Alcohol is a teratogenic compound (ie a substance that interferes with the normal development of the embryo or fetus) that readily crosses the placenta, potentially causing cell death and / or inhibiting cell growth.3 In the absence of a developed blood filtration system, the fetus is totally unprotected from alcohol circulating in the blood system. There are a number of ways PAE can affect the fetus, and these can result in a wide range of problems. The most severe effects are the intellectual disabilities associated with the adverse impact of alcohol on fetal brain development and the CNS (central nervous system). Damage to the brain is often, though not always, accompanied by distinctive facial deformities, physical and emotional developmental problems, memory and attention deficits, and a variety of cognitive and behavioural problems. Affected individuals are also at a high risk of developing a range of secondary comorbidities including mental illness, alcohol and drug addiction.

Over the past 40 years, considerable attention has focused on the role of PAE in the occurrence of a wide range of disorders classified under the umbrella term FASD. This is a non-diagnostic term that covers several medical diagnoses, from the full presentation of FAS (fetal alcohol syndrome), to a set of conditions – including PFAS (partial fetal alcohol syndrome),b ARBD (alcohol-related birth defects) and ARND (alcohol-related neurodevelopmental disorders) – that show some, but not all, of the features of FAS.3 The APA’s (American Psychiatric Association) 2013 publication DSM-5 (Diagnostic and statistical manual of mental disorders, fifth edition) includes criteria defining ND-PAE (neurobehavioural disorder associated with PAE) (see Appendix 2).4 This term is increasingly being used and is intended to encompass the full range of developmental disabilities associated with prenatal exposure to alcohol.

International data indicate that these conditions are associated with a significant financial burden. The adjusted lifetime cost of care for each individual with FAS in the US has been estimated at US $2 million,5 and the overall annual cost of FAS estimated at approximately US $3.6 billion.6 In Canada it has been estimated that the annual costs attributable to FASD in 2013 were between C$1.3 and C$2.3 billion.7 The highest contributor to these annual costs was the estimated loss of productivity as a result of disability and premature mortality.7 Based on data from the US, it is estimated that the annual cost of FASD in the UK is over £2 billion.5,6 Although a significant amount of research has focused on PAE and FASD, particularly in Canada and the US, there has been limited work on this in the UK. Determining the incidence of FASD is complicated by a lack of reliable and consistent data collection, and the difficulty in diagnosing the range of disorders. The incidence of FASD, either in the UK or internationally, is not therefore accurately known. The relationship between maternal alcohol consumption and the development of the range of disorders is also not fully understood. The level and pattern of alcohol consumption, and the stage of pregnancy during which alcohol is consumed are important determinants of the outcome of an alcohol-affected pregnancy,8,9 as well as genetic vulnerabilities and environmental factors.10

FASD are completely preventable through the elimination of drinking during pregnancy. Approximately 50 per cent of adult women in the UK drink weekly, with half of those drinking more than three units of alcohol on at least one occasion a week.11,12 Prevention requires a good understanding of the continuum of permanent birth defects associated with FASD, and an increased awareness of the risks of PAE among the general public and in particular women who are pregnant or considering a pregnancy. There is, however, a poor understanding of FASD in the UK by the general public and healthcare professionals.13,14 Further preventative measures include screening of pregnant women for maternal alcohol consumption, referral for brief interventions, and targeting of women at high risk of an alcohol-affected pregnancy. The effective management of FASD necessitates cooperation between a wide range of healthcare professionals as well as individuals in the fields of education and social services.3 Following diagnosis it is vital that appropriate treatment and support systems are implemented at the earliest possible stage to ensure the best outcomes for the child and their family, as well as to prevent the onset of secondary problems.