Earliest UK estimates of children affected in the womb by alcohol intake during pregnancy

By Dr. Liji Thomas, MDNov 30 2018

A report published on 30 November 2018 in Preventive Medicine reveals that a stunning 17 percent of children could possibly be affected by alcohol exposure during their intrauterine life. This refers to a group of lifelong conditions caused by prenatal drinking, called fetal alcohol spectrum disorder (FASD).

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Drinking during pregnancy is extremely common in the UK, which ranks fourth in the world in this respect. However, there are no population-based studies to provide an approximation of the number of people with FASD.

FASD is often classified as a relatively invisible and underdiagnosed disability, due to the lack of overt physical symptoms and signs. There is only one clinic that deals with this specialty directly in England.

To address this need, a team from the University of Bristol and Cardiff University used a screening tool to gather a wide range of information on maternal alcohol intake during pregnancy. In collaboration with medical professionals, the research covered 13,495 children whose development had been followed in the Bristol's Children of the 90s study.

The results were astonishing, showing alcohol exposure in up to 79 percent of children in the study, while a positive screen was obtained for FASD symptoms in up to 17 percent. The screen was defined to be positive if the child had problems with learning or behavior in at least three different areas, either with or without physical features such as growth deficiency and a distinctive facies marked by a smooth philtrum, a thin upper lip and small eye openings.

While the positive screening results for FASD were rightly distinguished from a diagnosis of the condition, the study outcome was disturbing in terms of the very high rate of drinking in pregnancy and the high prevalence of symptoms suggestive of FASD that it showed. This may indicate that FASD is probably a significant public health burden in the UK.

The ability to arrive at an approximate FASD prevalence is important since without such information, few people are likely to be aware of the condition. This would result in the condition going undiagnosed or being diagnosed late in children, adolescents and adults. As a result, they would be deprived of necessary support.

The researchers point out that the information they used is several years old. Meanwhile, the current medical opinion on the safety of drinking during pregnancy has officially changed. However, the rates of fetal alcohol exposure within the UK are still high, with recent information suggesting that 75 percent of women do drink while they are pregnant. A third of these women binge on alcohol. This could indicate that many people are currently experiencing FASD symptoms.

The most up-to-date guidance states that the safest approach is not to drink alcohol at all if you are pregnant, or if you think you may become pregnant. It is important that people are aware of the risks so that they can make an informed decision about drinking in pregnancy.”

Dr Cheryl McQuire, the leader of the study, who is a researcher in epidemiology and alcohol-related outcomes at the University of Bristol.

Moreover, she says, the study points to the need for future research to clearly identify how many people in the UK have FASD today.

Countries such as Canada, the US and Italy have made use of in-school screening measures to arrive at a prevalence of up to 10 percent among children, going up to a disturbing 30 percent when it comes to children who are being given care.

Another researcher, Dr Raja Mukherjee, who heads an FASD diagnostic clinic at Surrey and Boarders Partnership NHS Foundation Trust, pointed out that the current study shows an apparent mismatch between the findings and the rarity of the condition as reported by most clinicians. The research reveals that many people suffering with this condition are probably going undiagnosed in the general population.

It shows that it is a disorder that is seemingly hidden in plain sight that we need to pay attention to. Unless we start looking for it we will continue to miss it. If we fail to diagnose it then those affected individuals will continue to be affected by a lack of support… These results can be the first step in helping us in the UK to realise it is no longer a condition we can ignore.”

Dr Mukherjee

Sandra Butcher, Chief Executive of the NO-FAS UK, underlined the wide scope of the screening, saying that it “shines light on a staggeringly widespread and largely avoidable public health crisis.”

She states that the only way to go from here, for anyone in a position to influence or make public health policy and who cares about protecting those in society who are at most risk, both mentally and physically, is to put in place a complete training and action program which covers the prevention, diagnosis and support of FASD. Such support will be required lifelong, because FASD is an incurable condition, and requires increasing levels of support as affected children grow into adulthood and beyond.

The most current medical advice on drinking in pregnancy, from the Chief Medical Officer, in January 2016, states that for women who are pregnant or think they could become pregnant, it is safest to abstain from all alcohol to minimize the risk of fetal alcohol exposure. However, if small amounts of alcohol were ingested before pregnancy was detected or even during pregnancy, the risk of any toxicity is low, according to the guideline.

According to this advice, if a pregnant woman has drunk alcohol before knowing that she was pregnant, further drinking is to be avoided. It is safe to say that the baby will not be affected in the majority of these cases. The guideline goes on to suggest talking to a healthcare provider if a woman is concerned about using alcohol in pregnancy.