‘Learning And Physical Disabilities Linked To Fetal Alcohol Spectrum Disorders’

Learning and physical disabilities and behavioural problems are part of fetal alcohol spectrum disorders [FASD]. These lifelong conditions can drastically impact on the lives of the individual and those around them.

A newly published BMA report says the reality is that these conditions are completely preventable by not drinking any alcohol during pregnancy. The report, ‘Fetal alcohol spectrum disorders’, highlights how difficult it can be to detect FASD and how healthcare professionals need more guidance to help them diagnose and treat children suffering from the disorder.

The government in England has just revised its guidance and now advises pregnant women or women trying to conceive to avoid drinking alcohol. But if they do choose to drink, to minimise the risk to the baby, they should not consume more than one to two units of alcohol once or twice a week.

However, the BMA report says this can be misinterpreted, as individuals may not clearly understand how many units correspond to what they are drinking. The alcoholic strengths of different beers and wines, and the considerable variation of standard measures used in bars and restaurants and in the home, can make it difficult for women to tell how many units they are consuming.

The new advice from the English government has been disputed by some medical experts and the BMA is now calling for clear, evidence-based guidelines on alcohol consumption during pregnancy and for women who are planning a pregnancy.

Dr Vivienne Nathanson, Head of BMA Science and Ethics, said today: “The UK has one of the highest levels of binge-drinking in Europe and the highest rate of teenage pregnancies in Western Europe. Many women will not know they are pregnant during the early part of pregnancy, during which time they may continue to drink in their pre-pregnancy fashion with no awareness of the risk to their unborn child.”

There is proven risk that heavy drinking by pregnant women can cause these disorders in their children, says the BMA. The report states that evidence is continuing to emerge on the effects of low or moderate prenatal alcohol exposure and until there is clarification the only message is that it is not safe to drink any alcohol during pregnancy or when planning a pregnancy.

Dr Nathanson, added: “What is clear is that this is a complex concern and there is still so much that we do not know about this issue. It’s important that women who drank alcohol before realising they were pregnant do not panic. But pregnant women should try to reduce their alcohol intake, or better still give up completely. If they are anxious they should talk to their doctor or midwife at their next antenatal appointment.

“We need to raise awareness of the emerging evidence on FASD among healthcare professionals. They need training and guidance on how to identify these disorders so that children are diagnosed quickly and get the help they need. Early intervention is crucial in decreasing the risk of additional problems commonly found in individuals affected by these disorders. These include mental health problems, disrupted school experience, alcohol and drug addictions. The lack of awareness and research in the UK on this subject, together with the complexity of the syndrome itself is leading to delays in diagnosis and referral.

“Healthcare professionals also need to get the message across to expectant mothers that consuming alcohol can cause irreversible harm to their unborn child. It’s about giving people the right information so that they can act responsibly – and save children from completely preventable life-long disabilities.”

Recommendations in the report include:

  • There is an urgent need for further UK and international research on FASD.
  • Research should be undertaken to examine the relationship between different levels of prenatal exposure and the range of conditions associated with FASD.
  • The UK health departments should implement guidance and training programmes for healthcare professionals on the prevention, diagnosis and management of FASD.
  • Women who are pregnant, or who are considering a pregnancy, should be advised not to consume any alcohol.
  • Research should be undertaken to identify the most effective ways to educate the public about FASD and to alter drinking behaviour. This requires systematic studies that compare various universal strategies and their impacts across the different social groups.
  • All healthcare professionals should provide clear and coherent advice for expectant mothers and anyone planning a pregnancy on the risks of maternal alcohol consumption. This should be provided by GPs as part of routine clinical care and targeted at women of childbearing age.
  • Members of the antenatal care team should provide continued advice and support to expectant mothers throughout pregnancy.
  • Any woman who is pregnant, or who is planning a pregnancy, and who has a suspected or confirmed history of alcohol consumption at low-to-moderate levels should be offered brief intervention counselling to help them stop drinking. This should occur at the earliest possible stage in a pregnancy and be considered as part of routine antenatal care where required.
  • Any woman who is identified as being at high-risk of prenatal alcohol exposure should be offered referral to specialist alcohol services for appropriate treatment. Any referral should be followed up and assessed at regular intervals.