FASD 2013 EPIDEMIOLOGY of Fetal Alcohol Spectrum Disorders and Prenatal Alcohol Exposure

Beschreibung
Current analysis of FASD epidemiology and
the prevalence of maternal alcohol consumption
during pregnancy in the last five years from
2008/2009 to 2012 show from an active case
search that in elementary schools, at least one child
with FASD per class (1:21–25) must be expected
(Italy, MAY 2011; Croatia, PETKOVIC 2010).
Population-based studies on the state or federal level
reveal a significantly lower frequency (Germany,
Paditz 2012; Saxony-Anhalt/Deutschland, GOETZ
& RISSMANN 2012 in this volume; Israel,
Senecky 2009). Several indicators, such as maternal
alcohol consumption in 14% of women from Israel,
indicate that the real rate of incidence is higher.
The range of incidence of prenatal alcohol exposure
is found in national, cross-regional, or multicenter
surveys of between 2.5% in Canada and
54% in Russia (PubMed 949 studies 2008–2012,
including 21 studies from 13 countries with such
surveys). Mono-centric studies showed similar rates
of incidence between 6–29.5% (results from seven
countries).
Interviews with women from Australia (Aboriginal),
New Zealand (Niue), the USA (Hispanic/
Latina) and Ukraine indicate that prenatal alcohol
exposure is not only based on a lack of information
about embryo and fetal toxic effects of alcohol, but
that questions of self-image and the partnership
between men and women contribute significantly
to whether a woman enters into the vicious cycle
of alcohol consumption or not. In the same way, it
was found in Canada that the risk of maternal alcohol
consumption during pregnancy was increased
24-fold with the chronic abdominal pain of Colitis
Ulcerosa. Alcoholism and smoking increased this
risk “only” five or twofold, respectively (THAN &
JOHNSON 2010).
Epidemiology thus represents an essential tool for
the detection of initial conditions at the regional or
national level, as well as for the evaluation of the
effects of intervention, including the assessment of
relevant resources that are required for the care of
people with FASD. International comparisons are a
contributor, in that the experiences of other countries
are taken up, as well as benchmark projects are
initiated.
Epidemiology relies on well-defined diagnoses. A
list of differential diagnostics for FASD with
more than 25 relevant diagnoses pointed to the
possibility of false positive results. Geneticists from
Manchester (UK) found in 8.75% (7/80) of questionable
FASD cases, other diagnoses for which
existing symptoms could be held responsible
(DOUZGOU 2012). Subtle clinical observations
offered similar results in 1957 and 1968 in France
in FAS first accounts from ROQUETTE and
LEMOINE; also likely, set against the background
of France in the 50s and 60s of the 20th century,
France exhibited the highest alcohol consumption
world-wide, as well as that, in this period, the incidence
of congenital syphilis in numerous countries
declined significantly.

Einführung oder Vorwort
In writing this foreword I commend the authors of
‘FASD 2013 Epidemiology of Fetal Alcohol Spectrum
Disorders and Prenatal Alcohol Exposure’. It
represents a comprehensive presentation of the literature
on Prenatal Alcohol Exposure and Fetal Alcohol
Spectrum Disorders. At the same time it provides
insight into the challenges of diagnosis and ascertaining
prevalence. It is hoped that this document will
support policy that raises awareness of FASD and
reduces the impact of alcohol on the unborn child.

Our shared respect for new life and childhood
presents a focus point for prevention messaging
and a powerful lever for supporting and
motivating women not to drink in pregnancy.
Epidemiology is a tool for the detection of disease
and patterning where it finds its home, and for assessing
resources needed for intervention and the
impact of this intervention. Epidemiology is most
powerful when it is used by populations of people
themselves to identify, quantify and overcome their
most challenging issues. I emphasise the centrality
of ‘the studied’ because it is their stories that we tell
through data, and their struggle that we chronicle in
the patterning of disease. If the tools of epidemiology
are held firmly by those populations we study,
then we may better understand the layers of causality
behind disease states, and the policies and resources
most likely to overcome these disease states.
In the case of Prenatal Alcohol Exposure and FASD,
the richest data combines incidence and prevalence
with an understanding of the human stories that
give rise to this data. We must know how many women
drink in pregnancy. We must also understand
why the women drink in pregnancy and how their
child’s diagnosis relates to functional disadvantage
across the lifecourse. In understanding that populations
with high – risk alcohol consumption exist
because of historical and cultural trauma such as
from war or dispossession, we can create policy that
restricts supply at the same time as providing supports
at the individual, family and community level.

It is important to diagnose FASD – to link the
teratogenic effects of alcohol with dysmorphology
and functional impairment – because this is a
powerful tool for prevention. It is also important
to understand the specific functional impairments
of children with FASD so that we can tailor interventions
most likely to support them and prevent
secondary disability. The impact of false negative
and false positive diagnoses of FASD are significant
and well documented in the pages that follow.