Fetal Alcohol Spectrum Disorder (FASD)

Sex and Gender-based Analysis of this topic

Definition

Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term for a number of diagnoses associated with prenatal exposure to alcohol, including Fetal Alcohol Syndrome (FAS) Partial FAS (pFAS), Alcohol-related Neurodevelopmental Disability (ARND), and Alcohol-Related Birth Defects (ARBD). Fetal Alcohol Spectrum Disorder is considered the leading cause of preventable birth defects and developmental delay in Canadian children [1]. The incidence rate of FAS is currently estimated at 1 to 2 per 1,000 live births; rates for the full spectrum of disabilities (FASD) are more difficult to assess, but are predicted to be significantly higher than FAS rates [1].

Diagnosis of full Fetal Alcohol Syndrome (FAS) has four minimum criteria: 1) prenatal and/or postnatal growth restriction; 2) central nervous system involvement; 3) characteristic facial features; and 4) maternal alcohol use history [2]. Despite having national diagnostic standards, estimating the number of children born in Canada with FAS/FASD is difficult due to inadequate and varying diagnostic capacity [3]. Canadian research on incidence and prevalence has focused on specific sub-populations, such as youth in justice institutions [4] and children in the custody of child welfare authorities [5]. Estimates of maternal drinking are currently based on sources, such provincial antenatal records, and surveys, such as the Canadian Community Health Survey, which document self-reported alcohol consumption by women in their child-bearing years or during pregnancy [6].

 
 
Sex Issues

Research is ongoing as to the amount of alcohol consumed by women in pregnancy that creates a risk for FASD, but no safe amount has yet been determined [7-9]. The amount, timing, and frequency of alcohol intake are determining factors of risk, however there are other contributing factors, such as the mother’s age, health status, other substances used, and genetic susceptibility of both the mother and fetus [10].

 
 
Gender Issues

Other key factors that put women at a higher risk for drinking in pregnancy are a history of violence, mental health concerns, and poor social support [11-13], which are all highly gendered experiences. Research on gender differences in the manifestation and experience of FASD has not been conducted.

 
 
Diversity

Rates of drinking in pregnancy within different population groups is currently based on a combination of surveys of self-reported alcohol consumption during pregnancy or child-bearing years and research studies within specific groups. Surveys documenting reported alcohol consumption have found higher prevalence of drinking among women with higher incomes and higher ages (over 35 years of age) [14]. However, frequency of alcohol intake and amount of alcohol consumed per occasion were both higher among younger women (ages 18-20) and those with low incomes [14-16].  Higher-income, older women were more likely to be drinkers, but lower-income, younger women were more likely to drink heavily.

In terms of geographic diversity, survey data indicates that the highest rate of alcohol use during pregnancy was among women in Quebec (25%) while the rate is lowest for women in Atlantic Canada (8%) [14]. Though higher rates of FASD have been reported among Aboriginal populations, studies have generally focused on communities with identified alcohol problems; additional research is needed in this area [17].

 
 
Critique

As a leading cause of preventable birth defects and developmental delay in Canadian children, FASD prevention is an important women’s health issue. Approaches to prevention of FASD, intervention with those who have FASD, and relevant health and social policy depend on reliable, comparable data, which are currently lacking. One issue related to self-report of alcohol use, is the potential underreporting of alcohol use in pregnancy due to the stigma associated with women’s drinking and fear of losing custody of children based on alcohol use [18]. Another issue is the need for increased access to diagnosis, as a basis for understanding the incidence, prevalence, and societal impact of FASD. Additionally, to support multi-level prevention efforts [19], stigma concerning alcohol use during pregnancy will need to be replaced with understanding and action on the multiple influences on women drinking in child-bearing years.

 
 
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