A new meta-analysis has identified over 400 health problems that can co-occur in children diagnosed with Fetal Alcohol Spectrum Disorders (FASD), with severe cases that included high levels of hearing loss and impaired vision.
In the most comprehensive systematic review of its kind, researchers at the Center for Addiction and Mental Health (CAMH; Toronto, ON, Canada) have identified 428 distinct disease conditions that co-occur in people with FASD. “It isn’t safe to drink any amount or type of alcohol at any stage of pregnancy, despite the conflicting messages the public may hear,” said lead author Dr. Lana Popova, senior scientist at CAMH, “Alcohol can affect any organ or system in the developing fetus.”
FASD is a broad term describing the range of disabilities that can occur in individuals as a result of alcohol exposure before birth. The severity and symptoms vary based on how much and when alcohol was consumed as well as other factors in the mother’s life, such as stress levels, nutrition, and environmental influences. The effects are also influenced by genetic factors and the body’s ability to break down alcohol, in both the mother and fetus. Different Canadian surveys suggest that 6%–14% of women drink during pregnancy.
The 428 co-occurring conditions were identified from the 127 studies reviewed. These disease conditions, coded in the International Classification of Disease (ICD-10), affected nearly every system of the body, including the central nervous system (brain), vision, hearing, cardiac, circulation, digestion, and musculoskeletal and respiratory systems, among others. While some of these disorders are known to be caused by alcohol exposure – such as developmental and cognitive problems, and certain facial anomalies – for others, the association with FASD does not necessarily represent a direct cause-and-effect link.
However, many disorders occurred more often among those with FASD than the general population. Based on 33 studies representing 1,728 individuals with Fetal Alcohol Syndrome (FAS), the most severe form of FASD, the researchers were able to conduct a series of meta-analyses to establish the frequency with which 183 disease conditions occurred. More than 90% of patients with FAS had co-occurring problems with conduct. About 80% had communications disorders, related to either understanding or expressing language. 70% had developmental/cognitive disorders, and over 50% had problems with attention and hyperactivity.
Because most studies were from the US, the frequency of certain co-occurring conditions was compared with the general US population: among people with FAS, the frequency of hearing loss was estimated to be up to 129 times higher, and blindness and low vision 31 and 71 times higher, respectively.
“Some of these other co-occurring problems may lead people to seek professional help,” said Dr. Popova, “The issue is that the underlying cause of the problem, alcohol exposure before birth, may be overlooked by the clinician and not addressed.”
Improving the screening and diagnosis of FASD has numerous benefits. Earlier access to programs or resources may prevent or reduce secondary outcomes that can occur among those with FASD, including problems with relationships, schooling, employment, mental health, addictions, or with the law. “We can prevent these issues at many stages,” said Dr. Popova, “Eliminating alcohol consumption during pregnancy or reducing it among alcohol-dependent women is extremely important. Newborns should be screened for prenatal alcohol exposure, especially among populations at high risk. And alerting clinicians to these co-occurring conditions should trigger questions about prenatal alcohol exposure.”
“It is important that the public receive a consistent and clear message – if you want to have a healthy child, stay away from alcohol when you’re planning a pregnancy and throughout your whole pregnancy,” she said.
The study, by Popova S, Lange S, et al, was published online ahead of print January 5, 2016, in the journal the Lancet.
Centre for Addiction and Mental Health
Burden & Economic Impact of Fetal Alcohol Spectrum Disorder in Canada