A national survey of paediatricians in Ireland regarding Fetal Alcohol Spectrum Disorders was published in the March edition of the Irish Medical Journal. The aim of the study was to evaluate self-reported knowledge and practice of doctors working in paediatrics in Ireland with regards to FASDs and alcohol consumption during pregnancy. It suggests that prenatal alcohol exposure may not be routinely considered when evaluating children with developmental delay. Fetal Alcohol Spectrum Disorders (FASDs) are characterised by variable mental, physical, neurological and behavioural deficits, and are recognised internationally as a major contributor to intellectual impairment and disability and one of the major causes of preventable developmental delay. Many affected patients have long delays before a diagnosis is made or are never diagnosed at all. There is no register of children with FASDs in Ireland.
The umbrella of FASD includes Fetal Alcohol Syndrome (FAS), Partial Fetal Alcohol Syndrome (pFAS), Neurobehavioural Disorder associated with Prenatal Alcohol Exposure (ND-PAE) and Alcohol-related Birth Defects (ARBD), although the terminology has changed frequently. Fetal Alcohol Syndrome comprises only 10-15 per cent of all cases, and over 75 per cent of children with FASDs have no dysmorphic features to suggest an underlying aetiology to a clinician. Diagnosing these conditions is challenging, and recent research suggests only half of American Academy of Paediatrics members are confident in their ability to make the diagnosis.
Historically, the lack of a precise dose-response relationship has led to inconsistent advice from healthcare providers and professional bodies with regards to the safety of alcohol in pregnancy. Complete abstinence is now recommended in national guidelines for the USA, UK, Canada, New Zealand and Australia. Recent Irish studies have found that 75-81 per cent of expectant mothers in Ireland reported consuming alcohol in the periconceptual period. One of these, a retrospective study covering 1987-2005, found that the majority of expectant mothers reduced their alcohol intake during pregnancy, and 27.6 per cent abstained completely. Nonetheless, it concluded that “the risk of alcohol related fetal (sic) harm in Ireland is high” and that systemic change would be required to support paediatricians and other doctors in the assessment and diagnosis of children exposed to alcohol in utero.