It was not very long ago that health guidelines suggested that ‘moderate’ alcohol consumption of up to 1–2 standard drinks per day during pregnancy might be acceptable. It is now confirmed that there is no safe time, no safe amount, and no safe type of alcohol to consume during pregnancy (NOFASD, 2023). However, it is important to note that not all mothers may be aware of these guidelines, or they may consume alcohol during pregnancy for various reasons including addiction or being unaware of their pregnancy. Subsequently, it can be helpful for potential parents and health professionals or carers to understand the prevalence and risks involved with such behaviour.
The potential harm of alcohol on a developing foetus exists at any stage of pregnancy, including before the pregnancy is confirmed. In Australia, where approximately 50% of pregnancies are unplanned, many women may be exposed to alcohol unknowingly during the early stages of pregnancy (NOFASD, 2023). To prioritise the wellbeing of the foetus, healthcare professionals strongly advise complete abstinence from alcohol for individuals who could be pregnant or are planning a pregnancy. If alcohol consumption is chosen, it is crucial to ensure the use of effective contraception to prevent unintended exposure of the foetus to alcohol. Consuming alcohol during pregnancy can significantly increase the risk of miscarriage, stillbirth, premature birth, sudden infant death syndrome (SIDS), and can also lead to Foetal Alcohol Spectrum Disorder (FASD), a lifelong disability with various physical, cognitive, and behavioural impairments (Riley & Infante, 2019).
FASD is a global issue, affecting individuals across various cultures, socioeconomic backgrounds, and regions. Estimating the exact prevalence is challenging due to underreporting and misdiagnosis. However, studies suggest that FASD affects approximately 1–5% of children in the general population, making it a significant public health concern (May et al., 2018).
What is Foetal Alcohol Spectrum Disorder?
Foetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disorder caused by prenatal alcohol exposure. When a pregnant woman consumes alcohol, it passes through the placenta and affects the developing foetus. FASD encompasses a range of disabilities, including Foetal Alcohol Syndrome (FAS), Alcohol-Related Neurodevelopmental Disorder (ARND), and Alcohol-Related Birth Defects (ARBD) (Centers for Disease Control and Prevention [CDC], 2019). During pregnancy, alcohol disrupts the normal development of the foetal brain, leading to permanent structural and functional impairments. The severity of these impairments can vary based on factors such as the timing, amount, and frequency of alcohol consumption (Riley & Infante, 2019).
Symptoms and characteristics
FASD can manifest through a wide range of physical, cognitive, behavioural, and emotional symptoms. These may include:
- Physical abnormalities: facial malformations, growth deficiencies, and organ dysfunction.
- Cognitive impairments: learning difficulties, memory problems, poor attention and executive functioning.
- Behavioural challenges: impulsivity, hyperactivity, difficulties with social interactions and communication, poor judgment, and emotional regulation.
- Sensory processing issues: over- or under-sensitivity to sensory stimuli.
- Mental health concerns: anxiety, depression, and increased vulnerability to substance abuse (American Psychiatric Association [APA], 2013).
Although the facial malformations associated with FASD are most recognised, it is important to note that only 13% of people diagnosed with FASD display those specific features and the disorder is more commonly present without these features (NOFASD, 2023).
Misdiagnosis with ASD or ADHD
As you may have already identified, FASD often presents symptoms that overlap with Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). This overlap can lead to misdiagnosis, delaying or hindering appropriate interventions. Some common reasons for misdiagnosis include:
- Lack of awareness: professionals may not consider prenatal alcohol exposure as a potential cause for the observed symptoms.
- Masking effects: the cognitive and behavioural challenges of FASD can mask or mimic symptoms of ASD or ADHD, making accurate diagnosis more challenging.
- Co-occurring conditions: individuals with FASD may also exhibit symptoms of ASD or ADHD, creating diagnostic complexities.
- Inadequate assessment tools: the lack of specialised tools designed to distinguish between FASD and other neurodevelopmental disorders can contribute to misdiagnosis (Astley & Clarren, 2000).
The importance of accurate diagnosis
Accurate diagnosis of FASD is crucial for appropriate intervention strategies and support services. Misdiagnosis can lead to ineffective treatments and exacerbate the challenges individuals face. A thorough assessment should include a detailed developmental history, comprehensive evaluations, and consideration of prenatal alcohol exposure (APA, 2013).
Foetal Alcohol Spectrum Disorder (FASD) poses significant challenges for affected individuals and their families. By understanding its prevalence, developmental factors, symptoms, and potential misdiagnoses, we can work towards early identification and appropriate interventions. It is our responsibility as potential parents and as health professionals or carers, to raise awareness and ensure we minimise stigma and show empathy when exploring the potential of this diagnosis.
By Tiffany Copley
References
American College of Obstetricians and Gynecologists. (2019). Committee Opinion No. 736: Optimizing postpartum care. Obstetrics and Gynecology, 133(5), e156–e173.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Astley, S. J., & Clarren, S. K. (2000). Diagnosing the full spectrum of fetal alcohol-exposed individuals: Introducing the 4-digit diagnostic code. Alcohol and Alcoholism, 35(4), 400–410.
Centers for Disease Control and Prevention. (2019). Fetal Alcohol Spectrum Disorders (FASDs): Data and statistics. Retrieved from https://www.cdc.gov/ncbddd/fasd/data.html
May, P. A., Chambers, C. D., Kalberg, W. O., Zellner, J., Feldman, H., Buckley, D., … Hoyme, H. E. (2018). Prevalence of fetal alcohol spectrum disorders in 4 US communities. JAMA, 319(5), 474–482.
NOFASD. (2023). NHMRC Guidelines on Drinking Alcohol While Pregnant. NOFASD Australia. https://www.nofasd.org.au/alcohol-and-pregnancy/what-is-a-safe-amount-to-drink-while-pregnant/
Popova, S., Dozet , D., Laboni , S. A., Brower, K., & Temple, V. (2022). Why do women consume alcohol during pregnancy or while breastfeeding? Drug Alcohol Rev., 41: 759–777. https://doi.org/10.1111/dar.13425
Riley, E. P., & Infante, M. A. (2019). Fetal alcohol spectrum disorders: An overview. Neuropsychology Review, 29(3), 221–240.