Fetal Alcohol Syndrome Health Article

PUBLIC HEALTH BURDEN

The FAS incidence rate has been derived from a number of countries and is estimated to be 0.97 per 1,000 live births in the general population. The incidence of FAE is estimated to be ten times higher than FAS. The rates vary depending on the community, with some isolated, disadvantaged communities having much higher rates. FAS/FAE is a leading cause of birth defects, and may be the most common cause of mental disabilities, more common than Down syndrome (1 per 600 live births) and spina bifida (1 per 700 live births).

Beyond numbers of cases, there is a public health burden relating to cost. Estimates have been in the millions of dollars when health care, special schooling, and other costs are tallied in caring for children with FAS.

RISK FACTORS

Not all children whose mothers drank heavily during pregnancy have FAS. The extent and type of alcohol-related disabilities depend on the amount, pattern, and timing of exposure, the length of time during which the mother drank, nutrition, and other maternal health factors. Heavy alcohol exposure can come through daily drinking or drinking large amounts at one time. This refers to the pattern of drinking, and binge drinking (5 or more drinks at any occasion) is particularly risky for the fetus. Multiple maternal factors increase the likelihood of FAS, including older age, greater parity (having had previous children), and being a cigarette smoker. Poverty is considered to be a major determinant of the occurrence of FAS, and as Abel (1995) notes, "FAS is not an equal opportunity birth defect."

PUBLIC HEALTH MESSAGE

Various strategies have been used to decrease the use of alcohol during pregnancy, ranging from warning signs in places wherever alcohol is sold to midwives assisting those most at risk to improve health during pregnancy. Despite recognition of this serious birth outcome, many physicians still fail to recognize alcohol use in their patients and fail to diagnose FAS/FAE. Some medical professionals believe that until there are better treatment facilities for substance-abusing pregnant women, there is little value in identifying problem drinking. Public health messages note that women should either reduce heavy alcohol use during pregnancy or, if heavy drinking continues, delay becoming pregnant. The important aspect of FAS/FAE is that it is entirely preventable.

M. ANNE GEORGE

(SEE ALSO: Alcohol Use and Abuse; Congenital Anomalies; Maternal and Child Health; Pregnancy; Prenatal Care)

BIBLIOGRAPHY

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