Counting the costs of drinking alcohol during pregnancy: researchers are starting to shed light on the true extent of alcohol consumption during pregnancy

Q: What is fetal alcohol syndrome (FAS) and how much do we know about it today? A: Alcohol is poisonous to the developing fetus throughout the entire nine months of gestation. When a mother-to-be consumes alcohol, it goes directly to the fetus through her blood stream. These children may be born with fetal alcohol spectrum disorder (FASD), which is an umbrella term that covers all alcohol-related diagnoses, of which fetal alcohol syndrome (FAS) is the most severe and visibly identifiable form. FASD is associated with a wide range of physical, behavioural and learning problems including growth impairments, facial abnormalities, problems with brain function and developmental delays. Recently our team identified more than 400 conditions that co-occur in individuals with FASD, spanning 18 of the 22 chapters of the International statistical classification of diseases and related health problems. Many of these conditions occur more often among people with FASD than in the general population, although a causal link has only been made with some of these conditions. Q: When did you first become aware of these disorders? A: When I studied psychiatry as a medical student, I remember a few lines in our textbook saying that alcoholic mothers may deliver children with birth defects and other malformations. That was all there was in the curricula for medical students in the former Soviet Union. Physicians were not trained to recognize FASD and this is still the situation in many countries today. Q: How did research start in this area? A: FAS was first described in the French medical literature by Paul Lemoine and colleagues in a 1968 study of children of alcohol-dependent parents. Five years later, Ken Jones and David Smith published a paper in the Lancet on the association between alcohol abuse and morphological signs, and provided diagnostic criteria for this condition. Q: How did you start researching these disorders? A: The Centre for Addiction and Mental Health, where I work, is a WHO collaborating centre and I started researching FASD in 2009, when WHO asked our team to collaborate on developing a method that could be used to estimate the prevalence of FAS and FASD in all countries. The method was presented to and discussed with researchers from around the world at the first WHO global expert Meeting on Alcohol, Health and Development in Sweden in 2009. It was then refined with technical input from the National Institute on Alcohol Abuse and Alcoholism in the USA and discussed at a WHO planning meeting of principal investigators from more than 15 countries, organized alongside the first European conference on FASD in the Netherlands in 2010. I found that this field was severely under researched and since then I have become dedicated to research in this area. Q. Can you tell us about your study in The Lancet Global Health on the global prevalence of maternal drinking and FAS published in January? A. We wanted to draw the attention of health-care practitioners, health authorities and policy-makers to the problem of maternal alcohol consumption and FASD. As epidemiologists we know how important it is to determine the prevalence of a disorder in order to set priorities for public health policy, funding for public health initiatives and health-care planning. Most countries did not have prevalence data at a population level for alcohol use during pregnancy or FAS, so this study was urgently needed. Q: What were the key findings? A: We estimated that one out of 67 women who consume alcohol during pregnancy will deliver a child with FAS, which translates to about 119 000 such children born globally every year. We knew before the study that not every woman who drinks alcohol during pregnancy will deliver a child with FAS, because women drink different amounts and every mother and every fetus has a different ability to metabolize alcohol, and there are many other factors that may influence their vulnerability. …