400-Plus Conditions May Occur With Fetal Alcohol Spectrum Disorders


A new Canadian study has identified 428 distinct disease conditions that co-occur in people with fetal alcohol spectrum disorders (FASD). Researchers from the Centre for Addiction and Mental Health (CAMH) say the review is the most comprehensive of its kind, with the results published in The Lancet.

“We’ve systematically identified numerous disease conditions co-occurring with FASD, which underscores the fact that it isn’t safe to drink any amount or type of alcohol at any stage of pregnancy, despite the conflicting messages the public may hear,” said Dr. Lana Popova, lead author on the paper.

“Alcohol can affect any organ or system in the developing fetus.”

FASD is a broad term describing the range of disabilities that can occur in individuals as a result of alcohol exposure before birth.

Experts explain that the severity and symptoms associated with FASD vary, based on how much and when alcohol was consumed, as well as other factors in the mother’s life such as stress levels, nutrition, and environmental influences.

The effects are also influenced by genetic factors and the body’s ability to break down alcohol, in both the mother and fetus.

Researchers said surveys suggest that between six and 14 percent of women drink during pregnancy in Canada and the U.S.

The 428 co-occurring conditions were identified from 127 studies included in The Lancet review.

These disease conditions, coded in the International Classification of Disease(ICD-10), affected nearly every system of the body, including the central nervous system (brain), vision, hearing, cardiac, circulation, digestion, and musculoskeletal and respiratory systems, among others.

While some of these disorders are known to be caused by alcohol exposure — such as developmental and cognitive problems, and certain facial anomalies — for others, the association with FASD does not necessarily represent a cause-and-effect link.

Reviewers discovered many disorders occurred more often among those with FASD than the general population. Based on 33 studies representing 1,728 individuals with Fetal Alcohol Syndrome (FAS), the most severe form of FASD, the investigators were able to establish the frequency with which 183 disease conditions occurred.

More than 90 percent of those with FAS had co-occurring problems with conduct. About eight in 10 had communications disorders, related to either understanding or expressing language. Seven in 10 had developmental/cognitive disorders, and more than half had problems with attention and hyperactivity.

Because most studies were from the U.S., the frequency of certain co-occurring conditions was compared with the general U.S. population. Among people with FAS, the frequency of hearing loss was estimated to be up to 129 times higher than the general U.S. population, and blindness and low vision were 31 and 71 times higher, respectively.

“Some of these other co-occurring problems may lead people to seek professional help,” Popova said. “The issue is that the underlying cause of the problem, alcohol exposure before birth, may be overlooked by the clinician and not addressed.”

Researchers say improved screening and diagnosis of FASD has numerous benefits. Earlier access to programs or resources may prevent or reduce secondary outcomes that can occur among those with FASD, such as problems with relationships, schooling, employment, mental health and addictions, or with the law.

“We can prevent these issues at many stages,” said Popova. “Eliminating alcohol consumption during pregnancy or reducing it among alcohol-dependent women is extremely important. Newborns should be screened for prenatal alcohol exposure, especially among populations at high risk. And alerting clinicians to these co-occurring conditions should trigger questions about prenatal alcohol exposure.”

“It is important that the public receive a consistent and clear message — if you want to have a healthy child, stay away from alcohol when you’re planning a pregnancy and throughout your whole pregnancy,” she said.

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