Mothers of Children with Fetal Alcohol Spectrum Disorder

Abstract

Among 130 million live births each year globally, approximately 10% are exposed to alcohol during pregnancy, which increases risk of adverse neonatal outcomes and fetal alcohol spectrum disorders (FASD). Current estimates show that 1 of every 13 (7.7%) pregnant women who consumes alcohol during pregnancy delivers a child with FASD. The risk of FASD among infants is individualized and depends on variability of maternal-fetal protective and susceptibility factors for FASD. The factors include environmental risk modifiers such as smoking and other substance use and nutritional status. The role of paternal influences on FASD susceptibility requires additional research.

Globally, prenatal alcohol exposure results in 1.04 million new cases of FASD each year. This equates to 86,000 new cases/month (20,000/week or 2849/day, 118/h or 2/min). It is estimated that less than 1 of every 800 people living with FASD have been diagnosed. The annual cost of care for children with FASD is $23,810 per child, and additional unreimbursed costs of $25,993 to the family (total $53,683). For adults, the annual cost is $49, 077.

The high prevalence rate and costs of care underscores the potential benefits of targeted screening in high-risk populations. These populations include children of women in substance use disorder treatment, and all children entering foster care or juvenile corrections. Further research to improve routine screening in prenatal care, at delivery sites, and neonatal intensive care nurseries is needed. Every mother and child should be provided screening at least once during a well-child visit.

Since FASD is a very common cause of birth defects and developmental disabilities, screening for FASD should be a routine part of the clinical assessment of these children. Importantly, the diagnosis of other chromosomal, metabolic, or syndromal disorders does not reduce the need to investigate both prenatal alcohol exposure and FASD. No known disorder provides protection from prenatal alcohol exposure.

Recurrence among sibships accounts for nearly 20% of all cases of FASD. Identification of these women and intervention to prevent alcohol exposure during a subsequent pregnancy can prevent cases of FASD among younger siblings. Thus, proactive alcohol screenings and FASD diagnosis can be useful in prevention efforts by identification of risky alcohol behavior during pregnancy. Early identification of FASD also allows for early entry into diagnosis-informed care and can reduce excess disability in the future.