The use of alcohol during pregnancy can have many adverse consequences, one of which is fetal alcohol spectrum disorder (FASD). The term FASD refers to a spectrum of disorders ranging from fetal alcohol syndrome (FAS) at the most severe end of the spectrum to partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorders (ARND), and alcohol-related birth defects (ARBD). The incidence of FASD in North America is frequently estimated at 1% of newborns. Much higher figures, approximately 2% to 6%, have been reported in Italy (May et al, 2011); and a study from South Africa (May et al, 2007) reported that approximately 6% to 8% of newborns in that country are affected by the most severe forms of FASD, fetal alcohol syndrome (FAS) and partial fetal alcohol syndrome (pFAS).
Most individuals diagnosed with FASD do not present the recognizable facial abnormalities typically seen in FAS (Riley et al, 2011). For this reason, FASD is often labeled ‘a hidden disability.’ Those affected by the disorder may exhibit no abnormal physical characteristics and yet suffer serious cognitive impairments that lead to learning and behavioral problems, such as hyperactivity, poor judgment, aggressiveness, visual and hearing problems, and speech and other language difficulties (Stade et al, 2011).
There is no cure for FASD, and those affected face lifelong difficulties arising from both the primary and secondary disabilities associated with the disorder. Secondary disabilities are deficits that result from the interaction between primary disabilities and social conditions. For example, a cohort study examining adolescents and adults who had been diagnosed with FASD found that 79% reported problems with employment; 61% had experienced a disrupted school experience; 60% had been in trouble with the law; 50% had been confined to a detention center, jail, prison, or an in-patient psychiatric or alcohol/drug treatment center; 49% repeatedly demonstrated inappropriate sexual behavior; and 35% reported alcohol and drug problems (Streissguth et al, 2004). FASD therefore comes with significant costs, not only to those affected by it but also to society. Most individuals with FASD require extensive support throughout their lives from the healthcare system as well as other services such as home care, special education, social assistance and, in many cases, justice and correctional services.
When thousands of babies are born every year with serious brain injuries that have a known and preventable cause, the response ought to be development and implementation of truly effective measures for prevention. Prevention efforts must be comprehensive, as the reasons for drinking alcohol while pregnant are many and varied: lack of awareness of being pregnant; conformity to social norms of drinking; use of alcohol as a means of coping with challenging personal and socio-economic circumstances; and conflicting messages about a safe quantity of alcohol consumption, to name a few. To address these causes effectively, prevention strategies must be developed and adapted to the social, economic, and cultural context of each community.