcohol use of both men and non-pregnant women in the general population.
• For example, over 80% of Swedish women consume alcohol during the year prior to pregnancy and 14% consume alcohol at heavy levels. Overall, few women reduce consumption prior to pregnancy recognition.
• Male alcohol use in the pre-conception period may adversely affect the foetus and possibly subsequent generations through genetic modification of sperm.

Evidence for effective policies

• Policies that limit the availability, affordability and marketing of alcohol have been shown to effectively reduce heavy alcohol use (e.g. binge alcohol use) and alcohol-related harms in the general population. This includes alcohol consumption among those of reproductive age and effects on pregnancy and infant health have been demonstrated.
• Evidence of the potential risks of adverse outcomes linked with alcohol use during pregnancy should be widely promoted to the general population to support informed decision-making by policymakers and consumers.
• Guidelines in many high-income countries advocate abstinence from alcohol as the safest course throughout pregnancy.
• The evidence for effects of low-dose alcohol consumption in pregnancy suggests that abstinence is the safest choice.

The report’s key recommendations

1. Policies which reduce the availability, affordability and marketing of alcohol are needed to sustain a low risk environment for alcohol-related birth abnormalities.
2. There is a shared responsibility for society at large and healthcare providers to raise awareness of the risks of prenatal alcohol exposure and provide support to pregnant women and their partners to manage these risks and their consequences.
3. Persons planning a pregnancy, women as well as their partners, can improve the probability of a healthy pregnancy outcome by going alcohol-free.
4. It is safest to abstain from any alcohol consumption during pregnancy. Partners may also choose to go alcohol-free during this period, and if they choose to continue alcohol use they should do so within low-risk guidelines.
5. It is also safest to avoid alcohol exposure while breastfeeding. Those who choose to consume alcohol during breastfeeding should limit consumption to 1 standard alcoholic drink, consumed 2 hours prior to breastfeeding.
6. An expert national centre should be established charged with developing strategies to reduce prenatal alcohol exposure, monitor prevalence of exposure and provide training in screening and treatment.

Additional resources illustrating the magnitude of the problem

Alcohol consumption during pregnancy is a risk behaviour and can cause severe damage to a foetus, even at low doses. But the problem of FASD remains underestimated despite the magnitude of harm. There are blind spots in prevention and detection, there are barriers in care and support, and there is lack of political attention. This guest expert opinion provides a compelling analysis and charts a promising way forward.

A Nordic Welfare Centre report titled “How to strengthen the focus on children affected by prenatal alcohol exposure to help them live a good life?” provides recommendations to countries in order to give children and their families affected by prenatal alcohol exposure the best possible foundation for a healthy life.

The harmful role of Big Alcohol

Evidence shows that the alcohol industry is playing a harmful role in subverting awareness about the risks of alcohol exposure before, during and after pregnancy.

For example, in New Zealand and Australia Big Alcohol lobbied aggressively against the introduction of mandatory pregnancy warning labels on alcohol products – by claiming it was too costly.

Another example is how Big Alcohol lobbied against alcohol warnings in France – over a 20-year period. An ambitious study revealed that the alcohol industry deployed four tactics to undermine awareness of the risks of alcohol exposure before, during, and after pregnancy:

1. Downplaying the problem,
2. Claiming that “better” alternatives exist,
3. Questioning the effectiveness of pregnancy warnings labels, and
4. Claiming that pregnancy warnings would have counterproductive effects (on women and the wider economy).

Research also shows that alcohol industry–funded websites omit and misrepresent the evidence on key risks of alcohol consumption during pregnancy. This may “nudge” women toward continuing to consume alcohol during pregnancy.

These findings suggest that alcohol industry–funded bodies may increase risk to pregnant women by disseminating misinformation.

Understanding the real extent of the harm

A landmark study showed in 2019 that no amount of alcohol is safe for consumption during pregnancy. Prenatal exposure to alcohol can damage the developing fetus leading to birth defects, intellectual and neuro-developmental disabilities. One of the top causes for intellectual disability worldwide caused by prenatal alcohol exposure is Fetal Alcohol Spectrum Disorder (FASD).

Alcohol use during pregnancy and its effects on the fetus is a grave example of alcohol’s secondhand harms and an overlooked problem around the world.

This article provides an overview of how prenatal alcohol exposure affects the brain, fetal alcohol spectrum disorder, and the challenges with diagnosis.

Globally, in countries like Canada and the US, Lithuania as well as South Africa, FASD is a pervasive problem that is largely preventable. More and more stories as well as scientific facts highlight the need to do more for prevention and treatment.

The article also provides three examples of the way forward from Sweden, Australia, and the U.S.

Massive economic burden

All this leads to severe economic costs – in addition to the avoidable human suffering.

The report “The Burden and Economic Impact of Fetal Alcohol Spectrum Disorder in Canada“, by the Center for Addiction and Mental Health (CAMH) – and funded by the Public Health Agency of Canada – details the total costs associated with FASD in Canada for 2013: approximately $1.8 billion.

The following cost drivers were included in this study:

The father’s role and responsibility

As the landmark report from 2020 “Alcohol, pregnancy and infant health – a shared responsibility” showed the father plays an important role for a healthy pregnancy, infant development, and for the role alcohol plays in the family environments before, during, and after pregnancy.

According to research from 2020, the father’s alcohol use can harm the baby, too. The father’s sperm could be responsible for FASD, which affects one in every 100 infants.

And a 2021 study showed that the risk of birth defects is higher among couples with paternal alcohol consumption, after controlling for confounders. The finding suggests that future fathers should be encouraged to modify their alcohol intake before conceiving to reduce fetal risk.

FASD burden in countries worldwide

Many countries do not have the healthcare and data surveillance systems in place to properly assess and monitor the prevalence of FASD.

But some data exists from mainly high-income, but also a few low- and middle-income countries.

• For instance: the incidence of FAS in Sweden has been estimated at 0.1% to 0.3% of all births, or 100-300 cases per year, and for FASD 1% to 3%.
  • The cost of FAS to Swedish society is conservatively estimated at €1.4 billion per year – similar to Canada’s costs.

• New Zealand: 2021 Report Exposes Human Rights Violations of People with FASD.
• South Africa: Alcohol Remains Big Threat to the Unborn.
• Rwanda: Alcohol, Pregnancy Recipe For Disaster.
• Ethiopia: Prenatal Alcohol Exposure and Adverse Fetal Outcomes
• UK: New Study Shows Millions Affected By FASD.
• UK: Young Adults Unaware of Alcohol Risks During Pregnancy.
• USA: The Crisis of Fetal Alcohol Syndrome.

Source Website: Keep Updated with Movendi International