- Research released today on the prevalence of symptoms that may be linked to Fetal Alcohol Spectrum Disorder should not be interpreted as providing evidence of the prevalence of FASD, the British Pregnancy Advisory Service warns.
- The authors highlight the significant limitations of the research, stating that it is not possible to confirm alcohol as a causal factor in the symptoms identified, and that a “positive screening” via their analysis is “not equivalent to a formal FASD diagnosis.”
- Of the 13,495 people within the cohort studied, only 223 had full data sets. The estimated prevalence for this group with complete data was significantly lower at 7.0%, compared to 17% of the overall cohort.
- Nearly one in five (19%) of those who screened positive for FASD-related symptoms were born to mothers who reported consuming no alcohol during pregnancy, adding to calls for caution about the interpretation of these results.
- The British Pregnancy Advisory Service, bpas, warns that miscommunication of the risk of harm from pregnancy drinking causes women undue panic, particularly as many pregnancies are unplanned, and paves the way for unwarranted and inappropriate interventions in women’s lives
A study released today which uses what the researchers describe as a “novel approach” to identifying the prevalence of symptoms that may be linked to Fetal Alcohol Spectrum Disorder (FASD) has been met with caution over fears that the results could be misinterpreted – and cause significant harm and distress to parents and pregnant women.
In the UK, around half of pregnancies are not formally planned and many women may have an episode of binge drinking before they know they are pregnant. This helps explain figures which suggest that around 75% of women in the UK report drinking some alcohol in pregnancy. Overall levels of consumption across pregnancy are low, and these drop dramatically as pregnancy progresses. Just over a third of UK women (34%) drank any alcohol in the second trimester, when most are aware of their pregnancy, and of these the overwhelming majority (96%) drank low levels of just 1-2 units per week for which there is no evidence of harm.
The researchers stated that they “applied novel screening algorithms” to existing data relating to pregnancies from nearly 3 decades ago to screen for neurological impairments that may be symptomatic of FASD. Diagnosis of this complex condition, as the study notes, requires input from a multidisciplinary team, and as a result this paper only refers to children who meet the researchers’ symptom screening algorithm criteria. However, many of the impairments associated with FASD may be symptomatic of other conditions.
The screening algorithm identified 17% of the cohort as having an impairment in at least three learning and behavioural areas linked with FASD, but the authors make it clear that this does not amount to a formal diagnosis of FASD for these individuals. Nearly one in five (19%) of those who “screened positive” for FASD symptoms were born to mothers who stated they did not drink at all during their pregnancy, and more than half (51.1%) were born to mothers who drank less than one alcoholic drink per week during pregnancy. There is no evidence of harm caused at these low levels of drinking.
The data set was also incomplete in the vast majority of cases. Where the data sets were complete, the estimated prevalence was significantly lower. Within this group of 223 individuals, 7% were identified as “screening positive” for symptoms of FASD. The study also highlights that those children displaying symptoms associated with FASD were more likely to be born to mothers who were of lower socio-economic status, and the pregnancy was less likely to have been planned. The symptoms identified as being linked to FASD may therefore in fact be a result of wider factors.
Clare Murphy, Director of External Affairs at the British Pregnancy Advisory Service, bpas, said:
“We advise real caution over the interpretation and communication of these findings. This study, as the authors themselves acknowledge, does not prove any causal link between pregnancy drinking and the developmental outcomes recorded, and may cause pregnant women and parents needless anxiety.
“bpas sees over 70,000 women each year for pregnancy counselling and abortion care. Many women have drunk before finding out they are pregnant, and messaging around pregnancy drinking which overstates risk or distorts the available evidence can lead some women to consider ending what would otherwise be a wanted pregnancy, or spend that pregnancy wracked with guilt and anxiety. This does not benefit anyone.”
Professor Ellie Lee, Director at the Centre for Parenting Culture Studies, University of Kent, said:
“This research has sought to find evidence that a problem is bigger than anyone thought it was, in order to make an argument that more should be done to find a still larger incidence of the problem. Unsurprisingly, it has achieved its aim.
“Those who are not already committed to wishing to see FASD more widely diagnosed as the explanation for childhood disability might want to consider the fact that the children in this study were born almost 30 years ago and that the developmental difficulties recorded might be explained in alternate ways. The relation between socio-economic status and a higher incidence of disability is referred to almost in passing; this too deserves a great deal more consideration.
“The problems for women associated with efforts to create causal links between disputed categorisations of childhood disability and any and all drinking in pregnancy (including where a pregnancy is not planned) are ones that should be given much more consideration than they are at present.”
For further information please contact the bpas press office on firstname.lastname@example.org , 0207 061 3377 or 07788 725 185.
bpas is a charity which sees more than 70,000 women a year and provides reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception, at clinics across the UK. It supports and advocates for reproductive choice. More information can be found at bpas.org.