Day 84 of 99 Days to 9/9 or FASDay continues looking at alcohol use. Over the last few days, we looked at drinking habits of Canadians and Americans, today we look at the use of alcohol, around the world, during pregnancy.
Global Prevalence of Alcohol Use During Pregnancy
Highlights below are from the study: Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome by Svetlana Popova, PhD, Shannon Lange, MPH, Charlotte Probst, MSc, Gerrit Gmel, MSc, Prof Jürgen Rehm, PhD. Published in The Lancet Global Health, Volume 5, Issue 3.
Alcohol use can result in harm not only to the drinker, but also to other individuals associated with the drinker. A classic example of this harm to others is the harm caused by consuming alcohol during pregnancy. Alcohol is a teratogen that can readily cross the placenta, resulting in damage to the brain and other organs of the developing embryo and fetus.
Alcohol use during pregnancy has been established as a risk factor for adverse pregnancy outcomes including:
- spontaneous abortion,
- premature birth,
- intrauterine growth retardation, and
- and low birth-weight.
One of the most disabling potential outcomes of drinking during pregnancy is the risk of developing fetal alcohol syndrome (FAS).
However, to date, most countries do not have prevalence data at a population level for alcohol use during pregnancy or for FAS. Furthermore, to the best of our knowledge, the number of pregnant women in the general population who consume alcohol during pregnancy per case of FAS has not been previously estimated.
Authors of this study say it is important to note:
Although human research has not been able to delineate the pattern, amount, or critical period of prenatal alcohol exposure necessary for structural or functional teratogenesis, we do know that not every woman who drinks during pregnancy will deliver a child with FAS.
There are some other factors at play that might inﬂuence a fetus’s vulnerability to the teratogenic eﬀects of alcohol, such as:
- variability in the metabolism and genetic background of both mother & fetus,
- environmental inﬂuences,
- maternal smoking behaviour,
- nutritional status, stress levels, and
- and possibly paternal lifestyle.
Global prevalence of alcohol use (any amount) during pregnancy and FAS in the general population in 2012 by WHO region.
AFR = African region, AMR = region of the Americas, EMR = Eastern Mediterranean region, EUR = European region, SEAR = South-East Asia region, and WPR = Western Paciﬁc region.
Alarmingly, about a quarter of women in the general population of Europe drink alcohol during pregnancy, which, as one would expect, is mirrored by also having the highest FAS prevalence—a prevalence that is 2·6x higher than the global average. The lowest prevalence of alcohol use during pregnancy and FAS was found in the WHO EMR (50x lower than the global average) and WHO SEAR (5x lower than the global average).
Countries with highest prevalence of alcohol use during pregnancy
- Ireland at 60·4%
- Belarus at 46·6%
- Denmark at 45·8%
- UK at 41·3%
- Russia at 36·5%
The countries with the lowest prevalence of alcohol use during pregnancy (ie, 0%) were Oman, United Arab Emirates, Saudi Arabia, Qatar, and Kuwait.
More than 100,000 children are born with FAS worldwide. It is believed that the prevalence ratio of FAS to FASD is about one to nine or ten, indicating that FAS is only the tip of the iceberg.
The authors note:
The estimates presented in this report are for the general population of the respective countries. However, the prevalence of alcohol use during pregnancy has been reported to be much higher among some at-risk populations. For example, the prevalence of alcohol use during pregnancy among Inuit women in northern Quebec (Canada) was reported to be 60·5%, which is over ten times higher than the estimate for the general population of Canada.
6 Immediate Actions Recommended by the Authors:
- The harmful eﬀects of alcohol on a fetus should be recognised globally as a public health problem.
- Establish an FAS surveillance system to monitor prevalence throughout the world.
- Better education for women of childbearing age about the risks of alcohol use (especially binge and frequent drinking) during pregnancy.
- Prevention programmes aimed at changing alcohol use behaviour during and before pregnancy—since it greatly aﬀects the likelihood of prenatal drinking—should be implemented around the world.
- Appropriate screening for alcohol use in all women of childbearing age in combination with: preconception health promotion, contraceptive counselling, and referral to substance abuse programs for women identified to have an alcohol use disorder should become a routine standard of care in all primary care settings.
- Referrals to substance abuse programs, if necessary, are of the utmost importance as eﬀective treatment of any identified cases of alcohol dependence or alcohol use disorders could reduce the risk of having a child with FAS. In patients in whom it is not possible to detect alcohol use before pregnancy, detection of prenatal alcohol use should be the focus, as decreasing or eliminating the use of alcohol during pregnancy could reduce the severity of the eﬀects on the fetus. As the ﬁrst point of contact, physicians and other health-care providers are in a position to fulﬁl a crucial role in the primary prevention of FAS and other alcohol-related birth defects.
Day 6 of 99 Days to FASDay gave some ideas for clinicians counselling women.
Check back tomorrow for Day 85.