Child and Maternal Health
Thinking about Fetal Alcohol Spectrum Disorders
To mark International FASD Awareness Day, Scottish Government Professional Advisor, Dr. Christopher Steer, gives an account of FASD action in Scotland.
William Sutherland first proposed that alcohol harms the developing fetus more than a century ago in his study of alcoholic mothers detained in Liverpool Jail(1). Over recent decades clinicians and researchers have described and defined the harmful effects of alcohol, introducing the term Fetal Alcohol Spectrum Disorder (FASD). The 2019 SIGN (2) Guideline underlines that FASD is a common and potentially preventable cause of neurodevelopmental disorders in childhood with a prevalence of at least 30 per thousand births in the UK.
The Scottish Government recognises the importance of identifying and preventing FASD. We know that early diagnosis and support can positively improve the long term outcome and quality of life for those affected.
Prevention of FASD remains a priority. Section 18 Scottish Government’s Alcohol Strategy (3) summarises the wide range of measures underway in Scotland to reduce pregnancy related alcohol harm and support those affected. We have sponsored a FASD families information and support Hub hosted by Adoption UK (4). Work is ongoing on awareness raising, diagnostic training of clinical teams, and research projects.
Although FASD is preventable in theory, achieving this is challenging in practice. Potential barriers to FASD prevention include:
- Unintended or unplanned pregnancies.
- Lack of awareness of alcohol harm and FASD.
- Alcohol marketing and availability.
- Peer pressure, family and social media influences.
- Adverse life circumstances; intimate partner violence and coercion.
- Alcohol dependence.
- ‘Risk tolerance’ and ‘Risk plausibility’ – messages seen as not personally relevant or overstated.
We can all reflect on the above sometimes complex realities which contribute to existing challenges to FASD prevention.
Examples of current FASD prevention strategies can be against a background of wider public health measures to reduce drinking, including the introduction of Minimum Unit Pricing in Scotland. Measures specific for FASD involve devising sensitive and supportive awareness raising approaches, such as those included in the ‘Ready Steady Baby’ advice for parents (6), and ensuring mandatory labelling of alcohol products with clear indications of pregnancy risk. Screening for maternal alcohol use in pregnancy, followed up by appropriate counselling via Alcohol Brief Interventions or ABI’s is widely employed within maternity services. ABI guidance (7) gives helpful advice on how to broach difficult questions and provide support in a respectful and non-judgmental manner.
Alcohol harm deals with relative risks rather than certainties, and employing a precautionary principle is regarded as the safest approach. It is not currently clear why some pregnancy alcohol exposures result in more serious outcomes than others. Information should be accurate and non-contradictory so that risk is neither under or overstated. In Scotland increasing numbers of clinicians are trained in FASD recognition and can provide peer support, and advice if required. The Fetal Alcohol Advisory and Support Team, based in Ayrshire and Arran is one such valuable source of information and support (8). We know early assessment and diagnosis is essential to improve long term outcomes for FASD.
Want to learn more about FASD? Watch out for the updated FASD E-Learning Resource and The FASD Diagnostic Pathway which will shortly be available online.