Worldwide FAS affects an estimated 0.097% of live babies born each year1. The UN estimates births for 2003 to be 128.6 million which gives us the figure of 127,742. This is comparable and, on occasion, greater than worldwide rates of Down Syndrome and Spina Bifida. ARND and ARBD affect nearly 1% of children born each year2 or over one and-a-quarter million children. Alcohol and its abuse is a widely-used teratogen (something that causes birth defects) and it is estimated that up to 60% women drink alcohol at some point during pregnancy. Roughly 20% of those women have babies that are affected by that drinking in some way3. That's 12% of worldwide births or approximately 15.4 million estimated for 2003.
What do these acronyms stand for?
FAS stands for Foetal Alcohol Syndrome. A mother drinking while pregnant will not necessarily have a child with FAS, although there is no known safe level of alcohol consumption during pregnancy (see last paragraph). Most of the children and, subsequently, adults affected by alcohol exposure before birth do not have the physical facial abnormalities and growth retardation identified with FAS ('dysmorphic' or asymmetrical malformations of the face, the eye, and the ear and significantly low birth weight and growth) - however, they have brain-related and other impairments that are just as significant. So, from that point we're led to further definitions:
ARND stands for alcohol-related neurodevelopmental disorder which is evidence of central nervous system dysfunction or simply put, a change in brain function. People who have been affected may have a pattern of behavioural and learning problems, including difficulties with memory, attention and judgment. There may be mathematical deficiencies, difficulty with abstractions and problems with generalising from one situation to another. They may demonstrate poor attention and concentration skills, memory deficits, and impaired judgment, comprehension, and abstract reasoning. Hyperactivity and impulsive behaviour are common. Sufferers may exhibit social conduct problems such as lying, stealing, stubbornness, and argumentative behaviour. They may find it difficult to function socially or consider the consequences of their actions. Often there is lack of response to appropriate social cues, an inability to form two-way friendships, the seeking of social isolation, sullenness, moodiness, teasing and bullying. Various aspects of these symptoms or even all of them are present even into adulthood. All these symptoms can exhibit themselves without any outward physical deformity, since less than half of those affected have few or no facial or physical abnormalities. However, a large percentage do, which brings us to the next definition.
ARBD stands for alcohol-related birth defects. This is generally held to include deformed facial features, pre-natal, and post-natal growth abnormalities along with mental retardation. Approximately 80% of children with FAS have microcephaly (basically a small head, whether pronounced or subtle) and behavioural abnormalities which may not be immediately or physically apparent. As many as 50% of affected children also exhibit identifiable facial anomalies, such as facial distortions, cleft palate, and micrognathia, which is a underdeveloped lower jaw that can lead to dental problems later in life. Heart defects, hemangiomas (birth marks or skin discolouration) and eye or ear abnormalities (unusual skin growths or discolourations) are also common.
How often does this occur and should we be concerned? Taking Canada's statistics are not far from the worldwide average, although some northern regions and some aboriginal groups have a much higher incidence than the rest of the world - as high as 0.7%.4 In fact, those communities allowed for a more controlled environment for statistical analysis due to their isolation.
Only 0.2% of Canadian babies are born each year with Foetal Alcohol Syndrome5. One per cent of Canadian babies per year are born with Alcohol-Related Neurodevelopmental Disorder6. However, the comprehensive lifetime cost of just one baby with FAS could be as much as $6 million CDN (£3 million, or US$4 million). The cost to Canadian taxpayers for Foetal Alcohol Syndrome is estimated to be $300 million CDN (£145 million, or US$200 million) each year7. In addition, there is the unseen cost of the significant segment of the population who have minor or undiagnosed symptoms of this syndrome.
Internationally, the statistics are equally alarming. In the UK the dangers are well-known. More commonly known as the total of all three disorders, Foetal Alcohol Spectrum Disorder (FASD) is estimated to have a prevalence of around 1 in 300. With 621,469 births in England and Wales alone in 2003 that means that 186,441 children have been affected. The UK site this statistic comes from is full of more information.
How Much Alcohol is Safe During Pregnancy?
In 1997, the Royal College of Obstetricians and Gynaecologists conducted a large study including 400,000 American women, all of whom had consumed alcohol during pregnancy. Not a single case of Foetal Alcohol Syndrome occurred and no adverse effects on children were found when consumption was less than 8.5 drinks per week8. Note, however, that this was a study of FAS and not FASD. There is no 'magic number' for amount consumed other than a few generally agreed-on rules. Negative effects appear to be related to higher blood alcohol content levels (greater consumption in single instances)9. It appears to be very important never to consume more than one drink in any one day while pregnant and that in fact is the reccomendation of both the Royal College of Obstetricians and Gynaecologists in the UK, the Institute of Medicine of the National Academy of Sciences in the US, and the Centre on Substance Abuse in Canada. In addition, it is generally agreed that the first trimester is the most dangerous for consumption. It should be noted that several other organisations, such as some midwife organisations10 and individual doctors' groups11 recommend abstention.
1 Foetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment, NYU, 1996
2 "Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder": Sampson PD, Streissguth AP, Bookstein FL, Little RE, Clarren SK, Dehaene P, Hanson JW, Graham JM Jr, Teratology 1997, University of Washington, Seattle, USA
3 US National Institute on Drug Abuse, 1992
4 Canadian FAS Community Resource Centre, Canadian Government
5 Canadian National Organisation of Foetal Alcohol Syndrome
6 Canadian Centre on Substance Abuse
7 Canadian study by National Institute on Drug Abuse (estimated $1.9 billion per year equivalent in the US)
8 Wilkie, S: Global overview of drinking recommendations and guidelines. AIM Digest (Supplement), June, 1997, 2-4, p4
9 Goodlett, CR, and Peterson, SD: Sex differences in vulnerability to developmental spatial learning deficits induced by limited binge alcohol exposure in neonatal rats. Neurobiological Learning and Memory, 1995
10 Bennett, VR, Brown, LK (1990): Myles Textbook for Midwives, New York, Churchill
11 Streissguth, AP et al. (1991). 'Fetal Alcohol Syndrome in Adolescents and Adults.' JAMA. Vol. 265, No. 15